The Interagency Emergency Health Kit 2006

Publication date: 2006

      WHO/PSM/PAR/2006.4 Ecumenical Pharmaceutical Network   International Organization for Migration   United Nations Population Fund The Interagency Emergency Health Kit 2006 Medicines and medical devices for 10,000 people for approximately 3 months An interagency document     The Interagency Emergency Health Kit 2006   ii First edition 1990  Reprinted 1992  Second edition 1998  Third edition 2006      Each agency collaborating in the distribution and use of the interagency emergency health  kit will support the implementation of the interventions recommended in this booklet only  in so far as they are consistent with the existing policy and mandate of that agency.            © World Health Organization 2006 All  rights  reserved.  Publications  of  the  World  Health  Organization  can  be  obtained  from  Marketing  and  Dissemination,  World  Health  Organization,  20  Avenue  Appia,  1211  Geneva  27,  Switzerland  (tel: +41 22 791 2476; fax: +41 22 791 4857; email: Requests for permission to reproduce or  translate  WHO  publications  –  whether  for  sale  or  for  noncommercial  distribution  –  should  be  addressed  to  Publications, at the above address (fax: +41 22 791 4806; email:     The designations employed and the presentation of the material in this publication do not imply the expression of  any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,  territory,  city or area or of  its authorities, or  concerning  the delimitation of  its  frontiers or boundaries. Dotted  lines on maps represent approximate border lines for which there may not yet be full agreement.    The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or  recommended  by  the  World  Health  Organization  in  preference  to  others  of  a  similar  nature  that  are  not  mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital  letters.    The World Health Organization and the organizations listed on the title page do not warrant that the information  contained in this publication is complete and correct and shall not be liable for any damages incurred as a result  of its use.    Acknowledgments   iii Acknowledgments The following individuals and organizations contributed to the development of this revision  and their advice and support are gratefully acknowledged.    United Nations High Commissioner for Refugees (UNHCR): Nadine Ezard, Tsegereda  Assebe, Nadine Cornier  United Nations Childrenʹ Fund (UNICEF):  Murtada Sesay, Monique Supiot,   Hanne Bak Pedersen  Joint United Nations Programme on HIV/AIDS (UNAIDS): Françoise Renaud‐Théry    United Nations Population Fund (UNFPA):  Wilma Doedens, Thidar Myint  United Nations Development Programme/Inter‐Agency Procurement Services Office  (UNDP/IAPSO):  Jack Gottling  World Bank:  Yolanda Tayler, Juan Rovira   International Committee of the Red Cross (ICRC):  Stephanie Arsac‐Janvier   International Federation of Red Cross and Red Crescent Societies (IFRC):  Hakan  Sandbladh, Birgitte Olsen, Adelheid Marschang  International Office for Migration (IOM): Sajith Gunaratne, Daniel Grondin,   Stéphanie Krause  International Pharmaceutical Federation (FIP):  Xuan Hao Chan, Satu Tainio   WHO/Roll Back Malaria (RBM): Andrea Bosman, Charles Delacollette, Peter Olumese,  Aafje Rietveld, Maryse Dugué, David Bell (WHO Regional Office for the Western Pacific)  WHO/Contracting and Procurement Services (CPS):  Françoise Mas, Paul Acriviadis  WHO/Health Action in Crises (HAC):  Elisabeth Pluut, Christine Chomilier   WHO/Reproductive Health and Research:  Margaret Usher‐Patel   WHO/Making Pregnancy Safer (MPS):  Rita Kabra  WHO/Medicines  Policy  and  Standards  (PSM):    Hans  Hogerzeil,  Marthe  Everard,   Sophie Logez, Shalini Jayasekar, Clive Ondari, Willem Scholten  WHO/Child  and  Adolescent  Health  and  Development  (CAH):    Olivier  Fontaine,   Shamim Qazi, Martin Weber  WHO/Control of Neglected Tropical Diseases (NTD):  Pamela Mbabazi, Michelle Gayer  Médecins Sans Frontières:  Myriam Henkens, Olivier Raemdonck, Christa Hook,   Jean‐Marie Kindermans, Michel van Herp  Save the Children (UK):  Elizabeth Berryman   John Snow, Inc. (JSI): Carolyn Hart, Paula Nersesian  The Interagency Emergency Health Kit 2006   iv Ecumenical Pharmaceutical Network (EPN): Eva Ombaka  Merlin:  Elizabeth Berryman (previously with Save the Children, UK)  International Dispensary Association (IDA):  Connie van Marrewijk, Michiel de Goeje  Missionpharma:  Jens Rasmussen  Centrale Humanitaire Médico‐Pharmaceutique (CHMP): Alasanne Ba  Medical Export Group: Klaas‐Jan Koning    Special thanks are due to Dr Robin Gray (WHO/PSM) who until his retirement was the focal  point for coordinating the content updates of the last two emergency health kits.      List of contents   v Contents Acknowledgments .iii Introduction .1 Chapter 1. Essential medicines and medical devices in emergency situations.3 What is an emergency? .3 Principles behind the IEHK 2006.3 Composition of IEHK 2006.4 Referral system.5 Immunization and nutrition in emergency.5 Reproductive health .6 Malaria .7 HIV, AIDS, tuberculosis and leprosy.7 Procurement of IEHK 2006.7 Post‐emergency needs.7 Chapter 2: Selection of medicines and medical devices included in IEHK 2006.9 Selection of the medicines for IEHK 2006 .9 Medicines not included in IEHK 2006 .10 Selection of medical devices for IEHK 2006.10 Selection of equipment.11 Medical devices not included in IEHK 2006 .11 Major changes in content since the 1998 edition of the emergency health kit .12 Chapter 3: Content of IEHK 2006 .13 10 basic units ‐ for health care workers with limited training.13 One supplementary unit ‐ for physicians and senior health care workers.13 Basic unit (for 1,000 people for 3 months) .14 Supplementary unit (for 10,000 people for 3 months).16 Annex 1: Basic unit: treatment guidelines.23 Anaemia.23 Pain .24 Diarrhoea .24 Fever .27 Respiratory tract infections .28 Measles.28 ʺRed eyeʺ condition .28 Skin conditions.29 Sexually transmitted and urinary tract infections.29 Preventive care in pregnancy.29 Annex 2. Assessment and treatment of diarrhoea .31 A‐2.1 Assessment of diarrhoeal patients for dehydration.31 A‐2.2  Treatment of acute diarrhoea (without blood) .32 A‐2.3 Treatment Plan B: oral rehydration therapy for children   with some dehydration.34 A‐2.4  Treatment Plan C: for patients with severe dehydration .37 The Interagency Emergency Health Kit 2006   vi Annex 3: Management of the child with cough or difficult breathing.39 A‐3.1  Assess the child.39 A‐3.2  Decide how to treat the child .39 A‐3.3  Child less than two months old .40 A‐3.4  Child two months to five years old.41 A‐3.5  Treatment instructions .42 Annex 4: Sample data collection forms.45 Annex 5: Sample health card .49 Annex 6.  Guidelines for suppliers.51 Specifications for medicines and medical devices .51 Packaging.51 Packing list.52 Information slips.52 Annex 7.  Other kits for emergency situations .55 Immunization.55 Nutrition .55 Reproductive health .56 Annex 8. Guidelines for Drug Donations .59 Selection of drugs .59 Quality assurance and shelf‐life .60 Presentation, packing and labelling .61 Information and management .62 Annex 9. Model Regulatory Aspects of Exportation and Importation of  Controlled Substances .63 Introduction.63 Standard procedure for international transfer of narcotic and psychotropic substances.64 Procedure to be followed in disaster relief.64 Outline of standard agreement between supplier and control authorities of exporting  countries.66 Shipment request/notification form for emergency supplies of controlled substances.68 Annex 10. References.71 Medicines.71 Medicine management.71 Communicable diseases.71 General public health .72 Child health .72 HIV and STIs .72 International travel and health .72 Malaria .72 Mental health.73 Nutrition .73 Reproductive health .73 Tuberculosis .73 Annex 11. Useful addresses.75 Partners .75 Suppliers .78 Feedback form .81   Introduction   1 Introduction The  organizations  and  agencies  of  the  United  Nations  system  and  international  and  nongovernmental organizations are called upon to respond to an increasing number of large‐ scale emergencies and disasters, many of which pose a serious threat to health. Much of the  assistance  provided  in  such  situations  is  in  the  form  of  medicines  and  medical  devices  (renewable and equipment).    During  the  1980s,  the  World  Health  Organization  (WHO)  took  up  the  question  of  how  emergency  response  could  be  facilitated  through  effective  emergency  preparedness  measures. The aim was to encourage the standardization of medicines and medical supplies  needed in emergencies to permit a swift and effective response with medicines and medical  devices  using  standard,  pre‐packed  kits  that  could  be  kept  in  readiness  to  meet  priority  health needs in disaster situations.    The  Interagency Emergency Health Kit 2006  (IEHK 2006)  is  the  third edition of  the WHO  Emergency Health Kit which was the first such kit when it was launched in 1990. The second  kit,  ʺThe New Emergency Health Kit 98ʺ was revised and  further harmonized by WHO  in  collaboration  with  a  large  number  of  international  and  nongovernmental  agencies.  This  updated  third  edition  takes  into  account  the  global  HIV/AIDS  epidemic,  the  increasing  parasite resistance to commonly available antimalarials and the field experience of agencies  using the emergency health kit.    Over  the  years  the  concept  of  the  emergency  health  kit  has  been  adopted  by  many  organizations  and  national  authorities  as  a  reliable,  standardized,  affordable,  and  quickly  available source of the essential medicines and medical devices (renewable and equipment)  urgently needed  in  a disaster  situation.  Its  content  is based on  the health needs of  10,000  people for a period of three months.    This  document  provides  background  information  on  the  composition  and  use  of  the  emergency  health  kit.  Chapter  1  describes  supply  needs  in  emergency  situations  and  is  intended  as  a  general  introduction  for  health  administrators  and  field  officers. Chapter  2  explains the selection of medicines and medical devices ‐ renewable and equipment ‐ which  are  included  in  the  kit  and  also  provides more  technical details  intended  for  prescribers.  Chapter 3 describes  the composition of  the kit, consisting of  the basic and complementary  units.  The  annexes  provide more  details  on  treatment  guidelines,  sample  forms,  a  health  card, guidelines for suppliers, other kits for emergency situations, guidelines for medicines  donations,  a  standard  procedure  for  importation  of  controlled medicines,  references,  and  useful addresses. A feedback form is also included to report on experiences when using the  emergency health kit and to encourage comments and recommendations on the contents of  the kit from distributors and users for consideration when updating the contents.    The Interagency Emergency Health Kit 2006 2 The WHO Department of Medicines Policy and Standards (formerly known as the  Department of Essential Drugs and Medicines Policy) has coordinated the review process  and has published this interagency document on behalf of all collaborating partners.        Essential medicines and medical devices in emergency situations   3 Chapter 1. Essential medicines and medical devices in emergency situations What is an emergency? The  term “emergency”  is applied  to various situations resulting from natural, political and  economic disasters. The Interagency Emergency Health Kit 2006 (IEHK 2006) is designed to  meet  the  initial  primary  health  care  needs  of  a  displaced  population  without  medical  facilities, or a population with disrupted medical  facilities  in  the  immediate aftermath of a  natural disaster or during an emergency.  It must be emphasized  that, although  supplying  medicines,  medical  devices  (renewable  and  equipment)  in  standard  pre‐packed  kits  is  convenient early in an emergency, specific local needs must be assessed as soon as possible  and further supplies must be ordered accordingly.  Medicine and medical device needs in the context of an emergency situation The practical impact of many well‐meaning donations and support sent in emergencies has  often  been  diminished  because  the  supplies  did  not  reflect  real  needs  or  because  requirements were  not  adequately  assessed. Often  this  resulted  in donations  of unsorted,  unsuitable,  inadequately  labelled and  expired medicines and other medical devices which  could not  all be used  at  the  receiving  end. The  Interagency Guidelines  for Drug Donations,  revised in 1999, describe ʺgood donation practicesʺ and promote the principles necessary for  improved quality medicine donations. More detailed information is provided in Annex 8.    Morbidity  patterns  may  vary  considerably  between  emergencies.  For  example,  in  emergencies  where  malnutrition  is  common,  morbidity  rates  may  be  very  high.  For  this  reason  an  estimate  of  medicine  requirements  can  only  be  approximate,  although  certain  predictions can be made based on previous experience.  Principles behind the IEHK 2006 IEHK 2006 is designed principally to meet the first primary health care needs of a displaced population without medical facilities. Its content is a compromise and there will always be some items which do not completely meet requirements. An ideal kit can only be designed with an exact knowledge of the population characteristics, disease prevalence, morbidity patterns and level of training of those using the kit.   The Interagency Emergency Health Kit 2006 4 IEHK 2006 consists of two different sets of medicines and medical devices, named a basic unit  and  a  supplementary  unit.  To  facilitate  distribution  to  smaller  health  facilities  on  site,  the  quantities  of  medicines  and  medical  devices  in  the  basic  unit  have  been  divided  into  10 identical units for 1,000 people each.  Terminology Confusion has arisen over the words ʺkitʺ and ʺunitʺ. In this context, a kit refers to 10 basic  units plus one supplementary unit as explained in Figure 1.    Figure 1: Composition of IEHK 2006    1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000   1,000 } 10 x 1 basic unit for 10 x 1,000 people 10,000 } 1 supplementary unit for 1 x 10,000 people } Total: 1 emergency health kit for 10,000 people for 3 months Basic unit The  basic  unit  contains  essential  medicines  and  medical  devices  for  primary  health  care  workers  with  limited  training.  It  contains  oral  and  topical  medicines,  none  of  which  are  injectable. Combination  therapy  for  the  treatment  of uncomplicated  falciparum malaria  is  provided unless there is a specific request not to include it in the kit.    Standard  treatment guidelines, based on symptoms, have been developed  to help primary  health care personnel use the medicines rationally and these can be found in Annexes 1 to 3.  Two printed copies of this publication  in English, French and Spanish are  included  in each  basic  unit. Additional  printed  copies  can  be  obtained  from  the Department  of Medicines  Policy and Standards, WHO, Geneva,  see Annex 10. Electronic  copies  can be downloaded  from the web site:  Supplementary unit The supplementary unit contains medicines and medical devices for a population of 10,000  and is to be used only by professional health workers or physicians. It does not contain any  medicines  or devices  from  the  basic  unit  and  can  therefore  only  be  used when  these  are  available  as well. Modules  for malaria  and  for patient post‐exposure prophylaxis  (Patient  PEP) are provided unless there is a specific request not to include them in the kit.    The supplementary unit does not contain any medicines or medical devices from the basic units. The supplementary unit should only be used together with one or more basic units. Selection of medicines The  selection of medicines  in  the kit has been based on  treatment  recommendations  from  technical  units  within WHO.  A  manual  describing  the  standard  treatment  guidelines  for  Essential medicines and medical devices in emergency situations   5 target  diseases  was  developed  through  collaboration  between  Médecins  Sans  Frontières  (MSF) and WHO. Two copies of the manual in English, French and Spanish are included in  each  supplementary  unit.  Additional  printed  copies  can  be  obtained  from  MSF,  see  Annex 11.  Quantification of medicines The estimation of medicine requirements in the kit has been based on:    1. the average morbidity patterns among displaced populations;  2. the use of standard treatment guidelines;  3. figures provided by agencies with field experience.    The quantities of medicines supplied will therefore only be adequate if prescribers follow the  standard treatment guidelines.  Referral system Health  services  can  be  decentralized  by  the  use  of  basic  health  care  clinics  (the  most  peripheral  level  of  health  care)  providing  simple  treatment  using  the  basic  units.  Such  decentralization will: (1) increase the access of the population to curative care; and (2) avoid  overcrowding  of  referral  facilities  by  treating  common  health  problems  at  the  most  peripheral  level.  Standard  treatment  guidelines  included  in  the  kit  will  provide  primary  health care workers with information to enable them to take the right decision on treatment  or referral, according to the symptoms.    