THE FIRST RESPONSE

Multi-Sectoral Emergency Assessment Case Studies from India

Health, HIV & AIDS

Nutrition Water, Sanitation and Hygiene Child Protection Education

THE FIRST RESPONSE

Concept and Photograph by: Dr. Jorge Caravotta
Health Specialist and Emergency Focal Point UNICEF India

Multi-Sectoral Emergency Assessment Case Studies from India

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THE FIRST RESPONSE

CONTENTS
Foreword Acknowledgements Page No. v vi

1. INTRODUCTION ........................................................................................................................... 1 How to Use this Book 2 Multi-Sectoral Extended Assessment 3 Preparing a 100 Days Response Strategy 5 2. CYCLONE .................................................................................................................................... 10 Aila, West Bengal, June 2009 Health 28 Nutrition 38 Water, Sanitation & Hygiene 46 Child Protection 52 Education 54 Programme Communication 56 3. FLOOD ......................................................................................................................................... 58 Kosi, Bihar, August and October 2008 Health 76 Nutrition 84 Water, Sanitation & Hygiene 94 Child Protection 102 Education 106 Programme Communication 112

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Andhra Pradesh, October 2009 Health Nutrition Water, Sanitation & Hygiene Child Protection Education Programme Communication

116 126 132 136 144 146 148

4. DROUGHT ................................................................................................................................. 150 Bundelkhand, Uttar Pradesh and Madhya Pradesh, April 2008 Health 162 Nutrition 170 Water, Sanitation & Hygiene 178 5. CORE COMMITMENTS FOR CHILDREN IN HUMANITARIAN ACTION................................ 188 Annexure: Rapid Assessment Format 247 Abbreviations 270

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THE FIRST RESPONSE

FOREWORD
This case study compilation synthesises the learnings from four multi-sectoral extended assessment missions conducted by UNICEF and its partners in India during the major emergencies over 2008 and 2009. It seeks to facilitate the work of emergency focal points across programme sectors. The case studies reect the lessons learned and useful tips for a successful mission, compiled from presentations, assessment reports and eld experience. The book links ndings, observations and recommendations from the case studies to UNICEFs Core Commitments for Children in Humanitarian Action (CCC), providing crucial insights on disaster response across stakeholders. The rst step of a good response is the rapid assessment undertaken between 48 and 72 hours after the disaster to understand the extent of damage and/or mobilise preposition items. However, an in-depth knowledge of the needs and situation of children and women is required to full and protect their rights as per the CCC. This knowledge can only be obtained through multi-sectoral extended assessments conducted two to four weeks from the onset of the emergency. Finally, by highlighting the critical areas that need to be assessed by the eld teams and government counterparts to build the 100-days response strategy, this book is a useful tool to deliver effective and appropriate emergency responses.

Lizette Burgers Dy. Programmes (ad interim) UNICEF India

ACKNOWLEDGEMENTS
I would like to thank Dr. Kamal Raj, Sudha Murali, Laila Iren Lochting and Nomita Drall for the content revision; for design and layout, Mohan Godwal and George John; to Sunitha Balraj and Sarbjit Singh Sahota (Emergency section) for book distribution. Special thanks to Srdjan Stojanovic (Emergency Coordinator) and Mukesh Puri (Emergency Specialist) for joining the assessment teams while in the eld. I am very grateful to the UNICEF State Ofces of West Bengal, Bihar, Madhya Pradesh, Uttar Pradesh, Andhra Pradesh for providing the assessment teams with all necessary support for successful missions. This book was made possible thanks to the efforts of the following colleagues in UNICEF India Country Ofce (ICO) and the States. Dr. Jorge Caravotta August 2010 ASSESSMENT TEAMS

WATER & SANITATION

CHILD PROTECTION & EDUCATION PROGRAMME COMMUNICATION

: Nagendra Prasad Singh WES Ofcer, Lucknow Dr. Sunderaj Consultant, WES, West Bengal : Paramita Neogi Child Protection Ofcer, Kolkata : Nasir Ateeq Programme Communication Specialist, Kolkata

Contributors: Parnasri Ray Choudhury, Emergency Ofcer, Kolkata Shyamnarayan Dave, Ofcer in Charge, UNICEF West Bengal

FLOOD: Kosi, Bihar, August and October 2008

TEAM LEADER : Dr. Jorge Caravotta Health Specialist, ICO

CYCLONE: Aila, West Bengal, June 2009

TEAM LEADER HEALTH NUTRITION : Dr. Jorge Caravotta Health Specialist, ICO : Dr. Kaninika Mitra Health Specialist, Kolkata : Dr. Kamal Raj Emergency Focal Point, Nutrition Specialist, ICO Minakshi Singh Nutrition Specialist, Kolkata

TEAM 1 (PURNEA AND MADHEPURA) Sara Poehlman, Education Specialist, ICO Mohamed Ayoya, Nutrition Specialist, ICO Naseer, Programme Communications Specialist, UNICEF Kolkata Kamal Khdaga, WES Consultant, ICO OP Kansal, Health Ofce, UNICEF Patna Simrit Kaur, Child Protection Specialist, ICO TEAM 2 (PURNEA AND MADHEPURA) Nalin Kumar Mishra, Consultant-SANKALP (Education), UNICEF Patna Deepali Hariprasad, Consultant, Child Development & Nutrition, UNICEF Patna

vi

THE FIRST RESPONSE

SM Baqar, Consultant, Programme Communications, UNICEF Patna Manish Agarwal, Emergency Ofce, UNICEF Patna Mukesh Puri, Emergency Specialist

DROUGHT: Bundelkhand, April 2008

TEAM LEADER : Dr. Jorge Caravotta Health Specialist, ICO : Dr. Tanu Kanpur, UP : Dr. Paliwal Chitrakut, UP : Dr. Dhananjoy Gupta Health Consultant, UP/MP : Dr. Gayatri Singh Nutrition Specialist, Lucknow, UP : Dr. Vandana Agarwal Nutrition Specialist, Bhopal, MP : Ms Sonal Singh Consultant, Nutrition, MP : Nagendra Prasad Singh WES Specialist, UP : Dara Johnston WES Delhi, UP : Sanjay Singh Consultant, WES, MP

FLOOD: Andhra Pradesh and Karnataka, October 2009

TEAM LEADER and HEALTH NUTRITION WATER & SANITATION CHILD PROTECTION EDUCATION From Emergency Section From UNDMT : Dr. Jorge Caravotta Health Specialist, ICO : Saraswati Bulusu : Donald Burgess : Sudha Murali : Aarti Saihjee : Sunitha Balraj : Shairi Mathur

HEALTH

NUTRITION

KARNATAKA: RAICHUR DISTRICT Venkatesh, District Coordinator, Raichur Ajith, GSSPP (gender sensitisation and people-friendly police) Raghavendra, District Manager Nagesh, Coordinator Sudarshan, Coordinator ANDHRA PRADESH: KURNOOL DISTRICT Prasad Murthy, District Manager Janardhan Goud, Project Coordinator Susheela, Community Volunteer Praveen, Community Volunteer Swarndetha, Community Volunteer

WATER & SANITATION

Photographs on pages 14, 15, 16, 17, 50 and 51 courtesy UNICEF, Kolkata and pages 71 and 271 courtesy UNICEF, Bihar.

vii

INTRODUCTION
How to Use this Book Multi-Sectoral Extended Assessment Preparing a 100 Days Response Strategy

HOW TO USE THIS BOOK

This collection of multi-sectoral emergency assessment case studies from India is a reference and planning tool for dealing with the immediate aftermath of emergencies. The learnings from four multi-sectoral assessments conducted by UNICEF over 2008 and 2009 across different disaster types have been collated and presented here. The broad chapterisation is according to disaster type in this case, cyclones, oods and drought. Under each, the ndings and recommendations under each programme sector has been presented. (The wide use of photographs has been ensured to provide easy and fast understanding.) Chapter 5 provides the relevant details for each programme sector as outlined in the revised UNICEFs Core Commitments for Children (CCC). This will enable eld workers and ofcials to get a basic understanding of the requirements and the goals that need to be addressed. To further enable cross-disaster usage, each programme sector has been colour coded as under:

Health, HIV & AIDS Nutrition Water, Sanitation and Hygiene Child Protection Education
The Annexure contains the Multi-Sectoral Rapid Assessment format. The format is also available in the CD given in the inside of the front cover of this document. The CD has additional resources in the form of sample templates, powerpoints, fact sheets, and other material that may come in useful for eld personnel. It also contains a digital version of this book.

THE FIRST RESPONSE

MULTI-SECTORAL EXTENDED ASSESSMENT

The Multi-Sectoral Rapid Extended Assessment format, developed by SPHERE Indias Unied Approach Strategy (URS) and the Interagency Network of Education in Emergencies (INEE) Minimum Standards, was adapted by the Assessment Teams based on UNICEFs Core Commitments for Children (CCC) (see Annexure and CD). Specic questions for each sector and cross-cutting issues for all the programme sectors, including programme communication, are included.

INTRODUCTION

Programme Actions
Preparedness
Track and analyse potential and existing humanitarian situations, not limited to areas covered by country programmes, with sufcient rigour to trigger rapid assessments when necessary. Monitor ofce preparedness, including Emergency Preparedness and Response Planning (EPRP) completion and implementation of programme preparedness activities, using the Early Warning/Early Action (EW/EA) system. Identify existing hazard, vulnerability and capacity data to inform baselines, response and recovery. Collaborate with other agencies to develop the methodology, tools and information management systems needed, and identify the trained capacity required to conduct timely inter-agency rapid assessments. Identify qualied staff to ensure that performance monitoring can be undertaken in each sector. Ensure that benchmarks for performance monitoring are in place at the country level, including through clusters.

(SMART) objectives and available baseline information, and that they are designed to allow monitoring. Identify the objectives and scope of the assessment based on the scale and severity of the humanitarian crisis. Systematically collect all documentation relevant to the response for monitoring and evaluation purposes. Ensure that key performance information for all sectors is systematically collected, easily accessible and used in review processes to improve performance, and that it can be a used as a basis for future evaluative work. Ensure that evaluations of humanitarian response produce organisational lessons learned.

Early Recovery
Ensure that rapid assessments include assessment of early recovery needs and capacities. Where possible and appropriate, such assessments should involve national and/or local authorities as well as affected populations. Ensure linkages with the early recovery cluster/network, where this exists. Support efforts to sustain monitoring mechanisms, including the promotion of their integration into national, local and community systems. Ensure that early recovery programmes are designed with the involvement of affected populations and national and/or local authorities, as appropriate, according to results-based frameworks. Ensure wherever possible and appropriate that national and/ or local authorities are involved in evaluation of early recovery projects, and that summaries of evaluations are prepared, translated and made available to partners.

Response
Ensure that a rapid assessment (48-72 hours) and the extended multi-sectoral assessment (2-4 weeks) is undertaken with affected populations, including children, adolescents and women, as a joint inter-agency mechanism or, if necessary, independently, in order to dene humanitarian response. Ensure that a gender analysis is reected in any rapid assessment. Ensure that the ash appeal and response are based on standardised monitoring and assessment of relief transitions

THE FIRST RESPONSE

PREPARING A 100 DAYS RESPONSE STRATEGY

INTRODUCTION

affect the most vulnerable disproportionately in terms of health, housing, employment, livelihood and food security. At the same time, damaged public infrastructure impedes adequate access to health and education facilities, markets, and increases health risks, especially for the vulnerable and the poor. The ndings assisted in planning for effective rehabilitation of affected people and community infrastructure, and to help restore critical social and economic activities disrupted by the disaster.

Assessment Objectives
Health
To assess the impact on the health of the affected communities, especially women and children; To assess the quality and services in temporary health camps; To identify possible health threats in the visited villages; To assess the response from Government and other agencies, pertaining to health services; To assess the gaps, needs and recommendations for UNICEF and its partners regarding health interventions.

The aim of the multi-sectoral assessment is to dovetail ndings into an appropriate disaster rehabilitation framework (or action plan) being developed by UNICEF and its stakeholders. An effective, needspecic framework that takes into account realistic timelines and service-delivery criteria will, of course, be of considerable benet in protecting the poor and affected people from falling further prey to poverty. It will help families resettle, provide a safer and healthy environment, and will also help stabilise their livelihoods. The focus of these assessments was to take a close look at the hardship that affected people were going through and suggest redressal strategies that would lead to amelioration of their suffering. In addition, the assessments also laid emphasis on studying service delivery and their functional status in affected areas. While disasters do not pick and choose their victims, there is no doubt that they do

Nutrition
To assess children on their nutritional status using mid upper arm circumference (MUAC); To assess the availability of current nutritional services provided by other agencies to the affected women and children; To assess gaps, opportunities and immediate needs and make recommendations to UNICEF and other stakeholders so that a timely and appropriate response can be planned and executed.

THE FIRST RESPONSE

To identify gaps in schooling infrastructure and alternatives to ll those gaps; To identify major needs and potential areas for intervention.

Programme Communication (Cross-Cutting)

To assess the desired behaviours/practices; To assess if lactating mothers are breast-feeding; To assess if families are using ORS to manage diarrhoea; To assess if caregivers are allowing children to be immunised; To assess how users are treating/consuming safe water; To assess if people wash hands with soap/ash after defecation/ before eating; To assess if adults /children are using sanitary latrines.

Water Sanitation and Hygiene (WASH)

To assess the ground situation with respect to water, sanitation and hygiene service delivery; To provide information that will feed into immediate and medium term response.

Assessment Methodology
The Multi-sectoral Extended Assessment should be conducted in two to four weeks of a disaster with the aim of dovetailing assessment into programming. The information collected has to be fed into the CCC matrix (Unicef-Emergency handbook for eld workers).

Child Protection
To assess the vulnerability of the situation with regard to child protection issues; To assess vulnerability of the girl child and adolescent girl; To identify major needs and potential areas for intervention.

Steps to conduct a Multi-sectoral Assessment (MSA)

1. Prepare the TOR (template of TOR given in the CD). 2. Desk review and mapping of existing information on the most affected areas; coordination meetings with Government and NGOs; security assessment and clearance. 3. Field Visit: The effort should be to visit difficult-to-reach and most affected villages. The following must be included in the field visit.

Education
To assess the vulnerability of the situation with regard to child education issues;

INTRODUCTION

Area Facility

How to Assess Walk Through: -client areas (waiting areas, latrines, exam areas, wards, procedure areas, OT) -non-client areas (instrument processing area, waste disposal site, stores, blood bank) Observation and discussion Observe availability of staff Review current duty roster for 24-hour duty assignments Contact the provider on duty now, make trial call Ask staff: -experiences with getting providers during the night and holidays -if stafng is adequate and functional Look at equipment, supplies and drugs, and discuss with staff Check availability and functionality of equipment, such as: Oxygen tank Anaesthesia machine Instrument steriliser Suction machine Refrigerator Review contents of: Supply cabinets, drug trays, linen sets, etc. Instrument kits such as Caesarean section kit, adult and neonatal resuscitation kits Observe as many procedures available as possible (evaluation, labour exam, delivery, assisted delivery, repair of lacerations, manual removal of placenta, caesarean section, etc.) Observe management of as many complicated cases as possible. If observation is not possible, conduct a case review of a complicated case. Review 20 to 30 client entries in facility registers, such as: Labour and delivery Operating room Maternity ward Review 5 to 10 client records of: Normal cases Complicated cases (eclampsia, haemorrhage, blood transfusion, Caesarean section)

What to look for (Examples) Is each area clean? Is there running water? Is there a backup system? Is there functional electricity? Is there a backup system? How frequently have services been interrupted for lack of water or electricity lately? Is it secure day and night? Clients monitored for BP, HR, RR and bleeding before, during and after care Transportation (car, driver, fuel) and a referral facility available

Stafng

Current duty-roster with names and contact information posted in client care areas and nursing areas Staff available on-site who can: -perform normal labour and delivery -manage a complication (such as eclampsia, hemorrhage, infection) -Caesarean section, assisted delivery Anaesthetist available For equipment: Is each piece of equipment available where it should be? Is it functional? Can staff demonstrate its function now? Is there a functional repair and maintenance system? For supply and drugs: Are supplies adequate for client load? Does staff run out of supplies? Are drugs adequate for client load? Does staff run out of drugs? Storage: Does staff use rst-in-rst-out system? Are supplies and drugs stored in a dry, safe place? Are drugs within their expiry date? Promptness of evaluation and management-within 15 minutes of arrival for emergency cases Correct management and procedural technique If unstable, stabilising treatment (i.e., IV uids, MgSO4 or diazepam, oxytocin) provided promptly Correct infection prevention practices In facility registers: Is there a column for complications, and is it always lled out? Is there a column for procedures, and is it always lled out? Is there a column for outcome of mother and baby? Is the reason for Caesarean section noted? In client records, do they always contain: Admitting exam, including BP, HR and RR? Diagnosis/ treatment/ outcome? Is a partogram attached and used for monitoring labour? Procedural notes (drugs/indications/nding/procedure)? Post operation and discharge notes (status/instruction)?

Equipment supplies/ drugs

Clinical Technique

Records and Registers

THE FIRST RESPONSE

Facilities: health centres, CHC, hospitals, schools, anganwadis. Meetings with local government ofcials. Focal group discussions with women/mothers, men, children, SC/ST, community leaders and local NGO members.

Rapid surveys
Rapid surveys based on samples, coupled with on-site observation offer reliable information regarding water supply and sanitation, health and nutrition. For example, in the drought situation, water quality was assessed. Water samples were collected from randomly selected points in each of the villages under study. At each drinking water point, three samples were taken by using standard H2S bottles (bacteriological test for detection of fecal pollution). A rapid survey is normally undertaken as part of the assessment to obtain an overview of the nutritional situation, to identify any particular nutritional problems and to determine which areas and population groups are worst affected. The following steps are essential in planning an assessment: Dening the objectives and data required. Determining sample size. Specifying the indicators and sampling methods to be used. Selecting the training survey personnel. analysing, interpreting and reporting the ndings. Screening in a large population is done in two stages. In the rst stage, MUAC is measured in all children aged 1-5 years, where SAM = 11.5 cm and MAM = > 12.5 cm (at the time of the assessments in this book, the norm was SAM = 11 cm and MAM = 12 cm and these have since been revised). The second stage involves weight for height assessments of all those referred.

Information to be collected
For devising a proper response strategy, key information must be collected during the eld visit and included in the assessment. A check list of queries for walk-through health facilities is given in the table. Other information that can be included in the assessment is: Local health care system Is there an existing health facility in the immediate locality or district that can respond to obstetric emergencies? Is there a functioning operating theatre (OT)? Is there an obstetrician, surgeon and anaesthetist available 24 hours a day, seven days a week? Do blood testing and transfusion facilities function 24 hours a day, seven days a week? How many qualied midwives and nurses are available? Are water and electricity supplies available? How far away is the facility? What are the road conditions and what modes of transport are available? Does the facility have the capacity to respond to increased demand from the displaced population? Does the security situation allow staff to work in the health facilities at night?

INTRODUCTION

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THE FIRST RESPONSE

CYCLONE
'Aila' West Bengal June 2009

CYCLONE

11

Darjeeling Jalpaiguri
Cooch Behar

Kolkata North 24 Praganas Sandeshkali 1 and 2

Bangladesh Border Gosaba Block South 24 Parganas

Uttar Dinajpur

Dakshin Dinajpur
Malda

Murshidabad Birbhum

Purulia

Barddhaman Bankura

Nadia

Hooghly
Paschim Medinipur

North24 Parganas
Kolkata

Howrah

South24 Parganas

Purba Medinipur

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THE FIRST RESPONSE

On May 25, 2009, Cyclone Aila disrupted life in the state of West Bengal. Cyclonic high winds of 100 km/hr accompanied by heavy rainfall, ooding and landslides affected almost the entire state. Multiple breaches in the embankments (500km) at the delta of the Ganges river in the Sunderbans area created a major emergency two districts of the delta, i.e., South 24 Parganas and North 24 Parganas, were the most affected.

CYCLONE

13

Since much of the Sunderbans is below sea level, it provoked massive ooding and brought isolation, desperation, and grief to the vulnerable population. Women, boys, girls and the elderly were the most affected and vulnerable. Gender basic needs, by age, had to be assessed and recorded during eld visits so that it was reected in programming response.

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THE FIRST RESPONSE

CYCLONE

15

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THE FIRST RESPONSE

Due to almost complete destruction of livelihoods, huge damage to houses and breakdown in services, substantial rehabilitation efforts were also needed. The most affected populations in the assessed areas belonged largely to the poorest and most vulnerable communities with little social or economic capital.

CYCLONE

17

West Bengal: 138 casualties; 6.7 million affected; 920,000 houses damaged; 195,000 displaced; 485 relief camps set up. South 24 Parganas and North 24 Parganas Districts: 70 casualties; 2.5 million affected; 390,000 houses damaged; 182,000 displaced; 433 relief camps. In the three most affected blocks Sandeshkali 1 and Sandeshkali 2 (North 24 Parganas) and Gosaba (South 24 Parganas) 500,000 people were affected.

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THE FIRST RESPONSE

CYCLONE

19

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THE FIRST RESPONSE

Handpumps were submerged and water was unsafe for use in many places, due to lack of chlorination and hygiene. Stagnant water compounded the risk of disease. Due to physical isolation, many people had to walk long distances to collect water from safe handpumps.

CYCLONE

21

It may take up to one year for roads, communications and transportation to return to normalcy. Despite support from the Army, there was a shortage of speed boats to conduct the emergency operations.

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THE FIRST RESPONSE

CYCLONE

23

Tide line

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THE FIRST RESPONSE

Access to the affected areas was extremely difcult. Logistics thus greatly hampered relief supplies. Many villages were under water for days and difcult to reach. These were accessible only by boat. In other areas, where the roads were under water, access by autorickshaws (seen left) took hours. Villagers pointed to their necks to show how the water level rose that day over in just three hours after the cyclone struck. Using body language, they demonstrated the ferocity of the winds that made it difcult even to stand.

CYCLONE

25

The salty sea water entered the elds, ruined the crops and spoilt the soil. The damage to future agriculture was immense and nobody knows how long it will take to recover. The weak monsoon that followed the cyclone did not help matters.

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THE FIRST RESPONSE

CYCLONE

27

HEALTH
The areas visited in both districts were in normal circumstances among the most difcult-to-reach delta line areas of West Bengal and lacked adequate health care services. The main health problems identied among the population were diarrhoea, fever, cough and cold and skin infections. No deaths due to diseases had occurred since the cyclone on May 25. All immunisation activities had stopped since Aila. Health services were being delivered through mobile medical teams and through health sub-centres. The Blocklevel Primary Health Centre visited was intact and functional.

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THE FIRST RESPONSE

According to the sub-centre Auxiliary Nurse Midwife (ANM), for the rst two days following the cyclone, the subcentre was overcrowded. As soon as the water level started receding, diarrhoea cases were seen increasing again due to contamination of ground water. One case of fever with rash, conjunctivitis and cough suspected as measles was observed. This represented an early warning of the possibility of a measles outbreak. Measles outbreaks can occur in a population despite high levels of vaccine coverage. The current measles vaccine, under normal conditions, covers 85 per cent of the children in the state when administered at nine months of age. The aim is to ensure 100 per cent coverage of children aged six months to 14 years. A signicant number of people are still susceptible to measles and vulnerable to further outbreaks due to the extreme infectiousness of the disease.

All immunisation activities had stopped since Aila.

CYCLONE

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HEALTH

These twins were six weeks old and had not received any vaccination. There was need for newborn care in these affected villages. The essential package should include home visits (minimum three in the rst week) through ASHAS-AWW-ANMs. Assessment priorities in newborn care during emergencies: Understand the need to target neonatal health. Understand the main causes of neonatal mortality. Dene elements of essential neonatal care. Understand and discuss best practices of the affected population. Use relevant data and information to develop appropriate essential neonatal interventions in emergencies.

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THE FIRST RESPONSE

At the Block Primary Health Centre (BPHC), the common illnesses found were acute diarrhoea, fever, cough and cold. Eight acute diarrhoea patients were admitted; all of them were on intravenous (IV) uid. At the outpatient department (OPD), above-average number cases of diarrhoea (around 20-25 cases per day) were registered; however, the exact numbers could not be ascertained because records were not being maintained properly. Health workers reported that patients had watery diarrhoea with severe dehydration, sometimes with vomiting and cramps. There was little awareness about the severity of the disease. There was lack of systematic counselling for relatives on how to prevent diarrhoea.

Cholera
The State Health Department National Institute for Cholera & Enteric Diseases (NICED) was testing stool samples of diarrhoea cases from all the affected districts. Stool samples tested positive for Vibrio Cholera El Tor O1 Ogawa

in South 24 Parganas, North 24 Parganas and East Medinipur districts. Vibrios tested sensitive to Noroxacin and Ciprooxacin, and resistant to Tetracycline and Doxycycline. There is a need to rectify the actual protocol for Cholera cases providing case

Once cholera is suspected in a camp or facility, the spread of the bacteria should be prevented through early detection, conrmation of cases, appropriate treatment protocol based on the antibiotic sensitivity report and dissemination of hygiene messages.

CYCLONE

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HEALTH

management guidelines, IEC material and on-job training.

Sanitation in Health Facilities

Highly contaminant environment. Vomits and excreta. Lack of disinfection. No specic guidelines for sanitation. Patients walking without shoes. No alternative spaces for latrines in the campus. Relatives using the same toilets as patients. Danger of intra-hospital infections. Sufcient Water, Sanitation and Hygiene (WASH) in health facilities and adequate equipment for universal precautions are essential in all health facilities, even small health posts.

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THE FIRST RESPONSE

The nearest facility for deliveries involved about one hour travel in normal circumstances and after the cyclone, it took 2-3 hours, and that too only if boats were available. The nearest Comprehensive Emergency Obstetric care (CEmOC) facility was at the subdivision hospital which was another two hours distance. If any obstetric or any other emergency happened, there was no referral transport available.

