( By WHO - OMS, 1999 )

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10-Conducting the assessment

The assessment can be carried out either at national level, as in preparing a consolidated appeal for humanitarian assistance, or at subnational, provincial, district or local levels. With some differences, the categories of data needed for each level of assessment are the same: in Box 5 on p. 85 there is a form which has recently been used for rapid health assessment at local level in Bosnia and Herzegovina, and that can be adapted to other situations.

As the background explains, complex emergencies usually involve population displacement and at least the risk of famine. Therefore, this protocol is to be used in conjunction with Chapter 7 and Chapter 8.

Information can be collected from existing documents, interviews, visits to the affected areas (see Chapters 1, 7, and 8). The information collected from NGOs, the United Nations, other international organizations, and the media will be particularly relevant in complex emergencies.

The rapid assessment consists of: describing the conflict, the affected area and the population, assessing the health outcome, the specific variables, and existing resources and additional immediate needs.

Describing the conflict, the affected area, and the population

To put health needs in perspective within the context of complex emergencies, information about the following is needed:

- duration of the conflict;
- state and progress of political negotiations (e.g. discussions for cease-fire);
- patterns of violence;
- accessible population;
- inaccessible population;
- inaccessible areas;
- occurrence of epidemics;
- occurrence of starvation; and
- general economic situation.

Assessing the health outcome

This is done by looking at crude and under-five mortality rates and causes, cause-specific morbidity and acute malnutrition rates, at least for the most severely affected areas or groups.

Assessing the variables

Information on the following points will help identify priorities and outline programmes for intervention in the short and medium term.

Violence and security

Information should be collected on:

- deaths and injuries from violence;

- deaths and injuries from landmines;

- occurrence of sexual violence;

- occurrence of torture;

- attacks on health personnel and response and recovery operators;

- attacks on health facilities; number and percentage of health facilities destroyed, closed or inaccessible;

- attacks on water systems;

- attacks on agriculture, food-processing, storage and distribution systems;

- attacks on response and recovery convoys;

- attacks on other lifeline systems: electricity, public transport, communications; and

- use of other inhumane weapons (e.g. biological and chemical).

Population displacement

Information should be collected on occurrence and numbers involved (see Chapter 7):

- internally displaced persons (IDPs);
- refugees in neighbouring countries;
- actual and expected movements (voluntary repatriations, foreseen returns);
- unaccompanied children;
- existence of IDP camps; and
- concentrations in urban areas (e.g. rates of urban growth).

Loss of production, food stocks, purchasing power, and commerce

Information should be collected on the loss of production, stocks of food, purchasing power and commerce (see Chapter 8).

Assessing local response capacity and immediate needs

Local response capacity and immediate needs should be assessed to determine the type and quality of external support required. As far as possible this information should be collected by province or district (see Chapter 7).

Health networks and programmes

The following information should be gathered on health networks and programmes:

- national health strategies addressing the emergency;
- percentage of working health facilities;
- geographical distribution of national health personnel (are they also displaced?);
- function of health information system (at least epidemiological and nutritional surveillance);
- availability and performance of primary health care services and programmes;
- capacities for surgery and trauma care;
- state of blood bank and transfusion safety;
- national and international organizations andNGOs: health projects and areas of coverage;
- military health assets (as far as possible, of all conflicting parties);
- sectoral coordination mechanisms;
- health training activities;
- salaries of national health personnel;
- share of state budget allocated to health; and
- international assistance to the health sector.

Environment and infrastructure

Information should be collected on the following:

- susceptibility to (history of) natural technological hazards;
- percentage of functioning water systems (urban, rural, IDP camps);
- percentage of working sanitation systems (urban, rural, IDP camps);
- state of roads, bridges, airports, etc.;
- percentage of buildings destroyed, public and private;
- presence of unexploded landmines and ordnance;
- geographical and climatic features; and
- prevalence of endemic diseases, vectors, etc.

Humanitarian assistance

The following points should be considered when assessing the humanitarian assistance being offered and planning for future provision of humanitarian assistance:

- composition of humanitarian assistance package (food and non-food);

- special humanitarian assistance programmes (demobilization, mine-awareness, and demining);

- access to the territory (road convoys, river and sea shipping, airlifts and airdrops, “humanitarian corridors”, “windows of peace”, etc.);

- patterns of aid distribution (i.e. by government, NGOs, the United Nations), timetable, coverage and logistic network;

- communication network;

- security requirements and assets;

- coordination mechanisms;

- procedures for international aid agreements;

- rights and authorizations for movements of people and goods (overflight, transit, landing);

- customs regulations, clearance, and waivers;

- mobilization of resources (projects, appeals, and donors’ response); and

- general budget for humanitarian assistance (at least data from latest appeal and, if possible, trends).