The first referral level should be staffed by professional health care workers, usually medical  assistants or doctors, who will use medicines and medical devices  from both  the basic and  supplementary units.    It should be stressed here that the basic and supplementary units are not intended to enable  these health care workers  to  treat rare diseases or major surgical cases. For such patients a  second  level of  referral  is needed, usually a district or general hospital. Such  facilities are  normally part of the national health system and referral procedures should be arranged with  the local health authorities.  Immunization and nutrition in emergency situations IEHK 2006 is not designed for immunization or nutritional programmes: kits covering immunization and nutritional requirements may be ordered after an assessment of needs (see Annex 7).   Experience in emergencies involving displaced populations has shown that measles is one of  the  major  causes  of  death  among  young  children.  The  disease  spreads  rapidly  in  overcrowded conditions, and serious respiratory tract infections are frequent, particularly in  malnourished children.    The Interagency Emergency Health Kit 2006 6 Measles vaccine administration should  therefore be given a high priority, with all children  between six months and five years old being  immunized. Children  immunized before nine  months should be re‐immunized as soon after nine months as possible. All children  in  the  target age group should be immunized, irrespective of history.    Children with clinical measles should be  treated promptly  for complications, enrolled  in a  supplementary feeding programme and given appropriate doses of vitamin A.  Reproductive health IEHK 2006 is not designed for reproductive health services: reproductive health kits for emergencies may be ordered after a basic assessment of needs (see Annex 7).   A number of priority reproductive health interventions have been defined as essential for a  displaced  population  during  an  emergency.  The  Minimum  Initial  Service  Package  for  Reproductive Health  (MISP)  is  a  coordinated  set  of  activities,  including  the  provision  of:  emergency obstetric care to prevent excess neonatal and maternal morbidity and mortality;  provisions  to  reduce  HIV  transmission;  and  activities  to  prevent  and  manage  the  consequences of sexual violence.    Professional midwifery care is an essential service for which the necessary instruments and  medicines  are  included  in  the  kit. A  small  quantity  of magnesium  sulfate  for  severe pre‐ eclampsia  and  for  eclampsia  is  included  in  the  supplementary unit  for use  as  a  ʺholdingʺ  measure prior to referral.    The  use  of  emergency  contraception  is  a  personal  choice  that  can  only  be  made  by  the  woman  herself.  Women  should  be  offered  counselling  on  this  method  so  as  to  reach  an  informed  decision.  A  health  worker  who  is  willing  to  prescribe  ECPs  should  always  be  available to prescribe them to rape survivors who wish to use them.1    In  the  context  of  patient  post‐exposure  prophylaxis  (Patient  PEP),  a  limited  quantity  of  medicines  for:  (1)  presumptive  treatment  of  sexually  transmitted  infections,  including N.  gonorrhoea and C. trachomatis; for (2) prevention of transmission of human immunodeficiency  virus  (HIV);  and  (3)  prevention  of  pregnancy  (emergency  contraception)  for  survivors/  victims of sexual assault (rape), is included in the kit.    Supplies  for  routine  and  general  treatment  of  sexually  transmitted  infections  and  contraception will have to be ordered separately according to need (see Annex 7).    Comprehensive  reproductive health services need  to be  integrated  into  the primary health  care system as soon as possible and a referral system for obstetric emergencies must be made  accessible to the population. It is also recommended that a qualified and experienced person  be appointed as reproductive health coordinator.                                                           1   Clinical management of rape survivors. Developing protocols for use with refugees and internally displaced persons. Revised edition. Geneva: World Health Organization; 2004. Essential medicines and medical devices in emergency situations   7 To  assist  the  implementation  of  a  reproductive  health  programme,  the  Inter‐Agency  Working Group on Reproductive Health in Emergencies (IAWG) has designed a number of  reproductive health kits  for  all  levels of  the health  care  system during  an  emergency  (see  Annex 7). The kits can be ordered through the United Nations Population Fund (UNFPA)    IEHK 2006 will always be supplied with a Patient PEP module unless there is a specific request not to include these items at the time of ordering. Malaria In  recent  years,  the  pace  of  parasite  resistance  against  the  safest  and  least  expensive  antimalarials  has  been  accelerating.  A  new  approach  to  combat  malaria  is  combination  therapy. Artemether + lumefantrine is the first fixed‐dose antimalarial combination contain‐ ing an artemisinin derivative and  is  included  in  the kit  for  the  treatment of malaria due  to  Plasmodium  falciparum,  including  Plasmodium  falciparum  in  areas  with  significant  drug  resistance. It is not recommended for prophylaxis and should not be used by women in the  first  trimester  of  their  pregnancy,  since  safety  in pregnancy  has  not  yet  been  established.  Rapid diagnostic  tests  (RDTs) are  included  in  the malaria modules  for  the confirmation of  suspected malaria cases.    IEHK 2006 will always be supplied with malaria modules unless there is a specific request not to include these items at the time of ordering.  HIV, AIDS, tuberculosis and leprosy IEHK 2006 does not include any medicines against communicable diseases such as HIV, AIDS, tuberculosis or leprosy. Supplies for prevention and/or treatment of these communicable diseases will have to be ordered separately after an assessment of needs.  Procurement of IEHK 2006 Pharmaceutical suppliers who may supply the IEHK should ensure that (1) the content of the  IEHK  is  updated  according  to  the  following  kit  and  (2)  manufacturers  comply  with  the  international  guidelines  for  quality,  packaging  and  labelling  of  medicines  and  medical  devices. Pharmaceutical suppliers should  follow  the general  instructions given  in Annex 6.  Some suppliers may have a permanent stock of IEHK ready for shipment within 24 hours.  Post emergency needs IEHK 2006 is for use only in the early phase of an emergency. The kit is not designed and not recommended for re-supplying existing health care facilities.   After the acute phase of an emergency is over and basic health needs have been covered by  the basic and supplementary units, specific needs for further supplies and equipment should  be assessed as soon as possible.  The Interagency Emergency Health Kit 2006 8     Selection of medicines and medical devices included in IEHK 2006   9 Chapter 2. Selection of medicines and medical devices included in IEHK 2006 The contents of  IEHK 2006 are based on epidemiological data, population profiles, disease  patterns and certain assumptions based on experience gained in emergency situations.  These assumptions are:    ♦ The  most  peripheral  level  of  the  health  care  system  will  be  staffed  by  health  care  workers with limited medical training, who will treat symptoms rather than diagnosed  diseases using the basic units, and refer patients who need more specialized treatment  to the next level.  ♦ Half of the population is under 15 years of age.  ♦ The  average  number  of  patients  presenting  themselves  with  the  more  common  symptoms or diseases can be predicted.  ♦ Standard treatment guidelines will be used to treat these symptoms or diseases.  ♦ The rate of referral from the most peripheral to the next level of health services is 10%.  ♦ The  first  referral  level  of  health  care  is  staffed  by  experienced  nurses,  midwives,  medical assistants or physicians, with no or  limited  facilities  for  inpatient care. They  will use the supplementary unit in conjunction with one or more basic units.  ♦ If both the most peripheral and first referral health care facilities are within reasonable  reach of  the  target population, every  individual will, on average, visit  such  facilities  four  times per year  for advice or  treatment. The supplies  in  the kit  therefore serve a  population of 10,000 people for a period of approximately 3 months.  Selection of medicines for IEHK 2006 Injectable medicines There  are  no  injectable  medicines  in  the  basic  unit  as  most  common  diseases  in  their  uncomplicated form do not require injectable medicines. Any patient who needs an injection  must  be  referred  to  the  first  referral  level.  Injectable  medicines  are  provided  in  the  supplementary  unit  and  are  intended  for  use  by  professional  health  care workers  at  first  referral level.  Antibiotics Infectious  bacterial  diseases  are  common  at  all  levels  of  health  care,  including  the  most  peripheral, and basic health care workers should therefore have the possibility to prescribe  an antibiotic. However, many basic health care workers have not been  trained  to prescribe  antibiotics in a rational way. Amoxicillin is the only antibiotic included in the basic unit, and  The Interagency Emergency Health Kit 2006 10 this will enable the health care worker to concentrate on making the right decision between  prescribing  an  antibiotic  or  not,  rather  than  on  choosing  between  several  antibiotics.  Amoxicillin  is  active  against  bacterial pneumonia  and  otitis media. The  risk  of  increasing  bacterial resistance must be reduced by rational prescribing practice.  Medication for children Paediatric  formulations  included  in  the  kit  are  paracetamol  100  mg  tab,  the  fixed‐dose  antimalarial combination artemether + lumefantrine 20 mg + 120 mg tab for the weight group  5‐14  kg,  artemether  injection  20  mg/ml,  zinc  sulfate  20  mg  dispersible  tab,  ORS  (oral  rehydration salts) solution for children can be prepared with the sachets included in the kit.    Syrups  for  children are not  included because of  their  instability,  their  short  shelf‐life after  reconstitution  and  their  volume  and  weight.  Instead,  for  children,  half  or  quarter  adult  tablets may be crushed and administered with a small volume of fluid or with food.  Medicines not included in IEHK 2006 As indicated before, the kit includes neither the common vaccines nor any medicines against  communicable diseases such as AIDS, tuberculosis2 or leprosy.    No specific medicines are included for the treatment of sexually transmitted infections other  than  a  small  quantity  as  presumptive  treatment  of  gonococcal  infection,  chlamydia  and  prevention of HIV infection in the context of post‐exposure prophylaxis. Supplies for regular  contraception and condoms are not included in the kit.  Selection of medical devices for IEHK 2006 Syringes, needles and safety boxes Unsafe  injection  leads  to  the  risk  of  transmission  of  bloodborne  pathogens  including,  hepatitis  B,  hepatitis  C  virus  and  HIV.  Injection  associated  risks  for  patients  and  health  workers should be limited by:    ♦ limiting the number of injections;  ♦ using disposable syringes and needles only;  ♦ using  safety  boxes  designed  for  the  collection  and  incineration  of  used  syringes,  needles and lancets;  ♦ strictly following the destruction procedures for disposable material.    Only disposable syringes and needles are provided in the supplementary unit. Estimates of  needs are based on the number of injectable medicines included in the supplementary unit,  which are to be used in line with the treatment guidelines provided.                                                         2 The general prerequisites for the establishment of a tuberculosis control programme for refugees and displaced persons are: 1) the emergency phase is over; 2) security in and stability of the camp or site is envisioned for at least six months; 3) basic needs of water, adequate food and sanitation are available; and 4) essential clinical services and medicines are available. Selection of medicines and medical devices included in IEHK 2006   11 Gloves Disposable protective gloves are provided  in  the basic unit and  the supplementary unit  to  protect health workers  against possible  infection during dressings or handling of  infected  materials.  Sterile disposable  surgical  gloves  are  supplied  in  the  supplementary unit  to  be  used for deliveries, sutures and minor surgery, all under medical supervision.  Selection of equipment Sterilization A complete sterilization set  is provided  in the kit. The basic units contain two small drums  each to be used as containers for sterile dressing materials. Two drums are included to allow  sterilization of one while the other is being used. The supplementary unit contains one steam  sterilizer, drums for steam sterilization, TST indicators, timer and kerosene stove.  Dilution and storage of liquids The kit contains several plastic bottles to dilute and store liquids (e.g. chlorhexidine, benzyl  benzoate and gentian violet solution).  Water supply The kit contains several  items  to help provide clean water at  the health  facility. Each basic  unit  contains  a  collapsible  water  container  and  two  plastic  pails  with  bail.  The  supplementary  unit  contains  a  water  filter  with  candles  and  tablets  of  sodium  dichloroisocyanurate (NaDCC) to chlorinate the water.  Medical devices not included in IEHK 2006 Resuscitation/major surgery The  kit  has  been  designed  to  meet  the  first  primary  health  care  needs  of  a  displaced  population without medical facilities, and for that reason no equipment for resuscitation or  major surgery has been included. In situations of war, earthquakes or epidemics, specialized  teams with medicines and medical devices will be required.    IEHK 2006 does not contain equipment for resuscitation or major surgery.   The Interagency Emergency Health Kit 2006 12 Major medicine and medical device changes since the 1998 edition of the emergency health kit Basic unit albendazole tab replaces mebendazole tab aluminium hydroxide + magnesium hydroxide tab replaces aluminium hydroxide tab amoxicillin tab replaces co-trimoxazole tab artemether + lumefantrine tab replaces chloroquine tab ibuprofen tab partially replaces acetylsalicylic acid tab paracetamol 500mg tab partially replaces acetylsalicylic acid tab rapid diagnostic tests for malaria are added thermometer clinical, digital replaces clinical mercury thermometer zinc sulfate dispersible tab is added Supplementary unit artemether inj is added atenolol tab is added ceftriaxone inj replaces chloramphenicol inj clotrimazole pessary replaces nystatin vaginal tablet cloxacillin tab is added doxycycline tab and amoxicillin tab replace chloramphenicol tab levonorgestrel tab replaces ethinylestradiol + levonorgestrel tab miconazole tab replaces nystatin tab miconazole cream replaces benzoic acid + salicylic acid ointment azithromycin tab is added as part of Patient PEP cefixime tab for gonococcal infection is added as part of Patient PEP zidovudine + lamivudine tab is added as part of Patient PEP disposable syringes and needles replace all sterilizable syringes and needles Content of IEHK 2006   13 Chapter 3. Content of IEHK 2006 IEHK 2006 consists of 10 basic units and one supplementary unit. 10 basic units - for health care workers with limited training Each basic unit  contains medicines, medical devices  renewable and equipment,  for a population of  1,000 people for 3 months.    To  facilitate  identification  in an emergency, one green  sticker should be placed on each parcel. The  word “BASIC” should be printed on stickers for basic units.    One basic unit contains:  ♦ medicines  ♦ medical devices, renewable  ♦ medical devices, equipment  ♦ module: malaria items (uncomplicated malaria)3  One supplementary unit - for physicians and senior health care workers A supplementary unit contains medicines, medical devices renewable and equipment for a population  of 10,000 people for 3 months and is packed in cartons of a maximum weight of 50 kg.    To be operational,  the  supplementary unit  should be used  together with at  least one or more basic  units.    One supplementary unit contains:  ♦ medicines   ♦ essential infusions   ♦ medical devices, renewable   ♦ medical devices, equipment  ♦ module: patient PEP3  ♦ module: malaria items3    1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000 1,000   1,000 } 10 x 1 basic unit for 10 x 1,000 people 10,000 } 1 supplementary unit for 1 x 10,000 people } Total: 1 emergency health kit for 10,000 people for 3 months     One IEHK 2006 weighs approximately 1000 kg and occupies 4 m3 space.                                                         