CYCLONE

33

HEALTH

The nearest facility for deliveries took 2-3 hours to reach.

In the health sub-centre (SC), the ANM and Accredited Social Health Activists (ASHA) were seen to be providing services. Out of the ve sub-centres in the Gram Panchayat (GP), two were functional. According to the ANM, around 100 patients were examined daily. The staff manning the SC was on shift duty. Sufcient medicines and Oral Rehydration Salts (ORS) were found at the sub-centre. ANM also informed that mobile medical teams with doctors and paramedics were sent from the Block Primary Health Center (BPHC) daily to different areas. One of the paramedic teams was providing services from a makeshift camp at a boat stand at Bholakhali.

This picture shows Auxiliary Nurse Midwives (ANMs) working in the medical camps. The quantity of medicines was found to cover the demand. Doctors were deputed from Government or NGOs to do 100 to 150 consultations per day. But, there were no doctors to be seen when the assessment team visited the camp. Doctors and nurses had to put on a 12-hour duty roster, daily. Average time of consultation per patient was very short (less than two minutes) and there was lack of time for proper counselling. Clinical management of patients was through the syndromic approach. There was no space and lack of condentiality for medical examination.

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THE FIRST RESPONSE

Surveillance system was not in place in either the facilities or the medical camps. Unstructured way to collect data. Lack of capacity to detect early outbreaks or identify infectious diseases. Based on eld observation, the number of cases was greatly under-reported. The Integrated Disease Surveillance Project (IDSP) was functional but eld data collection was weak.

HIV/AIDS
In both areas visited, no HIV testing facility, such as voluntary counselling and testing centre, was available at block or sub-block level for either booked or unbooked cases. The nearest facility where HIV testing is available was about three hours away. There was no evidence that the risk of HIV/AIDS had increased after the cyclone.

CYCLONE

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HEALTH

Surveillance

There was no evidence that the risk of HIV/AIDS had increased after the cyclone.

Golden Opportunity for System Strengthening

Create Standard Treatment Protocol for Cholera Response (Facility-Community). Reinforce zinc and ORS for diarrhoea treatment. Conduct mcrobiological surveillance for Acute Diarrhoeal Diseases (ADD) and Cholera. Ensure 24x7 delivery facilities and First Referral Units (FRUs) within reach. Deliver newborn minimal package of care. Implement immunisation services.

RECOMMENDATIONS
Immediate and short term
Restart immunisation services. This should preferably be done in a campaign mode and focus on measles immunisation, Vit A and deworming. Conduct health education and awareness programme on health, hygiene, nutrition, protection and other issues, mainly with distribution of leaets through NGO partners and in collaboration with Government. Replenishment of halazone tablets, ORS and zinc stocks. Strengthen medical services by improving use of mobile medical teams. The teams can render medical and immunisation services. Teams can also provide health education and NGO members may accompany these teams for this purpose. As part of diarrhoea and cholera response, protocols of case management and orientation/training at facility and community level.

Cholera management needs to be developed jointly with NICED and the Health Department. Micro-biological surveillance has to be monitored on a weekly basis. Training to healthcare workers at facilities and community on case management protocols [Master Training for Medical College]. Training will have to be decentralised, so that ANMs or doctors are not pulled out from the affected areas. If cases are found to be sporadic, then management will have to be done accordingly. Strengthen Integrated Disease Surveillance Project (IDSP), provide formats and technical guidance. Maternity huts may be explored to provide delivery care in areas where population density is not covered by health services. Needs assessment required. Coordinate with National Institute of Malaria Research endemic area for malaria, dengue and monitor

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THE FIRST RESPONSE

the impact of the cycone in terms of increasing vectors in the area. Distribute bed nets if required. Tents, tarpaulin and blankets as required for all sectors. Assess the health facilities in the focus blocks, including cold chain and delivery services.

Long-term
Improvement of overall access to promotive, preventive and curative healthcare services in the riverine areas through mobile medical facilities. Mobile facilities should provide comprehensive services for women and children, including nutrition, health, education and sanitation. Detailed planning is needed, in consultation with the state, on the sustainability issue (this included boats in the delta river to reach the affected population in the islands). Livelihood issues, which are intimately related to health and nutrition of women and children.

CYCLONE

37

HEALTH

NUTRITION
Household food stocks had been washed off and the vast majority of families were left with no foodgrains whatsoever. The Anganwadi Workers (AWW) in both places had left the village either for safety reasons or had taken shelter in camps and relatives place for sustenance. Nutrition services had not been provided to children and mothers for over one week. There was no real dened plan in place to address malnutrition. An analysis of the specic context and its nutritional problems, and an understanding of the causes and potential risks of malnutrition are required.

An analysis of the specic context and its nutritional problems, and an understanding of the causes and potential risks of malnutrition are required.

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THE FIRST RESPONSE

Four main factors should be taken into consideration when making decisions to adjust the initial planning gure for energy. These include environmental temperature, the populations health and nutritional status, demographic characteristics and physical activity level.

CYCLONE

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NUTRITION

Aid workers involved with the assistance had limited capacity; there was no organisation on the ground looking into the nutrition services at the time of assessment; food assistance was very limited and inconsistent.

Markets
Some markets were fully functional but not easy to reach, especially for those who were in cut-off or isolated villages. Although different food items are available, the prices of all essential food commodities (rice/cereals, pulses, oil, sugar/spices/salt) had increased. Adopt 2,100 kcal/person as a reference gure. Ensure that food ration is adequate to address the protein, fat and micronutrient requirements of the population. Ensure that food ration is adequate to address the nutritional needs of children under ve, pregnant, lactating women and other groups at high risk. Establish a monitoring system to ensure adequacy of the ration.

ITEM RICE 50 kg PULSES 10kg Green vegetables

BEFORE Rs. 630 350 10

AFTER Rs. 700 380 12

ITEM Apples POTATOES Mangoes

BEFORE Rs. 16 6 12

AFTER Rs. 18 8 20

40

THE FIRST RESPONSE

Very few families were able to cook outside their tents and the environment was not conducive for cooking: there was still water everywhere and one hardly found any home which was intact. Wood was the main type of fuel used for cooking. There were many families with no cooking utensils; they had lost their entire belongings during Aila. Good targeting is necessary during emergencies because resources are almost always limited. Poor targeting risks omitting households in genuine need and in the most dire circumstances.

Good targeting is necessary during emergencies because resources are almost always limited.
CYCLONE

41

NUTRITION

Cooking facilities

Experience has shown that infant and child morbidity and mortality rates often dramatically increase during emergencies. As part of estimating food and nutritional needs, specic interventions are required during emergencies to protect and promote optimal infant- and child-feeding practices. All infants, including those born into populations affected by emergencies should normally be exclusively breastfed for the rst six months. The quantity, distribution and use of breast milk substitute (infant formula) at emergency sites should be strictly controlled.

Communities do get something to eat on a daily basis; however, the quantity is low and the quality poor.
42
THE FIRST RESPONSE

Malnutrition Status
A very small number of children aged 6 to 59 months (North 24 Parganas = 50 and South 24 Parganas = 10) were assessed for malnutrition, using MidUpper-Arm-Circumference (MUAC) tapes and Oedema. Out of the 60 children assessed by the mission team,

there were only two children with below 11.5 cm MUAC. But, prevalence of Medium-Acute Malnutrition (MAM) among children in both the regions appeared to be high. The extended period of isolation of the affected population and the prevailing

low quality of life before Aila in the area can explain the high prevalence of MAM among children. But post-disaster, these children faced the danger of slipping into the SAM category in the days to come if any disease outbreak struck, instability prevailed or if there was continued food insecurity and stress.

CYCLONE

43

NUTRITION

RECOMMENDATIONS
Immediate
Vitamin A and de-worming to be provided as a minimum to all children under ve in the two focus blocks and advocate with the partners to cover the rest. After an appropriate nutrition survey among children 6-59 months old, provide therapeutic and supplementary feeding. Extra food ration to be provided for all pregnant women and lactating mothers.

Short-term
Develop nutrition education messages (with focus on MAM and SAM children) on: a) Breast feeding; b) Appropriate complementary feeding. Training of AWWs and volunteers in dealing with post-emergency nutritional challenges follow up of MAM, growth promotion, ensuring referral and facilitating treatment.

Advocacy with the Government to make AWCs functional on priority basis. Explore if centres can temporarily be shifted to other locations like schools, as soon as school education resumes. Monitor the nutritional status of children. Identiy cases of SAM and address them through health facilities in case therapeutic feeding is required.

44

THE FIRST RESPONSE

Long-term
Support AWCs with supplies, revival of activities and serving of supplementary nutrition programme (preferably as cooked meal) for all children.

Advocacy focus and emphasis to: Provide high protein and calorie food items to people. Supply iron folic (IFA) to pregnant women, girls and infant children.

Re-initiate the midday meal for children in schools, which are still functioning. Foodgrains may have to be arranged and supplied to the schools.

CYCLONE

45

NUTRITION

WATER, SANITATION & HYGIENE

A total of 10,239 hand pumps and a number of piped water supply schemes were damaged during Aila. Handpumps are the main source of drinking water for villagers in the affected districts. Before the cyclone, there were 38,681 hand pumps and 398 piped water supply scheme meeting the requirement of drinking water for 10.26 millions villagers of the two districts (census 2001). During interaction with the community, it was observed that there is no special attention of water quality monitoring, surveillance, operation and maintenance of hand pumps. The average down time of hand pumps is about 5-10 days and in some cases more than a month

46

THE FIRST RESPONSE

People were practising hand washing after defecation with mud and simple hand washing (with water only) before eating. However, they were aware of good hygiene practices such as washing hand after defecation with soap, taking water from safe hand pump and household treatment of drinking water (use of halogen tablet). Proper storage and use of halogen tablets was not prevalent.

CYCLONE

47

WATER, SANITATION & HYGIENE

The general hygiene was poor.

Ensuring privacy to women and adolescent girls during bathing and defecation, and addressing need of menstrual hygiene is important this may requires construction of bathing/ washing platform along with cubicals. Promotion of hygiene (hand washing with soap at critical point, storage and handling of drinking water) is essential for the well-being of the communities. This may require regular (may be monthly) supply of washing soap. Additional toilet facilities should be provided, along with maintenance arrangements, so as to ensure availability of toilets.

48

THE FIRST RESPONSE

There was no system of solid waste management. This was despite the fact that secondary data indicates that the sanitation coverage in these two districts is very high. Out of the total 512 GPs, 156 GPs were awarded Nirmal Gram Puraskar (zero open defecation status). The overall toilet coverage in South and North 24 Parganas is 64 per cent and 95 per cent, respectively. During the mission, it was observed that most of the households toilets were washed away and people were practising open defecation. As saline water was still surrounding the houses, sanitation is an important issue, particularly for women, children, the sick and the old. The picture shows the waste being thrown through the window in this ooded community health centre.

Most of the households toilets were washed away and people were practising open defecation.
CYCLONE

49

WATER, SANITATION & HYGIENE

Everywhere there was stagnant water and organic matter had started to decay.

RECOMMENDATIONS
Short-term
Regular water quality surveillance and disinfection of drinking water sources. Decentralised operation and maintenance system to reduce the down time of the handpumps less than one day. Behaviour Change Communication (BCC) along with distribution of soap for promoting hand washing with soap and proper use of halogen tablets. Ensure improved access of safe drinking water and storage in difcult-to-reach places and institutions such as schools and health centres by providing and lling 500 litre storage tanks. Provision of community sanitation and bathing facilities, particularly for women with systems for their maintenance.

Setting of one WES camp at GP/ cluster level (population about 5,000) for improving service delivery, i.e., mechanic with hand pumps tool kits, spare parts, bleaching powder, halogen tablets, sweepers, soaps, toilet cleaning materials, brooms and Hydrogen Sulphide test (H2S).

Set up a water quality and diarrhoea surveillance system through mobile labs having water quality testing facilities along with medical and nutrition monitoring. Safe disposal of decaying organic matter and hospital waste in a pit (burial method) around the villages.

50

THE FIRST RESPONSE

Raising of select handpumps in most vulnerable area/villages, particularly those handpumps that had got submerged during the cyclone and in areas near high land. This will help in ensuring availability of drinking water during high tide also. Ensure linkages with interventions under the regular ongoing agship programme to ensure sustainability of our intervention. Assess the extent of damage of drinking water facilities (handpump and piped water supply/platforms) and restoring the same. Assess the extent of damage to toilets (individual/school toilets) and develop appropriate designs suitable for water logged areas and advocate for construction. Study the impact of inundation of saline water on the aquifer from where handpumps are getting water.

CYCLONE

51

WATER, SANITATION & HYGIENE

Ensure linkages with interventions under the regular ongoing agship programme to ensure sustainability.

Long-term

CHILD PROTECTION
Focused discussions with the women and children did not reveal any cases of abuse within the relief camps. While the parents were engaged in recovering belongings and rebuilding the damaged houses, adolescent girls were involved in cooking food in the shelters. Children were on their own, playing and running around without organised educational activities.

Apart from the presence of the NGOs like the Rama Krishna Mission, the Palli Unnayan Samity and the Tagore Society for Rural Development (which did not deal with protection issues), there was no other NGO or childrens group addressing protection issues and engaging children

in any therapeutic, educational or recreational activities. Some cases of trauma like nightmares were reported by parents of children in Gosaba. There was, however, no perceived discrimination with regard to caste or class in any of the shelters.

52

THE FIRST RESPONSE

Short-term
Raise awareness within communities and counterparts on mechanisms to prevent separation of children. Additional assessment by child protection section to be conducted 6-8 weeks later to establish coordinating mechanism for long-term action.

Long-term
Identify, document and reintegrate separated children and facilitate development of monitoring systems through use of missing children tracking portal and Childline.

CYCLONE

53

CHILD PROTECTION

RECOMMENDATIONS

EDUCATION
School building structures where ever intact were being used as shelters by the displaced people. Damage of text books was reported by both teachers and students. This need is being assessed by the school education department. Schooling activities will be hampered as long as people do not return and reconstruct their houses.

54

THE FIRST RESPONSE

Short-term
Provide recreational kits and support psycho-social recuperation activities in schools/centres through child-friendly school concept in relief camps through NGO partners. Advocate with the Government for reopening of schools as early as possible, ensuring protection of

Long-term
Strengthen the schools and SSKs systems in emergency preparedness with a child-friendly inclusive school and system approach through capacity building exercises.

CYCLONE

55

EDUCATION

RECOMMENDATIONS

children. Support reopened schools with select educational materials and tarpaulins, water tank, etc. Support alternative learning spaces/ camps with school in a box, recreation and sports kits, early learning kits and other materials. Adaptation of INEE standards in Bangla language for school teachers and education functionaries. Subject specic learning/remedial

camps and reading campaigns to bridge the gap. Psycho-social recuperation module for teachers and children.

PROGRAMME COMMUNICATION
RECOMMENDATIONS
Massive community mobilisation drive through strong BCC/IEC component, using the existing IEC and communication materials, such as leaet, booklet, training ip book, loud speakers, and lms on personal hygiene and sanitation. (For example, the panchayat building, which was not damaged, should be utilised for social mobilisation training and planning, lm shows, and this could be a good place to store IEC and communication materials too). The visit took place during school vacations. Focus group discussions, interaction with individual parents and children, and school infrastructure reveal that most children in the village do attend schools in normal times. There was no evidence found on child trafcking in any of the villages visited. However, some parents did inform that post-cyclone migration of their children had gone up. Lactating mothers in the village and temporary shelters reported breast-feeding, but exclusive breast-feeding does not seem to be a normal practice. The knowledge about the use and benets of ORS was fairly good. However, ORS sachets were not seen. The use of soap had declined, as affected family earnings did not allow for such items. Training of Panchayats by UNICEFsupported NGOs in inter-personal communication skills and community dialogues around correct practices. Village social mobilisation activities planning, implementation and monitoring should be facilitated by the UNICEF-supported NGO partners. UNICEF to facilitate crash training for the block-level functionaries of NGO partners.

56

THE FIRST RESPONSE

CYCLONE

57

58

THE FIRST RESPONSE

'Kosi' Bihar August and October 2008

FLOOD

FLOOD

59

Gandak River
West Champaran

FLOOD AFFECTED DISTRICTS

Nepal
East Champaran Sheohar Gopalganj Sitamarhi Madhubani

Old course

Kosi River New course

Ganga River
Siwan

Supaul Muzaffarpur Darbhanga Madhepura Saran Vaishali Samastipur Purnia Saharsa Khagaria Araria

Kishanganj

Buxar

Bhojpur

Patna Nalanda Sheikhpura

Begusarai

Katihar

Kaimur

Rohtas

Jehanabad

Munger

Bhagalpur

Lakhisarai Nawada Banka Jamui

Ganga River

Aurangabad

Gaya

Sone River
Fully Affected District Partially Affected District

60

THE FIRST RESPONSE

Heavy rains in the rst week of August 2008 saw the River Kosi mount pressure on the spurs at Kusaha, 12 km upstream in Nepal. The river began eroding its embankments that ultimately suffered an almost 1-km wide breach. What worsened the situation was that the River Kosi abruptly changed its course, rendering 2.4 million people homeless. Most of the affected areas were traditionally not considered ood-prone, leaving the people and the administrative machinery unprepared and hopelessly vulnerable in dealing with the situation.

FLOOD

61

The oods adversely affected more than 4.84 million people across 2,528 villages in 18 districts of North Bihar. A total of 3.21 million people in 1,021 villages were the worst affected, with children below the age of nine, numbering over 800,000, being amongst the worst affected. The human toll was 262, with another 1,939 people reported missing in the ve worst-hit districts of Supaul, Saharsa, Madhepura, Araria and Purnea.
(Source: UNICEF SITREP No 15, October 17th, 2008)

62

THE FIRST RESPONSE

FLOOD

63

64

THE FIRST RESPONSE

Roads in the district were severely damaged, some impassable. People went through the nightmarish situation of using boats, tractors, motorcycles or other means to reach the relief camps. Some just trudged through shoulder-deep water. The logistics needed in reaching these villages was not easy. A team of 8-10 people were required to drag the boats; team members had to walk several kilometers in knee to chest-deep water before reaching a village. As the water receded, the depth was insufcient for boats, yet road transport had still to resume.
FLOOD

65

Dispersed communities were coping with the situation in resilience mode but collective stress, helplessness and incertitude, were evident. Members of some socially excluded communities had chosen to stay behind in the marooned villages. Overall, though, there is no doubt that people cutting across social strata had been visibly scarred by the oods and were very anxious about their future.

66

THE FIRST RESPONSE

FLOOD

67

68

THE FIRST RESPONSE

With no electricity, lack of safe water, inadequate shelter and blankets, living in the camps became a nightmare. The population was split in two those trapped in the cut-off villages (communities) and those who succeeded in escaping and reaching safer places (camps). Those who lived in the cut-off villages often compard their situation with those living in camps, and felt the government should do more to help them.

FLOOD

69

Camps were set up alongside the roads and all the camps were full. At the time of the assessment, 2,54,000 people had been accommodated in 190 relief camps in ood affected areas. The Government had deployed 177 medical teams and opened 193 health centres to take care of their needs. Another 95 cattle camps had been opened to take care of cattle, which the people had rescued from the ood waters.
(Source: Unicef Sitrep No. 16, November 2, 2008)

70

THE FIRST RESPONSE

FLOOD

71

72

THE FIRST RESPONSE

Many women were wearing the same sari since the disaster hit. The people arriving by boats received a package from the Government which contained a sari for women and a lungi for men. In the camps, there were piles of donated clothes which were not being utilised. Clothing was distributed by NGOs. Women reported that these clothes were inappropriate to what they were used to.

FLOOD

73

This room in a school building was converted into a shelter for women and children. A signicant development was the closure of many small and mega camps, as the Government decided to help people resettle in their own villages. The Government announced 100-kg of grain (rice and wheat) and Rs. 2,250 for every family staying in villages. The rapidly changing situation in camps was a pointer to the fact that future humanitarian interventions must move away from a camp-centric to a village-centric approach, even in where villages are difcult to access.
74
THE FIRST RESPONSE

FLOOD

75

HEALTH
There is a need to implement a disease surveillance system to anticipate epidemic/disease outbreaks in cut-off villages. Health facilities were in poor condition; in many cases, they are non-functional. IEC/BCC communication effort needs to be strengthened and out-reach increased to cover potential problem villages/areas. Medical teams were hard pressed to reach cut-off villages. Absence of frontline health workers is a concern; it has impacted routine antenatal and immunisation schedules. Maternal health service delivery was poor. Knowledge about HIV/AIDS was almost non-existent, and so was service delivery and messaging. The red line in this picture indicates the water level at the height of ooding inundating this PHC in Laxmipur.

Water level

76

THE FIRST RESPONSE

This girl in a cut-off village was suffering from acute diarrhoea and had been vomiting for three days. No ORS was available; instead water, sugar and a pinch of salt was being given. There was no doctor available in the nearest health centre; no ANM and no ASHA.

This patient was one of the many observed in the camps with cramps and vomits. The team observed the presence of acute diarrhoeal disease with severe dehydration and vomiting. Once cholera is suspected in a camp or facility, the spread of the bacteria should be prevented through early detection, conrmation of cases, appropriate treatment base on the antibiotic sensitivity report, isolation of cases and dissemination of hygiene messages.

FLOOD

77

HEALTH

There were enough medicines available. Doctors from Government or NGOs. Camp of 8,000 people = 300 to 400 consultations per day. 12 hours daily duty of doctors. Average time per patient was one minute. Lack of time for proper counseling. Lack of space, condentiality and time for medical examination. Only male doctors were observed to be on duty.

Medical tents required for camps to ensure space for examination, condentiality and stock medicines.
78
THE FIRST RESPONSE

The eld team made the following observations with regard to surveillance processes and formats: Araria: Only one of the ve camps visited were reporting with standardised formats. Purnea: Four camps were reporting with no formats.

FLOOD

79

HEALTH

This picture shows a suspected cholera case in a camp where medical waste was not being properly disposed. The team found medical waste strewn around the patient.

Maternal Health
Routine antenatal care services were found to be very weak or unavailable. Midwifery kits were in place, but kept in a box. Emergency obstetric care was available only in the District Hospital; no FRU was functional. The Janani Suraksha Yojana (JSY), a safe motherhood intervention, decreases admissions in District Hospital due to increased camp and home childbirth. In Murliganj, before the oods there were 20-30 deliveries per day. Now, only two deliveries had taken place in 14 days. Pregnant women in camps were receiving Rs 10,000 if a boy was born and Rs 11,000 for a girl. As a result, many pregnant women from host populations wanted to deliver in camps. This was leading to crowding and lack of supplies.

80

THE FIRST RESPONSE

Access to and availability of immunisation services in cut-off villages was also found wanting. Service providers found it difcult to access these villages. Large scale relief operations were difcult to mobilise, whether human, material or nancial. Given the precarious situation, routine ante-natal and immunisation services in these areas were seriously disrupted. The district administration was planning a special contingency fund to ensure full scale immunisations in these areas. The deepfreeze in this picture was found to be damaged. As such, keeping supplies of medicines and vaccines was difcult. Vaccine carriers were not found and the ILR had to be repaired. The ood situation had led to electricity supplies being cut off. The health facility did not have a generator.

FLOOD

81

HEALTH

Immunisation

RECOMMENDATIONS
Short term
Support mobilisation of medical teams and necessary logistics for providing medical care. Strengthen maternal and newborn care services and cold chain system at nearby health facilities. Resume/catch up immunisation services. Strengthen supply of ORS and Zinc for management of diarrhoea. Collaborate with Nutrition and WES for provision of IFA tablets, Vitamin A supplementation, Albendazole, etc., in cut-off villages. PEP kits are not necessary. With increased migration, education on HIV/AIDS prevention needs to be mainstreamed into BCC and health initiatives.

A comprehensive disease surveillance and containment plan for early detection and prevention of outbreaks in cut-off villages. There is a need to build the capacity of ASHA workers to deal with the emerging situation. There is a need to collaborate with programme communication for BCC messages on health.

Challenges to implementation: Trained manpower for delivering basic health services not available in sufcient numbers. Transport of supplies (ORS, medicines, vaccines, IFA and halozone tablets) and maintaining cold chain during immunisation needs to be streamlined. Strengthening referral services is a felt need.

82

THE FIRST RESPONSE

FLOOD

83

HEALTH

NUTRITION
Communities, local NGOs were actively involved in food distribution puffed rice, biscuits, bread, etc. Food was being cooked and distributed without any discrimination. Members from displaced populations were not involved in cooking and distribution of food. Cooked food support was being provided to satellite camps. Some camp kitchens were catering to a population of over 6,000. Anganwadi workers displaced by oods and living in the camps were not playing any role. When contacted, they were willing to play an active role.

84

THE FIRST RESPONSE

Araria district
Food supplied by Government. Food cooked and distributed twice khichri (rice and pulses). Cooking pots and gas along with stoves provided by Government. Salt tested in two out of three camps both were uniodised.

Purnea district

Cooking pots borrowed from local community, wood used as fuel for cooking

Food being provided by Panchayats, communities, local NGOs and Government. Food cooked once a day rice and potatoes with occasional dal; puffed rice distributed once. Cooking pots were borrowed from local community; wood used as fuel for cooking. Salt tested in one out of two camps it was adequately iodised.

FLOOD

85

NUTRITION

Dissimilarities

QUALITY: Protein, fat and micronutrient content of the food cooked and distributed was inadequate. No variety. Difcult for young children to eat. QUANTITY: Quantity of individual serving sufcient, but inadequate for the entire day. FREQUENCY: Inadequate, especially for infants and young children, and pregnant and lactating mothers. Elderly people, women and members of marginalised communities nd barriers to access.

Frequency of meals inadequate, especially for infants and young children and pregnant and lactating mothers.

