Summary of the crisis overall judgment of humanitarian situation and the severity of needs identified short-term outlook (whether the crisis is worsening or becoming less serious) underlying causes of problems and risks threats to security (natural hazards, population movements, armed groups, etc.) population groups that are inaccessible (and if so, why) risk factors that could worsen humanitarian conditions or impede relief operations (bad weather, insecurity etc.) Problems and priorities identified by the affected population SECTION 1 – POPULATION DESCRIPTION Key issues identified, by section, by severity ranking Key for severity ranking Red Severe situation: urgent intervention required Orange Situation of concern: surveillance required Yellow Lack of/unreliable data: further assessment required Green Relatively normal situation or local population able to cope with crisis; no action required Section R O Y G Key issues identified (maximum of 3) Recommendations Population Sites and shelter Essential non-food items Water supply Sanitation
Blankets and bedding □ □ □ □ □ Cooking utensils □ □ □ □ □ Plastic sheeting □ □ □ □ □ 2.4.2 Main types of fuel used for cooking and heating Is there enough cooking fuel? Is there enough heating fuel? □ Firewood □ Petrol □ Yes □ Yes □ Coal □ Gas □ No □ No □ Diesel □ Other (specify) _________ □ DNK □ DNK 2.5 What are the priorities expressed by the population concerning shelter and non-food items? SECTION 3 WATER SUPPLY, SANITATION AND HYGIENE 3.1 Resource persons and other information sources 3.2 Existing capacities and activities Organisation or person(s) responsible Since when? Normal/current activities Limitations to capacity or performance (lack of staff, materials and equipment, funds, access etc.) 3.2.1 Water supply 3.2.2 Sanitation 3.2.3 Hygiene 3.3 Water supply Water resources: note in this table, data concerning sources of water available for the population at the site 3.3.1 Number of water sources of each type 3.3.2 Water source most used for human consumption at this site 3.3.3 Water source most used for animal at this site 3.3.4 Any water sources producing water 3.3.5 Any sources for which the quantity of water available will fall in the near future Borehole or well with functioning motor pump □ □ □ □
4.2.1 Management of severe acute malnutrition (facility or community based) □ Inpatient therapeutic feeding (TF) only □ In- & outpatient TF □ Outpatient TF only 4.2.2 Management of moderate acute malnutrition □ Selective supplementary feeding □ Blanket supplementary feeding 4.2.3 Micronutrient supplementation programs (e.g., vitamin A, iron) □ Yes □ No 4.2.4 General food distribution □ Yes □ No 4.2.5 Other nutrition programs Specify _________ 4.3 Changes in the total amount of food that people are eating since the crisis began, on average □ Amount consumed has increased □ Amount consumed is the same □ Amount consumed has decreased □ DNK 4.4 How many people in the community currently have food stocks in their households? □ Most □ About half □ Some □ None □ DNK 4.5 On average, how long will food stocks last in the households, according to the community? Cereals and roots/tubers □ less than 1 week □ 1-2 weeks □ more than 2 weeks Pulses and legumes □ less than 1 week □ 1-2 weeks □ more than 2 weeks Oils and fats □ less than 1 week □ 1-2 weeks □ more than 2 weeks 4.6 Does the community have physical access to functioning markets? □ Yes □ No □ DNK 4.7 Have infant milk products and/or baby bottles/teats been distributed since emergency? □ Yes □ No If YES, by whom? ______________ 4.8 What percentage of infants in your area are formula fed/formula dependent? □ None □ Less than 10% □ 10-25% □ More than 25% □ DNK 4.9 Has the community/health staff identified any problems in feeding children <2 years since crisis started? □ Yes □ No If YES, what problems? ______________ 4.10 Describe the current livelihood/food situation in this area 4.10.1 What are the major livelihoods in the area? 4.10.2 Has the crisis had an impact on livelihoods,
*including severe anaemia, hypertension, pre-eclampsia, eclampsia, and diabetes. SECTION 6 Health Facility Assessment (fill one per facility visited) 6.1 General information 6.1.1 Name of facility 6.1.2 GPS location in decimal digress Contact : 6.1.3 Facility type 6.1.4 Management □ Hospital □ Health centre □ Health post □ Other □ Ministry of Health □ NGOs □ Other (specify) 6.1.5 Is facility temporary or permanent? 6.1.6 Has facility been damaged? □ Temporary □ Permanent □ Yes □ No 6.1.7 Physical access to facility (check one): 6.1.8 Financial access to facility (check one) □ Easy □ With obstacles (Explain) □ Very difficult (Explain) Distance in km: …… Number of hours by normal means of transport (specify): ….. □ Free of charge □ Small payment (Explain) □ Large payment (Explain) Cost per consultation in local currency: …… 6.1.9 Name and type of closest referral facility? 6.1.10 Are vehicles or other means of transport available for referrals? □ Yes □ No □ DNK 6.1.11 Are community-based health services delivered in the catchment area of the health facility? If yes, who provides & how many? □ Yes □ No □ # _____ village midwives □ # _____ community health worker(s) □ # _____ traditional healer(s) □ # _____ others (specify) _________ 6.2 Resources 6.2.1 Who provides health care in this facility? (Check all that apply) # staff # consultations/day # staff # □ Nurse □ Midwife □ Medical doctor □ Lab technician □ Medical assistant □ Public health officer □ Vaccinator □ Other ______ 6.2.2 Essential drugs, vaccines and supplies Available Unavailable Available Unavailable Antibiotics Tetanus toxoid ORS Measles Anti-malarials DPT