3 These items are automatically provided unless a specific request is made not to include them in the kit. The Interagency Emergency Health Kit 2006 14 Basic unit (for 1,000 persons for 3 months) Items Unit Quantity Medicines albendazole, chewable tab 400mg tab 200 aluminium hydroxide + magnesium hydroxide, tab 400 mg + 400 mg4 tab 1,000 amoxicillin, tab 250 mg tab 3,000 benzyl benzoate, lotion 25%5 bottle, 1 litre 1 chlorhexidine gluconate, solution 5%6 bottle, 1 litre 1 ferrous sulfate + folic acid, tab 200 mg + 0.4 mg tab 2,000 gentian violet, powder 25 g 4 ibuprofen, scored tab 400 mg tab 2,000 ORS (oral rehydration salts)7 sachet for 1 litre 200 paracetamol, tab 100 mg tab 1,000 paracetamol, tab 500 mg tab 2,000 tetracycline, eye ointment 1% tube, 5 g 50 zinc sulfate, dispersible tab 20 mg8 tab 1,000 Malaria module (can be withheld from the order upon request) artemether + lumefantrine, tab 20 mg + 120 mg tab Weight group Treatments by weight 5-14 kg 6 x 1 tab box, 30 treatments 5 15-24 kg 6 x 2 tab box, 30 treatments 1 25-35 kg 6 x 3 tab box, 30 treatments 1 > 35 kg 6 x 4 tab box, 30 treatments 6 quinine sulfate, tab 300 mg tab 2,000 rapid diagnostic tests unit 800 lancet for blood sampling (sterile) unit 1,000 safety box for used lancets, 5 litres unit 2                                                                        4 WHO recommends aluminium hydroxide and magnesium hydroxide as single antacids. The Interagency Group agreed to include in the kit the combination of aluminium hydroxide + magnesium hydroxide tab. 5 WHO recommends benzyl benzoate, lotion 25%. The use of 90% concentration is not recommended. 6 WHO recommends chlorhexidine gluconate 5% solution. The use of 20% solution needs distilled water for dilution, otherwise precipitation may occur. Alternative: the combination of cetrimide 15% and chlorhexidine gluconate 1.5%. 7 The updated information about the ORS formulation is provided in the 2005 WHO Model List of Essential Medicines. 8 In addition to ORS for the treatment of acute diarrhoea in children. Content of IEHK 2006   15 Items Unit Quantity Medical devices, renewable bandage, elastic, 7.5 cm x 5 m, roll unit 20 bandage, gauze, 8 cm x 4 m, roll unit 200 compress, gauze, 10 cm x 10 cm, non-sterile unit 500 cotton wool, 500 g, roll, non-sterile unit 2 gloves, examination, latex, medium, disposable unit 100 soap, toilet, bar, approximately 110 g, wrapped unit 10 tape, adhesive, zinc oxide, 2.5 cm x 5 m unit 30 Stationery book, exercise, A4 size, 100 pages, hard cover9 unit 4 envelope, plastic, 10 cm x 15 cm unit 2,000 health card10 unit 500 pad, note, plain, A6 size, 100 sheets unit 10 pen, ball-point, blue unit 12 plastic bag, for health card, 11 cm x 25 cm, snap-lock fastening unit 500 Treatment guidelines for basic unit users11 - IEHK2006, English version unit 2 - IEHK2006, French version unit 2 - IEHK2006, Spanish version unit 2 Medical devices, equipment basin, kidney, stainless steel, 825 ml unit 1 bottle, plastic, 1L, with screw cap unit 3 bottle, plastic, 250 ml, wash bottle unit 1 bowl, stainless steel, 180 ml unit 1 brush, hand, scrubbing, plastic unit 2 drum, sterilizing, approximately 150 mm x 150 mm unit 2 forceps, artery, Kocher, 140 mm, straight unit 2 pail, with bail, handle, polyethylene, 10L or 15L unit 2 scissors, Deaver, 140 mm, straight, sharp/blunt unit 2 surgical instruments, dressing set12 unit 2 thermometer, clinical, digital, 32-43 Celsius unit 5 tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1 water container, PVC/PE, collapsible, 10L or 15L unit 1                                                        9 It is recommended that one exercise book be used for recording daily medicine dispensing and another for daily basic morbidity data, see Annex 4. 10 For a sample health card, see Annex 5. 11 For standard treatment guidelines, see Annexes 1, 2 and 3. 12 Surgical instruments, dressing set (3 instruments + box): • 1 forceps, artery, Kocher, 140 mm, straight • 1 forceps, dressing, standard, 155 mm, straight • 1 scissors, Deaver, 140 mm, straight, sharp/blunt • 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover. The Interagency Emergency Health Kit 2006 16 Supplementary unit (for 10,000 people for 3 months) Items Unit Quantity Medicines Anaesthetics ketamine, inj 50 mg/ml 10 ml/vial 25 lidocaine, inj 1%13 20 ml/vial 50 Analgesics14 morphine, inj 10 mg/ml15 1ml/ampoule 50 Recall from basic unit ibuprofen, tab 400 mg (10 x 2,000) 20,000 paracetamol, tab 100 (10 x 1000) 10,000 paracetamol, tab 500 mg (10 x 2,000) 20,000 Antiallergics hydrocortisone, powder for inj 100 mg vial 50 prednisolone, tab 5 mg tab 100 epinephrine (adrenaline) see “respiratory tract” Antidotes calcium gluconate, inj 100mg/ml16 10 ml/ampoule 4 naloxone, inj 0.4 mg/ml 17 1 ml/ampoule 20 Anticonvulsants/antiepileptics diazepam, inj 5 mg/ml 2 ml/ampoule 200 magnesium sulfate, inj 500 mg/ml 10 ml/ampoule 40 phenobarbital, tab 100 mg tab 500 Anti-infective medicines benzathine benzylpenicillin, inj 2.4 million IU/vial (long-acting penicillin) vial 50 benzylpenicillin, inj 5 million IU/vial18 vial 250 ceftriaxone, inj 1 g vial 800 cloxacillin, caps 500 mg19 caps 1,000 clotrimazole, pessary 500 mg pessary 100 doxycycline, tab 100 mg tab 3,000 metronidazole, tab 500 mg tab 2,000                                                        13 20 ml vials are preferred, although 50 ml vials may be used as an alternative. 14 Alternative injectable analgesics, such as pentazocine and tramadol, are not recommended by WHO. It is however recognized that these may be practical alternatives to morphine in situations where opioids cannot be sent. 15 See Annex 9 for more details. 16 For use as an antidote to magnesium sulfate overdose in case of severe respiratory depression or arrest. 17 Naloxone is an opioid antagonist given intravenously for the treatment of morphine overdose and to reverse the effects of therapeutic doses of morphine. 18 Benzylpenicillin inj 5 million UI/vial is provided for diseases requiring high dosage treatment. The vials are not intended for multiple use because of concerns over contamination. 19 Alternative: cloxacillin tablet 250 mg and doubling the quantity is acceptable. Content of IEHK 2006   17 Items Unit Quantity miconazole, muco-adhesive tab 10mg20 tab 350 procaine benzylpenicillin, inj 3-4 million IU/vial21 vial 200 Recall from basic unit: albendazole, tab 400 mg (10 x 200) 2,000 amoxicillin, tab 250 mg (10 x 3,000) 30,000 Malaria module (can be withheld from the order upon request) artemether, inj 20 mg/ml22 1ml/ampoule 200 artemether, inj 80 mg/ml 22 1ml/ampoule 72 quinine dihydrochloride, inj 300 mg/ml23 2 ml/ampoule 100 Recall from basic unit: malaria module artemether + lumefantrine, tab 20 mg+120 mg (10 x 6,120 tab) 61,200 quinine sulfate, tab 300 mg (10 x 2,000) 20,000 rapid diagnostic tests (10 x 800) 8,000 lancet for blood sampling (sterile) (10 x 1000) 10,000 safety box for used lancets, 5 litres (10 x 2) 20 Medicines affecting the blood folic acid, tab 5 mg tab 1,000 Recall from basic unit: ferrous sulfate + folic acid, tab 200 mg + 0.4 mg (10 x 2,000) 20,000 Cardiovascular medicines atenolol, tab 50 mg tab 1,000 hydralazine, powder for inj 20 mg24 ampoule 20 methyldopa, tab 250 mg25 tab 1,000 Dermatological medicines polyvidone iodine, solution 10% bottle, 200 ml 10 silver sulfadiazine, cream 1% tube, 50 g 30 miconazole, cream 2% tube, 30 g 25 Recall from basic unit: benzyl benzoate, lotion 25% (10 x 1L) 10 gentian violet, powder 25 g (10 x 4) 40 tetracycline, eye ointment 1% (10 x 50) 500                                                            20 WHO recommends nystatin, tablet, lozenge and pessary as an antifungal agent. The interagency group agreed to include in the kit miconazole muco-adhesive tablets as they are more agreeable for patients than oral nystatin. 21 The combination of procaine benzylpenicillin 3 million IU and benzylpenicillin 1 million IU (procaine penicillin fortified) is used in many countries and may be included as an alternative. 22 Alternative: artesunate, 60 mg for inj., 300, and 5 ml of glucose 5% or NaCl 0.9% inj, 300, is acceptable. Before using, inject the added 1 ml sodium bicarbonate 5% injection solution into the artesunate vial, dissolve and then add 5 ml of glucose 5% or NaCl 0.9% inj. Tuberculin syringe, disposable, 1 ml, sterile, 200, needs to be included too for administration purposes. 23 Intravenous injection of quinine must always be diluted in glucose 5%, bag 500 ml. 24 For the acute management of severe pregnancy-induced hypertension only. 25 For the management of pregnancy-induced hypertension only. The Interagency Emergency Health Kit 2006 18 Items Unit Quantity Disinfectants and antiseptics sodium dichloroisocyanurate (NaDCC), tab 1.67 g26 tab 1,200 Recall from basic unit: chlorhexidine, solution 5% (10 x 1L) 10 Diuretics furosemide, inj 10 mg/ml 2 ml/ampoule 20 hydrochlorothiazide, tab 25 mg tab 200 Gastrointestinal medicines promethazine, tab 25 mg tab 500 promethazine, inj 25 mg/ml 2 ml/ampoule 50 atropine, inj 1 mg/ml 1 ml/ampoule 50 Recall from basic unit: aluminium hydroxide + magnesium hydroxide, tab 400 mg + 400 mg (10 x 1,000) 10,000 Oxytocics oxytocin, inj 10 IU/ml27 1 ml/ampoule 200 Psychotherapeutic medicines chlorpromazine, inj 25 mg/ml 2 ml/ampoule 20 Respiratory tract, medicines acting on salbutamol, tab 4 mg tab 1,000 epinephrine (adrenaline), inj 1 mg/ml 1 ml/ampoule 50 Solutions correcting water, electrolyte and acid-base disturbances28 compound solution of sodium lactate (Ringer's lactate), inj solution, with IV giving set and needle 500 ml bag 200 glucose 5%, inj solution, with IV giving set and needle29 500 ml bag 100 glucose 50%, inj solution (hypertonic) 50 ml/vial 20 water for injection 10 ml/plastic vial 2,000 Recall from basic unit: oral rehydration salts, sachets (10 x 200) 2,000 Vitamins retinol (vitamin A), caps 200,000 IU caps 4,000 ascorbic acid, tab 250 mg tab 4,000                                                                  26 Each effervescent tablet containing 1.67g of NaDCC releases 1g of available chlorine when dissolved in water. 27 For prevention and treatment of postpartum haemorrhage. 28 Because of the weight, the quantity of infusions included in the kit is minimal. 29 Glucose 5%, bag 500 ml, for administration of quinine by infusion. Content of IEHK 2006   19 Items Unit Quantity Patient PEP module, 50 treatments (can be withheld from the order upon request) azithromycin, tab 250 mg30 tab 200 cefixime, tab 200 mg31 tab 100 pregnancy test unit 50 levonorgestrel, tab 1.50 mg32 tab 50 zidovudine (AZT) + lamivudine (3TC), tab 300 mg +150 mg33 tab 3,000 Guidelines WHO Model Formulary (latest edition), English version unit 2 MSF Essential Drugs, practical guide (latest edition) - English version unit 2 - French version unit 2 - Spanish version unit 2 MSF Clinical Guidelines, diagnostic and treatment manual (latest edition) - English version unit 2 - French version unit 2 - Spanish version unit 2 Medical devices, renewable cannula, IV short, 18G (1.3 x 45 mm), sterile, disposable unit 100 cannula, IV short, 22G (0.8 x 25 mm), sterile, disposable unit 50 cannula, IV short, 24G (0.7 x 19 mm), sterile, disposable unit 50 needle, disposable, 19G (1.1 x 40 mm), sterile34 unit 2,000 needle, disposable, 21G (0.8 x 40 mm), sterile unit 1,500 needle, disposable, 23G (0.6 x 25 mm), sterile unit 1,500 needle, disposable, 25G (0.5 x 16 mm), sterile unit 100 needle, scalp vein, 21G (0.8 x 19 mm), sterile, disposable unit 100 needle, scalp vein, 25G (0.5 x 19 mm), sterile, disposable unit 300 needle, spinal, 20G (0.9 x 90 mm), sterile, disposable unit 25 needle, spinal, 22G (0.7 x 40 mm), sterile, disposable unit 25 syringe, disposable, 20 ml, sterile35 unit 100 syringe, disposable, 10 ml, sterile unit 600 syringe, disposable, 5 ml, sterile unit 2,000 syringe, disposable, 2 ml, sterile unit 700 syringe, disposable, 1 ml, sterile36 unit 200                                                          30 For presumptive treatment of sexually transmitted infections (Clamydia infection) by sexual assault (rape). Alternative: azithromycin tab 500 mg and halving the quantity is acceptable.   31 For presumptive treatment of sexually transmitted infections (Gonococcal infection) by sexual assault (rape). It may be used in pregnancy. 32 For women who seek help within 72 hours of rape and wish to use emergency contraception to prevent pregnancy, they should take one tablet of levonorgestrel 1.50 mg. Alternative: levonorgestrel 0.75 mg tablets and doubling the quantity is acceptable. 33 For presumptive treatment to reduce the chances of HIV infection by sexual assault (rape) and by needle stick. 34 Included mainly for reconstitution purposes. 35 Included for the administration of magnesium sulfate only. 36 Included for the administration of artemether in children only. The Interagency Emergency Health Kit 2006 20 Items Unit Quantity safety box for used syringes/needles, 5 litres37 unit 50 syringe, feeding, 50 ml, conical tip, sterile38 unit 10 syringe, feeding, 50 ml, Luer tip, sterile38 unit 10 tube, aspirating/feeding, CH16, L125 cm, conical tip, sterile, disposable unit 10 tube, feeding, CH08, L40 cm, Luer tip, sterile, disposable unit 50 tube, feeding, CH05, L40 cm, Luer tip, sterile, disposable unit 20 catheter, Foley, CH12, sterile, disposable unit 10 catheter, Foley, CH14, sterile, disposable unit 5 catheter, Foley, CH18, sterile, disposable unit 5 bag, urine, collecting, 2000 ml unit 10 gloves, examination, latex, large, disposable unit 100 gloves, examination, latex, medium, disposable unit 100 gloves, examination, latex, small, disposable unit 100 gloves, surgical, 6.5, sterile, disposable, pair unit 50 gloves, surgical, 7.5, sterile, disposable, pair unit 150 gloves, surgical, 8.5, sterile, disposable, pair unit 50 compress, gauze, 10 cm x 10 cm, sterile unit 1,000 gauze, roll, 90 cm x 100 m, non-sterile39 unit 3 razor blade, double-edged, disposable (for use with razor, see p.21) unit 100 scalpel blade, No. 22, sterile, disposable unit 100 suture, absorbable, synthetic, braided DEC2 (3/0), curved needle 3/8 circle, 26 mm, triangular point unit 144 tape umbilical, 3 mm x 50 m, non-sterile unit 2 tongue depressor, wooden, disposable unit 500 indicator, TST (Time, Steam, Temperature) control spot unit 300 indicator, TST (Time, Steam, Temperature) control strip unit 100 masking tape, 2 cm x 50 m40 roll 1 Recall from basic unit: Medical devices, renewable bandage, elastic, 7.5 cm x 5 m, roll (10 x 20) 200 bandage, gauze, 8 cm x 4 m, roll (10 x 200) 2,000 compress, gauze, 10 cm x 10 cm, non-sterile (10 x 500) 5,000 cotton wool, 500 g, roll, non-sterile (10 x 2) 20 gloves, examination, latex, medium, disposable (10 x 100) 1000 soap, toilet, bar, approximately 110 g, wrapped (10 x 10) 100 tape, adhesive, zinc oxide, 2.5 cm x 5 m (10 x 30) 300 Stationery book, exercise, A4 size, 100 pages, hard cover (10 x 4) 40 envelope, plastic, 10 cm x 15 cm (10 x 2,000) 20,000 health card (10 x 500) 5,000 pad, note, plain, A6 size, 100 sheet (10 x 10) 100 pen, ball-point, blue (10 x 12) 120 plastic bag, for health card, 11 cm x 25 cm, snap-lock fastening (10 x 500) 5,000                                                        37 WHO/UNICEF standard E10/IC2: boxes should be prominently marked. 38 Alternative: the two types of feeding syringes 50 ml may be replaced by, syringe, feeding, 60 ml, with Luer and conical connector, unit, 20. 39 Alternative: gauze, roll, 60 cm x 100 m, non-sterile. 40 To secure small paper parcels of instruments for sterilization allowing contents and date to be written. Content of IEHK 2006   21 Items Unit Quantity Medical devices, equipment apron, protection, plastic, reusable41 unit 2 drawsheet, plastic, 90 cm x 180 cm unit 2 brush, hand, scrubbing, plastic unit 2 towel, Huck, 430 mm x 500 mm unit 2 stethoscope, binaural, complete unit 4 sphygmomanometer, (adult), aneroid unit 4 stethoscope, fetal, Pinard unit 1 otoscope set, cased42 unit 2 spare battery R6 alkaline AA size, 1.5 V (for otoscope) unit 12 scale, electronic, mother-and-child, 150 kg x 100 g unit 1 scale, (only) infant spring, 25 kg x 100 g unit 3 weighing trousers for scale infant spring, set of 5 unit 3 razor, safety, metal, 3 piece43 unit 2 tape measure, vinyl-coated, 1.5 m unit 5 tape measure, arm circumference, MUAC (mid-upper arm circumference) unit 50 tourniquet, latex rubber, 75 cm44 unit 2 thermometer, clinical, digital, 32-43 Celsius unit 10 sterilizer, steam, approximately 21 L or 24 L unit 1 stove, kerosene, single-burner, pressure unit 1 timer, 60 minutes unit 1 basin, kidney, stainless steel, 825 ml unit 2 bowl, stainless steel, 180 ml unit 2 drum, sterilizing, approximately 150 mm x 150 mm unit 2 forceps, artery, Kocher, 140 mm, straight unit 2 scissors, Deaver, 140 mm, straight, sharp/blunt unit 2 tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1 surgical instruments, suture set45 unit 2 surgical instruments, dressing set46 unit 5 filter, drinking, candle, 10-80 L per day unit 3                                                          41 Alternative: apron, protection, plastic disposable, unit, 100, may be supplied. 42 Spare bulb must be included within the otoscope set. 43 Alternative: razor, safety, disposable, unit, 100, may be supplied. 44 Alternative: tourniquet with Velcro, unit, 2, may be supplied. 