86

THE FIRST RESPONSE

Araria: Assessed nutritional status of under ves in two camps; Camp 1 SAM : 7.5% (sample 53) Camp 1 MAM: 28.3% Camp 2 SAM: 8.3% (sample 13) Camp 2 MAM: 33.3%

VILLAGE 1: SAM 8% [1/14] MAM: 50% [7/14] VILLAGE 2: SAM: 12% [3/25] MAM: 52% [13/25]

VILLAGE 3: MAM: 50% [6/12] CAMP RANDOMLY SELECTED SAM: 20% [6/30]

Purnea:
Camp 1 SAM: 8.7% (Sample 18) Camp 1 MAM: 26.3% Before crisis data : from Bihar Camp 1 Identied a case of Marasmic Kwashiorkor with Edema Grade 2 and medical complications.

MarasmicKwashiorkor form of Malnutrition: This is characterised by a combination of severe wasting and oedema.

This child was refused treatment by the doctor at the PHC.

Medical treatment of Severe Acute Malnutrition at hospital.

FLOOD

87

NUTRITION

Assessment in camps

Assessment in cut-off vilages

Breast milk output has been affected due to stress and shock. Nearly 90 per cent of lactating mothers interviewed reported substantial reduction in milk production Children in the age group of 6-24 months were fed on breast milk and animal milk (cow) before the disaster. Complementary foods in general started late and were inadequate in quality and quantity.

With breast milk output decreasing, non-availability of animal milk and the type of food served at the camps, incidence of SAM and MAM are likely to

increase signicantly. The observed high prevalence of ARI and diarrhoeal disease will further aggravate the severity and incidence of malnutrition and vice versa.

88

THE FIRST RESPONSE

All Anganwadi centres visited were kachcha buildings and completely destroyed. About 70 per cent of them had lost play/learning material, utensils and other equipment. Some centres had been restarted in a makeshift way in the camps or at relatives' places.

FLOOD

89

NUTRITION

Food Basket
Families did get to eat food on a daily basis but reports on food consumption patterns varied in both districts. Socially excluded communities reported greater food shortages. With uncertainty dogging supply of food, people voluntarily chose to reduce their quantum of daily food intake, fearing impending shortages.

90

THE FIRST RESPONSE

Most people's diets were found to be highly skewed due to lack of availability of proteins, fats and micronutrients. The vegetable seller seen here has little to offer mainly onions, potatoes and green chillies.

People voluntarily chose to reduce their quantum of daily food intake, fearing impending food shortages.
FLOOD

91

NUTRITION

After the oods, access to pulses, milk and green vegetables was limited in most areas. Rising food prices and poor connectivity further compounded this problem. Even where available, many were not able to afford it.

RECOMMENDATIONS
The strategy should focus on ensuring delivery of a package of nutritional services in a phased manner. As a priority, nutrition interventions should focus on high risk children living primarily in hard-to-reach villages. It should then move on to the easy-toaccess villages. These services should be planned and linked together with health and water/sanitation services. This will ensure effective synergies, optimum utilisation of resources and effective monitoring. Another crucial aspect in ensuring effective delivery and sustainability of services is meeting the HR challenge (training/ micro-planning/mobility).

Provide high protein and calorie food items (like sattu) to children.

92

THE FIRST RESPONSE

As per mandate and CCCs, UNICEF can offer to lead the nutrition sector. There is a need to ensure appropriate nutrition education messages on: Exclusive breastfeeding for children 0-6 months. Appropriate complementary foods and feeding practices for children 6-24 months. There is a need to support an intensive drive for vitamin A and deworming of children <5 years, adolescent girls and pregnant women. There is a need to initiate therapeutic and supplementary feeding only after an appropriate nutrition survey is conducted amongst children 6-59 months. There is a need to advocate with Government to make AWCs functional on priority. The idea of centres temporarily relocated to safer areas so they start functioning can be explored. Capacity building of AWWs and volunteers in dealing with post-emergency nutritional challenges is a must, especially in relation to follow

up of SAM, growth promotion, ensuring referral and facilitating treatment. Supporting replenishment of supplies for AWCs, revival of activities and serving Supplementary Nutrition Programme for all beneciaries needs to be carried out. There is a need to make efforts to advocate with Government for: Increased monetary allocation to SNP to handle price rise Provide high protein and calorie food items (like sattu) to beneciaries. Incentives for AWWs if involved in tasks in addition to their routine schedule (for example, therapeutic feeding to SAM, other campaigns) Supply IFA to pregnant women, adolescent girls and infant children. Advocate with Government for re-commencement of mid-day meals for children in schools which have re-opened. Support a massive community mobilisation drive with a strong BCC/ IEC component.

FLOOD

93

NUTRITION

WATER, SANITATION & HYGIENE

Situation in the camps
Handpumps currently providing sufcient quantity of water for the displaced in the camp. If camp grows in size, the number of handpumps will be insufcient. Concern about quality (safe water) of the drinking water due to nonprotected sources. All groups have access to water. Lack of containers to store water. Chlorination was not being undertaken. Halogen tablets and bleaching powder are available and ready for distribution.

94

THE FIRST RESPONSE

The safety of drinking water has to be conrmed, even if the source was in earlier use.
FLOOD

95

WATER, SANITATION & HYGIENE

Indiscriminate open air defecation is being practised, people have to go far away to the eld. Toilets are few, very dirty, not maintained, and there are privacy issues for women. Human waste in the open. No defecation close to handpumps. Solid waste disposal bins are not available, very little waste produced now, likely to change in the future. Waste disposal mechanism only for kitchen and pits. Drainage facilities are poor. Separate bathing facilities for women not available. Menstrual hygiene: Usually women use white cloth, but in the camp this was not available.

Repair and rehabilitation of damaged handpumps was important to ensure safe drinking water for the affected population. All handpumps were completely inundated during the oods and approximately 70 per cent were without platforms or proper drainage systems.

All handpumps were completely inundated.

96

THE FIRST RESPONSE

20-30 per cent of handpumps needed repair. Not a single handpump had been chlorinated in any of the villages There was no treatment at the household level. No reparation by Public Health Engineering Department (PHED). All groups reported access to water. Quantity is enough, however the quality of water is dubious. No handpumps were situated near toilets.

Quantity is enough, however the quality of water is dubious.

97

FLOOD

WATER, SANITATION & HYGIENE

Solid waste, including garbage, animal dung, rotten food and other household belongings, slush, etc., could be seen all around, posing serious environment and sanitation risks. No existing mechanism for collection and disposal for waste. People collect it outside their house and use it as manure for agriculture.

98

THE FIRST RESPONSE

Bathing facility for women highly inadequate and privacy is an area of concern. At the time of the visit, 20-30 per cent area in all villages was still inundated, both by stagnant and running ood water. People, specially women and children, were using this stagnant and running water for defecation. Cases of water-borne disease especially skin rashes, were very common while cases of diarrhoea were also being reported. Awareness about safe handling of water and excreta disposal almost negligible.

People use soil for hand washing, no availability of soap in assessed villages.

FLOOD

99

WATER, SANITATION & HYGIENE

People use soil for hand washing, no availability of soap in assessed villages.

RECOMMENDATIONS
As per mandate and CCC, UNICEF can assist in leading the WES sector in as appropriate a manner as is possible, since no other organisation is responding to the needs of these cut-off villages. The PHED, local authorities and communities must be included at all stages of planning, implementation, evaluation and overall response to these problems. A concerted effort must also be put in place for capacity building of all these agencies.

Repair and rehabilitation of damaged handpumps is important to ensure safe drinking water for the affected population. Further, since almost all other functional handpumps observed were without platforms or proper drainage systems, rehabilitation programmes should address these gaps. Depending on Government plans, UNICEF and other agencies can explore providing material and/ or technical support to implementing partners to establish safe water supply by rehabilitating defunct handpumps. As most houses had lost their water storage containers and could not store water, buckets/containers should be provided. Despite the fact that family latrines hardly existed prior to oods, the presence of open defecation sites caused by the disaster offers a potent threat to health and environment. Instead of temporary trench latrine construction, permanent pit latrine construction programme for safe excreta disposal is appropriate. Solid

waste disposal is not a major issue in the cut-off villages. Hand washing knowledge and practice in the affected areas was very poor. Soap and dissemination of hygiene messages in local languages are necessary to protect the public from dangers of water and excreta related diseases. All handpumps must be disinfected immediately. This must be done in collaboration with local line departments; it can also be carried out by micro planning with block-level PHED engineers, masons and PRI (water and sanitation committees). If a trained cadre of village volunteers is ready, then proper kits must be issued to them to carry out their task. Also, there is a need to ensure water treatment at household level by distributing water treatment tablets. Protection of handpumps to be ensured through construction of platforms and raising their height to reduce future vulnerabilities. This can be done through a survey of all handpumps by

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a trained cadre of village volunteers, who must take into account the sanitation habits being followed by the villagers. Providing support to block-level PHED engineers in planning and implementation, and leveraging Government funds for the same. Establishment of a water quality surveillance system from source to end-user level in all the affected villages needs to be carried out in concert with PHED and PRI (water and sanitation committee). This will lead to developing a trained cadre of local people at Gram Panchayat level, appropriately backed with necessary supplies like chloroscopes and H2S vials. Construction of temporary, low-cost community toilets for women and children; construction of temporary, low-cost community bathing cubicles for women; and cleanliness drive in all villages using trained village volunteers needs to be carried out urgently and in a sustained manner.

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CHILD PROTECTION
There were no cases of missing or orphaned children. Probability that whole families were wiped out is high. Children exhibited manifest psychosocial concerns; they were afraid of water; they got up in the night and shouted words like Bhago or Pani. There were no reported cases of abuse (physical, emotional and sexual).

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There was no structured activity for children and there were instances of physical abuse by parents. Daily routine of a child involved eating and rambling around as no school and other activities existed. Role of men and women had changed. Few adolescent girls were seen as they had not been brought from camps or relatives because of insecurity.

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Daily routine of a child involved eating and rambling around as no school and other activities existed.

RECOMMENDATIONS
Psychosocial support and counselling has to be an in-built component in alternative learning spaces/schools once they are running. Training of teachers and other personnel, who can help in these activities, is a must. This should be done at the earliest, preferably before a mass return of population takes place. As such, forming linkages between CP and Education may be a way forward because of the overlap. This aspect can also advocated with the State Government.

Advocate with Government to provide for activities where parenting skills can be improved. This will help them discipline their children in a positive manner. Parents can also assist teachers in implementing psychosocial support programmes in schools, anganwadi centres and communities. Advocate with the Government for design and implementation of specic activities focusing on psychosocial support for 3-5-year olds not yet in school. Such activities can be implemented in Anganwadis or madrasas that existed before the oods; even pre-school sections in alternative learning spaces can be included. Anganwadi workers, preschool teachers or community volunteers will need to be trained on this issue.

Monitoring and tracking system to be mainstreamed in District Child Protection Units (DCPU). Discussion and planning with PRIs needs to be taken up on a priority, since they can be effective watchdogs at the community level in checking trafcking, especially when families start returning, and also report such cases. BCC and awareness in communities needs to be strengthened, especially of women and children, on key child protection messages like the need for the family to be together and for children to be heard, loved and cared for during emergencies. The scale of operation may have to be increased in sectors like Child Protection. This need is now being felt and a village-based approach may be more effective.

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CHILD PROTECTION

EDUCATION
Most schools in villages of Supaul and Madhepura had been damaged because of inundation. The picture depicts the state of the Sarva Shiksha Abhiyan ofce in Madhepura.

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None of the visited schools were used as relief camps, but some rooftops were being used as a platform for survival. Almost all children had lost their study material, notebooks and stationery. 50-60 per cent teachers were found present in villages and rest had been deputed in camps or in relief work. People were demanding schooling in almost all visited villages. Midday meals were provided to children before oods, but the foodgrains store in the school had been washed away.

Almost all children had lost their study material, notebooks and stationery.
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All schools and educational activities had stopped. Around 20-30 per cent of schools were partially damaged due to inundation.

I am not happy that my school is not functioning any more! I lost all my books and my school bag. I dont know what will happen now and when my school will reopen. If I study I will be an educated man and will earn something for my family. I miss my school and my friends I miss my friends, my neighbours. There were many people in the village earlier, now there are so few of them. I dont know if they exist or where have they gone. Even my parents are very sad We all are very quiet and silent nowadays I used to feed my cow everydaywe had it for more than four years Now she is no more with us. We all are very sad

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Technical Support
Translate Inter-agency Network for Education in Emergencies (INEE) Minimum Standards for Education in Emergencies into Hindi or identify and translate alternate material on the same issue; simultaneously, organise training for state, district and blocklevel authorities. Produce teacher training modules for psychosocial support and other areas of education in emergencies (including disaster reduction) and organise rapid trainings. Introduce psycho-social support and learning activities for preschool age groups (3-5-years) and train teachers, Anganwadi works, para-teachers and volunteers in its use. Develop clear need-specic advocacy plans for the education department and promote child-friendly strategies for catching up missed school time.

RECOMMENDATIONS
UNICEFs role is to focus on specic technical support to complement Government effort. Interventions to improve relevancy and quality of education in cut-off areas (psychosocial support, and advocacy) and effective strategies for social inclusion. Beyond policy advocacy and technical

support, UNICEF support should focus on specic villages/areas with large marginalised populations. Advocate with Government for repair of damaged school buildings on priority. Advocate with Government for inclusion of clear and realistic distribution plans for education supplies in recovery process.

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Advocate for re-establishing of midday meals for school-going children as part of food assistance and as incentive for early return to schools; communicate availability clearly to parents.

Key Action Points

Conduct a social inclusion and gender assessment of proposed education recovery plans to ensure equal access to quality education. Also advocate for modication of strategy to reach marginalised or at-risk populations. Establish monitoring systems or appropriate support strategies as necessary for children preparing for examinations

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Key options to consider can include consultation with parents, teachers and village education committees (VSS) to nd locally-appropriate solutions, extended school year, training of teachers for accelerated learning, evening/vacation courses for children preparing for exams in the next two-three years and residential bridge courses for inaccessible villages (with separate provision for girls and boys). Advocate for improved quality of education activities, like drawing and painting, to allow for children to express their feelings in adapting to new realities. Develop new strategies in Multi Grade Multi Level (MGML) situations. Empower child forums (Child Cabinet, Meena Manch). Community mobilisation in new environment for student enrolment and retention.

Assess and replicate good practices from camps to cut-off villages. Set up alternative learning spaces as quickly as possible in cut-off villages. Possible strategies can include training and transferring volunteers from camps to cut-off villages, identifying other local community volunteers such as youth, creating learning and play time use of radio as a dissemination tool through organised listening and play time with communities, distribute play material and toys, and advocate for returning teachers to set up nonformal activities. Developing parent-education activities linked to ALS or ICDS to provide psycho-social support, positive childcare practices and other essential family practices like hand washing, breastfeeding, water treatment, waste management, etc. Producing appropriate education-

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EDUCATION

Demonstrate Best Practices

related radio messages and ensuring their regular broadcast; exploring other similar tools of communication to keep parents abreast about Government plans on aspects like education services, etc. These, in turn, could be vital in promoting a sense of normalcy amongst people living in affected areas. Undertake regular assessment of performance of children in affected areas over several school years to evaluate the correct level of achievement and ensure effective implementation of education programmes. This is necessary to avoid drop-outs and ensuring acrossthe-board quality. Ensure availability of adequate reading and writing material. Hire education staff to focus specically on emergency initiatives to avoid overburdening regular programmerelated staff.

PROGRAMME COMMUNICATION

Medium term strategy to focus on communication during rehabilitation phase

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Capacity Assessment
Are there community groups available for communication efforts (NGOs, CBOs, PRI, volunteers)? Are there active youth, AWW, teachers among displaced population available in camps who are under-utilised? Do these groups/individuals have any training on interpersonal communication/social mobilisation? NGO volunteers engaged by UNICEF for seven camps for integrated interventions are being trained on all relevant precautions during and after oods as well as IPC and community mobilisation skills. What IEC materials are available at the relief site? No visible communication materials. Flip charts, leaets, handbooks and tin plates being supplied by UNICEF. Is there anywhere to store communication materials? Warehouse with respective NGOs
Desired behaviour

Behavioural Assessment
Possible barriers Lack of Not knowledge perceived as important No support from family, others No No visible communication service/ supply/ effort facility Stress/ shock (*) Others (specify)

Lactating mothers are breastfeeding Families are using ORS to treat diarrhoea Caregivers allowing children to be immunised Users treating/ consuming safe water People wash hands with soap/ash after defecation/before eating Adults/children using sanitary latrines Children are going to school/participate in camp-based activity

Local storage in the camp management area at the camp site What communication channels currently exist at the relief site print, radio, TV, mobile phones Mobile/Radio Is the locality conducive for the

following communication options hoardings, folk media, miking, banners, video vans, wall paintings Hoardings Wall painting (in some camps which are in some permanent structures) Radio/Miking/Video vans

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RECOMMENDATIONS
Communication and social mobilisation activities are non-existent in cut-off villages, but there is a felt need in communities to disseminate positive behavioural practices. IPC can play critical role in ensuring desired behavioural practices in cutoff/high-risk villages by orienting local groups or individuals in communicating need-specic messages. PRIs and youth volunteers can be mobilised for communication and social mobilisation efforts. However, often there is paucity of CBO/CSOs in affected villages. Anganwadi centres, village pradhans house and surviving concrete structures can be used to store IEC material. Communication channels as currently existing are often limited. Mobile phones may still be operational, and thus can be a viable medium for disseminating BCC messages.

No comprehensive communication strategy for relief camps was needed, however technical support should be given to Government functionaries and NGOs. Medium term strategy to focus on communication during rehabilitation phase (preventive health and hygiene promotion in the marooned villages once people start moving back will be most critical).

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Existing mechanisms for awareness generation exist in form of AWCs, ANMs, ASHA, mahila mandals and primary schools. Special effort needed to identify womens groups, youth clubs/ groups/faith-based organisations, etc., who can be oriented to implement and monitor IEC/BCC in these villages. Existing messages on desired behaviour should be appropriately re-worked and given to Government for dissemination.

Alternative media like folk media (puppet) and street theatre can be effective stress busters and awareness generation tools. Preparation of demand-specic IEC/BCC material to address emerging issues (acute diarrhoeal disease) and linking dissemination to service or material delivery. Dissemination of IEC/BCC material through frontline workers and panchayats, especially on personal hygiene and nutrition.

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Andhra Pradesh and Karnataka October 2009

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Heavy rains in September-October 2009 caused ash oods in 15 northern districts of Karnataka state and 5 districts in the Rayalaseema region of Andhra Pradesh state. The situation was compounded with the discharge of waters from three dams across the major rivers of Krishna and Tungabhadra in Karnataka.

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An estimated two million people were affected. 300 lives were lost, 227 in Karnataka and 73 in Andhra Pradesh. Over 500,000 houses were damaged in Karnataka, with over 1 million hectares of cropped area affected. In Andhra Pradesh, the damage to houses was extensive over 1.7 million. APs Nagaldinne village became a ghost town with almost all the village population living in a temporary shelter (a high school) and also in shelters that the people had built on their own with whatever material they had.

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The water level due to the ash oods was as high as 12-20 feet in some villages in Raichur district. In Kurnool district in Andhra Pradesh, water levels reached almost 30 feet, submerging buildings. The devastation caused in many villages was akin to the havoc wreaked by the 2004 tsunami.

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Makeshift shelters mushroomed in safe areas. Seen below are shelters under construction in Raichur. As many as 300 families were to be accommodated here and each family was allocated 120 sq. ft. The small-sized quarters were fragile and prone to re.

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Temporary shelters

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HEALTH
Health facilities were generally poor in both states. Even though human resources were adequate, damage to amenities and medical stock was prevalent. Surveillance was generally weak and no medical camps/ mobile teams were seen in Karnataka. Cases of skin infection (contact with rotten mud) were detected in the villages and temporary shelters.

126 THE FIRSTResponse The First RESPONSE

Health centres in Andhra Pradesh had opened medical camps in the villages. The district hospital was running a medical camp till November 15, daily from 7.30 am to 11 am. A total of 400 children were seen every day in the camps. Outreach activities from the sub-centre and the PHCs were also going on.

Many cases of skin infection were detected in the villages and temporary shelters.

Cold chain
In Andhra Pradesh, the team found that conventional refrigerators were being used to store vaccines. ILR and deepfreezers had collapsed in the AP facilities and were not fully functional and maintained in Karnataka. There was no TT stock in any of the visited facilities.

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HEALTH

The assessment team found an acute need for newborn care in the affected villages. Essential package must include minimum three home visits through AWW/ANMs. ASHAs were not seen in any of the areas visited. In Karnataka, routine immunisation was working. But, the round scheduled for the rst week of October did not take place.

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This picture shows that the labour room in the Talamari Sub-Centre, Raichur, was being used for storage. The centre was not damaged and fully functional. There was clearly room for improvement in hygiene and cleanliness. There was no shortage of human resources or drugs. There had also been no increase in OPD cases since the oods.

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HEALTH

This 104 Referral Transport cum Mobile Clinic was spotted in Kurnool, Andhra Pradesh. These clinics provide ORS, cotrimoxazol and paracetamol. The mobile clinics were usually manned by paramedics, who prescribed the medicines. In Karnataka, no mobile teams were seen. Despite the constitution of 51 Mobile Health Teams by the district administration, the assessment team did not get any report of their existence from the places visited.

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Immediate
Advocacy: Re-establish immunisation services (especially for measles) in a catch-up mode. The routine rounds need to be followed up and linked with the Vitamin A bi-annual round. Advocate for a measles, vitamin A campaign plus deworming in a campaign mode for those temporary shelters that will run for three months and longer. Assessment of cold chain. (UNICEF to provide technical support) Outreach activities for active case nding in the affected villages. Supply of zinc and ORS in the health facilities PHC/sub-centres. Promote health education and awareness on hygiene, nutrition and sanitation. Develop IEC material and awareness of the major diseases (diarrhoea, measles) to prevent outbreaks.

Surveillance: Monitoring/ reporting for early detection of disease outbreaks. Strengthen the Integrated Disease Surveillance Project (IDSP), providing technical guidance. Deworming to be linked with routine immunisation and continued in the sub-centre and primary health centre for the next three months. Strong advocacy for ASHA presence and training in the affected villages. Strengthen SNCUs in district hospital.

Long-term
Advocate for improvement of overall access to promotive, preventive and curative healthcare services. Advocate for ASHA presence and posted in the eld Training, support and supervision to handle post-natal care visits (minimum 3) plus minimal package for newborn care. Advocate for livelihood issues, which are intimately related to health and nutrition of women and children.

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HEALTH

RECOMMENDATIONS

NUTRITION
MUAC for SAM and MAM
Rapid assessment undertaken for children aged 6 to 59 months SAM 11 cm MAM 12 cm Availability of food was restricted by the fact that there were no markets (xed or mobile) near the villages and temporary shelters. In addition, the prices of all essential food commodities had increased due to two factors, namely loss of crops and decrease of purchasing power. SAM 2.16% (1 out of 46) MAM 8.6% (4 out of 46)

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Alampur Village 15 Children Screened SAM nil MAM 1 child (Female aged 1 year 11.5 cm Nidzur Village 6 Children Screened SAM nil MAM nil Nagaladinne Village 5 Children Screened SAM 1 child (Female aged 3 years 10.8 cm) MAM nil

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NUTRITION

Temporary Shelter: Talmari Village SAM 3.27% (2 out of 61) MAM 8.19% (5 out of 61)

Cooking in villages/shelters Raichur District (Karnakata)

Food supplied by Government. Food (rice and dal) cooked and distributed once at 3 p.m. People shared cooking pots and used their own chulas (stoves)

Kurnool District (AP)

Food being provided by Panchayats, communities, local NGOs and Government. Food cooked twice a day rice and potatoes with occasional dal. Cooking pots borrowed from nearby community; tinder used as fuel for cooking.

Advocate for extra food ration to be provided for all pregnant women and lactating mothers.
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Immediate
Refresher training for AWWs on the IYCF components in the 25 villages. IEC materials to be distributed to the communities. Systematic monitoring of SAM/MAM over the next 3-6 months. Systematic monitoring of the linking of Vitamin A and deworming along with routine immunisation (including measles) over the next six months. Advocate for extra food rations to be provided to all pregnant women and lactating mothers.

Short-term:
Develop nutrition education messages (with focus on MAM and SAM children) on: a) Breast feeding; b) Appropriate complementary feeding. Training of AWWs and volunteers in dealing with post-emergency nutritional challenges - follow up of MAM, growth promotion, ensuring referral and facilitating treatment.

Advocacy with the Government to make AWCs functional on priority basis. Explore if centres can temporarily be shifted to other locations like schools, as soon as school education resumes.

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NUTRITION

RECOMMENDATIONS

WATER, SANITATION & HYGIENE

At the time of the visit, 80 per cent of the water supply had not been restored and water supplied by tankers was untreated and insufcient. The stress of collecting water on a dialy basis was clearly evident as long queues formed even before the tankers arrived. In Andhra Pradesh, there were reports of ghts over water.

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Access to safe and clean water was extremely low. Many water points were submerged and possibly contaminated. To guard against disease outbreaks, the Government had distributed halozone tablets but the team found that these had not been used at all. Jerrycans used to store water were provided by the Government. There was no other system of water storage.

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WATER, SANITATION & HYGIENE

Water points were submerged and possibly contaminated.

Water collected from the tankers was dirty and turbid.

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THE FIRST RESPONSE

Wherever drains did exist, they were choked with dirt and contaminated water. The debris in the villages had not been removed and was just lying around. The sanitation drive was weak and needed proper organisation.

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WATER, SANITATION & HYGIENE

Environmental sanitation was found to be poor. A rotten, decaying smell pervaded the air and posed a public health hazard.

There was no waste disposal mechanism for households.

Debris could be seen everywhere, compounded by the rotten smell hanging in the air. It was difcult to live indoors in many places. Even where families cleaned their houses, the debris was kept outside. There was no waste disposal mechanism for people to follow.

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In the temporary shelters, no toilets had been constructed by the Government. This only encouraged the practice of open defecation. In Karnataka villages, there was less than 5 per cent of toilets per people in the village.

A child defecates in the open.

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WATER, SANITATION & HYGIENE

Open defecation was found to be common. There were few private places for women and children.

RECOMMENDATIONS
Immediate
Advocate for a strong sanitation drive with focus on hygiene promotion and access to sanitation. Advocate for access to safe and clean water to the affected communities. Develop IEC materials on safe water usage, safe sanitation practices, use of ORS, halozone, etc. Advocate for fogging to be conducted at xed intervals to control vector borne diseases. Promote usage of indigenous techniques for water ltration. Advocacy for building latrines/ sanitation facilities in the temporary shelters.

Short-term:
Regular water quality surveillance and disinfection of drinking water sources. Advocate decentralised operation and maintenance systems to reduce the down time of handpumps in the area. Awareness about hand washing and proper use of halozone tablets through distribution of IEC materials in the local language. Explore and advocate for improved access of safe drinking water and storage in difcult-to-reach places and institutions such as schools and health centres through providing 500 litre storage tanks. Setting of one WES camp at GP/ cluster level (population about 5,000) for improving service delivery i.e. mechanic with hand pumps tool kits, spare parts, bleaching powder, halozone tablets, sweepers, soaps, toilet cleaning materials, brooms, H2S vile, etc. Encourage the safe disposal of decaying organic matter and hospital waste in a pit (burial method) around the villages.

Medium and Long Term

Technical support to the Government in reactivating/reinstalling/disinfecting the water supply system as per the standards. Monitor for gaps in water treatment and support the Government in maintaining water quality. Monitoring of effective usage and maintenance of sanitation facilities in the temporary shelters existing over three months. Advocate sanitation and safe drinking water. Ensure improved access of safe drinking water and storage in difcult-to-reach places and institutions such as schools and health centres through providing 500 litre storage tanks. Assess the extent of damage to toilet (individual/school toilet) and develop appropriate designs suitable for waterlogged areas. Study the impact of inundation of saline water on the aquifer from where handpumps are getting water. Advocate for community sanitation and bathing facilities, particularly for women.

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WATER, SANITATION & HYGIENE

CHILD PROTECTION
Parents were sending their children, especially adolescent girls (above 11 years) to their relatives for shelter, food and safety. The AWW conrmed this trend in Chickamanchali village. No visible evidence of children being separated from parents.

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Immediate
Advocate for monitoring of movement/ migration of children and their families. UNICEF to facilitate information campaigns in the affected areas through existing networks in BCC, Village Planning and CP. Follow-up on missing and found children through Child Welfare Committees and the police.

Medium and Long Term

Strengthen childrens resilience by using the emergency as an opportunity to expand the space for child participation in communities and schools through cultural expression (theatre, art, and folk media) and facilitate social integration and resilience. UNICEF to support capacity-building. Drawing the Psychosocial Distress by children

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CHILD PROTECTION

RECOMMENDATIONS

EDUCATION
There was no structural damage in the schools assessed. Schools in the assessed area were mostly ooded. They needed major cleaning, sanitisation, and whitewashing in order to be functional. In some cases, rebuilding was also required. School oors were covered in slush and mud as the waters receded, as shown in the picture on the opposite page.

All children said that they had lost their textbooks, stationery items, uniforms, school bags, etc. Mid-day meal stocks were destroyed in the schools.

School oors were covered in slush and mud as the waters receded.

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THE FIRST RESPONSE

Immediate
Advocate for and monitor immediate cleaning of schools and getting children back to school. Mobilise community to ensure children are attending regularly. Provide basic back to school package for individual children - especially in the worst-affected villages that are to be relocated (UNICEF package to supplement government initiative and will focus on stationery items). Monitor that children in temporary shelters (located usually within 1 km of the village) are attending school in the village. If not, then arrange alternative learning space/material in the temporary shelters.

Medium and Long Term

Strengthen childrens ability to deal with emergencies through the child panchayats/forum. UNICEF to support capacity-building. Advocate at the state level for inclusion of disaster preparedness in the school curriculum.

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RECOMMENDATIONS

PROGRAMME COMMUNICATION
No awareness campaigns/IEC were seen in the villages/temporary shelters in Karnataka. In Andhra Pradesh, one meeting was organised by the neighbouring villages using girls clubs, and messages on health, hygiene and sanitation were promoted.

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RECOMMENDATIONS
Advocate massive community mobilisation drive through strong BCC/ IEC component using the existing IEC and communication materials, such as leaets, booklets, training ip books, miking, and lms on personal hygiene and sanitation. Training of Panchayats by UNICEF supported NGOs in inter-personal communication skills, community dialogues around correct practices womens meetings, village inuencers meetings, etc. Village social mobilisation activities planning, implementation and monitoring should be facilitated by the UNICEF-supported NGO partners. UNICEF to facilitate crash training for the block-level functionaries of NGO partners.

Panchayats may be trained by UNICEFsupported NGOs in inter-personal communication skills.

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DROUGHT
Bundelkhand Region April 2008

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THE FIRST RESPONSE

Bundelkhand region is a semi-arid plateau that encompasses 12 districts of northern Madhya Pradesh and 5 districts of southern Uttar Pradesh. The drought primarily affected 7 districts of Uttar Pradesh and 21 districts of Madhya Pradesh. In the Bundelkhand region alone, approximately 21 million people were affected, out of which some 8.4 million were children under 14 years of age.

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Severe drought has been sweeping the Bundelkhand region since 2003. Data shows that there has been a continuous decline in the annual rainfall due to which there is a decline in the total irrigated area. The total irrigated area was above 50 per cent in 2003 and slipped to less than half, i.e., 24 per cent in 2007. This year we are dreading summer, drinking water is already scarce, and it is only February. I do not dare think about how it will be in May.
A boy in Madhya Pradesh

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DROUGHT

155

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THE FIRST RESPONSE

The dismal state of agriculture has also affected the condition of livestock. Most families have either lost their cattle to drought or have set it free. As the villagers struggle, the survival of their cattle is the last thing on their mind.

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Most agriculture is single crop, rainfed with supplementary water from private open irrigation wells. A large number of farmers are highly dependent on the monsoon rains to recharge these wells. Recurrent crop failure in the drought-stricken areas is forcing villagers to migrate to nearby states in large numbers.
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DROUGHT

159

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THE FIRST RESPONSE

Water sources are varied and often seasonal. In recent years, water quality has also emerged as a principal environmental concern in the region. Bundelkhand region as whole has been facing severe water quality problems in terms of the presence of uoride, nitrate, iron and bacteria in the water.

Taking water samples for quality test.

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HEALTH
There is a complete absence of private sector healthcare providers in the assessed districts. Human resources: In both UP and MP, there was shortage of staff like doctors, staff nurses, ANMs and other supporting para-medical workers. Government health plan for drought: Distribution of bleaching powder and chlorine tablets had been completed. Special medicine kits for school children had been procured in UP that will be distributed through schools. Essential drugs for any poossible emergency had also been obtained. Disease surveillance was not established in any of the districts/ blocks visited. There was no emergency preparedness plan by the district administration.

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Disease surveillance was not being undertaken in any of the districts or blocks visited.

In Uttar Pradesh, few health facilities at district and block level have been established in both Mahoba and Hamirpur. District hospital, CHCs and PHCs are newly built with better space, bed strength and infrastructure facilities. Special wards and beds had been earmarked for drought relief. All the observed health facilities had adequate bed strength to meet the needs of the population.

In Madhya Pradesh, health facilities were not found to meet adequate standards. All the sanctioned bed strength had not been physically established. The CHC/PHCs had less than the required space to provide routine healthcare services. Health facilities were overburdened by patients. In both states, district hospitals and most CHCs had working operation theatres,

radiology, laboratory facilities. Many CHCs were yet to operationalise newborn care units. Utilisation of these specialised services was dependent on availability of staff. Specialised services, costly equipment, supplies and infrastructure were underutilised. The health system in the surveyed areas is unlikely to provide quality healthcare services to the resident population.

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163

HEALTH

Immunisation
Routine immunisation services are not optimally functional. Immunisation services in all the visited districts were irregular, that led to lower coverage. Poor measles immunisation coverage. Alternative vaccine delivery is not implemented in UP due to non-release of funds to district. ANMs were found collecting vaccines themselves. Cold chain was functioning well. However, shortage of electricity affected the cold chain, putting in risk the efcacy of vaccines. There was enough vaccine stock to run the immunisation programme.

Looking for Bitot spots

Many children had not received immunisation cards even though they were being immunised.
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All districts showed unsatisfactory immunisation coverage, indicating the need for an urgent attention to strengthen the routine immunisation programme. Full immunisation coverage was found to be between 13 to 19 per cent only, which is well below the national target of 85 per cent. Many children had not received immunisation cards even though they were receiving immunisation. BCG coverage: Coverage ranged from 52 per cent (Chhatarpur) to 69 per cent (Tikamgarh), signifying a moderate initial reach of the immunisation programme. The children left out were in the range of 31-48 per cent, which is somewhat high. DPT1 coverage: Coverage of rst dose of DPT ranged between 48 per cent (Chhatarpur) and 65 per cent (Mahoba). DPT3 coverage: Coverage of third dose of DPT dropped further to a low of 11 per cent (Hamirpur) rising to 38 per cent (Tikamgarh district). Measles coverage: Measles coverage was signicantly low and ranged from 13 per cent to 17 per cent. Low coverage signies presence of high percentage of population susceptible to measles infection. Vitamin A: Only 23-45 per cent children had received a dose of vitamin A in the last six-month period. Dropout rates in all the districts were considerably high. DPT1-Measles dropout rate ranged between 64 per cent (Chhatarpur) and 80 per cent (Mahoba). Services of ASHAs and ANMs were not fully utilised to track left-out and droppedout children.The Government of India has targeted reduction in dropout rates to less than 10 per cent.

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Survey of 111 children in four districts of Uttar Pradesh and Madhya Pradesh

The success of Janani Suraksha Yojana has led to considerable increase in institutional delivery rates that increased by 4-5 times over the previous year. This result while welcomed, put pressure on health infrastructure and quality of service provision. The woman in the picture is lying on the oor with her newborn.

The situation of labour and delivery rooms was far from satisfactory in terms of hygiene, sanitation and cleanliness.

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Emergency obstetric care is largely insufcient across the board. There is an acute shortage of staff, especially nurses and paramedics. Many of the operation theatres, newborn care units and x-ray machines were not used due to insufcient workforce and manpower vacancies.

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The situation of labour and delivery rooms was far from satisfactory in terms of hygiene, sterilisation and cleanliness. A dog was seen roaming around the labour room in one health facility.

RECOMMENDATIONS
Continue sustained improvement of routine healthcare services (immunisation, maternal and child services, newborn care). Build an optimal utilisation of infrastructure in AWW Centres, PHCs, CHCs and District Hospitals.

Short Term
Strengthen the disease surveillance system in drought-affected districts. Provide support to the preparation of a comprehensive health relief plan for drought relief. Ensure adequate supply and stocking of ORS, zinc, IV uids and antibiotics. Ensure availability of chlorine tablets for disinfection. Support IEC activities for correct use

of chorine tablets and bleaching powder to treat drinking water. Improve immunisation coverage and increased monitoring of measles immunisation in the affected districts. Prioritise and support quality ASHA and health workers training on immunisation and neonatal care. Advocacy with the State Government for contingency policy for increasing outreach of health services in droughtaffected districts.

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Mid Term
Support completion of ANM training on immunisation. To benet from technical assistance for routine immunisation system, strengthening the Mapping of left out and missed areas. Mapping of public and private healthcare facilities for disaster preparedness.

Long Term
Capacity building of selected health ofcials on disaster management and healthcare during emergencies. Development of disaster management plan.

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HEALTH

Support provision of healthcare in relief camps set up for drought-affected population, if any in future. Operationalisation of VHND for integrated care.

NUTRITION
Storage of Ber (kind of fruit) and similar strategies need to be inculcated to prepare for the future and ensure food for survival. There are important knowledge gaps among frontline workers and district ofcials. Quality training of functionaries therefore represents a mandatory strategic priority while the number of frontline workers needs to increase. At present, the system is overloaded and unable to respond adequately.

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The proportion of children with acute moderate-to-severe acute malnutrition is large enough to deserve immediate attention, particularly given the fact that there is a total absence of policy and programme response for children with severe acute malnutrition. This is more worrisome given the expected increase of infection and morbidity levels in the coming months when diarrhoea and measles incidence will increase. In the absence of a systematic and reliable system to monitor childrens nutritional status particularly in UP and, more importantly, respond to their nutrition needs through protection, promotion, support, and treatment interventions can easily lead to a nutrition emergency on a large scale that will be neither detected nor responded to in time.

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A total of 430 children in the 12-59 month age group were surveyed in 15 villages of UP and MP. The proportion of children with severe acute malnutrition ranged from 0-3 per cent while that of children with moderate acute malnutrition ranged between 10 and 17 per cent. The proportion of children with moderate acute malnutrition was found to be higher in UP districts at 15-17 per cent than in MP (10-13 per cent). The ICDS service delivery was more efcient in MP. Community participation was also better in MP leading to increased attendance of children. AWC provide hot meals to children and bi-annual growth monitoring is done to identify malnourished children. Additional medical care and therapy was also given to malnourished children through the Muskan Programme.

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AWCs were functioning at a suboptimal level. Less demand of ICDS services. Infrequent growth monitoring. Food scarcity is evident. The population do not get the food they want. Insufcient crop is compounded by vegetable scarcity. Market prices have increased 15 per cent in the last three months.

Families reported that they manage to purchase enough cereals everyday to meet their needs but have fewer meals per day because low-cost foods are not available. In addition, food habits are gradually changing, with vegetables and other nutrition-rich foods slowly disappearing from daily household menus. Consumption of milk and dairy products has also fallen.

Families reported that they manage to purchase enough cereals everyday.

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RECOMMENDATIONS
There is need to strengthen effective nutrition services targeting the most vulnerable (children under three years old, children from socially excluded groups and those with acute malnutrition) through ICDS programmes that stress counselling and support on improved feeding practices and provide age-appropriate foods for children, therapeutic feeding programmes that provide timely and quality care for children with severe acute malnutrition, and mid-day meal programmes.

Immediate
Ensure that all children below three years in the Anganwadi catchment area are weighed on a monthly basis. Enumeration and weighing drives will need to be undertaken with active involvement of ICDS supervisors. In consultation with the district, plans for the same will be need to developed and implemented.

Training/refresher training of the ICDS functionaries in the drought affected area on growth monitoring and promotion and infant and young child feeding, stressing counselling on and support improved child feeding, care and hygiene practices. All children with grade III or IV malnutrition to be referred to a facilitybased therapeutic feeding programme.

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This will require treatment protocols for management of severe acute malnutrition, diarrhoea and ARI. Advocate with the Health Department and District Administration, and capacity building for setting up facilitybased nutrition rehabilitation centres at the district level. UNICEF can provide technical support for setting up and monitoring the NRCs. Currently pregnant women, nursing mothers and children below three years (6-35 months) are provided their share of dry rations for the week every Saturday. This opportunity of contact with the caregivers should be utilised to counsel the family on breastfeeding, immunisation, complementary feeding, and feeding of the sick child. Reactivate/regularise the visit of the ANMs to the Anganwadi centre at least on one Saturday in a month to provide health services and advice to pregnant women, nursing mothers and young children. Ensure that vitamin A supplementation is an integral part of measles catch-up immunisation. In addition, also explore the possibility of screening children for malnutrition in the catch-up

immunisation rounds with active participation of ICDS functionaries. Ensure bi-annual vitamin A supplementation (children 6-59 months old) and deworming (children 12-59 months old), and also to all children (universal coverage). Ensure timely provision of food supplements to pregnant women and

lactating mothers in food insecure areas/households.

Medium Term
The demand for ICDS services from the community is poor due to the poor quality of the services provided by the centre. The AWC is perceived as a centre for education of young

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Public distribution system

Provide support to the Government in monitoring the equitable food supply to all sections of people. Advocate the Government for distribution of micronutrient fortied foods to drought affected populations. Provision of food in relief camps in case of large-scale displacement.

children. It is therefore important that AWCs be fully functional and that communities be informed about the full complement of ICDS services. The mothers committee constituted at the Anganwadi-level need to be strengthened and oriented on basics messages related to feeding and care

of infants, young children, pregnant women and lactating mothers Advocate with the Government to set up a nutrition surveillance system in the drought affected districts Advocate with the Government for provision of weighing scales and growth chart registers for the AWCs

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WATER, SANITATION & HYGIENE

There is acute scarcity of water for irrigation. People are also fetching drinking water from open wells. However, only 2-4 wells had water with very less yield. Most likely, these wells will go dry in a few weeks

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To overcome the surface water decit, ground water has been intensively tapped for irrigation and farming by boring more tube wells and going still deeper. Consequently, the ground water table has gone down and natural process of recharging the ground water has not kept pace. In Chatarpur and Tikamgarh, the impact of the drought is considerable especially in terms of drinking water availability, food and employment. There were fewer working handpumps in villages (0.5 HPs per 250 persons), while the Government of India norm is 1 handpump per 250 persons. Peasants and villagers have to travel long distances to fetch water. Even under the

NREGA scheme, the employment opportunities are insufcient for communities to cope with the drought. Reboring of wells should be explored as one of the works to be taken up under NREGA. Though the Government has a plan to supply drinking water through tankers, in the coming months there could be a severe drinking water scarcity and inequitable distribution among different community segments. A comprehensive response plan is needed to support the whole region.

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WATER, SANITATION & HYGIENE

In Hamirpur and Mahoba districts, the impact of drought was milder due to a rapid Government response in terms of improving drinking water availability, providing additional employment opportunities to the population under NREGA and increasing availability of and access to food. The drinking water scarcity was tackled by the installation of 843 new handpumps and repairing/reboring of 550 old handpumps. In the affected districts, people were mostly concerned about irrigation. However, a comprehensive response plan is still required to provide water, employment, health and nutrition services to the affected districts on a medium and long-term basis.

In Madhya Pradesh, every Gram Panchayat has been provided with a water tanker. The PHED has identied and mapped the most vulnerable villages. However, ground level planning for tankers timelines, frequency of transport, positioning, sources for fetching water, quality control are not in place. In the Uttar Pradesh disitrcts, the district Water tankers were the norm for villages where the water table had gone down drastically and deepening or reboring of handpumps was difcult. Most of the schools, Anganwadi centres and health facilities did not have functional water sources due to depletion in ground water level and were dependent on tanker water or distant sources. One CHC used water from long distance by spending Rs. 50/day.

administration has used remote sensing and previous years data to identify villages where the water table has gone down drastically and lowering or reboring will not help at all. In these villages, the government has drafted a contingency plan to supply water through tankers. The administration is condent of mobilising a sufcient number of water tankers for this purpose.

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The administration has used remote sensing and previous years data to identify villages where the water table has gone down drastically.
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WATER, SANITATION & HYGIENE

Generally, the functional sources (handpumps or wells) are located on the periphery of the village. Household members have to walk on an average 0.5 to 1 km and spend about 30 minutes to more than 1 hour to collect approximately 40-50 litres of water for household use. These working wells and hand pumps are the only source of drinking water for villagers, including their cattle. There is higher risk of waterborne diseases. Only 10 to15 per cent handpumps are functional. Up to 20 per cent handpumps are partially operational (intermittent and less yield). People were seen fetching water from handpumps as well as open wells.

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Water quality: 25 to 30 per cent of the H2S samples taken from working water sources in Uttar Pradesh turned black, signifying bacteriological contamination. The gure for Madhya Pradesh was 33 per cent.

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WATER, SANITATION & HYGIENE

The environment surrounding functional water sources (handpumps and wells) was not hygienic. At some places, platforms and drains were missing and the construction was not appropriate.

In Madhya Pradesh, the team found limited sanitation facilities in the villages. The district authorities stated that some non-governmental organisations had been engaged for promotion of sanitation but very slow progress was achieved due to the limited availability of water. The

environment surrounding handpumps in Uttar Pradesh was poor and needed dramatic improvement. In some villages, though sanitation coverage was quite good. About 90 per cent APL and 50 BPL families did use toilets. Decrease in use of toilets due to drought was not detected.

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DROUGHT

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WATER, SANITATION & HYGIENE

Empty job cards shown in MP signify a wasted opportunity while in UP some work was underway under the National Rural Employment Guarantee Act (NREGA). It is important that works undertaken under NREGA may be prioritised and attention paid to renovation of old ponds, digging of new wells and re-channelisation of water.

RECOMMENDATIONS
There is need to improve basic drinking water services in the villages most seriously affected by the drought; strengthen the district capacity in planning and implementation of activities to improve sanitation and hygiene. Importantly, one has to shift from relief work to comprehensive planning for water management on longterm basis so that recurrent drought situations can be handled.

Short term
Deepen all handpumps by another 30 feet. Re-bore defunct tubewells (before end of March) and coverage should be well spread in the village. Hydro-Fracturing of dry wells. Institute a cluster level O&M system with stock-piling of spare parts, including pipes and cylinders.
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Organise training of mechanics, if required. Promotion of use of safe drinking water, including use of chlorine tablet/ chlorination.

Mid Term
Reinforce the Rajiv Gandhi National Rural Drinking Water Quality Monitoring and Surveillance

Long-Term
Switch over from present irrigation methods/crops to the most suitable crops and methods of irrigation. Promotion of wise water management, including use of gray water for irrigation/recharging- UNICEF can pilot it in schools/PHC, etc. Watershed management, checking the run-off and recharging the aquifer. Construction of small check dams in catchment areas. Regulation to prevent over-exploitation of underground water for irrigation purposes.
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WATER, SANITATION & HYGIENE

Programme. This will include training of trainers, assessment and strengthening of laboratories. Develop guidelines for renovation of ponds and wells. Dovetailing NREGA for renovating well and ponds. Upgrade environment surrounding the drinking water sources. Hydro geological mapping of the area (through remote sensing). Identifying most suitable crops and options of crops which require less water. Promotion of rainwater harvesting in schools and at household level.

188

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CORE COMMITMENTS FOR CHILDREN IN HUMANITARIAN ACTION

Framework, principles and accountability Programme commitments Operational commitments

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I. FRAMEWORK, PRINCIPLES AND ACCOUNTABILITY

1.1 Goal
The Core Commitments for Children (CCCs) in Humanitarian Action are a global framework for humanitarian action for children undertaken by UNICEF and its partners. This framework is guided by international human rights law, in particular the Convention on the Rights of the Child1 and, in the case of complex emergencies, also by international humanitarian law. On an operational level, the CCCs are based on global standards and norms for humanitarian action (see Section 1.1). The CCCs promote predictable, effective and timely collective humanitarian action. They are realised through a partnership between governments, humanitarian organisations (including UNICEF) and others, mobilising both domestic and international resources. The CCCs are driven by the need to fulll the rights of children affected by humanitarian crisis, and they are therefore relevant in all countries. The CCCs are also applicable to both acute sudden-onset and protracted humanitarian situations. UNICEF works with partners in pursuing a principled approach and seeks to build an alliance with partners around the CCCs. The organisation contributes to the achievement of the CCCs through

resource mobilisation, direct support to partners and advocacy. The fullment of the CCCs, however, depends on many factors, including the contributions of other partners and the availability of resources. The CCC sector-specic programme commitments form part of a collective programmatic response for children affected by humanitarian crisis and are designed to support wider interagency cluster coordination.

1.2 Partnerships
The CCCs are realised through close collaboration among partners, host governments, civil society organisations, non-governmental

1 Convention on the Rights of the Child, article 45: In order to foster the effective implementation of the Convention and to encourage international cooperation in the field covered by the Convention: (a) The specialized agencies, the United Nations Childrens Fund, and other United Nations organs shall be entitled to be represented at the consideration of the implementation of such provisions of the present Convention as fall within the scope of their mandate.

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organisations (NGOs both national and international), UN agencies and donors. This is consistent with UNICEF commitments under interagency humanitarian reform, including the Principles of Partnership.

1.3 Scope
A humanitarian situation is dened as any circumstance where humanitarian needs are sufciently large and complex to require signicant external assistance and resources, and where a multisectoral response is needed, with the engagement of a wide range of international humanitarian actors.2 This may include smaller-scale emergencies; in countries with limited capacities, the threshold will be lower than in countries with strong capacities. An emergency is a situation that threatens the lives and well-being of large numbers of a population and requires extraordinary action to ensure their survival, care and protection.3

The CCCs
Constitute a global framework, developed by UNICEF in collaboration with its partners, for protecting the rights of children affected by humanitarian crisis. Apply to all children affected by humanitarian crisis, regardless of the state of economic and social development in which they nd themselves or the availability of UNICEF resources. Cover programme and operational commitments and include interventions for nutrition, health, water and sanitation, HIV and AIDS, education and child protection.

Reect actions taken throughout the preparedness and response phases, including actions for early recovery, with emphasis on results and benchmarks (see Figure 1). The CCCs include the inter-agency responsibilities of UNICEF and its humanitarian partners as well as coordination with authorities, and they express an explicit commitment to capacity development in humanitarian action. Are grounded in human rights and humanitarian principles, and they are a cornerstone of UNICEFs humanitarian action. Are activated by a rapid decline in the relative situation and wellbeing of large numbers of children and women, which calls for extraordinary action. Include explicit strategies to reduce disaster risk and develop local capacity at all stages of humanitarian action, including preparedness. Timeliness and effectiveness are priorities in responding to meet the commitments outlined in the CCCs. Focus on action in the rst eight critical weeks of humanitarian response and provide guidance for action beyond that, moving towards dened benchmarks. Include both programme and operational commitments, corresponding to results-based sectoral programmes and operational areas considered necessary for an effective response. Provide internal policy guidance for UNICEF, with a recognition that strengthening partnership and collaboration is key to the success of its humanitarian action. Within the context of partnership and depending on access, security

2 Inter-Agency Standing Committee, Guidance Note on Using the Cluster Approach to Strengthen Humanitarian Response, IASC, Geneva, 24 November 2006. 3 United Nations Childrens Fund, Programme Policy and Procedure Manual: Programme Operations, UNICEF, New York, 22 January 2009.