45 One suture set should be reserved for repair of postpartum vaginal tears. Abscess/suture set (7 instruments + box) • 1 forceps, artery, Halsted-mosquito, 125 mm curved • 1 forceps, artery, Kocher, 140 mm, straight • 1 forceps, tissue, standard, 145 mm, straight • 1 needle holder, Mayo-Hegar, 180 mm, straight • 1 probe, double-ended, 145 mm • 1 scalpel handle, No. 4 • 1 scissors, Deaver, 140 mm, curved, sharp/blunt • 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover. 46 Dressing set (3 instruments + box) • 1 forceps, artery, Kocher, 140 mm, straight • 1 forceps, dressing, standard, 155 mm, straight • 1 scissors, Deaver, 140 mm, straight, sharp/blunt • 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover. The Interagency Emergency Health Kit 2006 22 Items Unit Quantity Recall from basic unit: Medical devices, equipment basin, kidney, stainless steel, 825 ml (10 x 1) 10 bowl, stainless steel, 180 ml (10 x 1) 10 drum, sterilizing, approximately 150 mm x 150 mm (10 x 2) 20 forceps, artery, Kocher,140 mm, straight (10 x 2) 20 scissors, Deaver,140 mm, straight, sharp/blunt (10 x 2) 20 thermometer, clinical, digital 32-43 Celsius (10 x 5) 50 tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm (10 x 1) 10 surgical instruments, dressing set (10 x 2) 20     Basic unit: treatment guidelines   23 Annex 1: Basic unit: treatment guidelines These  treatment  guidelines  are  intended  to  give  simple  guidance  for  primary  health  care  workers  using  basic  units.  In  these  guidelines,  five  age  groups  have  been  distinguished,  except for the treatment of diarrhoea with oral rehydration fluid where six age and weight  categories are used.     When dosage  is  shown as  ʺ1  tab x 2ʺ, one  tablet  should be  taken  in  the morning and one  before bedtime. When dosage  is  shown  as  ʺ2  tab  x  3ʺ,  two  tablets  should be  taken  in  the  morning,  two  tablets  should  be  taken  in  the  middle  of  the  day  and  two  tablets  before  bedtime.    The treatment guidelines contain the following diagnostic/symptom groups:    ♦ anaemia  ♦ pain  ♦ diarrhoea (see detailed diagnosis and treatment schedules in Annex 2a, b and c)  ♦ fever  ♦ respiratory tract infections (see detailed diagnosis and treatment schedules in Annex 3)  ♦ measles  ♦ ʺred eyeʺ condition  ♦ skin conditions  ♦ sexually transmitted and urinary tract infections  ♦ preventive care in pregnancy  ♦ worms.  Anaemia Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ≥35 kg Age Diagnosis/ Symptom 0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ≥15 yrs Severe anaemia (oedema, dizziness, shortness of breath) REFER Moderate anaemia (pallor and tiredness) REFER ferrous sulfate + folic acid 1 tab daily, for at least 2 months ferrous sulfate + folic acid 2 tab daily, for at least 2 months ferrous sulfate + folic acid 3 tab daily, for at least 2 months ferrous sulfate + folic acid 3 tab daily, for at least 2 months The Interagency Emergency Health Kit 2006 24 Pain Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ≥35 kg Age Diagnosis/ Symptom 0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ≥15 yrs Pain (headache, joint pain, toothache) paracetamol tab 100 mg ½ - 1 tab x 4 paracetamol tab 100 mg 1 - 2 tab x 4 or ibuprofen tab 400 mg ½ tab x 4 paracetamol tab 500 mg 1 tab x 4 or ibuprofen tab 400 mg 1 tab x 4 paracetamol tab 500 mg 2 tab x 4 or ibuprofen tab 400 mg 2 tab x 4 Stomach pain REFER Al + Mg hydroxide tab ½ tab x 3 for 3 days Al + Mg hydroxide tab 1 tab x 3 for 3 days Diarrhoea Weight 0 - < 5 kg 5 - 7.9 kg 8 - 10.9 kg 11 - 15.9 kg 16 - 29.9 kg >30 kg Age* Diagnosis/ Symptom <4 mths 4 - 11 mths 12 - 23 mths 2 - 4 yrs 5 - 14 yrs ≥15 yrs Quantity of ORS 200-400 ml 400-600 ml 600-800 ml 800 ml-1.2 L 1.2 - 2.2 L 2.2 - 4 L Diarrhoea with no dehydration Treatment Plan A (see Annex 2) Give more fluids than usual to prevent dehydration and zinc sulfate 20 mg dispersible tab and continue to feed. Advise that the patient returns to the health worker in case of frequent stools, increased thirst, sunken eyes, fever or when the patient does not eat or drink normally, or does not get better within three days, or develops blood in the stool or repeated vomiting. Diarrhoea with some dehydration Treatment Plan B (see Annex 2) Approximate amount of ORS solution to give in the first 4 hours. In addition, give zinc sulfate 20 mg dispersible tab as soon as the child is able to eat. Diarrhoea with severe dehydration Treatment Plan C (see Annex 2) REFER patient for nasogastric tube and/or IV treatment. Diarrhoea lasting more than two weeks or in malnourished or poor condition patient Give ORS according to dehydration stage and zinc sulfate 20 mg dispersible tab and REFER. Bloody diarrhoea (check the presence of blood in stools) Give ORS according to dehydration stage and zinc sulfate 20 mg dispersible tab and REFER.   * Use the patientʹs age only when you do not know the weight. The approximate amount of ORS required (in ml)  can also be calculated by multiplying the patient’s weight in kg by 75.     All children should be given supplemental zinc (20 mg) daily for 10 - 14 days.   Basic unit: treatment guidelines   25 Confirmed malaria diagnosis     In low malaria transmission areas Parasite-based diagnosis47 for all patients of all age groups before treatment is started. In high malaria transmission areas Parasite-based diagnosis47 for all adult patients, including pregnant women, and children > 5 years before treatment is started. For children < 5 years, fever or history of fever or evidence of high temperature (feeling hot or temp. > 37.5C), to be treated on the basis of having had a clinical diagnosis of malaria before treatment is started.   Performing the test   Things to remember when using a rapid diagnostic test (RDT): • prior instruction in the use and interpretation of the particular product is vital; • a management plan for results must be in place; • blood-safety precautions should be followed; • product instructions should be strictly followed; • RDT should be discarded if the envelope is punctured or badly damaged; • test envelope should be opened only when it has reached ambient temperature, and the RDT used immediately after opening; • result should be read within the time specified by the manufacturer; • RDT cannot be re-used if preparation is delayed after opening the envelope, humidity can damage the RDT.                                                          47 By microscopy or RDTs. The Interagency Emergency Health Kit 2006 26 Figure 2: Sample decision chart for treatment of malaria based on the results of a  malaria rapid diagnostic test      Derived from model in National Treatment Guidelines for Malaria (2002), Ministry of Health, Kingdom of Cambodia. Suspected cases (clinical criteria) RDT/Microscopy Positive Negative Falciparum Non-falciparum High suspicion of malaria Treatment protocol Treat while excluding other illnesses Uncomplicated malaria Severe malaria Treatment protocol Treatment protocol Look for other illness Review/Refer Suspected cases (clinical criteria) RDT/Microscopy Positive Negative Falciparum Non-falciparum High suspicion of malaria Treatment protocol Treat while excluding other illnesses Uncomplicated malaria Severe malaria Treatment protocol Treatment protocol Look for other illness Review/Refer Basic unit: treatment guidelines   27 Fever Weight 0 - <10 kg 10 - <15 kg 15 - <25 kg 25 - <35 kg ≥35 kg Age Diagnosis/ Symptom 0 -<1 yr 1 - <5 yrs 5 - <10 yrs 10 - <15 yrs ≥15 yrs Fever in malnourished or poor condition patient or when in doubt REFER Fever with chills in confirmed uncomplicated malaria REFER artemether/ lumefantrine tab 20mg A+120mg L 1 tab at once, followed by 5 doses of 1 tab after 8h, 24h, 36h, 48h and 60 hours artemether/ lumefantrine tab 20mg A+120mg L 2 tab at once, followed by 5 doses of 2 tab after 8h, 24h, 36h, 48h and 60 hours artemether/ lumefantrine tab 20mg A+120mg L 3 tab at once, followed by 5 doses of 3 tab after 8h, 24h, 36h, 48h and 60 hours artemether/ lumefantrine tab 20mg A+120mg L 4 tab at once, followed by 5 doses of 4 tab after 8h, 24h, 36h, 48h and 60 hours Pregnant women: Fever with chills in confirmed uncomplicated malaria quinine sulfate tab 300 mg 2 tab x 3, for 3 days Fever with cough REFER See respiratory tract infections below. Fever (unspecified) REFER paracetamol tab 100 mg 1-2 tab x 4, for 1 to 3 days paracetamol tab 100 mg 2-3 tab x 4, for 1 to 3 days or ibuprofen tab 400 mg ½ tab x 4, for 1 to 3 days paracetamol tab 500 mg 1 tab x 4, for 1 to 3 days or ibuprofen tab 400 mg 1 tab x 4, for 1 to 3 days paracetamol tab 500 mg 2 tab x 4, for 3 days or ibuprofen tab 400 mg 2 tab x 4, for 1 to 3 days The Interagency Emergency Health Kit 2006 28 Respiratory tract infections Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ≥35 kg Age Diagnosis/ Symptom 0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ≥15 yrs Severe pneumonia Annex 3 Give the first dose of amoxicillin (see pneumonia) and REFER. Pneumonia Annex 3 REFER amoxicillin tab 250 mg ½ - 1 tab x 2, for 5 days amoxicillin tab 250 mg 1- 1½ tab x 2, for 5 days amoxicillin tab 250 mg 1½ -2 tab x 2, for 5 days amoxicillin tab 250 mg 4 tab x 2, for 5 days Reassess after 2 days; continue (breast) feeding, give fluids, clear the nose; return if breathing becomes faster or more difficult, or not able to drink or when the condition deteriorates. No pneumonia: cough or cold Annex 3 REFER Paracetamol48 tab 100 mg ½ tab x 4, for 1 to 3 days paracetamol tab 100 mg 1 tab x 4, for 1 to 3 days or ibuprofen tab 400 mg ½tab x 3, for 1 to 3 days paracetamol tab 500 mg 1 tab x 4, for 1 to 3 days or ibuprofen tab 400 mg 1 tab x 3, for 1 to 3 days paracetamol tab 500 mg 2 tab x 4, for 1 to 3 days or ibuprofen tab 400 mg 2 tab x 3, for 1 to 3 days Supportive therapy; continue (breast) feeding, give fluids, clear the nose; return if breathing becomes faster or more difficult, or not able to drink or when the condition deteriorates. Prolonged cough (30 days) REFER Acute ear pain and/or ear discharge for less than 2 weeks REFER amoxicillin tab 250 mg ½ - 1 tab x 2, for 5 days amoxicillin tab 250 mg 1- 1½ tab x 2, for 5 days amoxicillin tab 250 mg 1½ -2 tab x 2, for 5 days amoxicillin tab 250 mg 4 tab x 2, for 5 days Ear discharge for more than 2 weeks, no pain or fever Clean the ear once daily by syringe without needle using lukewarm clean water. Repeat until the water comes out clean. Dry repeatedly with clean piece of cloth. Measles Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ≥35 kg Age Diagnosis Symptom 0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ≥15 yrs Measles Treat respiratory tract disease according to symptoms. Treat conjunctivitis as “Red eyes”. Treat diarrhoea according to symptoms. Continue (breast) feeding, give retinol (vitamin A). "Red eye" condition Red eyes (conjunctivitis) Apply tetracycline eye ointment 3 times a day for 7 days. If not improved after 3 days or if in doubt, REFER.                                                        48 If fever is present. Basic unit: treatment guidelines   29 Skin conditions Wounds: extensive, deep or on face REFER Wounds: limited and superficial Clean with clean water and soap or diluted chlorhexidine solution.49 Gently apply gentian violet solution50 once a day. Severe burns (on face or extensive) Treat as for mild burns and REFER. Mild moderate burns Immerse immediately in cold water, or use a cold wet cloth. Continue until pain eases then treat as wounds. Severe bacterial infection (with fever) REFER Mild bacterial infection Clean with clean water and soap or diluted chlorhexidine solution.49 If not improved after 10 days refer. Fungal infections Apply gentian violet solution50 once a day for 5 days. Infected scabies Bacterial infection: clean with clean water and soap or diluted chlorhexidine solution.49 Apply gentian violet solution50 twice a day. When infection is cured: Apply diluted benzyl benzoate51 once a day for 3 days. Apply non diluted benzyl benzoate 25% once a day for 3 days. Non-infected scabies Apply diluted benzyl benzoate51 once a day for 3 days. Apply non diluted benzyl benzoate 25% once a day for 3 days. Sexually transmitted and urinary tract infections Suspicion of sexually transmitted or urinary tract infection REFER Suspicion of sexual violence REFER Preventive care in pregnancy Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ≥35 kg Age Diagnosis/ Symptom 0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ≥15 yrs Anaemia for treatment see under anaemia ferrous sulfate + folic acid 1 tab daily, throughout pregnancy Hookworm in endemic areas: albendazole can be safely given in the second and third trimesters of pregnancy albendazole chewable tab 400 mg, 1 tab once                                                        49   Chlorhexidine 5% must always be diluted before use: 20 ml in 1L of water. Take the 1L plastic bottle supplied with the kit; put 20 ml of chlorhexidine solution into the bottle using the 10 ml syringe supplied and fill up the bottle with boiled or clean water. Alternative: chlorhexidine 1.5% + cetrimide 15% solution should be used in the same dilution. 50   Gentian violet 0.5% concentration = 1 teaspoon of gentian violet powder/1L of boiled/clean water. Shake well, or use warm water to dissolve all powder.  51 Dilute by mixing ½L benzyl benzoate 25% solution with ½L clean water in the 1L plastic bottle supplied with the kit. The Interagency Emergency Health Kit 2006 30 Worms Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ≥35 kg Age Diagnosis/ Symptom 0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ≥15 yrs Roundworm Pinworm Threadworm Hookworm Hookworm in pregnant women: see above albendazole tab 400 mg ½ -1 tab once albendazole tab 400 mg 1 tab once albendazole tab 400 mg 1 tab once Assessment and treatment of diarrhoea   31 Annex 2. Assessment and treatment of diarrhoea52 A-2.1 Assessment of diarrhoeal patients for dehydration Table 1: Assessment of diarrhoea patients for dehydration A B C 1. Look at: Conditiona Eyesb Thirst Well, alert Normal Drinks normally, not thirsty Restless, irritable Sunken Thirsty, drinks eagerly Lethargic or unconscious Sunken Drinks poorly or not able to drink 2. Feel: Skin pinchc Goes back quickly Goes back slowly Goes back very slowly 3. Decide: The patient has no signs of dehydration If the patient has two or more signs in B, there is some dehydration If the patient has two or more signs in C, there is severe dehydration 4. Treat: Use Treatment Plan A Weigh the patient, if possible, and use Treatment Plan B Weigh the patient and use Treatment Plan C Urgently a Being lethargic and sleepy are not the same. A lethargic child is not simply asleep: the child's mental state is dull and the child cannot be fully awakened; the child may appear to be drifting into unconsciousness. b In some infants and children the eyes normally appear somewhat sunken. It is helpful to ask the mother if the child’s eyes are normal or more sunken than usual. c The skin pinch is less useful in infants or children with marasmus or kwashiorkor or in obese children.                                                        52 Department of Child and Adolescent Health and Development. The treatment of diarrhoea - a manual for physicians and other senior health workers. Geneva: World Health Organization; 2005. The Interagency Emergency Health Kit 2006 32 A-2.2 Treatment of acute diarrhoea (without blood) Treatment Plan A to treat diarrhoea at home Use this plan to teach the mother how to:    ♦ prevent dehydration at home by giving the child more fluid than usual;  ♦ prevent  malnutrition  by  continuing  to  feed  the  child,  and  why  these  actions  are  important;  ♦ recognize signs indicating that the child should be taken to a health worker.    The four rules of Treatment Plan A:  Rule 1: Give the child more fluids than usual, to prevent dehydration ♦ Use recommended home fluids. These include: ORS solution, salted drinks (e.g. salted  rice water  or  a  salted  yogurt drink),  vegetable  or  chicken  soup with  salt,  and plain  clean water.   ♦ Avoid fluids that do not contain salt, such as: plain water, water in which a cereal has  been  cooked  (e.g.  unsalted  rice water),  unsalted  soup,  yoghurt  drinks without  salt,  green  coconut water, weak  tea  (unsweetened),  unsweetened  fresh  fruit  juice. Other  fluids  to  avoid  are  those with  stimulant,  diuretic  or  purgative  effects,  for  example:  coffee, some medicinal teas or infusions.  ♦ Be  aware  of  fluids  that  are  potentially  dangerous  and  should  be  avoided  during  diarrhoea.  Especially  important  are  drinks  sweetened  with  sugar,  which  can  cause  osmotic  diarrhoea  and  hypernatraemia.  Some  examples  are:  commercial  carbonated  beverages, commercial fruit juices, sweetened tea.  ♦ Use ORS solution for children as described in the box below. (Note: if the child is under  6 months and not yet taking solid food, give ORS solution or water.)    Give  as much  as  the  child  or  adult wants until diarrhoea  stops. Use  the  amounts  shown  below  for ORS  as  a guide. Describe  and  show  the  amount  to be given  after  each  stool  is  passed, using a local measure.    Age Amount of ORS to be given after each loose stool Amount of ORS to provide for use at home ≤ 24 months 50-100 ml 500 ml/day 2 - 10 years 100-200 ml 1L/day ≥10 years as much as wanted 2L/day   Show the mother how to mix ORS and show her how to give ORS.    ♦ Give a teaspoonful every 1‐2 minutes for a child under 2 years.  ♦ Give frequent sips from a cup for older children.  Assessment and treatment of diarrhoea   33 ♦ If the child vomits, wait 10 minutes. Then give the solution more slowly (for example, a  spoonful every 2‐3 minutes).  ♦ If diarrhoea continues after the ORS packets are used up, tell the mother to give other  fluids as described in the first rule above or return for more ORS.  Rule 2: Give supplemental zinc sulfate 20 mg tab to the child, every day for 10 to 14 days Zinc sulfate can be given as dispersible  tablets. By giving zinc sulfate as soon as diarrhoea  starts,  the duration  and  severity of  the  episode  as well  as  the  risk of dehydration will be  reduced. By continuing zinc sulfate supplementation for 10 to 14 days, the zinc  lost during  diarrhoea is fully replaced and the risk of the child having new episodes of diarrhoea in the  following 2 to 3 months is reduced.  