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Figure 2: Time frame for sudden emergencies

A time frame for response establishes timelines for suddenonset emergencies: The rst 72 hours involve actions required for management and operational processes. The rst 8 weeks involve actions relevant to critical response and early recovery. Early recovery actions in the CCCs are actions and approaches that should be applied immediately and in parallel with immediate response.

and availability of funding, UNICEF, with its partners, commits to ensuring the provision of services. UNICEFs role and that of its partners will vary according to local conditions and respective capabilities.

The impact of political and security-related developments on girls, boys, women and men, and their implications for the operations and response of UNICEF and its partners, including humanitarian access and advocacy. Review of ongoing work by humanitarian agencies and other stakeholders as well as the strategy and operations of UN missions, where deployed. Sex-and age-disaggregated data analysis of all grave violations against children including those outlined in Security Council resolutions on child recruitment, attacks on schools or hospitals, and sexual violence against children and women (see SCR 1882, 1820, and 1888, respectively) and their implications for UNICEF reporting and response. Assessing the impact of humanitarian crisis on specic programme sectors to prioritize and coordinate response. Identifying opportunities to support recovery for girls, boys, women and men within programme sectors.

1.4 Strengthening UNICEFs programming framework

The CCCs are an integral component of UNICEFs country programmes because they: Recognise the link between humanitarian action and development, and provide an explicit focus on disaster risk reduction. Underscore the critical role of preparedness for rapid response. Provide a platform for early recovery. Establish a framework for evaluation and learning.

1.6 Humanitarian principles

UNICEF is committed to applying humanitarian principles in its humanitarian action. Such principles include: Humanity: upholding the principle that all girls, boys, women and men of every age shall be treated humanely in all circumstances by saving lives and alleviating suffering, while ensuring respect for the individual. Impartiality: ensuring that assistance is delivered to all those who are suffering, based only on their needs and rights, equally and without any form of discrimination. Neutrality: a commitment not to take sides in hostilities and

1.5 Contextual analysis

The application of the CCCs is informed by a contextual analysis that includes:

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to refrain from engaging in controversies of a political, racial, religious or ideological nature. Humanitarian principles are reinforced by raising awareness, building trust and advocating for childrens rights in humanitarian situations, together with state authorities, non-state entities and communities.

1.7 Human rights-based approach to programming

UNICEF is committed in all humanitarian action to further the realisation of human rights through the framework of the human rights-based approach to programming. This approach identies rights holders and their entitlements, as well as corresponding duty bearers and their obligations. The approach aims to strengthen the capacities of rights holders to make their claims and of duty bearers to meet their obligations. It focuses on the realisation of the rights of excluded and marginalised populations, and those whose rights are at risk of being violated. The CCCs put children and women at the centre of humanitarian action, as active participants rather than recipients of assistance. The application of a human rights-based approach to programming must be contextualised for humanitarian situations and recognize, in particular, the additional challenges arising in complex humanitarian situations. It must also take into account the role of humanitarian agencies as duty bearers in complex emergencies, as prescribed by international humanitarian law.

UNICEF, with the support of its partners, is committed to reinforcing a human rights-based approach to programming in humanitarian actions by: Addressing inequalities and disparities in analysis, programme design, implementation and monitoring, recognising that inequalities may cause or exacerbate vulnerabilities in humanitarian crises. Promoting the participation of children, adolescents, women and affected populations, including in the analysis, design and monitoring of humanitarian programmes. Strengthening the capacities of state authorities and nongovernmental and community organisations as an essential strategy for joint and effective humanitarian action. Advocating for the rights and voices of children and women as an integral component of humanitarian action.

1.8 Gender equality in humanitarian action

A human rights-based approach to programming and gender equality programming are complementary and mutually reinforcing approaches. The term gender4 equality refers to the equal enjoyment by girls, boys, women and men of rights, socially valued goods, opportunities, resources and rewards. Equality does not mean that girls, boys, women and men are the same, but that their enjoyment of rights, opportunities and life chances is not governed or limited by whether they were born female or male.

4 The term gender refers to the social attributes and opportunities associated with being male or female and to the relationships among girls, boys, women and men. These attributes are context- and time-specific and changeable. In most societies, there are differences and inequalities between women and men in responsibilities assigned, activities undertaken, access to and control over resources, as well as decision-making opportunities (Office of the Special Adviser on Gender Issues and Advancement of Women, Important Concepts Underlying Gender Mainstreaming, Factsheet 2, OSAGI, New York, August 2001).

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Humanitarian crises can exacerbate pre-existing gender inequalities and may lead to increased risks, exclusion and discrimination. They can, however, also provide opportunities for positive change, allowing for a shift in traditional roles, attitudes, beliefs and exclusion practices. UNICEF is committed to ensuring that gender equality is integrated consistently in its disaster prevention, humanitarian response and recovery programmes. Promoting gender equality in humanitarian action is most effectively achieved by ensuring that the assistance and protection provided are planned and implemented to benet girls, boys, women and men, in line with an analysis of their rights, needs and capacities. This fosters a more accurate understanding of the situation, facilitates the design of more appropriate responses, highlights opportunities and resources within the affected community, and provides a link between humanitarian assistance and long-term development.

1.10 Global norms and standards

In its humanitarian efforts, UNICEF is accountable to a body of global norms and standards, both from intergovernmental forums and humanitarian partnerships. These norms and standards include: International human rights law and human rights principles, including the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination against Women. International humanitarian law, including the Geneva Conventions, which contributes to dening roles and responsibilities of humanitarian agencies in armed conict. Humanitarian principles, derived from international humanitarian law and described in General Assembly resolutions, and which are meant to be applied in all humanitarian action. General Assembly resolutions, in particular Resolution 46/182, which creates the Inter-Agency Standing Committee (IASC) and tasks the United Nations, inter alia, with supporting and strengthening state capacity for emergency response in order to care for the victims of natural disasters and other emergencies. Relevant Security Council resolutions, including those pertaining to the protection of children affected by armed conict. Existing and emerging global humanitarian standards, including the Humanitarian Charter and Minimum Standards in Disaster Response (Sphere Standards) and the Inter-Agency Network for Education in Emergencies (INEE) Minimum Standards, which set minimum standards in core areas of humanitarian assistance in order to improve the quality of assistance provided to people affected by disasters and to enhance the accountability of the humanitarian system in disaster response.

1.9 Do No Harm principle

UNICEF is committed to do the Do No Harm principle. This implies that humanitarian action must: Avoid exacerbating disparities and should avoid discrimination between affected populations on the basis of the causes of crisis. Eschew creating or exacerbating environmental degradation. Avoid creating or exacerbating conict and insecurity for affected populations. Take into account the special needs of the most vulnerable groups of children and women including internally displaced persons, unaccompanied minors and the disabled and develop relevant, targeted programme interventions.

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1.11 Monitoring, analysis and assessment

UNICEF is committed to supporting humanitarian action through systematic monitoring, analysis and assessment of performance against benchmarks in concert with its partners. This entails: Monitoring and analysing the situation of children, adolescents and women on an ongoing basis, directly and with partners, to ensure joint rapid assessments and timely humanitarian response. Supporting humanitarian action based on rapid assessments conducted with partners and affected populations, including children, adolescents and women. These assessments, conducted through joint inter-agency mechanisms or independently, are the rst critical step in dening humanitarian response. Measuring progress to identify and address results for children and women against benchmarks gaps and better manage and the resulting humanitarian response. The benchmarks adopted in the CCCs represent globally accepted performance levels for humanitarian response, drawn from inter-agency standards, including the Sphere Standards and INEE Minimum Standards. UNICEF and its partners will dene the respective contributions towards reaching benchmarks as appropriate to each country context and within the contexts of the humanitarian country team (HCT) and cluster coordination efforts. Evaluation to provide deeper analysis and contextualisation of performance, taking into account issues of access, security and availability of funding. Guiding its performance in relation to the CCCs by wider organisational management accountability and oversight functions, in accordance with UNICEFs accountability framework. This entails commitment to both preparedness and response.

Mindful of different approaches by partners, UNICEFs regular audit principles and practices will be fully applied in humanitarian action supported by the organization. UNICEF will, wherever possible, carry out audits in the early stages of humanitarian operations so that ongoing programme adjustments can be made.

1.12 Inter-agency humanitarian reform

Coordination and collaboration are critical to successful humanitarian action. UNICEF is fully committed to interagency humanitarian reform and supports this through: Provision of leadership and participation in assigned clusters and sectors. Partnerships that commit UNICEF to collaborative and principled work in a manner that is consistent with internationally accepted norms and that reinforces the practical application of the Principles of Partnership. Funding to partners that is timely and exible. Participation in and contribution to effective strategic humanitarian leadership.

1.13 Integrated programme approach

An integrated programme approach is used to ensure a close linkage between the different sectoral commitments as well as to strengthen the interconnections between the different phases of humanitarian action. Integration is achieved by: Using disaster risk reduction to minimize vulnerabilities and reduce disaster risks for children and women in all programming. This is achieved by investing in early warning and emergency preparedness and strengthening resilience to disasters.

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Ensuring a critical role for preparedness that will lead to a rapid, effective and timely humanitarian response. Managing results and standards to ensure that the sum of all interventions is sufcient to achieve the expected results. This is driven by strategic management decisions based on and informed by up-to-date data, assessments, benchmarks, targets and performance monitoring. Commencing early recovery in parallel with humanitarian response, in order to sustain the results of life-saving interventions, support self-initiated recovery actions by affected populations, take advantage of early entry points for recovery, and reduce vulnerability to future crisis risk. UNICEF will actively engage in early recovery and post-crisis inter-agency mechanisms, including needs assessments, recovery strategies, resource mobilisation, programme delivery and integrated mission-planning processes at all levels, when deployed.

Should be based on the Convention on the Rights of the Child, the Convention on the Elimination of All Forms of Discrimination Against Women and other international legal instruments, peace agreements, and other commitments made by governments and non-governmental entities. Yields the best results when undertaken on a collective basis and in partnership with others. Leads to specic actions targeted to attract greater political, human and nancial support; facilitates better humanitarian access; promotes adherence to international laws and standards; and leads to accountability for perpetrators of child rights violations. In a humanitarian situation, the absence of advocacy may have a direct impact on the ability of UNICEF and its partners to deliver services. UNICEF, in collaboration with its partners, will take due account of the possible adverse effects of engaging in advocacy strategies on staff security, country programmes and vulnerable populations.

1.14 Advocacy
Advocacy is understood to constitute deliberate efforts, based on demonstrated evidence, aimed at persuading decision makers to adopt policies and take actions to promote and protect the rights of children and women in humanitarian situations. It aims to communicate the legitimacy and primacy of their perspectives and helps to address critical humanitarian programming or policy gaps. Advocacy for children and women: Constitutes an integral part of humanitarian action. Should be context-specic and, when possible, evidencebased, and should target the full range of stakeholders, including governments, policymakers, international organisations and nongovernmental entities.

1.15 Communication for development

Communication for development in emergencies seeks to share relevant, action-oriented information so that when disaster strikes, people in affected communities know what actions to take to maintain and protect the health and wellbeing of all their members, including those with disabilities, the elderly and other especially vulnerable groups. It is a consultative process among programme and communication specialists, local authorities, change agents and communities. It is misguided to presume that communities affected by humanitarian situations are too shocked and helpless to take

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on responsibilities. In fact, many people, including children, are able to return to normalcy more quickly when they participate in helping others and themselves during and after an emergency. Communication for development can help to: Support programme sectors in consulting adults, children and young people in affected groups from the onset of a crisis. This has been shown to be a key factor in reducing deaths and promoting psychological healing, cohesion and social mobilisation. Forge alliances and bring stakeholders together. Establish a central health education and communication coordination centre. Focus on establishing or re-establishing positive individual and social practices. Conduct a rapid assessment of communication channels and resources. Participate in sectoral assessments that help to identify highrisk practices that have implications for behaviour change communication, as well as opportunities for developing community-based response mechanisms.

1.16 Risk management and assessment

A consistent approach to identifying, assessing and managing risk is required in all UNICEF partnerships and programming. Strengthening risk management is particularly important in humanitarian action due to increased security risks and disaster risks as well as a more complex operating environment. UNICEFs risk management principles5 include: Accepting risk when benets outweigh costs, and anticipating and managing risk by contingency planning and mitigation of identied risks. Making decisions promptly, recognizing that afrmative management of risks is critical to success. The best strategy may involve a combination of different responses to risks. Taking calculated risks and pursuing innovations that are not contradicted by control measures or compliance requirements, and encouraging innovative actions while employing sound management practices.

5 United Nations Childrens Fund, UNICEF Risk Management Policy, UNICEF, New York, May 2009.

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II. PROGRAMME COMMITMENTS

Programme commitments of the CCCs in humanitarian action are premised on corresponding benchmarks derived from global standards in the respective programme areas. They are designed to allow UNICEF and its partners to exibly contribute to reaching the benchmarks collectively, depending on their capacities. The benchmarks in the CCCs are the globally accepted performance levels for humanitarian response, drawn from inter-agency standards, including INEE Minimum Standards and the Sphere Standards, and the outcomes of discussions in inter-agency and cluster forums (particularly in the case of the child protection benchmarks). The use of globally accepted benchmarks aligns the CCCs with humanitarian reform. UNICEF contributes to the programme commitments through the programme actions. UNICEF has identied key preparedness, response and early recovery actions to contribute to each sectoral commitment, based on available evidence and best practices, recognising that partners will employ diverse strategies to work towards global benchmarks for children in humanitarian action. The sector-specific programme commitments cover nutrition; health; water, sanitation and hygiene (WASH); HIV and AIDS; education and child protection. These actions are supported by rapid assessment, monitoring and evaluation; operational commitments; supply; communications for development; and security (see Figure 3).

2.1 Performance monitoring

UNICEF utilises its own performance monitoring system for measuring progress against CCCs benchmarks. Partners may employ different tools for their own performance monitoring. Monitoring progress is an element of the broader UNICEF performance management system (see Figure 4). The activity

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provides information on progress towards achievement of the CCC benchmarks, highlighting gaps that need to be covered. Performance monitoring is critical in identifying where the CCCs are not being met and in mobilising resources to address these gaps. Monitoring provides management with information on the quality, quantity and timeliness of progress towards the achievement of results for children and women under the CCCs. CCC performance monitoring has corresponding indicators for each benchmark. Where monitoring of standard indicators is not feasible, proxy indicators may be used. Collecting data requires collaboration with partners. Data are be reported through three systems: Country Ofce (CO) Annual Reports, DevInfo or other national or HCT-supported platforms for reporting on programme achievements. UNICEFs resource planning and performance management system, the Virtual Intergrated System of Information (VISION). UNICEFs early warning/early action (EW/EA) system for reporting on the status of preparedness. Country representatives are responsible for collecting, analysing, monitoring and reporting on progress against agreed-upon CCC benchmarks. Where necessary, they must also develop countryspecic proxy indicators. CCC performance monitoring must inform decision-making in rapidly changing situations. Monitoring

and reporting against CCC benchmarks must be sufciently frequent, should be determined on a case-by-case basis by the CO and Regional Ofce (RO), and should include gender-sensitive data collection.

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2.3 NUTRITION

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Technical justication/evidence: The CCCs for nutrition aim to address major causes of nutritional deterioration and death by protecting the nutritional status of children and women, including their micronutrient status, and by identifying and treating those already suffering from undernutrition using evidence-based interventions and according to inter-agency agreements and existing inter-agency standards (e.g., Sphere Standards). Globally, more than one-third of all under-ve deaths are attributable to undernutrition, either as a direct cause of death or through the weakening of the bodys resistance to illness. The risk of mortality from acute malnutrition is directly related to the severity of malnutrition. A child with severe acute malnutrition is nine times more likely to die than a well-nourished child. The harmful consequences of micronutrient deciencies for women and infants include greater risk of maternal death during childbirth, giving birth to an underweight or mentally-impaired baby and poor health and development of breastfed infants. For young children, micronutrient deciency increases the risk of death due to infectious disease and impaired physical and mental development. Provision of fortied foods and micronutrient supplements is an integral component of the response. In addition, because breastfed children are at least six times more likely to survive in the early months, the support, promotion and protection of breastfeeding is fundamental to preventing undernutrition and mortality among infants in emergencies.

Programme actions
Preparedness
Clarify the responsibilities of UNICEF and its partners regarding nutrition in humanitarian situations; strengthen existing coordination mechanisms or, if unavailable, create them in collaboration with national authorities to ensure that the humanitarian response is timely and coordinated, and that it conforms to humanitarian principles and agreed-upon standards and benchmarks. Support a multi-sectoral rapid assessment mechanism and format that includes priority nutrition information. Ensure the availability of guidelines and capacity for conducting and reporting on rapid nutrition surveys and assessments; advocate for the inclusion of nutritional assessment and programme monitoring data in national early warning systems; and ensure availability of key nutrition baseline data (including data on pre-existing malnutrition and disease prevalence and feeding practices) to inform response.

Establish integrated guidelines for management of acute malnutrition; assess coverage of existing services for management of severe acute malnutrition (SAM) and establish a contingency supply and distribution plan. Establish guidance on micronutrient supplementation and set up partnerships to implement emergency micronutrient activities. Form a contingency plan and mechanism for procurement and distribution of all necessary supplies for emergency micronutrient interventions (vitamin A, iodised salt, multiple micronutrient supplements), including stockpiles or standby arrangements with providers of micronutrient supplements. Advocate for and provide guidance on appropriate quantities of quality complementary foods to add to the food basket; dene essential infant and young child feeding (IYCF) interventions in emergency scenarios; develop, translate and pre-position appropriate materials for IYCF; and include emergency IYCF in ongoing training of health workers and lay counsellors. Map community capacities and existing communication channels

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to identify the most effective ones for nutrition information, and draft appropriate nutrition messages to be incorporated into multi-sectoral communication initiatives. With Supply and Logistics, prepare supply plans, distribution strategies and long-term agreements where this is possible locally.

Response
Strengthen and/or establish a nutrition cluster/inter-agency coordination mechanism to ensure rapid assessment of the nutrition sector; prepare a nutrition cluster/inter-agency plan of action and coordinate the implementation of a harmonized and appropriate response to address all critical nutrition gaps and vulnerabilities identied in the rapid assessment, including for children and women. Undertake a multi-sectoral rapid assessment, including key priority information for nutrition, within the rst week of an emergency, and a rapid household-level nutrition assessment within six weeks. Monitor unsolicited donations, distribution and use of breast milk substitutes or milk powder, and take corrective action. In collaboration with the World Food Programme, ensure appropriate management of moderate acute malnutrition for children and supplementary feeding for vulnerable groups, including pregnant and lactating women, according to identied needs.

Support existing capacity for management of SAM for children at the community and facility levels, and initiate and support additional therapeutic feeding as required to reach the estimated population in need. Support and establish systems for community mobilisation as well as for the identication and referral of acute malnutrition. According to the context, ensure provision of high-dose vitamin A supplementation with vaccination for all children 659 months old, and deworm all children (1259 months old) in collaboration with health sector workers. Ensure that iodised salt is included in the emergency food basket. If this is not possible, and household consumption is less than 20 per cent, consider iodised oil supplement distribution for children 624 months old and women of childbearing age. Ensure provision of multiple micronutrient preparations for children 659 months old6 unless fortied complementary foods are provided and multiple micronutrient supplements for pregnant or lactating women. Protect, support and promote early initiation and exclusive breastfeeding of infants, including establishment of safe spaces with counselling for pregnant and lactating women; support safe and adequate feeding for non-breastfed infants less than six months old,7 while minimising the risks of articial feeding; ensure appropriate counselling regarding infant feeding options and follow-up and support for HIV-positive mothers; and, with the

6 Current formulations of multiple micronutrient powders should not be provided to children in malaria-endemic areas due to their iron content. Policies are under development for these contexts. 7 IFE Core Group, Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Programme Managers, Oxford, IFE Core Group, Oxford, February 2007, version 2.1.

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World Food Programme and partners, ensure availability of safe, adequate and acceptable complementary foods for children. Consult with the community for development and implementation of programme communication, and include relevant and evidence-based nutrition messages in all programme communication activities. Identify and transmit supply inputs to Supply and Logistics.

Early recovery
Ensure that nutrition coordination and action links to recovery and long-term development by applying sustainable technologies, strategies and approaches to strengthen the national nutrition sector capacity; link to existing national strategies and the early recovery cluster/network; and establish a reporting mechanism to inform decision-making. Introduce, reinforce and/or adapt the nutrition information system (including routine monitoring of data from malnutrition management programmes, results of nutrition surveys and

surveillance data) to facilitate national or regional situation analysis and decision-making for enhanced disaster risk reduction and prevention. Initiate discussion on national policy, strategy and guidelines for sustainable management of SAM, if not already in place. Ensure that micronutrient activities build on and support existing national capacities, and initiate discussion of long-term strategies to provide micronutrients and potentially incorporate new approaches introduced during the emergency. Ensure that IYCF activities build on and support existing national networks for infant feeding counselling and support. Adapt the communications strategy for nutrition activities for routine use in health facilities and outreach services, and consolidate such activities to increase coverage and respond to changing situations. Initiate a gap analysis of local and national capacities and ensure integration of capacity strengthening in early recovery and transition plans, with a focus on risk reduction.

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2.4 HEALTH

Technical justication/evidence: The CCCs for health are based on addressing the major causes of maternal, neonatal and child mortality through evidenced-based interventions, inter-agency agreements and existing inter-agency standards (e.g., Sphere Standards). In the immediate post-emergency phase, direct causes, such as injuries or violence, may account for a substantial number of deaths. In protracted humanitarian situations, most deaths are attributable to common health conditions prevalent in the community, such as malnutrition, pneumonia, diarrhoea, measles, malaria (in malaria-endemic areas) and neonatal causes. The actual package of interventions will therefore vary depending on the context. UNICEF is committed to supporting the continuum of care across the maternal, newborn and early childhood period, acknowledging that maternal health is critical in ensuring healthy babies and children. UNICEF also supports the continuum of care from the household, community and health facility, with an increasing emphasis on community health approaches.

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Programme actions
Preparedness
Clarify the responsibilities of UNICEF and its partners regarding health in humanitarian situations. Strengthen existing coordination mechanisms or, if unavailable, create mechanisms in collaboration with national authorities and the World Health Organization, to ensure that the humanitarian response is timely and coordinated and conforms to humanitarian principles and agreedupon standards and benchmarks. Support a multi-sectoral rapid assessment mechanism and format (including priority health information). Ensure that emergency prepardness and response planning includes delivery strategies, resource requirements, plans for supply and re-supply, and a clear delineation of roles and responsibilities of key partners. Develop and maintain an inventory of essential health supplies, including vaccines, cold chain and essential drugs. Identify senior technical staff with health policy experience in emergency and early recovery to strengthen surge capacity. Ensure periodic training of health workers, including community agents, in emergency preparedness and response. Ensure that data on pre-emergency coverage of critical maternal, neonatal and child health interventions is up to date and, if necessary, strengthen and/or establish monitoring, evaluation and tracking systems. Develop appropriate health education and promotion messages at the regional level through community involvement, and ensure availability of, and agreement on, suitable partners for

implementing behaviour change communication activities at the country level. In collaboration with Supply and Logistics, prepare supply plans and distribution strategies based on local capacity to ensure appropriate supplies deliveries. Develop long-term agreements for procurement of essential supplies where these are locally available. Develop the capacity of national stakeholders, at all levels, to respond to emergencies.

Response
Support a strong health cluster/inter-agency coordination mechanism (as a cluster partner or lead, as appropriate) to ensure rapid assessments of the health sector and the implementation of an appropriate response to maternal, neonatal and child survival needs. Ensure the rapid provision of a context-appropriate package of services. Typically this includes measles vaccination and distribution of vitamin A, long-lasting insecticide-treated nets and deworming medication, but the actual package and delivery mechanism will depend on the context. Ensure the re-establishment of disrupted essential care services for women and children, including the provision of essential drugs, diagnostics and supplies. Priority essential health services will include: Treatment of conditions with a high impact on maternal, neonatal and child survival, such as pneumonia, diarrhoea and malaria (where appropriate). Critical services such as maternal health services, the

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Expanded Programme on Immunization (EPI) and HIV prevention and treatment services. Clinical and psychosocial services for victims of sexual violence and/or child abuse. Ensure dissemination of key health education and promotional messages and behaviour change communication to affected populations, with a focus on available health services, home management, danger signs for common life-threatening conditions (depending on context) and universal health promotion and precautions (e.g., breastfeeding, health-seeking behaviour, safe motherhood, hand washing, hygiene and sanitation). Ensure the supply and distribution of culturally and socioeconomically appropriate essential household items to affected populations. Identify and transmit supply inputs to Supply and Logistics.

Early Recovery
Ensure that health coordination and action links to recovery and long-term development by supporting national stakeholders

and the Early Recovery Cluster/Network in elaborating transition strategies and plans that strengthen local and national ownership, and develop the capacity of both government and civil society, addressing risk reduction. Ensure that early recovery and transition plans incorporate key maternal, neonatal and child survival needs. It is important that these plans link to existing national health strategies (e.g., health systems strengthening plans and health sector reform plans). Provide critical inputs towards re-establishment of routine services, e.g., cold chain for resumption of EPI services. Initiate discussions on the use of the emergency response as a platform for sustainable scale-up of critical maternal, newborn and child health interventions, and utilize opportunities provided by the emergency to review existing strategies and protocols with a view to building back better. Initiate a gap analysis of local and national capacities in health, and ensure integration of capacity strengthening in early recovery and transition plans, with a focus on risk reduction.

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2.5 WATER, SANITATION AND HYGIENE

Technical justication/evidence: A balanced and integrated WASH approach is essential to preventing and reducing mortality, especially among children in humanitarian crises. Recent empirical evidence shows that diarrhoea is one of the leading causes of death and illness for children in humanitarian crises. Every episode sets back growth and development. Almost 90 per cent of diarrhoeal cases are preventable through safe drinking water, basic sanitation and appropriate hygiene behaviour. Diarrhoeal episodes are reduced by 25 per cent by improving the water supply, 32 per cent by improving sanitation, 44 per cent by hand washing with soap, and 39 per cent by household water treatment. Water quality interventions could play a role in reducing diarrhoeal episodes by roughly half to 70 per cent or more.

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Programme actions
Preparedness
Clarify the responsibilities of UNICEF and its partners regarding WASH in humanitarian situations. Strengthen existing coordination mechanisms or, if not available, create mechanisms in collaboration with national authorities to ensure that the humanitarian response is timely and coordinated and conforms to humanitarian principles and agreed-upon standards and benchmarks. Establish a multi-sectoral rapid assessment mechanism and format, including priority WASH information. Develop a contingency plan with budget and supply needs and, where possible, pre-position essential gender-sensitive sanitation and hygiene supplies, water supplies, purication technologies and chemicals, and tools. Establish long-term agreements for procurement of specied WASH supplies, assess local market for potential water-trucking capacity, and ensure the availability of water delivery partners and agreement on methods and standards. Identify key resource people and/or institutions with specic knowledge and skills in sanitation and hygiene education and behaviour change for deployment in emergency planning and response; and collect pertinent information on sanitation and hygiene education. Ensure that contingency planning is undertaken for children in their learning environments (e.g., schools); pre-position essential WASH supplies and tools for enhancing childrens learning environments; and raise awareness of the WASH CCCs

in humanitarian action among local and national government ofcials, civil society, traditional and religious leaders, etc.

Response
Strengthen and/or establish WASH cluster/inter-agency coordination mechanisms; prepare a WASH cluster/inter-agency WASH plan of action and coordinate its implementation. Ensure that the rights and needs of children and women to a safe water supply, sanitation and hygiene are included in the WASH response plan, budget and appeal documents, and ensure that children and women are provided priority access to safe water of appropriate quality and quantity. Ensure that childrens WASH needs in their learning environments and child-friendly spaces are included in the WASH sector response plan. Ensure that the WASH humanitarian response contributes to the rights and needs of children and that water, toilets, washing facilities and soap are available at all times to children and women. Ensure that the WASH humanitarian response fulls the rights and needs of children as related to toilets in their learning environments, that soap is available at all times for hand washing, and that such facilities are child- and disabled-friendly, private, secure, culturally appropriate and appropriately segregated by gender. Ensure that children, women and caregivers receive essential and culturally appropriate information on hygiene education and key hygiene practices, and that an appropriate number of hygiene education promoters are in place, trained and equipped with hygiene education materials.

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Early recovery
Ensure that WASH coordination and action are linked to recovery and long-term development phases and the early recovery cluster/ network, and that they address risk reduction. Ensure that water technologies and approaches are compatible with national standards and longer-term sustainable development thus addressing risk reduction and that a capacity development plan is put in place for local-level operation and maintenance of water services. Ensure that sanitation and hygiene approaches and technologies are appropriate, conform to national standards and are coordinated with longer-term sustainable development, addressing risk reduction. Ensure that a periodic surveillance mechanism is put in place to keep track of trends regarding access to and use and maintenance of hygiene facilities as well as related disease trends.

Ensure that hygiene promotion strategies are compatible with national approaches and longer-term sustainable development, addressing risk reduction; that a capacity development plan is put in place to sustain hygiene promotion efforts; and that a surveillance mechanism is established. Ensure that WASH strategies and technologies for childrens learning environments are compatible with national strategies and longterm development, addressing risk reduction, and that a capacity development plan is put in place for local-level operation and maintenance of childrens WASH facilities in learning environments. Ensure that WASH interventions are based on a robust assessment and analysis of disaster risk. Initiate a gap analysis of local and national capacities in water and sanitation, and ensure integration of capacity strengthening in early recovery and transition plans, with a focus on risk reduction.

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2.6 CHILD PROTECTION

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Technical justication/evidence: Experience demonstrates that humanitarian situations both exacerbate existing protection risks and create new ones. The prevention and programmatic response to specic violations committed against children such as the separation of children from their families; association with armed forces and groups; exposure to GBV, landmines and unexploded ordinance; and psychosocial distress are supported by the development and implementation of interagency guidelines in these areas. There is also increasing recognition of the need to strengthen a range of child protection mechanisms to prevent and respond to various forms of violence, abuse and exploitation (see UNICEF Child Protection Strategy, 20 May 2008).

Programme actions
Preparedness
Clarify the responsibilities of UNICEF and its partners regarding child protection in humanitarian situations. Strengthen existing coordination mechanisms to ensure that the response is timely and coordinated, and that it conforms to humanitarian principles and standards. If no coordination mechanisms exist, create mechanisms in collaboration with national authorities. Clarify coordination mechanisms for gender-based violence and mental health and psychosocial support. Develop an inter-agency preparedness plan, in consultation with the government, based on identied risks, capacities and resources. Develop performance benchmarks for child protection, GBV and child protection components of MHPSS. Train staff and partners about child protection in an emergency, using policies, tools and the CCCs. Agree to use global common inter-agency registration, tracing and family reunication forms; develop messages with communities and key actors to prevent family separation and minimize institutionalisation; and develop and pre-position family tracing, and reunication and alternative care kits.

Identify and disseminate relevant legal and regulatory frameworks, response protocols, referral mechanisms and knowledge of social attitudes and values. Identify stakeholders, services and partners with the capacity to address violence, exploitation or abuse, including GBV; and build capacity of partners to provide multi-sectoral response services (e.g., health, psychosocial support, security and legal/justice) to victims and survivors. Identify key opportunities for integration of psychosocial support into child protection programming, in line with IASC MHPSS guidelines. Identify and disseminate information on the international and national standards on minimum age for recruitment in armed forces and groups and, where necessary, advocate for the adoption of international commitments in national legislation. Identify and address risk factors that lead to child recruitment as well as the illegal and arbitrary detention of children, and prepare a checklist for armed forces; and raise awareness in detention facilities to prevent violations of childrens rights. Advocate against the use, stockpiling, production and transfer of landmines and other indiscriminate and/or illicit weapons, and conduct capacity mapping. Build capacities for surveillance and mine risk education.

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Establish long-term agreements for procurement of specic supplies, and pre-position essential supply components.

Response
Establish, activate and support coordination mechanisms for child protection, GBV and MHPSS in consultation with the government and other partners to coordinate rapid assessment, mapping, funding, strategy development and involvement of affected populations. In armed conict, initiate the establishment of monitoring and reporting mechanisms focused on grave violations against children and sexual violence against both children and women, with a view to developing action plans; and ensure that affected children and women are referred to existing services. Support community-based safe environments for women and children, including child-friendly spaces, with particular attention to girls, adolescents and their caregivers, and provide support for early childhood development activities. Ensure usage of common registration and tracing forms, and explore usage of the inter-agency child-protection database to identify, register, verify, reunify and follow up on separated and unaccompanied children. Advocate immediately for family-based care for separated children, and work to prevent separation during displacement and extreme economic hardship. Mobilise childrens and womens existing social support networks and support the resumption of age-, gender- and culturally appropriate structured activities for children and women. Seek commitments from armed groups and forces to stop or avoid recruiting and using children, in line with the Paris

Commitments; negotiate to screen combatants and dependents, and to register, identify and release associated children. Advocate against the illegal or arbitrary detention of children, and facilitate access to legal and other assistance for children in contact with the law. Identify threats from landmines, other explosive devices and unsecured weapons and munitions. Coordinate and conduct audience-specic mine risk education, and monitor, report on and advocate against the use or presence of indiscriminate, unsecured or illicit weapons and ammunitions. Identify and transmit supply input needs to Supply and Logistics.

Early recovery
Strengthen involvement and/or leadership by government counterparts and other national partners in coordination structures. Support partners in identifying, monitoring and reporting on serious protection concerns to trigger response and advocacy. Build the capacity of government, community and protection systems for children and women. Advocate for and provide technical support on the inclusion of issues pertinent to fullling the rights of children and women in ruleof- law and security sector reform; support the resumption and/or strengthening of birth registration systems. Initiate systems for safe and supportive kinship and foster care, and advocate against premature adoption; when possible and in the best interest of children, build on existing national socialwelfare systems. Engage local capacities to address violence and exploitation; and support service providers, law enforcement actors, womens

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rights groups, communities and children to prevent violence, exploitation and abuse, including GBV. Integrate psychosocial support in child-friendly spaces and other protection responses for children and women, and coordinate with and refer to MHPSS in other sectors. Initiate release and demobilization for an inclusive, communityoriented approach to reintegration, based on the Paris Principles. Initiate non-stigmatizing, community-oriented approaches to social reintegration and livelihood support for vulnerable women and children.

Initiate integration of mine risk education into existing public awareness and education programmes, and establish prevention, education and survivors assistance programmes in coordination with partners. Initiate a gap analysis of local and national capacities in protecting children and women, and ensure integration of capacity strengthening in early recovery and transition plans, with a focus on risk reduction.

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2.7 EDUCATION

Technical justication/evidence: Education is not only a right, but in situations of emergency, chronic crisis and early reconstruction, it provides physical, psychosocial and cognitive protection that can be both life-saving and life-sustaining. Education sustains life by offering safe spaces for learning and support for affected individuals, particularly younger children and adolescents. Education mitigates the psychosocial impact of conict and disasters by giving a sense of normalcy, stability, structure and hope for the future during a time of crisis, and it provides essential building blocks for future economic stability. Education can also save lives by protecting against exploitation and harm, and by providing the knowledge and skills to survive a crisis through the dissemination of lifesaving messages. Integrating disaster risk education into national curricula and building safe school facilities are two priorities that contribute to a countrys progress towards the Millennium Development Goals (see INEE Minimum Standards for Education in Emergencies, Chronic Crises and Early Reconstruction).

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Programme actions
Preparedness
Clarify the responsibilities of UNICEF and its partners regarding education in humanitarian situations. Strengthen existing coordination mechanisms or, if unavailable, mechanisms in collaboration with national authorities to ensure that the humanitarian response is timely and coordinated, and that conforms to humanitarian principles and agreed-upon standards and benchmarks. Support a multi-sectoral rapid assessment mechanism and format, including priority education information. Advocate for an emergency component in education sector plans and budgets, including preparedness plans; and pre-position education and early childhood development kits or enter into stand-by agreements with suppliers and partners. Support national authorities in planning for appropriate temporary learning spaces; establish codes of conduct to address all forms of violence, sexual exploitation, abuse and discrimination in learning situations; and ensure joint preparedness planning with WASH and protection clusters and partners (see also WASH and child protection CCCs). Support national authorities in adjusting the education system to respond to students psychosocial needs and increased vulnerabilities in emergency situations; and agree on training packages and approaches that include psychosocial support, risk and vulnerability reduction, as well as basic health, hygiene and nutrition promotion. Agree with partners on education information and communication strategies and approaches, including strategies that promote the

participation of adolescents, using existing materials that have been adapted. Promote school emergency preparedness plans, advocate for safe school structures and include basic disaster risk-reduction measures in school curricula. Develop the capacity of education authorities in preparing the school system, at all levels, to respond to emergencies.

Response
Establish and activate transparent and inclusive education-cluster coordination mechanisms, and assign staff to lead inter-agency coordination. Revise and develop a response framework, strategy and plan of action for education response, based on assessment ndings. Monitor implementation of programme activities, and ensure that capacity is in place at all levels to effectively respond to the crisis. Ensure that education is integrated in ash appeals, donor briengs, the Central Emergency Response Fund (CERF) and other funding proposals in order to guarantee that the sector is given adequate attention. Advocate for and support the reopening of schools and establishment of non-formal education and recreational programmes; provide appropriate basic education, early learning and recreational materials; and include special measures for children needing help to re-engage in education (e.g., girls, and vulnerable and socially excluded children). Set up safe temporary learning spaces for all age groups in consultation with communities and, where appropriate, establish community services such as water supply and sanitation around schools, complemented by hygiene promotion.

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Address violence in and around learning spaces and schools including safety of children on the way to school with a focus on adolescent girls. Mobilise available psychosocial support for teachers and students, and provide appropriate activities for them in temporary learning spaces, and for young children and adolescents in childfriendly spaces; and establish initial links to basic health and nutrition services. Ensure the development and implementation of contextrelevant life skills programmes and learning content (e.g., basic health, nutrition and hygiene promotion), as well as prevention, protection, inclusion and support regarding HIV and AIDS (see also HIV and AIDS CCCs) and GBV, conict resolution, and information about the situation (e.g., earthquakes and armed conict); and involve the affected population, particularly adolescents and young people. Identify and transmit supply needs to Supply and Logistics.

Early recovery
Ensure that the education-cluster coordination mechanism integrates emergency response with long-term vision and recovery planning. Participate in, establish or lead, as appropriate, the early recovery

coordination mechanism for education, and support the early recovery cluster/network. Ensure that the implementation of education emergency response includes principles of child-friendly approaches. Ensure that education interventions are based on a robust assessment and analysis of disaster risk. Advocate for and support the redevelopment of schools according to safe, inclusive, equitable and child-friendly models, including all children without discrimination, as well as school emergency preparedness measures. Support inclusion of a disaster risk-reduction component in educationsector plans and budgets. Advocate for and support the development of sustainable and appropriate child-friendly and hazard-resistant standards and designs for reconstruction of schools. Advocate for appropriate compensation for teachers and paraprofessionals, according to agreed-upon inter-agency guidelines. Advocate for and support integration of life skills, with a focus on disaster risk reduction, in both formal and non-formal education. Initiate a gap analysis of local and national capacities in education and ensure integration of capacity strengthening in early recovery and transition plans, with a focus on risk reduction.

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2.8 HIV AND AIDS

Technical justication/evidence: HIV and humanitarian situations overlap and interact worldwide. Because HIV infection is irreversible, it is critical that adequate preventive measures be undertaken in all situations, including humanitarian situations. The implementation of care and treatment initiatives for HIV and AIDS, including meeting adherence and compliance requirements, has been demonstrated to be practically feasible, and reduction in mortality is well documented.

Programme actions
Preparedness
Develop context-specic HIV information material, identify and involve existing community networks, and develop partnerships between clusters to ensure mainstreaming of HIV in sector responses.

Agree with partners on mechanisms to reach and track children and women who may lose access to HIV-related essential services, and prepare for rapid provision of a buffer supply of medication. Ensure that all women enrolled in prevention of PMTCT services and all community members using ART, including children, have record cards detailing treatment.

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Response
Ensure coverage of HIV in health-sector initiatives for community health-promotion campaigns, as well as in education-sector initiatives. Track patients who were previously accessing PMTCT and ART, and refer them to health facilities for care, including for nutrition support and infant-feeding counselling and support. Inform children and mothers about where to access basic health and support services, including access to condoms, the treatment of sexually transmitted infections, prophylaxis and treatment of opportunistic infections, receipt of cotrimoxazole, continuation of PMTCT and ARV services, fullment of nutritional needs, and psychosocial support activities for children and caregivers. Ensure continued access for patients to PMTCT and ART drugs, care and support services, including support and counselling on infant feeding options, subsequent support for HIV-positive mothers according to the acceptable, feasible, affordable,

sustainable and safe (AFASS) criteria and code; management of acute malnutrition; and provision of ARV prophylaxis and cotrimoxazole. Ensure provision of psychosocial support for survivors of rape, including children. Identify and transmit supply inputs to Supply and Logistics.

Early recovery
Build and support existing peer networks, and support the expansion and of peer education networks. Engage children, women and people living with HIV in developing communications plans and messages. Begin re-establishing prevention, care and treatment services that were affected by crisis, and ensure condentiality. Initiate a gap analysis of local and national capacities, and ensure integration of capacity strengthening in HIV and AIDS in early recovery and transition plans, with a focus on risk reduction.

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2.9 SUPPLY AND LOGISTICS

Programme actions
Preparedness
Identify and compile all supplies required to respond to all CCC activity implementation; create and maintain longterm agreements with suppliers at the global, national and regional levels. Arrange adequate and cost-effective stockpiling strategies for emergency supplies, where appropriate; establish and maintain long term agreements (with service providers or other agencies) for the provision of transport and freight services; and evaluate procurement processes of prospective local partners. Establish partnership agreements for the provision of in-kind goods and services. Identify member(s) of the Supply and Logistics team to receive

interagency, emergency supply simulation, certication and/or other forms of training. Source potential Supply and Logistics candidates for the internal and external staff roster and submit the list to the Supply Division. Ensure that Supply and Logistics staff are familiar with tools and templates available through the supply intranet; and sensitize key programme staff regarding emergency processes, freight budgeting and estimation, and inland logistics costs. For business continuity purposes, ensure that emergency arrangements with vendors and suppliers are established in case of crisis. This will include the development of service-level agreements with these entities, ensuring preferred customer status for UNICEF. Identify alternative strategies in the event that vendors and suppliers are unable to comply with these agreements.

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Conduct supply planning exercises to identify medium-and long-term supply inputs, and investigate possible local and regional sources. Assess the procurement capacity of government counterparts and operational partners for specic product groups, including construction materials. Identify capacity gaps within government counterparts and operational partners; prepare plan for capacity strengthening for possible transfer of identied logistics activities following a response.

Response
Ensure early collaboration with all logistics partners; ensure UNICEF presence within the logistics cluster; and actively engage with UNICEFled clusters, providing guidance on supply activities within those clusters, including potential provision of free or pooled transport, storage, or other service provision. Provide supply input for programme implementation at the onset of the emergency; ensure that a rst-response supply plan is created and that product costs (including freight and

inland logistics costs) are calculated and factored into budgets and appeals. Design a Supply and Logistics concept of operation with the Supply Division and regional support, detailing supply sources, border crossings, warehouse requirements, corridors, partners and potential routing bottlenecks; ensure availability of adequate and acceptable management storage facilities. Ensure adequate supply-chain management, particularly for tracking and inventory. Monitor all logistics and procurement activities from origin to nal distribution, and provide regular updates on the status of receipts and deliveries. Based on the logistics concept of operations and the initial supply plan, request additional staff resources within 72 hours.

Early recovery
Prepare a medium- to long-term supply plan with identied resource and stafng needs and a revised logistics concept of operation to cover the period from the end of the appeal to the next update of the annual work plan.

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III. OPERATIONAL COMMITMENTS

UNICEF will resort to its enhanced media and communications, security, human resources, resource mobilisation, nance and administration, and information and communication systems to fulll obligations to meet the universal commitments regarding the needs of children in crisis. Partners will be expected to employ their diverse modalities and operational capacities to work jointly with UNICEF. Where feasible, UNICEF will share its capacities with partners to realise the rights of children in emergencies.

Maintain a list of staff members with appropriate language skills who are authorised to speak with the media in an emergency, as well as a list of media contacts and UNICEF emergency focal points. In collaboration with Supply and Logistics, ensure availability of basic communication equipment and visibility items, such as satellite phones, video cameras, cameras, posters and banners. Ensure availability of template statements, key messages, fact sheets and country proles on issues related to children and women, which can be immediately updated and used in an emergency. Ensure that contracts for essential media and communications services are pre-established.

3.1 Media and communications

Commitment 1 Accurate information about the impact of the situation on children and women is rapidly provided to national committees and the general public through local and international media. Humanitarian needs and the actions taken to address them are communicated in a timely and credible manner to advocate for child-friendly solutions, increase support for the response and, where necessary, assist with fundraising.

Response
Within 24 hours, disseminate information to the media, the public and national committees to immediately raise awareness of the urgent needs of children and women. During the rst week, produce daily updates, key messages and Q&As for internal circulation, as well as regular communication materials for an external audience. Ensure that communication material is in line with UN guidelines and that it complements the overall message of the UN country team and HCT. In situations of grave child rights violations and/or crisis, consult within 24 hours with RO and HQ on ways of advocating for the respect and protection of childrens rights, and inform the UN country team or HCT. The in-country risk management analysis should inform communication. If necessary, support partners in advocacy.

Commitment 2

Preparedness
Ensure that a communication strategy is part of preparedness planning. Identify surge-capacity needs in the areas of information and communication and in report writing.

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While media attention is at its peak, provide updates on childrelated issues and on the humanitarian response to the national committees, media and public. Use interviews, human interest stories, briengs, photographs and video footage, highlighting voices of children and youth. During eld visits, ensure that UNICEF-branded material is visible. Identify and transmit to Supply and Logistics.

Early recovery
Advocate for ethical reporting on children; where possible, contribute to the capacity-building of national and local media and the empowerment of youth, especially girls. Report on the humanitarian and early recovery response, the ongoing needs of children and women, and the actions taken by stakeholders, including the affected communities. When possible, organise eld visits for the media, celebrities, Goodwill Ambassadors, National Committees and donors for public advocacy purposes.

security plan (as an annex/compliment to the UN security plan) linked to the UN humanitarian response plan. Maintain and sustain UNICEFs security plan by, inter alia, securing nancial resources, training staff (including testing key aspects of security plan), procuring equipment related to Minimum Operational Security Standards (MOSS), meeting MOSS-related ofce requirements, and establishing MOSS-related procedures. Link mitigation aspects those aimed at intending to mitigate the impact of event of the security plan with business continuity plans, and evaluate the effectiveness of day-to-day security measures and the key aspects of the security plan in order to manage the risk to staff and assets.

Response
Implement the security plan immediately, including establishing the location of all staff members, and review, with Department of Safety and Security, the effectiveness of security measures. Ensure all staff, programmes and ofces have proper MOSSrelated equipment, and follow security-mandated procedures during programme implementation. Periodically review, in collaboration with UN security advisors, the programme implications of security risk assessment, in the context of the changing situation. Identify and transmit supply inputs to Supply and Logistics.

3.2 Security
Commitment 1 Security risks that could affect staff and assets, and subsequently the emergency response, are identied, assessed and managed.

Preparedness
Ensure that an assessment is undertaken of all the relevant security risks associated with the humanitarian response plan. Examine UN Security Risk Assessment for implications to humanitarian programmes, and establish and maintain a UNICEF

Early recovery
Adjust UNICEF security plan to account for post-emergency threat environment; monitor the effectiveness of these security measures and plans.

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3.3 Human resources

Commitment 1 Appropriate and experienced staff and personnel with relevant deployment training are provided and rapidly deployed, primarily through internal redeployment of staff. This is complemented by external recruitment and standby personnel to allow for recruitment of possible longer-term posts, as needed. Well-being of staff is assured. Sexual exploitation and abuse by humanitarian workers is prevented. UNICEF staff members and key partners have knowledge and skills for effective emergency preparedness and response. This includes knowledge about humanitarian reform and the cluster approach.

Commitment 2 Commitment 3 Commitment 4

Preparedness
Establish and maintain a staff mobilisation plan for both immediate and medium-term needs, and identify and communicate stafng needs through established systems and practices. At the regional level, produce an analysis to mitigate risks and identify gaps and actions. Include deployment training as a key element in the recruitment process. Provide all staff, as part of UNICEF deployment training, with information and support to address their well-being, including information on safety and security measures and procedures, HIV and AIDS, traumatic stress and chronic work stress.

Disseminate to staff members the UN rules governing behaviour related to sexual exploitation and abuse, as contained in the Secretary-Generals bulletin; implement a monitoring and complaints mechanism within the organisation and as part of the General Assembly victim assistance policy; and train focal points. Develop and implement a training plan that includes capacity building of UNICEF staff and partners for emergency preparedness and response planning, as well as Principled Approach to Humanitarian Action e-learning. Ensure that all new UNICEF staff have completed induction training that integrates key emergency elements, and establish processes for the completion of deployment training for relevant UNICEF staff, standby partners and consultants. Ensure the mandatory completion by all staff of e-learning training on sexual harassment. For business continuity purposes, ensure that critical staff and their alternates are identied and trained in sustaining the critical business processes of the ofce. Staff who will be working from home will need to be identied to ensure that they are provided with remote access capabilities and vital records to support onsite critical staff. This will include identifying Activated Key Staff when technological support is required for internal recovery. Ensure that staff members with special needs, afictions and illnesses are provided with support in case of an internal crisis affecting ofce operations.

Response
CO to mobilise surge capacity, to be launched in parallel with humanitarian appeals and in coordination with RO and HQ. This will be done through established rapid response mechanisms, using

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the emergency response team and other internal redeployment, external recruitment and standby arrangements with partners. Reassign and/or redeploy staff within the CO and RO to support emergency response, or redeploy staff within the region. Identify and recruit external candidates via the global web roster e-recruitment platform, other external sources and standby partners. Monitor completion of UNICEF deployment training for staff and consultants deployed for emergency response. Provide all staff with the contact details of the UNICEF staff counsellors ofce, as well as of any local counselling resources identied, including UN counsellors, local counsellors and peer helpers. Ensure that all UNICEF staff and partners sign the code of conduct, and make them aware of appropriate mechanisms for reporting breaches of its six core principles. In case of emergency deployment, ensure that UNICEF staff being deployed on mission, external candidates (including consultants), as well as standby partners complete UNICEF deployment training before deployment, immediately upon arrival at their duty stations and after completion of the assignment.