Rule 3: Continue to feed the child, to prevent malnutrition ♦ Breastfeeding should always be continued.   ♦ The infantʹs usual diet should be continued during diarrhoea and increased afterwards;  ♦ Food should never be withheld and the childʹs usual food should not be diluted;  ♦ Most  children  with  watery  diarrhoea  regain  their  appetite  after  dehydration  is  corrected;  ♦ Milk:  • Infants of any age who are breastfed should be allowed to breast‐feed as often and  as long as they want. Infants will often breastfeed more than usual, encourage this;  • Infants who are not breastfed, should be given their usual milk feed (formula) at  least every three hours, if possible by cup.  • Infants  below  6 months  of  age who  take  breast milk  and  other  foods  should  receive  increased  breastfeeding.  As  the  child  recovers  and  the  supply  and  the  supply of breast milk increases, other foods should be decreased.  • A  child who  is at  least 6 months old or  is already  taking  soft  foods  should be  given cereals, vegetables and other foods, in addition to milk. If the child is over 6  months and such foods are not yet being given, they should be started during the  diarrhoea episode or soon after it stops.  • Recommended food should be culturally acceptable, readily available. Milk should  be mixed with a cereal and if possible, 1 ‐ 2 teaspoonfuls of vegetable oil should be  added to each serving of cereal. If available, meat, fish or egg should be given.  • Foods rich in potassium, such as bananas, green coconut water and fresh fruit juice  are beneficial;  − offer the child food every three or four hours (six times a day);  − after  the diarrhoea  stops,  continue  to give  the  same  energy‐rich  food,  and  give one more meal than usual each day for at least two weeks.  The Interagency Emergency Health Kit 2006 34 Rule 4: Take the child to a health worker if there are signs of dehydration or other problems The mother should take her child to a health worker if the child:    ♦ Starts to pass many watery stools  ♦ Vomits repeatedly   ♦ Becomes very thirsty  ♦ Is eating or drinking very poorly  ♦ Develops a fever  ♦ Has blood in the stool; or  ♦ Does not get better in three days‐  Treatment Plan B: oral rehydration therapy for children with some dehydration Table 2: Guidelines for treating children and adults with some dehydration Approximate amount of ORS solution to give in the first 4 hours Age* <4 mths 4-11 mths 12-23mths 2-4 years 5-14 years ≥15 years Weight < 5 kg 5-7.9 kg 8-10.9 kg 11-15.9 kg 16-29.9 kg ≥30 kg Quantity 200-400 ml 400-600 ml 600-800 ml 800 ml-1.2 L 1.2-2 L 2.2-4 L In local measure Use the patient's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the patient’s weight in kg by 75. • If the patient wants more ORS than shown, give more. • Encourage the mother to continue breastfeeding her child. NOTE: during the initial stages of therapy, while still dehydrated, adults can consume up to 750 ml per hour, if necessary, and children up to 20 ml per kg body weight per hour.    How to give ORS solution ♦ Teach a family member to prepare and give ORS solution.  ♦ Use a clean spoon or cup to give ORS solution to infants and young children. Feeding  bottles should not be used.  ♦ Use droppers or syringes to put small amounts of ORS solution into mouths of babies.  ♦ Children  under  2  years  of  age,  should  get  a  teaspoonful  every  1‐2  minutes;  older  children (and adults) may take frequent sips directly from a cup.  ♦ Check from time to time to see if there are problems.  ♦ If  the  child  vomits,  wait  5‐10  minutes  and  then  start  giving  ORS  again,  but  more  slowly, for example, a spoonful every 2‐3 minutes.  Assessment and treatment of diarrhoea   35 ♦ If the child’s eyelids become puffy, stop the ORS and give plain water or breast milk.  Give ORS according to Plan A when the puffiness is gone.  Monitoring the progress of oral rehydration therapy ♦ Check the child frequently during rehydration.  ♦ Ensure that ORS solution is being taken satisfactorily and the signs of dehydration are  not worsening.  ♦ After four hours, reassess the child fully following the guidelines in Table 1 and decide  what treatment to give.  ♦ If signs of severe dehydration have appeared, shift to Treatment Plan C.   ♦ If signs indicating some dehydration are still present, repeat Treatment Plan B. At the  same  time  offer  food, milk  and  other  fluids  as described  in Treatment  Plan A,  and  continue to reassess the child frequently.  ♦ If there are no signs of dehydration, the child should be considered fully rehydrated.  When rehydration is complete:  ƒ skin pinch is normal;  ƒ thirst has subsided;  ƒ urine is passed;  ƒ child becomes quiet, is no longer irritable and often falls asleep.  ♦ Teach the mother how to treat her child at home with ORS solution and food following  Treatment Plan A. Give her enough ORS packets for 2 days.    ♦ Also  teach  her  the  signs  that mean  she  should  bring  her  child  back  to  see  a  health  worker.  If oral rehydration therapy must be interrupted If the mother and child must leave before the rehydration with ORS solution is completed:  ♦ Show her how much ORS to give to finish the 4‐hour treatment at home.  ♦ Give her enough ORS packets to complete the four hour treatment and to continue oral  rehydration for two more days, as shown in Treatment Plan B.  ♦ Show her how to prepare ORS solution.  ♦ Teach her the four rules in Treatment Plan A for treating her child at home.  When oral rehydration fails ♦ If signs of dehydration persist or reappear, refer the child.  Giving zinc sulfate ♦ Begin to give supplemental zinc sulfate tablets, as in Treatment Plan A, as soon as the  child is able to eat following the initial four hour rehydration period.  Giving food ♦ Except  for  breast  milk,  food  should  not  be  given  during  the  initial  four‐hour  rehydration period.  The Interagency Emergency Health Kit 2006 36 ♦ Children continued on Treatment Plan B longer than four hours should be given some  food every 3‐4 hours as described in Treatment Plan A.  ♦ All children older than 6 months should be given some food before being sent home.  This  helps  to  emphasize  to  mothers  the  importance  of  continued  feeding  during  diarrhoea.  Assessment and treatment of diarrhoea   37 Treatment Plan C: for patients with severe dehydration Follow the arrows. If the answer is “yes” go across. If “no” go down. Can you give intravenous (IV) fluids immediately?   Yes ⎬  Start IV fluids immediately. If the patient can drink, give ORS by mouth while the drip is set up. Give 100 ml/kg Ringer’s Lactate Solution (or if not available normal saline), divided as follows:     Age First give 30ml/kg in: Then give 70ml/kg in:     Infants (under 12 months) 1 hour* 5 hours     Older 30 minutes* 2 ½ hours   No     *  Repeat once if radial pulse is still very weak or non‐detectable.      ♦ Reassess the patient every 1-2 hours. If hydration is not improving, give the IV drip more rapidly.     ♦ Also give ORS (about 5 ml/kg/hour) as soon as the patient can drink: usually after 2-4 hours (infants) or 1-2 hours (older patients).     ♦ After 6 hours (infants) or 3 hours (older patients), evaluate the patient using the assessment chart. Then choose the appropriate Plan (A, B or C) to continue treatment. Is IV treatment available nearby (within 30 minutes)?   Yes ⎬  ♦ Send the patient immediately for IV treatment. ♦ If the patient can drink, provide the mother with ORS solution and show her how to give it during the trip to receive IV treatment.   No     Are you trained to use a naso-gastric tube (NG) for rehydration?   Yes ⎬  ♦ Start rehydration by tube with ORS solution: give 20 ml/kg/hour for 6 hours (total of 120ml/kg).       ♦ Reassess the patient every 1-2 hours: • if there is repeated vomiting or increased abdominal distension, give the fluid more slowly. • if hydration is not improved after 3 hours, send the patient for IV therapy.   No    ♦ After 6 hours, reassess the patient and choose the appropriate treatment plan. Can the patient drink?   Yes ⎬  ♦ Start rehydration by mouth with ORS solution, giving 20 ml/kg/hour for 6 hours (total of 120 ml/kg).       ♦ Reassess the patient every 1-2 hours:       • if there is repeated vomiting, give the fluid more slowly-if hydration is not improved after 3 hours, send the patient for IV therapy.   No    ♦ After 6 hours, reassess the patient and choose the appropriate treatment plan. Urgent: send the patient for IV or NG treatment. NB: If possible, observe the patient for at least six hours after rehydration to be sure the mother can maintain hydration giving ORS solution by mouth. If the patient is over two years old and there is cholera in your area, give an appropriate oral antibiotic after the patient is alert.  The Interagency Emergency Health Kit 2006 38 Management of the child with cough or difficult breathing   39 Annex 3. Management of the child with cough or difficult breathing A-3.1 Assess the child Ask  • How old is the child?  • Is the child coughing? For how long?  • Is the child able to drink (for children age 2 months up to 5 years)?  • Has the young infant stopped feeding well (for children less than 2 months)?  • Has the child had fever?  For how long?  • Has the child had convulsions?    Look and listen (the child must be calm)  • Count the breaths in a minute.  • Look for chest indrawing.  • Look and listen for stridor.  • Look and listen for wheeze. Is it recurrent?  • See if the child is abnormally sleepy, or difficult to wake.  • Feel for fever, or low body temperature (or measure temperature).  • Look for severe undernutrition.  A-3.2 Decide how to treat the child The child aged less than two months: � see Annex 3.3 The child aged two months up to five years: • who is not wheezing � see Annex 3.4 • who is wheezing � Refer Treatment instructions � see Annex 3.5 • give an antibiotic • advise mother to give home care • treatment of fever. The Interagency Emergency Health Kit 2006 40 A-3.3 Child less than two months old No fast breathing (LESS than 60 a minute) Fast breathing (60 per minute or MORE) Not able to drink Convulsions and or Abnormally sleepy or difficult to wake Stridor in calm child Signs: No severe chest indrawing Severe chest indrawing Wheezing Or Fever or low body temperature No pneumonia - cough or cold Severe pneumonia Very severe disease Classify as: Advise mother to give following home care: keep infant warm Refer URGENTLY to hospital Refer URGENTLY to hospital Breastfeed frequently Clear nose if it interferes with feeding Give first dose of an antibiotic Give first dose of an antibiotic Treatment: Advise mother to return quickly if: Illness worsens Breathing is difficult Breathing becomes fast Feeding becomes a problem Keep infant warm (If referral is not feasible, treat with an antibiotic and follow closely) Keep infant warm (If referral is not feasible, treat with an antibiotic and follow closely) Management of the child with cough or difficult breathing   41 A-3.4 Child two months to five years old Signs:  No chest  indrawing and  No fast  breathing (less  than 50 per  minute if child  2‐12 months of  age or 40 per  minute if child  1‐5 years)  No chest indrawing  and  Fast breathing (50  per minute or  MORE if child 2‐12  months of age or 40  per minute if child  1‐5 years)    Chest indrawing  Not able to  drink  Convulsions  Abnormally  sleepy or  difficult to  wake  Stridor in calm  child or  Severe  undernutrition  Classify  as:  No  pneumonia:  cough or cold  Pneumonia  Severe  pneumonia    Very severe  disease    If coughing more than 30  days, refer for  assessment  Advise mother to  give home care  Refer  URGENTLY to  hospital  Refer  URGENTLY to  hospital  Treat‐  ment:  Assess and  treat ear  problem or  sore throat if  present  Give an antibiotic    Give first dose of  antibiotics  Give first dose  of antibiotics    Assess and treat other  problems  Treat fever if  present  Treat fever if  present  Treat fever if  present      Advise mother to give home  care  Treat fever if  present  Advise mother to  return in 2 days for  reassessment, or if  the child is getting  worse  (If referral is not  possible, treat  with an antibiotic  and follow  closely)  If cerebral  malaria is  possible, give  an antimalarial  medicine  È    Reassess in 2 days a child who is taking an antibiotic for pneumonia    Signs:  Improving    Less fever  Eating better  Breathing slower  The same  Worse    Not able to drink  Has chest indrawing  Has other danger  signs    Treatment:  Finish 5 days of  antibiotics  Change antibiotic  or  Refer  Refer URGENTLY to  hospital    The Interagency Emergency Health Kit 2006 42 A-3.5 Treatment instructions A-3.5.1 Give an antibiotic • Give first dose of antibiotic in the clinic.  • Instruct mother on how to give the antibiotic for five days at home   (or to return to clinic for daily procaine‐penicillin injection).    Amoxicillin tab 250 mg Age or (Weight) Twice daily for 5 days < 2 mths (< 6 kg)* ¼ tab 2 - 12 mths (6-9 kg) ½ tab 12 mths - 5 yrs (10-19 kg) 1 tab   *  Give oral antibiotic for five days at home if referral is not feasible.  A-3.5.2 Advise mother to give home care (for child age 2 months up to 5 years) • Feed the child − feed the child during illness − increase feeding during illness − clear the nose if it interferes with feeding • Increase fluids − offer the child extra to drink − increase breastfeeding − soothe the throat and relieve cough with a safe remedy • Most important: for the child classified as having no pneumonia, cough or cold, watch for the following signs and return quickly if they occur: − breathing becomes difficult − breathing becomes fast − child not able to drink − child becomes sicker } This child may have pneumonia Management of the child with cough or difficult breathing   43 A-3.5.3 Treat Fever (see also page 27) Malaria is not confirmed: Give paracetamol, see table below. Fever is high: (> 39°C) Parasite-based diagnosis53 for all patients of all age groups Malaria is confirmed: Give artemether/lumefantrine treatment see Fever on page 27(or follow national malaria treatment recommendations) Malaria is not confirmed: Advise the mother to give more fluids. In low malaria transmission areas Fever is not high: (38-39°C) Parasite-based diagnosis53 for all patients of all age groups Malaria is confirmed: Give artemether/lumefantrine treatment see Fever on page 27 (or follow national malaria treatment recommendations) Malaria is not confirmed: Give paracetamol, see table below. Parasite based diagnosis53 for all adult patients and children > 5 years Malaria is confirmed: Give artemether/lumefantrine treatment see Fever on page 27 (or follow national malaria treatment recommendations) In high malaria transmission areas All cases of fever For children < 5 years, to be treated on the basis of a clinical diagnosis of malaria Give artemether/lumefantrine treatment see Fever on page 27 (or follow national malaria treatment recommendations) Fever alone is not a reason to give an antibiotic, except in a young infant (age less than 2 months). Give first dose of an antibiotic and Refer URGENTLY to hospital.   PARACETAMOL Every six hours, for 1 to 3 days Age or Weight 100 mg tab 500 mg tab 3 - 12 mths (6-<10 kg) ½ - 1 1- < 5 yrs (10-<15 kg) 1 - 2 5 - < 10 yrs (15-<25 kg) 2 - 3 ½ 10-<15 yrs (25-<35 kg) 1                                                              53 By microscopy or by RDTs The Interagency Emergency Health Kit 2006 44 Sample data collection forms   45 Annex 4: Sample data collection forms Daily morbidity data Location: Clinic:   Date: Children Children five years under 5 years old and older, and adults Total Diarrhoea with blood Diarrhoea without blood Fever Confirmed malaria Malnutrition Measles Meningitis Severe acute respiratory infections/pneumonia Sexually transmitted infections Others Totals Number of cases referred to other services: Other information: The Interagency Emergency Health Kit 2006 46 Weekly mortality statistics Location: Total population: Week: Cause of death Children under 5 years Children 5 years and older, and adults Total Male Female Male Female Male Female ARI54/pneumonia Diarrhoea Diarrhoea with blood Fever Confirmed malaria Malnutrition Maternal deaths Measles Meningitis Others Totals Other information                                                        54 ARI = Acute Respiratory Infection Sample data collection forms   47 Daily medicine consumption form Date: Location: Item/medicine Quantities dispensed* Total 1. albendazole 400 mg chewable tab 2. aluminium hydroxide 400 mg + magnesium hydroxide 400 mg tab 3. amoxicillin 250 mg tab 4. artemether + lumefantrine, 20 mg + 120 mg tab 6 x 1 tab 6 x 2 tab 6 x 3 tab 6 x 4 tab 5. benzyl benzoate 25%, lotion 6. chlorhexidine 5%, solution 7. ferrous sulfate + folic acid 200 mg + 0.4 mg tab 8. gentian violet, powder 9. ibuprofen 400 mg scored tab 10. ORS, sachets 11. paracetamol 100 mg tab 12. paracetamol 500 mg tab 13. tetracycline 1% eye ointment 14. quinine sulfate 300 mg tab 15. zinc sulfate 20 mg dispersible tab * For example: 10 + 30 + 20… The Interagency Emergency Health Kit 2006 48         Sample health card   49 Annex 5. Sample health card HEALTH CARD  Card No.  Carte No.  CARTE DE SANTE  Date of registration  Date d’enregistrement    Site  Lieu    Section/House No.   Section /Habitation No.    