The CO and RO should consult the Public Sector Alliances and Resource Mobilisation Ofce (PARMO) website to review available donor proles, standard agreements, and the processes for accessing and managing emergency funds. The COs and ROs should contact PARMO (Brussels, New York, Tokyo) and private fundraising and partnerships donor focal points to map donor interests and seek other guidance, as necessary. Liaise with local donors to establish good working relationships, demonstrate UNICEFs preparedness to initiate action and emphasise the importance of thematic funding as a exible and efcient mechanism with fewer transaction costs. Familiarise CO management with the procedures, processes and format for accessing the emergency programme fund and CERF to jump start emergency programme response. Ensure that staff participate in internal and external training (e.g., public-private partnership and CERF) to better understand workplanning processes and procedures, including resource mobilisation in emergencies.

Response
Reprogramme regular resources within the country programme budget, or reprogramme other resources; when needed, prepare an emergency programme fund loan request within 2472 hours, in close coordination with the RO and Ofce of Emergency Programmes. Prepare an Immediate Needs Document within the rst 2472 hours of a sudden-onset emergency, to be shared with the government, donors and national committees, to seek Other Resources emergency resources. Through an inter-agency process, led by the humanitarian coordinator or resident

3.4 Resource mobilisation

Commitment 1 Quality, exible resources are mobilised in a timely manner to meet the rights and needs of children and women in humanitarian crises.

Preparedness
Develop an emergency resource mobilisation strategy in conjunction with the strategy for funding the regular country programme.

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coordinator, submit a proposal for CERF funding alongside the ash appeal process, as appropriate. Within 57 days, prepare an emergency appeal in coordination with other UN agencies (ash appeal, as per guidelines) or, in the absence of the inter-agency appeal process, a stand-alone UNICEF appeal (crisis appeal). Ensure that the continuing needs of women and children are adequately reected in the inter-agency Consolidated Appeals Process (CAP) and UNICEFs Humanitarian Action Report (HAR). Issue regular humanitarian action updates that provide the CO and RO with the opportunity to report on results and highlight funding gaps and requirements. Engage with donors, both locally and at the headquarters level, by providing regular updates on the evolving situation; manage funds and prepare quality reports on contributions according to specied donor conditions and time frames.

funds, to ensure their effective operation and advocate for the inclusion of programmes targeted to children and women.

3.5 Finance and administration

Commitment 1 Effective and transparent management structures are established, with support from the Regional Ofce and UNICEF headquarters, for effective implementation of the programme and operational Core Commitments for Children. This is done in an environment of sound nancial accountability and adequate oversight.

Preparedness
Through the emergency preparedness and response plan, gauge nancial and administrative capacity in-country, including: Internal control system segregation of duties and readiness for manual accounting. Physical security ofce and residential premises, inventory and other assets. Ensure that liquidity is assured at all times and that alternative sources and arrangements are made for business continuity purposes. In case an alternative recovery location for the ofce is identied for purposes of business continuity: Ensure that the site is ready to receive critical staff and provide appropriate administrative, information technology and telecommunications support facilities to allow for operational continuity. Ensure that there are sufcient supplies and provisions, taking into consideration both gender and special needs.

Early recovery
Ensure that early recovery approaches are mainstreamed into the planning processes and are adequately reected in response appeals (CAPs, HARs, ash appeals, early recovery appeals). Participate in early recovery needs assessments, including postconict and post-disaster needs assessments, to ensure that the rights of children and women are prioritized and that the assessment, national prioritization and costing of needs of children and women are included in advocacy for adequate funding through donor mobilisation processes. Where appropriate, fully participate from the earliest stages in the design of pooled funding mechanisms, including common humanitarian funds, emergency relief funds and multi-donor trust

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Response
Review, operationalise (as appropriate) and monitor: Appropriateness of delegated authorities (including those of review committees) given changes in staff, geographic location and programme activity; Accessibility of UNICEF corporate nancial systems and alternatives, if appropriate; Requirements for additional residential and ofce premises, and security of inventory and other assets; and Methods of obtaining liquidity and making disbursements. Respond rapidly to queries regarding nance and administration from RO and CO (Division of Financial and Administrative Management). Division of Financial and Administrative Management to consult with RO and CO and Division of Human Resources on the deployment of nance and administration staff to emergency duty stations, as required.

Preparedness
Ensure the immediate availability of essential emergency information and communication technology (ICT), and telecommunications equipment and services, by having supply contracts in place with an emergency delivery clause (HQ/RO). Pre-position essential rapid-deployment emergency ICT solutions in high-risk ofces (RO/CO); and put in place licensing and agreements with host governments on importation and licensing of key telecommunications-response equipment and services (CO/ interagency). Ensure the timely availability of trained and experienced emergency ICT responders by maintaining internal and external emergency response rosters (HQ/RO). Ensure that all UNICEF COs have a minimum of one emergencytrained ICT professional (CO/RO). Ensure that ICT is included in all UNICEF country and regional emergency-simulation exercises (RO/HQ); and conduct annual emergency ICT training and simulation exercises (HQ/RO/CO). Ensure that CO ICT personnel are trained in MOSS/security telecommunications requirements (HQ/RO/CO) and that evaluation of and reporting on MOSS telecommunications compliance is included in regular ofce ICT activities (RO/CO). Support implementation of inter-agency and NGO emergency ICT/ telecommunications working groups at the eld-ofce level (CO/ RO/HQ). Support and ensure inter-agency standardisation for emergency ICT/telecommunications equipment, services and procedures (HQ). For the purpose of business continuity, ensure that critical staff have the requisite remote connectivity and access to UNICEF

Early recovery
Review arrangements introduced during the emergency to regularise controls, procedures and systems, and to ensure that administrative and accounting requirements have been fullled.

3.6 Information and communication technology

Commitment 1 Timely, effective and predictable delivery of telecommunications services to ensure efcient and secure programme implementation, staff security and compliance with inter-agency commitments.

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core systems (RO/CO), as per individual ofce requirements and established from Information Technology Solutions and Services Division and business and continuity plans (HQ). Conduct remote connectivity tests as per individual ofce requirements and established policies and guidelines from Information Technology Solutions and Services Division and business continuity plans. Ensure remote execution of ofcecritical processes, where applicable (RO/CO). Ensure, where applicable and as per individual ofce requirements, remote access to vital records requirements to execute critical processes for critical staff on-site and for those working from home (RO/CO).

delivery, and take responsibility as cluster lead at the local level, if required and as per inter-agency agreements (CO/RO). Request deployment of trained emergency ICT/ telecommunications responders and emergency telecommunications project coordinators, as required (RO/CO). Produce a consolidated supply plan covering identied ICT and telecommunications equipment and service requirements (CO). Provide key UNICEF users with remote access to corporate applications using secure connectivity solutions, such as virtual private networks (CO).

Early recovery
Provide secure corporate data connectivity such as Very Small Apeture Terminal (VSAT) and implement core UNICEF information systems and associated infrastructure required to support the longer-term emergency operation (CO). Conduct a follow-up and in-depth ICT/telecommunications assessment to establish requirements for early recovery and longer-term operation; support planning, execution and hand-over to capable partners of interagency joint emergency ICT projects (RO/CO).

Response
Perform an immediate emergency ICT and telecommunications gap assessment to identify critical gaps in MOSS/security telecommunications compliance and data communications (Internet, email, etc.) service availability; determine resource requirements and need for eventual external support (RO/CO). Collaborate with cluster partners to identify opportunities for shared telecommunications and data-communications service

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GENERIC MONITORING AND EVALUATION PLAN CCC IN HUMANITARIAN ACTION

Levels 1. Strategic result HEALTH
Excess mortality amongst children and women in humanitarian crisis is prevented

Indicators IMPACT
Crude mortality rate maintained or reduced to % of the baseline rate documented for the population before the disaster The under-5 mortality rate is maintained at, or reduced to, % of the baseline rate documented for the population prior to the disaster* The maternal mortality rate is maintained at, or reduced to, % of the baseline rate documented of the population prior to the disaster*

Disaggregation
Gender/Social status Social status

MoVs
Data health dept/partners Impact monitoring Special/annual review

Social status Incidence rates for diarrhea & malaria maintained at the level of the baseline documented for the population before the disaster 1.1 Outcome Children and women have access to life saving interventions through populations-based/ community-based activities Short term and medium term effects generated by the outputs At least 95% of the children 6-59 months covered with measles vaccination* At least 95% of the chilldren 6-59 months have been dewormed* At least 95% of children 6-59 months have received an appropriate dose of Vitamin A* 1.1.1 Output Measles Vaccination campaign implemented No. of children vaccinated Routine ongoing vaccination of 9-months old children established* 1.1.2 Output Vitamin A supplement provided to children 1.1.3 Output Deworming of children implemented 1.1.4 Output Insecticide-treated bed nets provided to families in the malaria endemic areas No. of bed nets distributed Social status Data health dept Field reports No. of children dewormed Social status Data health dept Field reports No of children provided with vitamin A Social status Data health dept Field reports Social status Data health dept Field reports Social status Data health dept/partners Special/annual review

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Levels
1.1.5 Output Acute diarrheoa prevention and management implemented through demonstration and distribution of ORS and Zinc 1.2 Outcome Children, women and adolescents equitably access essential health services with sustained coverage of high impact preventive and curative interventions 1.1.1 Output Expanded Program of Immunization functionning 1.1.2 Output Emergency obstetric care services functionning 1.1.3 Output Pregnant women vaccinated against Tetanus 1.1.4 Output Cold chain functionning 1.3 Outcome Women and children exposed to behaviour change communication interventions towards improving health care and feeding practices

Indicators
No. of children provided with zinc/ORS No. of ORS sachets distributed

Disaggregation

MoVs
Data health dept Field reports

Short term and medium term effects generated by the outputs 90% of children aged 12-23 months fully covered with routine EPI vaccine doses At least 1 basic emergency obstetric care facility available for 100,000 population * No. of children vaccinated No. of women beneting from EOC No. of women vaccinated against tetanus No. of cold chain equipment provided to health facilities Short term and medium term effects generated by the outputs % of mothers who use ORS sachets appropriately Field reports Impact monitoring RTE Data health dept/Field reports Data health dept/Field reports Data health dept/Field reports Data health dept/Field reports Data health dept/partners Special/annual review

X% of mothers who are aware/wash hands before feeding children and after cleaning childrens faeces 1.3.1 Output Diarrheoa prevention activities implemented No. of ORS sachets/halogen tablets/bleaching solution distributed No. of leaets distributed No. of households/people who received halogen tablets/ORS sachets/bleaching solution No. of participants in awareness sessions Distribution reports Field reports

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Levels 2. Strategic result NUTRITION

The nutritional status of children and women is protected from the effects of humanitarian crisis

Indicators IMPACT
Malnutrition-related morbidity and mortality rates are stable Cases of micronutrient deciencies are stable % recovered cases among SAM children < 5 admitted to therapeutic programmes >75% * % recovered cases among MAM children <5 treated in SFP >75% * % death cases among SAM children <5 admitted to therapeutic programmes <10% *

Disaggregation
Age/social status Age/social status

MoVs
Nutritional monitoring & surveillance, Special/Annual review

2.1

Outcome

Short term and medium term effects generated by the outputs Reports from partners, eld visits, impact monitoring, RTE

% of targeted mothers who practice: initiation of BF in Support for appropriate infant and young child feeding (IYCF) is accessed by affected women and the 1st hour, exclusive BF during 6 months, introduction of appropriate complementary food after 6 months children 2.1.1 Output Awareness activities implemented towards mothers to promote: - initiation of breastfeeding in the rst hour - exclusive breastfeeding during 6 months - introduction of complementary food after 6 months - introduction of appropriate complementary food 2.1.2 Output Potential inappropriate donation and use of breast No. of cases of inappropriate donation of breast milk milk substitutes monitored substitutes registered and addressed No. of women participating in awareness activities No. of IEC material distributed

Field reports Data partners

Field reports Data health dept/ partners

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Levels
2.2 Outcome Timely nutritional assessment and surveillance systems are established and/or reinforced

Indicators
Short term and medium term effects generated by the outputs Assessments provide a demonstrated understanding of the scope and severity of the nutritional situation, including the underlying causes of malnutrition Nutritional monitoring and surveillance system established % of households in affected area registered in the Nutrition Surveillance System >90%

Disaggregation

MoVs

Impact monitoring RTE- Annual/ special review Field reports Social status Nutrition surveillance reports Annual/Special review RA and rapid nutrition assessment reports

2.2.1 Output Multi-sectoral rapid assessment (incl.key priority information for nutrition) carried out within the rst 72 hours of an emergency and rapid household-level nutrition assessment within 6 weeks 2.2.2 Output Systems for community mobilisation, identication and referral of acute malnutrition supported/established 2.3 Outcome Children and women with acute malnutrition have access to appropriate acute malnutrition management % of households in affected area registered in the Nutrition Surveillance System >90% Short term and medium term effects generated by the outputs >50% of the target population in rural areas,>70% in urban areas, 90% in camps, is screened and treated * % children <5 suffering from SAM being treated in therapeutic programme (>50% rural areas, >70% urban areas, 90% in camps) * 2.3.1 Output Rapid Nutritional screening and case detection implemented 2.3.2 Output Children suffering from SAM are treated in facility No. of children admitted into UNICEF supported or community-based therapeutic programme therapeutic programmes Social status Nutrition surveillance reports Reports Therapeutic program No. and % of children screened in target areas Nutrition surveillance reports Data Health dept Nutrition surveillance reports Data Health dept Impact monitoring RTE Nutrition surveillance reports Data Health dept Impact monitoring RTE Social status Nutrition surveillance reports RA and rapid household-level nutrition assessment carried out in a timely manner

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Levels
2.4 Outcome Children<5, pregnant and lactating women have access to micronutrients from fortied foods,supplements, or multiple-micronutrient preparations

Indicators
Short term and medium term effects generated by the outputs % children aged 6-59 months in the affected areas registered in a multi-micronutrient supplementation programme % of pregnant and lactating women registered in a micronutrient supplementary programme X% children under 5 suffering from MAM reached by supplementary feeding programme % of households in the affected areas consuming adequately iodized salt (target 90%) % of pregnant and lactating women registered as having received iron-folate supplements % of children receiving complementary food by WFP

Disaggregation

MoVs

Social status

Nutrition surveillance reports Reports SFP Data Health dept Impact monitoring RTE

Social status Social status Social status Social status Social status Reports SFP Data Health Dept Distribution reports Field reports Data Health Dept SFP/ distribution reports

2.4.1 Output Supplementary Feeding Program establishment supported 2.4.2 Output Supplementary food support distributed by government to children within the communities 2.4.3 Output Pregnant and lactating women provided with iron-folate supplements 2.4.4 Output Iodized salt included in the food basket for emergency 2.5 Outcome Children and women have access to relevant information about nutrition programme activities Food basket composition Short term and medium term effects generated by the outputs % of affected population informed about nutrition programme activities Impact monitoring RTE Distribution reports No. of women and children registered in SFP Qty of supplementary food distributed No. of beneciaries receiving supplementary food No. of pregnant and lactating women provided with iron-folate supplements No. of iron-folate supplements distributed to pregnant and lactating women

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Levels
2.5.1 Output

Indicators

Disaggregation

MoVs
Field reports

Information activities conducted to provide No. and type of information activities implemented information on nutrition services and entitlements

3.

Strategic result WES

Children and women have protected and reliable access to sufcient, safe water and sanitation and hygiene facilities

IMPACT
Water-borne diseases related mortality rate Vector- borne diseases related mortality rate Incidence of water borne diseases Short term and medium term effects generated by the outputs At least 15l/person/day available in each household * Gender/disability/ social status Field reports Data Health Dept/ partners Impact monitoring RTE Data Health Dept Disease surveillance reports Impact monitoring RTE Annual/special review

3.1

Outcome Children and women have access to sufcient water of appropriate quality and quantity for drinking, cooking and maintaining personal hygiene

X% of women and children who drink water from a protected/treated source % household who have at least 2 clean water collecting containers of 10-20 liters, plus enough clean water storage containers * % of households that received appropriate water treatment supplies % water collection points not meeting sphere target of 0/100 ml faecal coliforms * 3.1.1 Output Government supported to protect/clean/ rehabilitate/construct water points 3.1.2 Output Government supported to set up standpipes and/ or distribution tanks 3.1.3 Output Suitable containers (jerry cans) provided fby the government for collecting and storing water No. of water points protected/rehabilitated/constructed by the government No. of standpipes set up No. of distribution tanks set up No. of jerry cans distributed No. of households provided with jerry cans

Gender/disability/ social status Gender/disability/ social status

Field reports Data govt/partners

Field reports Data govt/partners

Distribution reports Field reports Gender/disability/ social status

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Levels
3.1.4 Output Family water kits or Purication tablets/bleaching solution distributed to affected population 3.1.5 Output Water tanks provided to health centers and schools 3.1.6 Output Bacteriological water testing implemented 3.2 Outcome

Indicators
No. of items distributed No. of households covered No. of water tanks distributed to health centres & schools No. and % of health centers & schools that received water tanks Nb of water supply points regularly monitored Short term and medium term effects generated by the outputs

Disaggregation
Gender/disability/ social status

MoVs
Distribution reports Field reports

Distribution reports Field reports

Field reports Data partners

Children and women receive critical WASH related Hygiene Promotion sessions attendance information to prevent child illness, especially diarrhea X % of women who are aware/practice hand washing before handling food X% of mothers who are aware/wash hands before feeding children and after cleaning childrens faeces X% of mothers who wash hands after defecation X% of women menstruating age using sanitary materials Quantity of soap accessed per person in the affected areas (target sphere 250g bathing soap/pers/month and 200g laundry soap/pers/month)* 3.2.1 Output hygiene kits/hygiene items (soap for bathing and laundry)/sanitary material for women of menstruating age distributed by government to affected population No. of hygiene kits distributed

Field reports- Data Health dept Impact monitoring RTE Annual/special review

Distribution reports Field reports

No. and % of households covered

Age/disability/ social status

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Levels

Indicators
No. of sanitary material distributed to women menstruating age No. and % of women menstruating age covered

Disaggregation

MoVs

Age/disability/ social status Field repots Age/disability/ social status Age/disability/ social status Field reports Data government Field reports Data Education dept

3.2.2 Output Hygiene promotion sessions organized IEC material effectively designed by UNICEF No. of mothers attending hygiene sessions No. of children attending school hygiene sessions 3.3 Outcome Children and women have access to toilets and washing facilities that are culturally appropriate, secure, and sanitary, and are user-friendly and gender appropriate Short term and medium term effects generated by the outputs % of people who have acces to toilets Gender/disability/ age/social status Field reports Data Health Dept/ partners Impact monitoring RTE

% of people who use toilets % of people who bury faeces away from home and public areas % of people who practice hand washing after defecation 3.3.1 Output Trench/pit latrines/toilets are constructed by the government 3.3.2 Output Sanitation supplies are provided to affected population (shovels, tarpaulins, etc.) 3.3.3 Output Hand washing facilities are available as close as possible to the latrines/toilets No. and % of latrines/toilets having washing facility at a reasonable distance No. of latrines/toilets constructed No. of sanitation supplies distributed No. of people who received sanitation supplies

Gender/disability/ age/social status

Gender/disability/ age/social status Field reports Data govt/partners Distribution reports/Field reports Disability/age/ social status Field reports Data health dept/ partners

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Levels
3.3.4 Output Anal cleansing material provided 3.3.5 Output Sessions on the importance of burying faeces away from home and public areas organized 3.4 Outcome Children have access to safe water, sanitation and hygiene facilities in their learning environment 3.4.1 Output

Indicators
No. and % of latrines/toilets having anal cleansing material available No. of sessions organized Sessions attendance Short term and medium term effects generated by the outputs % of children who have access to sanitation facilities within their schools

Disaggregation

MoVs
Field reports Data health dept/ partners Field reports Data health dept/ partners

Gender/disability/ age/social status

Disability

Field reports Data Education dept/partners Field reports Data Education dept/partners

Toilets within the existing schools are constructed/ No. of toilets constructed/renovated within existing renovated by the govt schools Latrines are constructed nearby the learning spaces 3.4.2 Output Water supply and storage facilities provided by govt to schools/temporary learning spaces No. of latrines constructed nearby learning spaces No. of water tanks distributed to schools No. of schools that received water tanks

Field reports Distribution reports Data Education dept/partners

4.

Strategic result EDUCATION

Children access safe and secure education and critical information for their own well-being

IMPACT
School enrollment rate School dropout rate School attendance rate Gender/Age/social Data Education dept Annual/ status/disability special review Gender/Age/social status/disability Gender/Age/social status/disability

4.1

Outcome Children, including girls and other excluded children, have access to quality education opportunities

Short term and medium term effects generated by the outputs Education needs better integrated in the emergency response at the government level School enrolment/dropout/attendance rate Gender/Age/social RTE Annual/special review status/disability Data Education dept

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Levels
4.1.1 Output Advocacy at government level to better integrate education in the emergency response 4.1.2 Output Government's capactiy built on international minimum standards 4.1.3 Output Alternative learning spaces set up

Indicators
Dialogue ongoing on educational response

Disaggregation

MoVs
UNICEF reports RTE Annual/ special review

No. of alternative learning spaces set up No. and % of affected children who benet from alternative learning spaces No. of school in a box distributed Quantity of note books, etc. distributed Short term and medium term effects generated by the outputs No. and appropriateness of building back better measures taken by the govt Gender/Age/ Social status/ disability

Data Education dept UNICEF reports

4.1.4 Output Teaching, learning materials are provided 4.2 Outcome Safe and secure learning environments that promote the protection and well-being of learners are established 4.2.1 Output Building back better (eg. Cyclone resistant buildings) approaches are advocated for towards government 4.2.2 Output Government is supported in ensuring that displaced children have access to education through e.g peer to peer education 4.3 Outcome Psychosocial services for children and teachers are integrated in the educational response

Distribution reports Field reports

UNICEF report Impact monitoring RTE

Ongoing dialogue on building back better approaches

UNICEF report Impact monitoring RTE

No. of displaced children who have access to education during displacement Short term and medium term effects generated by the outputs Average hours per week allocated in the curriculum for recreation in the UNICEF-assisted schools No. and % of children beneting from recreational activities Children satisfaction towards recreational activities Gender/Age/social status/disability

Data Education dept UNICEF reports

Data partners and education dept Impact monitoring RTE

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Levels
4.3.1 Output Recreation kits provided 4.3.2 Output Teachers are trained by partner NGOs in developing recreational/psychosocial support activities 4.3.3 Output Child-Friendly spaces established 4.4 Outcome Adolescents, young children and caregivers have access to life skills training and information about the emergency and educational options

Indicators
No. of recreational kits distributed No. of teachers trained

Disaggregation

MoVs
Distribution reports Field reports Data education dept/partners Field reports

No. of child friendly spaces established Short term and medium term effects generated by the outputs % of adolescents, young children and caregivers who benet from life skills training and information Children's interest and satisfaction towards self-esteem and health and hygiene activities

Data education dept/partners Field reports

Gender/Age/social Data Govt and partners status/disability Impact monitoring RTE

4.4.1 Output Sports for development programme implemented No. of children who benet from sports for development programme 4.4.2 Output Health and hygiene promotion activities conducted in the schools 4.4.3 Output Self-esteem enhancement activities conducted in the schools No. of children attending school hygiene sessions No. of sessions organised No. of children participating to the self-esteem activities Data education dept/partners Field reports Data education dept/partners Field reports Data education dept/partners Field reports

5.

Strategic result CHILD PROTECTION

Children's rights to protection from violence, abuse and exploitation are sustained and promoted

IMPACT
Increased awareness amongst government, donors, staff, religious groups and communities on the issue of separation No. of children prevented from trafcking and exploitation No. of children reunited with their families Impact monitoring RTE Annual/special review Monitoring system for separated children

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Levels
5.1 Outcome Separation of children from families/caregivers is prevented and separated children are identied, registered and cared for 5.1.1 Output Linkages established with the government in order to ensure proper follow-up and tracking of separated children 5.1.2 Output Awareness raising activities conducted amongst government, donors, staff, religious groups and communities on the issue of separation 5.1.3 Output znsure that partners work towards identifying vulnerable families and linking them to the available support services 5.1.4 Output Identied separated children referred to civil society/community-based/governmental emergency care facilities 5.1.5 Output Government supported to reunify families 5.2 Outcome Violence, exploitation and abuse of children and women is prevented, including gender-based violence

Indicators
Short term and medium term effects generated by the outputs No. of children separated from their families

Disaggregation

MoVs

Age/Gender/social Government database for status separated children

No. of children reunited with their families Government has established a tracking and identication system and shares data with UNICEF Reports/data from the government

No. of IEC material distributed No. and type of awareness raising activities Field reports Partners' reports

No. of vulnerable families identied and linked to available servces

Social status

Field reports Partners' reports

No. and % of separated children properly referred to existing emergency care facilities

Field reports Data partners

No. of children reunited with their families Short term and medium term effects generated by the outputs No. of children prevented from trafcking and exploitation Increased awareness and understanding on the issue of violence (incl. gender based violence), exploitation and abuse, within the communities Age/Gender/ Social status

Government database for separated children

Community based vigilance groups Data partners & other stakeholders Impact monitoring RTE

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Levels
5.2.1 Output Strategic plan prepared to address the problem of women and girls turning to prostitution and the safety of women and children in camps for refugees and IDPS 5.2.2 Output Awareness raising activities are implemented towards women in the communities, women's groups, NGOs and national authorities on the issue of gender based violence 5.2.3 Output Community support systems built and stregthened within the communities to raise awareness of communities and prevent violence, exploitation and abuse of children 5.2.4 Output

Indicators
Strategic plan prepared

Disaggregation

MoVs
UNICEF reports

No. of awareness activities No. of families, women's groups, NGOs and national authorities representatives participating in awareness activities No. of families reached by awareness activities No. of community based vigilance groups established

UNICEF reports Field reports

UNICEF/Partners reports

Adovacy towards the governement undertaken to Discussions ongoing on the establishement of tracing establish tracing and referral of children victims of and referral exploitation and abuse 5.3 Outcome Psychosocial support is provided to children and their caregivers Short term and medium term effects generated by the outputs No. of children in need of specialized assistance referred to competent level % of affected children who have beneted from structured psychosocial activities Children satisfaction towards recreational activities 5.3.1 Output Collaboration developed with other sectors and partners to ensure the establishment of childfriendly spaces 5.3.2 Output Staff is trained in psychosocial support No. of staff trained No. of child-friendly spaces set-up No. of children who benet from child-friendly spaces Gender/Age/ Social status/ Disability

UNICEF reports

Report partners Field reports Impact monitoring RTE

Data education dept/partners Field reports

UNICEF reports Field reports

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Levels
5.3.3 Output Referral services for children/adults in need of specialized assistance are identied

Indicators
Referral services identied

Disaggregation

MoVs
UNICEF reports Field reports

6.

Strategic result HIV AIDS

Vulnerability to HIV infection in humanitarian crisis is not increased and HIV-related care needs caused by humanitarian crisis are met

IMPACT
% of new HIV infections prevented among children born from HIV positive pregnant women Short term and medium term effects generated by the outputs % of young people (10-24), women and children in the affected areas reached through awareness activities Gender/social status/age Data Health dept/partners Impact monitoring RTE Special/annual review Field reports Data Health Dept/ partners Data health dept- Special/annual review

6.1

Outcome Children, young people and women have access to information on HIV and AIDS prevention, care and treatment during crisis

6.1.1 Output No. of mothers and children reached through Children and mothers are informed where to access basic health and support services including awareness actvities access to condoms, STI treatment, prophylaxis and treatment of OI, receipt of cotrimoxazole, continuation of PMTCT and ARV services, nutritional needs, and psychosocial support activities for children and caregivers 6.2 Outcome Children, young people and women have access to HIV and AIDS prevention, care and treatment during crisis Short term and medium term effects generated by the outputs % of people who sought post-rape care who received appropriate services (target 100%) % of estimated at risk adolescents receiving uninterrupted intervention for prevention of new HIV infection % of young people (10-24) in the affected areas reached through community-based awareness activities 6.2.1 Output Post rape care kits provided to health centres No. of kits provided No. and % of health facilities provided with kits Distribution reports Data Health Dept Field reports Data Health dept/partners Impact monitoring RTE Special/annual review

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Levels
6.2.2 Output Post exposure prophylaxis provided to health centres 6.2.3 Output Staff trained on use of post rape care kits and PEP 6.2.4 Output Participatory discussions conducted on the ABC of prevention 6.2.5 Output Population at risk linked to testing services 6.3 Outcome Prevention, care and treatment services for children, young people and women are continued

Indicators
No. of PEP provided to health centres No. and % of health facilities provided with PEP

Disaggregation

MoVs
Distribution reports Data Health Dept Field reports

No. and % of staff trained No. of participatory discussions Attendance to the discussions Gender/social status/age

Data health dept/partners Field reports Data health dept/partners Field reports Data health dept/partners Field reports

No. of people at risk linked to testing services Short term and medium term effects generated by the outputs % of young people (10-24), women and children in the affected areas informed about comprehensive HIV prevention and treatment opportunities No. and % of HIV positive pregnant women receiving uninterrupted ARV prophlaxis No. and % of estimated HIV positive pregnant women receiving uninterrupted PPTCT services % of estimated affected children receiving psychosocial and educational support

Data Health dept/partners Impact monitoring RTE Special/annual review

6.3.1 Output Young people and women are informed about comprehensive HIV prevention and treatment opportunties No. of young people and women informed Data health dept/partners Field reports

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Levels
6.3.2 Output Patients previously accessing PMTCT and ART are tracked and refered to health facilities for care, including prophylaxy for pregnant women,nutrition support and infant feeding counseling and support 6.3.3 Output If essential services are insufcient, advocacy activities are implemented for these services to be set up 6.3.4 Output Affected children benet from psychosocial and educationnal support

Indicators
No. of patients tracked and referred

Disaggregation

MoVs
Data health dept/partners Field reports

No. of advocacy activities implemented

No. of children beneting from psychosocial and educational activities

Data health dept/partners Field reports

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Month 3

Month 4

Month 5

Month 6

Month 7

Month 8

Month 9

Month 10

Month 11
X X X X
CCC

One-off surveys/Assessments Rapid Assessment (RA) Situation monitoring/analysis Shall be conducted on regular basis to update on the situation changes and feed into decision-making. Within 48 hours after the onset of the crisis Expanded RA to feed into mediumterm response,e.g a 100-day plan Timeline: 3-4weeks after the onset of the emergency at the latest X RA shall be repeated regularly. Frequency will depend on the evolution of the context

Technical surveys

Ad hoc periodic data collection based on a sampling of the population. Can be cross-sectoral or sector -focused : nutrition, health, etc. Ad-hoc or periodic exercises, either as routine data collection on the situation in general or on programmes.

Shall be conducted as soon as the situation allows it or if the situation dramatically deteriorates in a specic sector. The more structured and systematically led the data collection and eld trip reports are, the more they contribute to monitoring function. X X

Ongoing Monitoring Field visits X X X X X X X X X

Disease surveillance Nutritional monitoring & surveillance Distribution reports Impact monitoring

Monitoring of health data Monitoring of nutrition data

X X

X X

X X

X X

X X

X X

X X

X X

X X

X X

Monitoring of supplies, medicines, etc., to facilities and communities Assess programme impact during implementation, on a regular basis, in order to detect unintended and/ or negative effects of intervention, feed back on strategic programme orientation. Preferred tools would be: key informant interviews, groups interviews, community interviews

X X

Timing and frequency linked to RA and eld visits

Month 12
X X X

Activity types

M&E Objective

Comments

Month 1 Month 2

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Key partners data collection Health Department Education Department Monitoring of health related data Monitoring of education related data X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X

Social Welfare Monitoring of childs protection Department violations cases Partner NGO's Situation analysis (technical surveys, situation reports) and activities implemented on behalf of UNICEF Evaluation/reviews Real Time Evaluation Internal rapid review carried out early on in the response (usually between six weeks to 2 months after the onset of the emergency) in order to gauge effectiveness and to adjust or correct the manner in which the response is being carried out. Systematic and in-depth review of the intervention in relation to objectives and expected results. Can take the form of an externallyfacilitated CPE if there has been a dramatic change in country context. More evaluative than the RTE, it will be used to raise for example issues of relevance and impact, but also sustainability Major tools: Key informant (semi-structured) interviews, FGD. The Most Signicant Change Methodology and other PRA techniques can also be used bearing in mind the reduced timeframe and the need to look at process rather than impact.

X
X

Special Review

Annual Review

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ANNEXURE: RAPID ASSESSMENT FORMAT

RAPID MULTI-SECTORAL ASSESSMENT CUT OFF VILLAGES DAMAGE FORM Feed into CCC UNICEF perspective for programming
TYPE OF DISASTER: ASSESSMENT DATE AND TIME: AESSESSMENT BY:

Urban Area Assessed Affected Area/site

Rural Camp

WATSAN-HYGIENE Sector/s assessed: HEALTH EDUCATION LIVELIHOOD AFFECTED AREAS Village Worst Affected Affected Moderately Affected Any available Maps 1.b) AFFECTED POPULATION What is the approx number of people reported death or missing? Number of people displaced? From where? Number of children? How many people remain in your village? Population ow: Settlement Growing Getting smaller Are families separated? Vulnerable groups? Who are they? Gram Panchayat Block/Taluka

FOOD/NUTRITION SHELTER CHILD PROTECTION NON-FOOD ITEMS District

where people are going? Numbers?

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From District Administration

Est. no. of villages affected Est. no. of families affected Est. no. of persons affected Est. no. of women affected Est. no. of children affected Est. no of infants affected Est. no of elderly affected Est. no. of female headed HH Est. displaced population

VILLAGE

PANCHAYAT

TOWN/BLOCK

DISTRICT

STATE

1.c) PHYSICAL INFRASTRUCTURE IN THE AREA VISITED FOR ASSESSMENT

Roads Functional: Damaged: Destroyed: Est. time to repair: Remarks Rail Link Power Water Supply Communication Fuel pumps Others

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1.d) SOCIAL INFRASTRUCTURE IN THE AREA VISITED FOR ASSESSMENT

Primary School No. Existing: No. Functional: No. Damaged: No. Destroyed: No. Used as relief cetres/camps: Distance from the area visited: Capacity in terms of beds/persons: Remarks 1.e) Evacuation Status 1.f) Status on Search and Rescue Sec/High School Anganwadi Centers Health Centres/ dispensaries Hospital PDS Shops & Panchyat ofce Relief Shelters

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SECTION 2: FOOD, FOOD SECURITY & NUTRITION

2.a) Food Basket FOOD BASKET PER PERSON CURRENTLY AVAILABLE
ITEM QUANTITY Adequate (Yes/No) FROM WHERE WHO PROVIDES?

2.b) Households/Families in the Village Normal Food consumption patterns of the affected populations (No. of meals, etc.) Expected food availability trend among HH Food availability by categories of populations Is there equal distribution of food at the house hold level? Are there any people without food? For how long? Any difference between groups? 6m-3 yrs Next three weeks 3-6 yrs Pregnant Women Next month Lactating Mothers Others (Specify)

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2.c) Malnutrition Status Malnutrition rate among children under ve yrs and micronutrient deciencies? Total number of children 5 to 59months screened with MUAC? Number of children w/MUAC less than 110 mm? Number of children w/MUAC 111 -125 mm? Number of children w/Oedema? Out of the total SAM children identied, was any child given any treatment? Symptoms of malnutrition and micronutrient deciencies since the disaster Food (Yes/No) (If yes, give no. of children) Medicine (Yes/No) (If yes, give no. of children) Referral (Yes/No) (If yes, give no. of children)

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2.d Breastfeeding Infant feeding

% 0 to 6 EBF? % Has been a decrease in EBF? 2. d. 1 Complementary feeding? % 6 and above % Are they been given CF? % Any decrease noticed? Any supplementary food programme for children 6m to 6y, and pregnant and lactating mothers? Has any mother reported to have difculty in feeding her child? Lactation Age <6m 7 and above months Any special food items prepared or purchased by the household for the following groups? Infants Children 1-4 yrs Pregnant and lactating mothers For malnourished For micronutrient decient For 55 yrs plus people Lactation failure (Yes/No)

2.d) Cooking Facilities

From where to the families get water? Is there storage facility for water? Where do they cook? Is there separate place to wash? Is there any kitchen drain? Where to they dump the kitchen waste What type of fuel do they use? From where do they get the fuel? Are they families using Iodine salt? LPG Buy Kerosene Own Coal Collect Wood Relief Leaves Secure Source YES Kitchen YES YES NO Room NO NO Outside If yes, where is it located If yes, is it secure? Open and insecure source If yes, is it sufcient YES Others: NEARBY YES FAROFF NO NO

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2.e) Market
Availability of food in the market Access to the market? Market price of essential commodities Before After ANGANWADI CENTERS How far is the AWC nearby? Kms: Is the centre in working condition? Yes/No If no, what is the reason? If yes, does the centre have an AWW? Yes/No If yes, are children attending the AWC? Yes/No What services have been provided in past one week to mothers and children?

Cereals/Rice

Pulses

Oil

Sugar/spices/salt

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SECTION 3: WATER, HYGIENE AND SANITATION

3.a) SAFE DRINKING WATER
Total No. of units River Ponds Canal/stream Open Wells Handpumps Piped Systems Tanker/Truck Package drinking water Other Remarks/Notes on perceived quantity of water available/distance/access/safe 1) Do all groups are having access? 2) Are people have containers for water? How many nos and capacity of containers? (Observation on collection, storage and chances of contamination) 3) Is the water sufcient for all beneciaries? 4) Is the water safe for drinking? 5) Are sources protected and how? 6) Is the water being treated (ltration, boiling, chlorination) effectively? What is the extent and nature of damage to water system? Is there any effort/action been made to repair or disinfect handpumps? Functional Units Defunct Units Repairable units % of HH using Average distance Capacity Flow/access

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3.b) Household Level Water Consumption (ESTIMATED AVERAGE)

Quantity (ltrs) Average HH size Direct consumption Cooking Washing/cleaning Bathing Bathing cubicles Sanitation Source Distance Responsibility Storage Facility

3.c) Sanitation
Defecation practices Open Air Toilets If open air, how far is the place If toilets, are they being used now? (men/women/children) Type of toilets and cleanliness? Is water available for anal cleaning? % families using open space % of families having toilets How many toilets are there in the village? How far is the water source? Are the toilets secured?

Is the defecation practice a threat to water supplies? Do you nd evidence of human waste in the open? Notes/Remarks:

3.d) Hygiene
What is the traditional practice of hand washing (men/women/children)? Are they washing hands on at least four critical times? (before eating, before feeding children, before cooking, after defecation) Are hygienic items (soap, etc.) available? What is the bathing facility of women and does it provide adequate privacy? How is menstrual hygiene being managed?

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3.e) Waste Disposal

Do You nd evidence of sewage in open, both at household level and in general? Is there any solid waste disposal bins in the household level? Is there any existing waste collection and disposal mechanism? Is there any proper drainage facility at the household level or at the site? YES YES YES YES NO NO NO NO

Notes/Remarks:

3.f) Vector Borne Diseases

Is there any evidence/reporting of vector borne disease in the area If yes, what type of disease is reported? Malaria/Dengue/VL How many people are affected? Are there any existing vector control measures? If yes, what are they? YES NO YES NO

3.g) Shelter
Do households without male labour suffer a disadvantage? What shelter materials are locally available? Do people need to pay for these materials? Is there sufcient privacy and security for women? Do people have access to blankets and clothing if necessary? (Given the fact that winter season in approaching) Any response from government (Govt. has already declared to provide compensation in the range of Rs.45,000/- to 1,50,000/- towards repairing/re-construction of shelter), what is current situation? Is government assessing the shelter damage? Have they started giving compensation? (Please look into the social exclusion issues)

3.h) Environment
Is there any direct and visible impact of ood on the environment (land erosion; change in river course; loss of vegetation and plantation, land degradation due to prolonged water logging; pollution of water sources by debris, decomposed bodies, human waste, etc.) If livelihoods options were to become limited due to the ood, what are the possible likely impacts on the environment

256

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SECTION 4: HEALTH AND MEDICAL

What are the main morbidities? (Top 5) including measles, diarrhoeal disease, ARIs, malaria, injuries) and who is primarily affected? Deaths and causes (e.g. malnutrition, measles, injury, Acute Respiratory infection (ARIs), acute diarrhoea? Is the disease surveillance in place? Any outbreaks reported, IF YES investigation done, steps for containment undertaken? Any Supplementary Immunisation Activity(SIA) undertaken, if yes what and which age group for Measles? Vitamin A supplementation (look for Bitot spots) and age group? Last dose of VIT A to any 5 children? Nearest health facility available known to the population? If yes, is it operational? How do people access it? Any medical relief camp accessible to the population? How far from the village? HEALTH FACILITIES Initial data on physical damage to the assessed building/equipment? List any cold chain equipment that may have been destroyed? Name Number Capacity Location

Performance in service delivery: health camps, mobile teams. Approximate numbers of patients treated (above 5 and under 5), available and disease prole? Mobile Health Units Available with Govt NGOs UN Agencies

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Availability of services and manpower, shortages of drugs, syringes and other supplies. (Indicate specic commodities that are out of stock) Are more mobile health units required? If yes, for how long. Availability of medical professionals Availability of laboratories Access of populations to medical supplies and services? HIV AIDS Vulnerable groups: pregnant women? (Special emphasis on access to safe delivery services, HIV testing, Neverapine and essential newborn care (immunisation and breastfeeding). Access to HIV testing in case of emergency delivery/un booked/un registered cases) In which conditions? MATERNAL HEALTH Availability of facilities for deliveries How and where conducted? HR: Is there ANM, TBA, DAI? If not, who assists or helps in the deliveries? Need for Comprehensive Emergency Obstetric care? Where the woman is referred? Access to transportation? How, where? Emergency contraception? Status of animal medical facilities Mortality and morbidity status of livestock? And reasons. Unmeet needs for livestock health care

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Availability of essential medicines and medical consumables in the affected area Drugs IV fuilds Syringes and needles Blood bank ORS Vaccines Serums Contraceptives Dressing and bandages Surgical Supplies Antiseptics Disinfectants Blood transfusion and infusion sets Availability of capacity for correction of disabilities

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SECTION 5: NON-FOOD ITEMS

Total number of households needing assistance. How are people construct shelters? Materials used? Types and average numbers needed per household:

Items
Plastic Sheeting Clothing and type Washing/cleaning Transport Bed nets available? Cooking: Fuel/Stoves Heating Blankets/Quilts/Mattresses Family toilet kits/Hygiene kits Water containers for storage Cooking/kitchen utensils Disinfectants (Phenyl, Dettol, Chlorine, Bleaching powder, etc.)

Numbers (Approximate)

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SECTION 6: SITE AND SHELTER

No of families remaining on the site of their damaged/destroyed shelter Number of families displaced and accommodated by host families Number of families displaced and accommodated collectively within existing publicly or privately owned houses such as schools, temples, community houses, etc. Displaced and collectively settled in newly built relief camps/temp shelters. Availability and number of temporary shelters For people For livestock

Public buildings which are being used as temporary shelters and their capacity Types of temporary shelters Tents Polythene Sheets Tarpaulin Sheets Tin Sheets Straw and pullas

Accessibility of vulnerable and marginalized groups to temporary shelters Need for additional temporary shelters and their expected duration

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SECTION 7: LIVELIHOOD
Major livelihood pattern and options for the community Pre-ood Currently

Extent of damage to livelihood focal groups discussionsExtent of loss of employment opportunity and likely migration Coping mechanisms: What are people doing to help themselves? What kind of possessions are in the villages? Assess feelings (i.e anger, stress, incertitude) Is there a difference in between marginalized groups and general population? (needs, possessions, strategies)

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7.1) AGRICULTURE
1 2 3 4 Amount crop totally lost in the area. How much of the available land is cultivable? Where in the cropping cycles are farmers, e.g. harvest, preparation, planting Number of households still have the following: Current seasons crops(s) Multiple seasons crop(s) Seed stocks Labour sources Tools Livestock Market access Resources available for land reclaiming Damage to agricultural infrastructure (nance, seeds banks, marketing-corporatives) Status on irrigation facilities Current status of fodder availability 6 7 8 9 Improvements required (e.g. irrigation systems, storage facilities, fencing, terraces) What is the current response plan by the government to address the livelihood issues in the community? Are other agencies planning to respond? How? Are partners planning to respond? How?

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SECTION 8: EDUCATION AND COUNSELING

Extent of damage to school infrastructure Percentage of schools being used as relief centres Impact on educational and schooling activities Damage to educational material (books, uniform etc) Are children being engaged with other activities (labour, domestic help, etc) Are there alternative learning spaces? Are there teachers present/or volunteers in the villages? What are the others factors hindering resuming school and attendance of children/teacher? For how long the school is expected to remain closed? How would children complete their syllabus due to time lost Was Mid-day-meal provided in schools before ood? Is it feasible to restart the mid-day-meal? Is there any on-going educational activities for early childhood (Madarsa, Anganwadi, etc) Are there any especial vulnerable groups? Who are they, and what are their age, caste, sex, and numbers? Before ood were children going to school? What is the ratio of school going girls and boys who have no access to education? Views of different groups on resuming schools? Are the views different for girls and boys? What is the structure of family in this new environment and who is the decision maker regarding education particularly older age girls? Roles of different stakeholders like INGOs, PRI, communities, government, etc., in resuming schooling? Is learning in school relevant to the present situation? What other things children would like to do in this crisis?

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SECTION 9: CHILD PROTECTION

Are there children who are orphans or are unaccompanied (children with out parents or other care givers) in the village/community? What are the community support systems available for them? Are there children who have been separated from their parents/care givers? Are their parents looking for their children? Are there any obvious cases of trauma or psychological distress due to sudden loss of family members or personal belongings or just witnessing the oods (indicators of sleeplessness, nightmares, bedwetting, withdrawal, aggressive behaviour)? After oods, is there a signicant increase in the number of children and families moving away/migrating from the village? With whom are they moving? And why? Have people been found in the village promising jobs/marriage/better opportunities/ better safety and care especially for girls? Are there more strangers/unknown people present? Are children getting into child labour after the oods? Are there children being trafcked? Do you know of girls getting trafcked? Who do they go with? How do children pass their time? Has formal/informal schooling started? What is their daily routine? Is there a signicant difference in pre and post oods scenario? Have the care-giving patterns in the communities changed? Are adolescent girls putting themselves at risk to overcome the situation of distress? Are there any cases of abuse reported in the communities (physical, emotional, sexual and neglect)? In cases of abuses reported, what would you do? Who would you talk to? Is there anybody in the community who is monitoring and responding to these protection issues? Are there people/agencies (teachers, NGOs etc.) that are addressing CP issues in the village? Are there opportunities in place for parents to discuss and seek support for distressing difculties that they and their children must deal with? Are there youth groups/childrens groups which engage children in various activities? Are there groups of children more vulnerable than others? Who are they? What is the demographic information with regard to caste and class? What is the situation postood? Does it have any implications on how children are treated?

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Womens Protection

What are the major differences in women and mens roles in the current situation, and the difference in roles before the ooding? (E.g. increase in vulnerability in terms of work load, domestic violence, and sexual exploitation?) What are the major difculties women are facing? What are their specic needs? Has or will the current and emerging situation affect womens income? What impact has the current situation brought in their status within the family and community? What are their suggestions to improve the living conditions, health, food, livelihoods and other protection concerns? What do most women do during the day? Do any of them have jobs earning money? What opportunities are there of earning income (that do not involve exchanging sex for money and resources)?

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SECTION 10: PROGRAMME COMMUNICATION

Behavioural Assessment Checklist (please put a
Desired behaviour

as applicable)
Possible barriers Lack of knowledge Not perceived as important No support from family, others No visible communication effort No service/ supply/ facility Stress/ shock (*) Others (specify)

Lactating mothers are breastfeeding Families are using ORS to treat diarrhoea Caregivers allowing children to be immunised Users treating/consuming safe water People wash hands with soap/ash after defecation/ before eating Adults/children using sanitary latrines Children are going to school/participate in camp-based activity Care givers are able to prevent children from being trafcked/migrating parents are playing with young children (0-5 yrs)

(*) It will be useful to probe this as mothers often complain of lack of lactation and hence inability to breastfeed due to stress and shock. C Key questions in PC
Are there community groups available for communication efforts (NGOs, CBOs, PRI, volunteers)? Do these groups/individuals have any training on interpersonal communication/social mobilisation? What IEC materials are available at the relief site? Is there anywhere to store communication materials? What communication channels currently exist at the relief site print, radio, TV, mobile phones Is the locality conducive for the following communication options hoardings, folk media, miking, banners, video vans, wall paintings? What is the level of understanding of HIV/risk perception especially among young people? SECTION 10: UNMEET NEEDS

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SECTION 11: KEY CONTACT DETAILS

Administration/Local Leadership (please give name, designation and contact details, if any)
State Relief Authority:

District Relief Authority:

Block Relief Authority/dealing ofcer:

Panchayat/Municipal President:

Village level representative:

Local leadership 1:

Local leadership 2:

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SECTION 12: INFORMATION ON ASSESSMENT PROCESS AND METHODOLOGY

No. of people interviewed
Interview with local affected persons Interview with local leaders Interview with elected representatives

Male

Female

Children

Category of leadership

No.
Interview with government ofcers

Male

Female

Category of representative

Place and time

Focus Group Discussions

No. of participants (male/female/child)

Remarks

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LIST OF ABBREVIATIONS
ANM ASHA AP APL AWC AWW BCC BCG BPHC BPL CCC CEmOC CHC CP CSO DCPU DPT EPRP EW/EA FRU GP ICDS IDSP IEC IFA ILR INEE IV JSY Auxiliary Nurse Midwife Accredited Social Health Activist Andhra Pradesh Above Poverty Line Anganwadi Centre Anganwadi Worker Behaviour Change Communication Bacillus Colmmette Guerin Block Primary Health Centre Below Poverty Line Core Commitments for Children in Emergencies (UNICEF) Comprehensive Emergency Obstetric Care Community Health Centres Child Protection Civil Society Organisation District Child Protection Unit Diphtheria Tetanus Pertussis Emergency Preparedness and Response Planning Early Warning/Early Action First Referral Unit Gram Panchayat Integrated Child Development Services Integrated Disease Surveillance Programme Information, Education and Communication Iron and Folic Acid Ice Line Refrigerator Inter-agency Network of Education in Emergencies Intra-Venous Janani Suraksha Yojana MAM MP MSA MUAC NGO NICED NREGA OPD OPV ORS OT PDS PHC PHED PRI SAM SC SHG SMART SNP SSK ST TOR UP URS WASH WES WFP Medium Acute Malnutrition Madhya Pradesh Multi-Sectoral Assessment Mid Upper Arm Circumference Non-Governmental Organisation National Institute of Cholera and Enteric Diseases National Rural Employment Guarantee Act Out-Patient Department Oral Polio Vaccine Oral Rehydration Salts Operating Theatre Public Distribution System Primary Health Centre Public Health Engineering Department Panchayati Raj Institution Severe Acute Malnutrition Scheduled Caste Self Help Group Standardised Monitoring and Assessment of Relief Transactions Supplementary Nutrition Programme Sarva Shiksha Kendra Scheduled Tribe Terms Of Reference Uttar Pradesh Unied Approach Strategy Water, Sanitation and Hygiene Water and Environment Sanitation World Food Programme

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Annexure

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NOTES:

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THE FIRST RESPONSE

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