Date of arrival at site  Date dʹarrivée sur le lieu    Family name  Nom de famille    Given names  Prénoms    Date of birth or age  Date de naissance ou âge    Or  Ou  Years  Ans    Sex  Sexe  M/F  Name commonly known by  Nom d’usage habituel    Mother’s name  Nom de la mère    Father’s name  Nom du père    Height  Taille  CM  Weight  Poids    KG  Percentage weight/height  Pourcentage poids/taille    Feeding programme  Programme d’alimentation    Immunization  Measles  Rougeole  Date  1  2  BCG  Date    Others  Autres    C H I L D R E N          E N F A N T S  Immunization  Polio    Date    DPT Polio   Date  DTC Polio  1  2  3  Pregnant  Enceinte  Yes/No  Oui/Non  No. of pregnancies  No. de grossesses    No. of children  No. d’enfants    Lactating  Allaitante  Yes/no   Oui/Non  Tetanus  Tétanos  Date  1  2  3  4  5  W O M E N  F E M M E S  Feeding programme  Programme d’alimentation        C O M M E N T S  O B S E R V A T I O N S  General (Family circumstances, living conditions etc.)  Générales (Circonstances familiales, condition de vie, etc.)                      Health (Brief history, present condition)  Médicales (Résumé de l’état actuel)    The Interagency Emergency Health Kit 2006 50       DATE  CONDITION  (Signs/symptoms/diagnosis)    ETAT  (Signes/symptômes/diagnostic)  TREATMENT  (Medication/dose time)    TRAITEMENT  (Médication/durée de la dose)  COURSES  (Medication due/given)      APPLICATION  (Médication requise/effectuée)  OBSERVATIONS  (Change in condition)  NAME OF HEALTH WORKER    OBSERVATIONS  (Changement d’état)  NOM DE L’AGENT DE SANTE                                                                          Guidelines for suppliers   51 Annex 6. Guidelines for suppliers Specifications for medicines and medical devices 1. Medicines, and medical devices ‐ renewable and equipment ‐ in the kit should comply  with  specifications  given  in  UNICEF  web  catalogue  where  items  specifications  are  updated on line, at:    2. Suppliers  should  purchase  as much  as  possible  from manufacturers which  are  pre‐ qualified by WHO. The list of pre‐qualified manufacturers and products can be found  on    3. Medicines, and medical devices ‐ renewable and equipment ‐ in the kit should comply  with specifications and advice given in Interagency Guidelines for drug donations. Revised  1999. World Health Organization Geneva (WHO/EDM/PAR/99.4).    4. Suppliers  should  contact  WHO/Procurement  Services  (Annex  11)  for  the  latest  specifications  of  Rapid  Diagnostic  Tests  (RDTs),  and  information  on  the   most  appropriate  tests  for  use  in  different  regions  (see  also  Packaging 1. The  tablets  or  capsules  should  be  packed  in  sealed  waterproof  containers  with  replaceable lids, protecting the contents from light and humidity.   2. There will be  ʺno objectionʺ against blister packaging provided  it will be waterproof  and protecting the contents from light and humidity where applicable.   3. Liquids should be packed in unbreakable leak‐proof bottles or containers.  4. Containers  for  all pharmaceutical preparations must  conform  to  the  latest  edition of  internationally recognized pharmacopoeial standards.  5. Ampoules must either have break‐off necks, or sufficient files must be provided.  6. Each  basic  unit  should  be  packed  in  one  carton  with  the  malaria  module  packed  separately. The supplementary unit must be packed  in cartons of a maximum weight  of 50 kg each.   7. Medicines,  infusions,  renewable  medical  devices  and  medical  devices,  and  other  equipment  should  all be packed  in  separate  cartons, with  corresponding  labels. The  cartons should preferably have two handles attached.  The Interagency Emergency Health Kit 2006 52 8. Each carton must be marked with labels permitting identification and classification of  each carton within  the kit. The word “BASIC” must be printed on each  label  for  the  basic unit.   Packing list Each  consignment must be  accompanied by  a  list of  contents,  stating  the  total number of  cartons and for each carton, the following should be clearly specified:     1. name of each product;  2. batch number of each product;  3. quantity of each product; and  4. expiry date of each product, especially for pharmaceutical products.   Information slips Each basic unit carton and a number of  the supplementary unit cartons should contain an  information  slip  in,  at  least,  three  languages  (English,  French,  Spanish)  which  reads  as  follows:  English ʺThe Interagency Emergency Health Kit 2006 is primarily intended for displaced  populations without medical  facilities;  it may also be used  for  initial  supply of  primary health care  facilities where  the normal system of provision has broken  down. It is not intended as a re‐supply kit and, if used as such, may result in the  accumulation of items and medicines which are not needed.    It is recognized that some of the medicines, medical devices contained in the kit  may not be appropriate for all cultures and countries. This is inevitable as it is a  standardized  emergency  kit,  designed  for worldwide  use, which  is  prepacked  and kept ready for immediate dispatch.    The  kit  is  not  designed  for  immunization  programmes,  cholera, meningitis  or  specific  epidemics  such  as  those  caused  by  Ebola  virus,  SARS  and  avian  flu  virus.”   French << Le Kit Sanitaire d’Urgence  Inter‐institutions 2006 est principalement destiné  aux populations déplacées n’ayant pas accès à un système de soins médicaux. Il  peut également être utilisé pour donner des soins de santé primaires, partout où  le  système  habituel  nʹest  plus  fonctionnel.  Il  ne  doit  en  aucun  cas  servir  de  réapprovisionnement car cela pourrait entraîner une accumulation  inappropriée  de matériel médical et de médicaments.    Dans  la mesure  où  ce  kit  est  standardisé, destiné  à  être utilisé dans  le monde  entier et préconditionné afin dʹêtre distribué immédiatement en cas de nécessité,  Guidelines for suppliers   53 il  est  inévitable  qu’une  partie  du  matériel  médical  et  des  médicaments  qu’il  contient ne conviennent pas à tous les pays et à toutes les cultures.      Ce kit n’est ni conçu pour les programmes de vaccination, choléra, méningite, ni  pour des  épidémies  spécifiques  comme  celles dues  au virus Ebola,  SARS  et  le  virus de la grippe aviaire. >>  Spanish <<  El  botiquín  médico  de  emergencia  interorganismos  2006  está  destinado  principalmente  a  las  poblaciones  desplazadas  carentes  de  servicios  médicos;  podrá  utilizarse  también  para  la  prestación  inicial  de  servicios  de  atención  primaria  de  salud  donde  el  sistema  normal  de  prestación  esté  paralizado. No  tiene por objeto reabastecer el botiquín, pues si se utiliza con este fin ello puede  dar lugar a que se acumulen artículos y medicamentos innecesarios.    Se  reconoce  que  algunos  de  los  suministros  y medicamentos  contenidos  en  el  botiquín pueden  no  ser  apropiados  en  todos  los  contextos  culturales  y países.  Esto  es  inevitable,  ya  que  se  trata  de  un  botiquín  estándar  de  emergencia  destinado para su uso en todo el mundo, preempaquetado y listo para su envío  inmediato.    El botiquín no está destinado a  los programas de  inmunización ni a combatir el  cólera, la meningitis o epidemias particulares como la provocada por el virus de  Ébola, SRAS y la gripe aviar. >>  The Interagency Emergency Health Kit 2006 54     Other kits for emergency situations   55 Annex 7. Other kits for emergency situations The following additional kits covering immunization, nutrition and reproductive health may  be provided after assessment of needs. Please see Annex 11  for  the addresses of Médecins  Sans Frontières (MSF), OXFAM, and the United Nations Population Fund (UNFPA).  Immunization Immunization kit for 10,000 immunizations by 5 teams The kit may be used for mass immunization campaigns for epidemic prevention or control (measles,  meningitis and yellow fever, etc.) It is composed of cold chain, logistic and medical devices divided  into  7 modules,  including  a generator,  refrigeration,  cold  chain  transport  and  equipment,  logistics,  stationery, and medical device renewable items. Vaccines must be ordered separately.  MSF code: KMEDKIMM3‐  Nutrition Nutrition kits OXFAM  and  MSF  have  developed  kits  for  nutritional  support.  The  nutritional  kits  contain  the  necessary equipment to set up a nutritional programme. The MSF anthropometric kit is different from  the one from Oxfam (Kit 1). The other kits developed both by Oxfam and MSF have different codes  but are comparable. The nutrition kits will be packed and labelled by Oxfam.  Survey kits for measuring weight and height of children This kit contains equipment for measuring weight and height of children to assess nutritional status and  materials needed for nutritional surveys by two teams.  OXFAM anthropometric kit ‐ Kit 1   MSF anthropometric kit code: KMEDKNUT4M‐  Registration kits These  kits  contain  material  needed  for  registering  children  and  record  keeping  for  nutritional  programmes.  OXFAM registration kit for supplementary feeding (wet) ‐ Kit 2A  MSF registration kit for supplementary wet feeding, 250 beneficiaries   code: KMEDMNUT61‐    OXFAM registration kit for supplementary feeding (dry) ‐ Kit 3A   MSF registration kit for supplementary dry feeding, 500 beneficiaries   code: KMEDMNUT71‐    The Interagency Emergency Health Kit 2006 56 OXFAM registration kit for therapeutic feeding‐ Kit 4A  MSF registration kit for therapeutic feeding, 100 severely malnourished children  code: KMEDMNUT51‐  Supplementary feeding (wet) kit Designed for 250 people, moderately malnourished children or other vulnerable groups and includes  feeding and cooking equipment. Recent guidelines discourage the use of wet supplementary feeding  programmes  but  do  recommend  that  they  are  only  implemented  when  populations  have  limited  access to fuel and water, where security conditions place people at risk when taking rations home, or  for groups who are in need of additional food but are unable to cook for themselves.  OXFAM Supplementary Feeding (wet) ‐ Kit 2  MSF Nutrition, supplementary wet feeding, 250 beneficiaries  code: KMEDMNUT62‐  Supplementary feeding (dry) kit Designed for 500 people, moderately malnourished children or other vulnerable groups and includes  equipment  for mixing  and distributing  food.  It  is not  intended  for  general  food distribution  of  an  entire population in need of food aid.  OXFAM Supplementary Feeding (dry) ‐ Kit 3  MSF Nutrition, supplementary dry feeding, 500 beneficiaries  code: KMEDMNUT72‐  Therapeutic feeding kit Designed for therapeutic feeding of 100 severely malnourished children. The kit should only be used  by trained staff who are able to recognize and respond to the main health problems associated with  severe malnutrition. There should be access to medical care as the kit contains no medicines.   OXFAM Therapeutic Feeding ‐ Kit 4  MSF Therapeutic Feeding, 100 severely malnourished children  code: KMEDMNUT52‐  Reproductive health Interagency reproductive health kits for crisis situations The  reproductive health kits prepared by UNFPA provide  the  supplies needed  to  implement basic  reproductive health services during the early phase of a crisis.  The RH kits are designed for a varying population for 3 months There are 12 kits divided into three blocks:  Block 1: Six kits for use at the community and primary health care level for a population of 10,000 people for 3 months. They contain mostly disposable medical devices and equipment. Kit 0 ‐ Administration kit  To facilitate administration and training activities.  Kit 1 ‐ Condoms kit  120 gross (17,280) male condoms with 400 safe sex leaflets;  3.8 gross (540) female condoms with 25 use leaflets.  Other kits for emergency situations   57 Kit 2 ‐ Clean delivery kit  200 individual packets containing items and pictorial instruction sheet for home delivery plus  material for traditional birth attendants.  Kit 3 ‐ Rape treatment kit  Management of the immediate consequences of sexual violence with appropriate medicines  and supplies: basic treatment after a rape and PEP treatment for HIV (including treatment  for children).  Kit 4 ‐ Oral and injectable contraception   To respond to womenʹs needs for hormonal contraception.  Kit 5 ‐ Treatment of sexually transmitted infections  To diagnose and treat STIs in people presenting with complaints.  Block 2: Five kits for use at primary health care and referral hospital levels, designed for a population of 30,000 people for 3 months Kit 6 ‐ Clinical delivery kit  To perform normal deliveries, repair episiotomies and perineal tears under local anesthetics and  stabilize women with obstetric complications (eclampsia and haemorrhage) before transfer to a  referral unit, for trained personnel, midwives, nurses with midwifery skills and medical doctors.  Kit 7 ‐ Intra‐uterine device kit  To place IUDs either as contraception or as emergency contraception, and to remove IUDs and  provide preventive antibiotic treatment, for trained personnel.  Kit 8 ‐ Management of miscarriage and complications of abortion   To treat the complications arising from miscarriage and unsafe abortion, including sepsis,  incomplete evacuation and bleeding, for trained personnel.  Kit 9 ‐ Suture of tears vaginal/cervical and vaginal examination kit  To allow vaginal examination and suturing of cervical and vaginal tears, for trained personnel,  midwives, physicians, nurses with midwifery skills.  Kit 10 ‐ Vacuum extraction delivery kit  To assist in vaginal delivery by using manual vacuum extraction method to deliver the newborn.  Block 3: Two kits designed for referral surgical/obstetric level for 150,000 people for 3 months. Kit 11 ‐ Referral level kit for reproductive health (part A+B)  Medical devices, renewable and equipment and medicines for use at the referral level for  caesarian sections, resuscitation of mothers and babies, treatment of complications of sexually  transmitted infections, and complications of pregnancy and delivery.  Kit 12 ‐Blood transfusion kit  To perform safe blood transfusion after testing for HIV, syphilis and hepatitis B and C.   The Interagency Emergency Health Kit 2006 58   Guidelines for Drug Donations   59 Annex 8. Guidelines for Drug Donations55 Selection of drugs 1. All drug donations should be based on an expressed need and be relevant to the disease pattern in the recipient country. Drugs should not be sent without prior consent by the recipient.   Justification and explanation This provision  stresses  the point  that  it  is  the prime  responsibility of  the  recipients  to  specify their needs. It is intended to prevent unsolicited donations, and donations which  arrive unannounced and unwanted. It also empowers the recipients to refuse unwanted  gifts.  Possible exceptions In  acute  emergencies  the  need  for  prior  consent  by  the  recipient  may  be  waived,  provided  the drugs are amongst  those  from  the WHO Model List of Essential Drugs  that  are  included  in  the UN  list  of  emergency  relief  items  recommended  for  use  in  acute emergencies (    2. All donated drugs or their generic equivalents should be approved for use in the recipient country and appear on the national list of essential drugs, or, if a national list is not available, on the WHO Model List of Essential Drugs, unless specifically requested otherwise by the recipient. Justification and explanation   This  provision  is  intended  to  ensure  that  drug  donations  comply with  national  drug  policies and essential drugs programmes.  It aims at maximizing  the positive  impact of  the  donation,  and  prevents  the  donation  of  drugs  which  are  unnecessary  and/or  unknown in the recipient country.   Possible exceptions   An exception can be made for drugs needed in sudden outbreaks of uncommon or newly  emerging  diseases,  since  such  drugs  may  not  be  approved  for  use  in  the  recipient  country. 3. The presentation, strength and formulation of donated drugs should, as much as possible, be similar to those of drugs commonly used in the recipient country. Justification and explanation Most staff working at different health care levels in the recipient country have been trained to use a certain formulation and dosage schedule and cannot constantly change their treatment practices. Moreover, they often have insufficient training in performing the necessary dosage calculations required for such changes.                                                        55 Reprinted from: Interagency guidelines for drug donations. Revised 1999. Geneva: World Health Organization; WHO/EDM/PAR 99.4. The Interagency Emergency Health Kit 2006 60 Quality assurance and shelf-life 4. All donated drugs should be obtained from a reliable source and comply with quality standards in both donor and recipient country. The WHO Certification Scheme on the Quality of Pharmaceutical Products Moving in International Commerce should be used. Justification and explanation   This provision prevents double  standards: drugs of unacceptable quality  in  the donor  country should not be donated to other countries. Donated drugs should be authorized  for  sale  in  the  country  of  origin,  and manufactured  in  accordance with  international  standards of Good Manufacturing Practice (GMP).     Possible exceptions   In  acute  emergencies  the use  of  the WHO Certification  Scheme may not  be practical.  However,  if  it  is not used, a  justification  should be given by  the donor. When donors  provide  funds  to  purchase  drugs  from  local  producers,  those  which  comply  with  national  standards  should not be excluded on  the  sole grounds  that  they do not meet  quality standards of the donor country. 5. No drugs should be donated that have been issued to patients and then returned to a pharmacy or elsewhere, or were given to health professionals as free samples. Justification and explanation   Patients  return  unused  drugs  to  a  pharmacy  to  ensure  their  safe  disposal;  the  same  applies to drug samples that have been received by health workers. In most countries it is  not  allowed  to  issue  such  drugs  to  other  patients,  because  their  quality  cannot  be  guaranteed. For this reason returned drugs should not be donated either. In addition to  quality issues, returned drugs are very difficult to manage at the receiving end because of  broken packages and the small quantities involved. 6. After arrival in the recipient country all donated drugs should have a remaining shelf- life of at least one year. An exception may be made for direct donations to specific health facilities, provided that: the responsible professional at the receiving end acknowledges that (s)he is aware of the shelf-life; and that the quantity and remaining shelf-life allow for proper administration prior to expiration. In all cases it is important that the date of arrival and the expiry dates of the drugs be communicated to the recipient well in advance. Justification and explanation   In  many  recipient  countries,  and  especially  under  emergency  situations,  there  are  logistic  problems.  Very  often  the  regular  drug  distribution  system  has  limited  possibilities for immediate distribution. Regular distribution through different storage  levels (e.g. central store, provincial store, district hospital) may take six to nine months.  This provision especially prevents the donation of drugs  just before their expiry, as in  most cases such drugs would only reach the patient after expiry. It is important that the  recipient  official  responsible  for  acceptance  of  the  donation  is  fully  aware  of  the  quantities of drugs being donated, as overstocking may lead to wastage. The argument  that  short‐dated  products  can  be donated  in  the  case  of  acute  emergencies,  because  they  will  be  used  rapidly,  is  incorrect.  In  emergency  situations  the  systems  for  reception, storage and distribution of drugs are very often disrupted and overloaded,  and many donated drugs tend to accumulate. Guidelines for Drug Donations   61 Additional exception   Besides  the  possible  exception  for  direct  donations  mentioned  above,  an  exception  should be made for drugs with a total shelf‐life of less than two years, in which case at  least one‐third of the shelf‐life should remain. Presentation, packing and labelling 7. All drugs should be labelled in a language that is easily understood by health professionals in the recipient country; the label on each individual container should at least contain the International Nonproprietary Name (INN) or generic name, batch number, dosage form, strength, name of manufacturer, quantity in the container, storage conditions and expiry date. Justification and explanation All donated drugs, including those under brand name, should be labelled also with their INN or the official generic name. Most training programmes are based on the use of generic names. Receiving drugs under different and often unknown brand names and without the INN is confusing for health workers and can even be dangerous for patients. In the case of injections, the route of administration should be indicated. 8. As much as possible, donated drugs should be presented in larger quantity units and hospital packs.   Justification and explanation   Large quantity packs are cheaper,  less bulky  to  transport and conform better  to public  sector  supply  systems  in most developing  countries. This  provision  also prevents  the  donation of drugs  in sample packages, which are  impractical  to manage.  In precarious  situations,  the  donations  of  paediatric  syrups  and  mixtures  may  be  inappropriate  because of logistical problems and their potential misuse. 9. All drug donations should be packed in accordance with international shipping regulations, and be accompanied by a detailed packing list which specifies the contents of each numbered carton by INN, dosage form, quantity, batch number, expiry date, volume, weight and any special storage conditions. The weight per carton should not exceed 50 kilograms. Drugs should not be mixed with other supplies in the same carton. Justification and explanation   This  provision  is  intended  to  facilitate  the  administration,  storage  and  distribution  of  donations  in emergency situations, as  the  identification and management of unmarked  boxes with mixed drugs  is very  time‐ and  labour‐intensive. This provision  specifically  discourages  donations  of  small  quantities  of  mixed  drugs.  The  maximum  weight  of  50 kilograms ensures that each carton can be handled without special equipment. The Interagency Emergency Health Kit 2006 62 Information and management 10. Recipients should be informed of all drug donations that are being considered, prepared or actually under way. Justification and explanation   Many drug donations  arrive unannounced. Detailed  advance  information  on  all drug  donations is essential to enable the recipient to plan for the receipt of the donation and to  coordinate  the donation with other  sources of  supply. The  information  should at  least  include:  the  type  and  quantities  of  donated  drugs  including  their  International  Nonproprietary Name (INN) or generic name, strength, dosage form, manufacturer and  expiry date; reference to earlier correspondence (for example, the letter of consent by the  recipient);  the expected date of arrival and port of entry; and  the  identity and  contact  address of the donor.   11. In the recipient country the declared value of a drug donation should be based upon the wholesale price of its generic equivalent in the recipient country, or, if such information is not available, on the wholesale world-market price for its generic equivalent. Justification and explanation   This provision is needed solely to prevent drug donations being valued in the recipient  country according to the retail price of the product in the donor country. This may lead  to elevated overhead costs  for  import  tax, port clearance and handling  in  the  recipient  country. It may also result in a corresponding decrease in the public sector drug budget  in the recipient country.     Possible exception In the case of patented drugs (for which there is no generic equivalent) the wholesale price of the nearest therapeutic equivalent could be taken as a reference. 12. Costs of international and local transport, warehousing, port clearance and appropriate storage and handling should be paid by the donor agency, unless specifically agreed otherwise with the recipient in advance. Justification and explanation   This provision prevents the recipient from being forced to spend effort and money on the  clearance  and  transport  of  unannounced  consignments  of  unwanted  items,  and  also  enables the recipient to review the list of donated items at an early stage.     Model regulatory aspects of exportation and importation of controlled substances   63 Annex 9. Model Regulatory Aspects of Exportation and Importation of Controlled Substances Introduction Organizations  involved  in  the  provision  of  medical  supplies  in  emergency  situations  are  often  faced  with  serious  difficulties  in  providing  narcotic  and  psychotropic  medicines  because of  the  regulatory  requirements  concerning  their exportation and  importation. The  lack of these medicines results in additional human suffering by depriving those in need of  adequate pain relief and sedation. This makes  these medicines an essential part of medical  supply in emergency situations.     The  Basic  Unit  of  the  Interagency  Emergency  Health  Kit  2006  does  not  contain  any  substances  that  are  regarded  as  narcotics  or  psychotropics,  so  they  are  not  under  international control and will not require additional formalities for international transport.     However,  the  Supplementary Unit  contains  several  substances  under  international  control,  and  other  substances  in  it  are under discussion  for  future  control. Also,  certain  countries  have additional national regulations for medicines not under international control.    Substances from the Kit under international control are morphine injection 10mg/ml, 1 ml-ampoule; diazepam injection 5mg/ml, 2 ml-ampoule and phenobarbital tablets 100mg. Morphine requires import and export licences in any case. For the two other substances this may vary with the country. Some countries have brought additional substances under their national regulations. This could be the case in some countries for ketamine injection 50mg/ml 10 ml-vial, promethazine tablets 25 mg, promethazine injection 25 mg/ml, 2ml-ampoule and chlorpromazine injection 25mg/ml, 2ml- ampoule. At present there is an assessment going on, in order to decide whether ketamine needs to be brought under international control.    There are three international treaties that control narcotic and psychotropic substances:     • UN Single Convention on Narcotic Drugs (1961, amended by protocol of 1972)  • UN Convention on Psychotropic Substances (1971)   • UN Convention against the Illicit Traffic in Narcotic Drugs and Psychotropic  Substances (1988).    These treaties are quite complex and it would go too far to go into details here. For the really  interested,  their  texts  can  be  found  at  the  website  of  the  International  Narcotics  Control  Board (INCB) (   The Interagency Emergency Health Kit 2006 64 Those who need to consult the most recent lists of scheduled substances can find them at this  website too.  Standard procedure for international transfer of narcotic and psychotropic substances The  international  transportation  of  narcotic  medicines  and  psychotropic  substances  is  ʺexportation” from one country and ʺimportationʺ to the other one. This requires an export  authorization from the authorities of the sending country as well as an import authorization  from the authorities of the receiving country. The export authorization  is granted only after  the issue of the import authorization.    As  such,  the  import/export  authorization  system  makes  the  quick  international  transportation  of  controlled  medicines  to  sites  of  emergencies  virtually  impossible.  In  addition, countries have  to estimate  their narcotic drug consumption  in advance and send  the estimates to the INCB. Only after the INCB has received an estimate for a substance from  a  receiving  country,  the  sending  country  will  grant  an  application  for  an  export  authorization. It will be clear that the rigorous application of the estimate system can further  complicate the procedure, especially in situations of suddenly risen demands.    This procedure takes too  long to meet the acute need  for relief  in emergency situations  ‐from several  weeks up to many months. This will be even more true when the control authorities in the receiving  country are struck themselves by the disaster.  Procedure to be followed in disaster relief Model guidelines were prepared to enable adequate procurement of controlled substances in  disaster  relief.  The  procedures  would  allow  suppliers  to  ship  controlled  medicines  internationally  in  emergency  situations  at  the  request  of  recognized  agencies  providing  humanitarian assistance without prior export/import authorizations. The defined procedures  are acceptable to the control authorities and the INCB.    The  INCB  has  advised  control  authorities  that  emergency  humanitarian  deliveries  are  considered  as  being  consumed  in  the  exporting  country.  This  makes  that  no  additional  estimate has to be sent by the authorities of the receiving country. (As the sent amounts are  usually relatively small  in comparison  to  the domestic use of  the sending country,  in most  cases  the existing estimation  is  large enough  to  comprise  the amount  sent, and hence,  the  sending country has no additional estimations to submit to the INCB either.)    The  INCB  recommends  to  limit  control  obligations  in  emergency  situations  to  the  authorities  of  exporting countries.56                                                         56 This principle was endorsed by the UN Commission on Narcotic Drugs in 1995, and was further reinforced by its resolution entitled “Timely provision of controlled medicines for emergency care” adopted at the 39th session in 1996. This and a similar resolution adopted by the 49th session of the World Health Assembly requested WHO to prepare model guidelines to assist national authorities with simplified regulatory procedures for this purpose, in consultation with the relevant UN bodies and interested governments. (Model Guidelines for the International Provision of Controlled Medicines for Emergency Medical Care, WHO/PSA/96.17). Model regulatory aspects of exportation and importation of controlled substances   65 Who should do what? The operator57 should make a written request for emergency supplies of controlled substances  to the supplier58, using the attached model form. The operator is responsible for:    ♦ selection of suppliers;59  ♦ information provided on the form;  ♦ actual handling of  controlled medicines at  the  receiving end or adequate delivery  to  the reliable recipient;  ♦ reporting  to  the  control  authorities  of  the  receiving  country  (whenever  they  are  available) as soon as possible;  ♦ reporting  to  the  control  authorities of  the  receiving  country on unused quantities,  if  any, when the operator is the end‐user or to arrange for the end‐user to do so;  ♦ reporting to the control authorities of the exporting country through the supplier, with  copy to the INCB, any problems encountered in the working of emergency deliveries.    Before responding to the request from the operator, the supplier should be convinced that the  nature  of  the  emergency  justifies  the  application  of  the  simplified  procedure  without  export/import authorizations. The supplier is also responsible for:    ♦ submitting immediately a copy of the shipment request to the control authorities of the  exporting country;  ♦ submitting  an  annual  report  on  emergency  deliveries  and  quantities  of  medicines  involved as well as their destinations, with copy to the INCB;  ♦ reporting  to  the control authorities of  the exporting country, with copy  to  the  INCB,  any problems encountered in the working of emergency deliveries.    The control authorities of the exporting country should inform their counterpart in the receiving  country (whenever they are available) of the emergency deliveries.                                                          57 Operators: organizations engaged in the provision of humanitarian assistance in health matters recognized by the control authorities of exporting countries. 58 Suppliers: supplier of medicines for humanitarian assistance at the request of an operator (either a separate entity or a department of an operator). 59   Suppliers should be limited to those recognized by the control authorities of exporting countries. They should at least have: • adequate experience as a supplier of good quality emergency medical supplies; • managerial capability to assess the appropriateness of requests for the simplified procedure from operators; • adequate level of stock and a responsible pharmacist; • sufficient knowledge about the relevant international conventions; • standard agreement with the control authorities of exporting countries (see attached document with outlines for the agreement).   The Interagency Emergency Health Kit 2006 66 The control authorities of the receiving country have the right to refuse the importation of such  deliveries.   Outline of standard agreement between supplier and control authorities of exporting countries60 The standard agreement should at least cover:  1.   Criteria  for  acceptance  of  shipment  requests  from  operators  (a  model  form  is  attached at the end).  The criteria  for  immediate acceptance of shipment  requests  from operators should at  least specify the essential information to be furnished to the supplier concerning:  a.  credibility of the requesting operator  A  pre‐determined  list  of  credible  operators  ought  to  be  prepared.  A  credible  operator  should  (i) be an established organization;  (ii) have adequate experience  for  international  provision  of  humanitarian  medical  assistance;  (iii)  have  responsible  medical  management  (medical  doctor(s)  or  pharmacist(s));  and  (iv)  appropriate logistic support.   b.  nature of the emergency and the urgency of the request  A statement to the supplier on the nature of the emergency by the operator, or  if  appropriate, by a UN agency.   c.  availability of control authorities in the receiving country.  d.  diversion prevention mechanism after delivery  Indicate if the requesting operator itself is the user of the supplies. If not, the name  and organization of the person responsible for receipt and internal distribution of  the supplies should be indicated. As far as possible, the recipients in the receiving  country should be identified.   2.  Timing and mode of reporting to the control authorities and the INCB  When control authorities are available in the receiving country, they should be notified  as soon as possible by the control authorities of the exporting country and the operator  of a consignment of the emergency delivery, while their import authorization may not  have to be required under the circumstances of an emergency situation.     Suppliers  should  inform  the  control  authorities  of  the  exporting  country  of  each  emergency shipment being made in response to a request from an operator so that the  control authorities can intervene if necessary.     Suppliers should submit to the control authorities of the exporting country an annual  report on emergency deliveries and quantities of medicines  involved as well as  their  destinations in duplicate, so that one copy can be forwarded to the INCB.                                                           60 When an operator is also a supplier, the agreement will be between the operator and the control authorities. Model regulatory aspects of exportation and importation of controlled substances   67 Suppliers, or operators through the suppliers, should inform the control authorities of  the exporting countries, with copy  to  the  INCB, of any problems encountered  in  the  working of emergency deliveries.  3.  Other relevant matters  As appropriate, the agreement may include provisions on other relevant matters such  as inspection and guidance by the control authorities. Although the quantities involved  would be rather small,  it may  touch upon estimated/assessed requirements based on  the  principle  that  the  medicines  provided  should  be  regarded  as  having  been  “consumed” in the exporting country.  The Interagency Emergency Health Kit 2006 68 Shipment request/notification form for emergency supplies of controlled substances Operator: Name: .   Address: .   Name of the responsible medical director/pharmacist: .   Title: .   Phone No.  . Fax No. .     Requests the supplier:61 Name: .   Address: .   Responsible pharmacist:  .   Phone No.  . Fax No.  .     For an emergency shipment62 of the following medicine(s) containing controlled substances: Name of product (in INN/generic name) and dosage form, amount of active ingredient per unit dose,  number of dosage units in words and figures    Narcotic medicines as defined in the 1961 Convention (e.g. morphine, pethidine, fentanyl)   [e.g.morphine injection 1 ml ampoule; morphine sulfate corresponding to 10 mg  of morphine base per  ml; two hundred (200) ampoules]  .   .   .   .     Psychotropic  substances  as  defined  in  the  1971  Convention  (e.g.  buprenorphine,  pentazocine,  diazepam, phenobarbital)  .   .   .   .     Others (nationally controlled in the exporting country, if applicable)  .   .                                                          61 If the operator is exporting directly from its emergency stock, it should be considered as a supplier. 62 Emergency deliveries do not affect the estimate of the recipient country since they have already been accounted for in the estimate of the exporting country.  Model regulatory aspects of exportation and importation of controlled substances   69 To the following recipient (whichever applicable): Country of final recipient: .   Responsible person for receipt: .   Name: .   Organization/Agency:.   Address: .   Phone No. . . Fax No. .     For use by/delivery to: Location:  . Organization/Agency .   .   .   .   .     Consignee (If different from above e.g. transit in a third country):  Name:  . Organization/Agency .   Address: .   Phone No. . . Fax No. .     Nature of the emergency (Brief description of the emergency motivating the request):  .   .   .     Availability of, and action taken to contact the control authorities in the receiving country:  .   .     I certify that the above information is true and correct. My Organization will:     ♦ Take  responsibility  for  receipt,  storage,  delivery  to  the  recipient/end‐user,  or  use  for  emergency care (strike out what is not applicable) of the above controlled medicines;  ♦ Report  the  importation  of  the  above  controlled medicines  as  soon  as  possible  to  the  control authorities (if available) of the receiving country;  ♦ Report the quantities of unused controlled medicines, if any, to the control authorities of  the receiving country (if available), or arrange for the end‐user to do so (strike out what  is not applicable).    Title: .Date:    .   Location:  .   .   (Signature)  The Interagency Emergency Health Kit 2006 70   References   71 Annex 10. References The books and documents  referenced below may be obtained  (some are priced others are  free of charge) from the respective organizations ‐ contact details are provided in Annex 11  or can be found on the organizationsʹ websites.  Medicines WHO. Electronic Essential Medicines Library and WHO Model Formulary  URL:    WHO. WHO Model List of Essential Medicines.  Medicine management UNHCR. UNHCR Drug Management Manual 2006. Policies, Guidelines, UNHCR List of Essential  Drugs. UNHCR, Geneva, 2006‐bin/texis/vtx/publ/opendoc.pdf?tbl=PUBL&id=43cf66132    John Snow, Inc./DELIVER. Logistics Handbook: A Practical Guide for Supply Chain Managers in  Family Planning and Health Programs. 2004,3144386,93_3144425&_dad=portal&_schema=PORT AL    John Snow, Inc./DELIVER in collaboration with WHO. Guidelines for the Storage of Essential  Medicines and Other Health. Arlington, VA: John Snow, Inc./DELIVER; 2003.,3144386,93_3144425&_dad=portal&_schema=PORT AL  Communicable diseases WHO. Communicable Disease Control in Emergencies ‐ A Field Manual. WHO/CDS/2005.27. ISBN  92 4 154616 6ʺ    WHO. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae  type 1. World Health Organization, Geneva 2005. (ISBN 92 4 159233 0)    WHO/Department of Child and Adolescent Health and Development. The treatment of diarrhoea ‐ A  manual for physicians and other senior health workers. World Health Organization, Geneva, 2005.  (ISBN 92 4 159318 0)‐adolescent‐ health/New_Publications/CHILD_HEALTH/ISBN_92_4_159318_0.pdf      The Interagency Emergency Health Kit 2006 72 WHO. Environmental health in emergency situation. A practical guide. Control of communicable  diseases and prevention of epidemics. World Health Organization, Geneva, 2002.  General public health MSF. Refugee health: an approach  to emergency situations. London: Macmillan; 1997.  ISBN 0‐333‐ 72210‐8    WHO. Environmental health in emergencies and disasters: a practical guide. Geneva: World Health  Organization; 2003. ISBN 92 4 154 541 0    UNHCR.  Water  manual  for  refugee  situations.  Geneva:  Office  of  the  United  Nations  High  Commissioner for Refugees; 1992  Child health WHO. Child health in emergencies. 2003‐adolescent‐health/publications/pubemergencies.htm     WHO. Report of consultative Meeting to Review Evidence and Research Priorities in the  Management of Acute Respiratory Infections (ARI). Geneva 29 September ‐ 1 October 2003.  WHO/FCH/CAH/04.2.‐adolescent‐ health/New_Publications/CHILD_HEALTH/WHO_FCH_CAH_04.2.pdf  WHO. Technical updates of the guidelines on the Integrated Management of Childhood Illness  (IMCI). Evidence and recommendations for further adaptations. World Health Organization,  Geneva 2005.‐adolescent‐health/New_Publications/IMCI/ISBN_92_4_159348_2.pdf  HIV and STIs IASC. Guidelines for HIV interventions in emergency settings.  Inter‐Agency standing committee . Geneva: Joint United Nations Programme on HIV/AIDS; 2003.     WHO. Guidelines  for  the management of  sexually  transmitted  infections. Geneva: World Health  Organization; 2003. ISBN 92 4 1546263. URL:‐health/publications/rhr_01_10_mngt_stis/  International travel and health WHO. Internal travel and health. Geneva: World Health Organization; 2005. ISBN 92 4 1580364  Malaria WHO. Guidelines for the treatment of malaria. Geneva: World Health Organization; 2006. ISBN 92 4  154694 8. WHO/HTM/MAL/2006.1108.    References   73 WHO. Malaria control in complex emergencies. An Interagency field handbook. Geneva: World  Health organization; 2005. ISBN 92 4 159389 X. WHO/HTM/MAL/2005.1107  Mental health WHO.  Tool:  Rapid  Assessment  of  Mental  Health  Needs  of  Refugees,  Displaced  and  other  Populations  affected  by  Conflict  and  Post‐Conflict  Situations.  Geneva:  World  Health  Organization; 2001. MNH/MHP/99.4 rev.1  Nutrition WHO. Guiding principles for feeding infants and young children during emergencies. Geneva  World Health Organization; 2004.ISBN 92 4 154606 9.  Reproductive health UNFPA. Inter‐agency reproductive health kits for crisis situations, 3rd edition. Draft April 2005.    WHO/UNHCR. Clinical management of survivors of rape. Developing protocols for use with  refugees and internally displaced persons. Revised edition. Geneva, World Health Organization;  2005. Eng: ISBN 92 4 159263 X.  FR: ISBN 92 4 259263 3‐ health/publications/clinical_mngt_survivors_of_rape/clinical_mngt_survivors_of_rape.pdf    UNHCR. Sexual and gender‐based violence against refugees, returnees, and internally displaced  persons: guidelines for prevention and response. Geneva: Office of the United Nations High  Commissioner for Refugees; May 2003. URL:‐ bin/texis/vtx/protect/opendoc.pdf?tbl=PROTECTION&id=3f696bcc4    UNFPA. Reproductive Health for Communities in Crisis. UNFPA Emergency Response, 2001    UNFPA/UNHCR/WHO. Reproductive  health  in  refugee  situations:  an  interagency  field manual:  Geneva: Office of the United Nations High Commissioner for Refugees; 1999  Tuberculosis WHO.  TB/HIV  a  clinical  manual  2004.  Geneva:  World  Health  Organization;  2004.  2nd  edition.  WHO/HTM/TB/2004.329. URL:    WHO. Treatment of tuberculosis: guidelines for national programmes. 3rd.edition. Geneva: World  Health Organization; 2003. WHO/CDC/TB/03.313 URL:    WHO/UNHCR. Tuberculosis Control in Refugee Situations: an Interagency Field Manual. Geneva:  World Health Organization; 1997. WHO/TB/97.221  The Interagency Emergency Health Kit 2006 74   Useful addresses   75 Annex 11. Useful addresses Partners Ecumenical Pharmaceutical Network  Community Initiatives Support Services International  P.O. Box 73860  Nairobi  Kenya  Tel: +254 20 444 4832/5020  Fax: +254 20 444 5095/444 0306  E‐mail:,    International Committee of the Red Cross   19 Avenue de la Paix  CH‐1202 Geneva  Switzerland  Tel. +41 22 734 6001  Fax: +41 22 733 2057  E‐mail:    International Federation of Red Cross and Red Crescent Societies  17 Chemin des Crêt  Petit Saconnex   P.O. Box 372   CH‐1211 Geneva  Switzerland  Tel: +41 22 730 4222  Fax: +41 22 733 0395  E‐mail:    International Organization for Migration  17 route des Morillons  P.O. Box 71  CH‐1211 Geneva 19  Switzerland  Tel: +41 22 717 9111  Fax: +41 22 7986150  E‐mail:    The Interagency Emergency Health Kit 2006 76 John Snow, Inc.  JSI Logistics Services  1616 N Fort Myer Drive, 11th floor  Arlington VA 22209  United States of America  Tel: +1 703 528 7474  Fax: +1 703 528 7480  E‐mail: or    Médecins Sans Frontières  Belgium Office  94 rue Dupré  B‐1090 Brussels   Belgium  Tel: +32 2 474 7474  Fax: +32 2 474 7575  E‐mail:    Merlin  207, Old Street, 12th floor  London EC1V 9NR  United Kingdom  Tel: +44 20 7014 1600  Fax: +44 20 7014 1601  E‐mail:    OXFAM  Oxfam House  John Smith Drive  Cowley  Oxford OX4 2JY  United Kingdom  Tel: +44 1865 473 727   E‐mail:    United Nations Children’s Fund  UNICEF House  3 United Nations Plaza  New York, New York 10017  United States of America  Tel: +1 212 326 7000  Fax: +1 212 887 7465  E‐mail:    Useful addresses   77 United Nations High Commissioner for Refugees  Case Postale 2500  CH‐1211 Geneva 2 Dépot   Switzerland  Tel: +41 22 739 8111  Fax: +41 22 731 9546   E‐mail:    World Council of Churches   Christian Medical Commission, Churches’ Action for Health  150 Route de Ferney   P.O. Box 2100  CH‐1211 Geneva 2  Switzerland  Tel: +41 22 791 6111  Fax: +41 22 791 0361  E‐mail: koa@wcc‐;  http://www.wcc‐    United Nations Population Fund  UNFPA/HRU  11 Chemin des Anémones  CH‐1219 Geneva  Switzerland  Tel: +41 22 917 8315  Fax: +41 22 919 8016  E‐mail:  Website:    World Health Organization  20, Avenue Appia  CH‐1211 Geneva 27  Switzerland  Tel: +41 22 791 2111  Fax: +41 22 791 3111  E‐mail:  Website:  The Interagency Emergency Health Kit 2006 78 Suppliers Centrale Humanitaire Médico‐pharmaceutique  4 voie militaire des Gravanges  F‐63100 Clermont‐Ferrand  France  Tel: +33 4 73982481  Fax: +33 4 73982480  E‐mail:    International Dispensary Association Foundation  Slocherweg 35  1027 AA Amsterdam  PO Box 37098  NL‐1030 AB Amsterdam   The Netherlands   Tel: +31 20 403 3051   Fax: +31 20 403 1854   E‐    Missionpharma  Vassingeroedvej 9  3540 Lynge  Denmark  Tel.: +45 4816 3200  Fax: +45 4816 3248  E‐mail:    MSF ‐ Supply  Preenakker 20  B‐1785 Merchtem  Belgium  Tel.: +32 52 2610 00  Fax: +32 52 2610 04  E‐mail: office‐    Medical Export Group  Papland 16  P.O. Box 598  4200 AN Gorichem  The Netherlands  Tel: +31 20 403 3051   Fax: +31 20 403 1854   E‐mail:    Useful addresses   79 United Nations Children’s Fund ‐ Supply Division  UNICEF Plads  Freeport   DK‐2100 Copenhagen Æ,   Denmark  Tel: +45 35 37 35 27  Fax: +45 35 26 94 21  E‐mail:    UNFPA Nordic Office  Procurement services  Midtermolen 3   DK‐2100 Copenhagen  Denmark   Tel: +45 35 467 000  Fax: +45 35 467 018  E‐mail:    World Health Organization  Procurement Services  20, Avenue Appia  CH‐1211 Geneva 27  Switzerland  Tel: +41 22 791 2111  Fax: +41 22 791 0746    United Nations Development Programme  Interagency Procurement Services Office  Midtermolen 3  P.O. Box 2530  DK‐2100 Copenhagen Ø  Denmark  Tel: +45 35 46 7000  Fax: +45 35 46 7001  E‐mail:  The Interagency Emergency Health Kit 2006 80 Feedback form   81 Feedback form The  purpose  of  this  form  is  to  seek  your  opinion  about  the  contents  of  the  Interagency  Emergency Health Kit 2006. Any remarks, suggestions or recommendations you may have  are welcomed. We will use your written feedback about the kit during the next revision of its  contents which is planned for 2008. Your input will be acknowledged.     Please  send  your  feedback  either  by  post  to WHO, Department  of Medicines  Policy  and  Standards, 20 Avenue Appia, CH‐1211 Geneva 27, Switzerland; or by fax: +41 22 791 4167 or  e‐mail:    Feedback on the Interagency Emergency Health Kit 2006 Emergency situation Please describe briefly  the  situation  in which you used  the  Interagency Emergency Health  Kit 2006.    Date/period and year:     ……………………………………………………………….  Country:         ……………………………………………………………….  Kind of emergency situation:    ……………………………………………………………….  ……………………………………………………………………………………………………………  Your qualification and position:   ……………………………………………………………….  ……………………………………………………………………………………………………………    I. Content of the basic unit   Selected medicines  1. Are the contents of the basic unit appropriate for the needs of the displaced population  in terms of the selected medicines?                  Yes    No  If no, which medicines are inappropriate?:          If no, which medicines are missing?:            Selected renewable medical supplies  2. Are the contents of the basic unit appropriate for the needs of the displaced population  in terms of the selected renewable medical supplies?         Yes    No  If no, which renewable medical supplies are inappropriate?:    If no, which renewable medical supplies are missing?:        Selected health equipment  3.   Are  the  contents  of  the  basic  unit  appropriate  for  the  needs  of  the  displaced  population in terms of the selected health equipment?      Yes    No  If no, which health equipment is inappropriate?:    If no, which health equipment is missing?:      The Interagency Emergency Health Kit 2006 82   II. Content of the supplementary unit   Selected medicines    4. Are the contents of the supplementary unit appropriate for the needs of the displaced  population in terms of the selected medicines?        Yes  No  If no, which medicines are inappropriate?:          If no, which medicines are missing?:       Selected renewable medical supplies    5. Are the contents of the supplementary unit appropriate for the needs of the displaced  population in terms of  selected renewable medical supplies?    Yes  No  If no, which renewable medical supplies are inappropriate?:    If no, which renewable medical supplies are missing?:      Selected health equipment     6. Are the contents of the supplementary unit appropriate for the needs of the displaced  population in terms of selected health equipment?      Yes    No  If no, which health equipment is inappropriate?:    If no, which health equipment is missing?:      III. Information   7.  Does  the  booklet  IEHK  2006  provide  appropriate  information  and  instructions  to  understand the emergency health kitʹs guiding principles?    Yes    No     If no, why not?            8. Does the booklet IEHK 2006 provide appropriate treatment guidelines for the use of the  contents of basic units?              Yes  No     If no, why not?            9. Are all sections of the booklet IEHK 2006 relevant?      Yes    No    If no, what would you take out?:         If no, what would you like to see included?:      10. Are all annexes of the booklet IEHK 2006 relevant?      Yes    No    If no, what would you take out?:         If no, what would you like to see included?:      11. Was there any technically inaccurate or incomplete information?     Yes  No      If yes, what?:              12. What are your 3 suggestions to improve the contents of the kit and the booklet IEHK  2006 for the next update?  1.             2.             3.               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