Emergency Health Kit
Emergency Health Kit
Emergency Health Kit
WorldHealthOrganization
InternationalCommitteeoftheRedCross
InternationalFederationofRedCrossandRedCrescentSocieties
MdecinsSansFrontires
UnitedNationsChildrensFund
UnitedNationsPopulationFund
UnitedNationsHighCommissionerforRefugees
WHOLibraryCataloguinginPublicationData:
Theinteragencyemergencyhealthkit2011:medicinesandmedicaldevicesfor10000people
forapproximatelythreemonths.
ISBN9789241502115
(NLMclassification:WB105)
WorldHealthOrganization2011
Allrightsreserved.PublicationsoftheWorldHealthOrganizationareavailableonthe
WHOwebsite(www.who.int)orcanbepurchasedfromWHOPress,WorldHealth
Organization,20AvenueAppia,1211Geneva27,Switzerland(tel.:+41227913264;
fax:+41227914857;email:[email protected]).Requestsforpermissiontoreproduce
ortranslateWHOpublicationswhetherforsaleorfornoncommercialdistribution
shouldbeaddressedtoWHOPressthroughtheWHOwebsite
(http://www.who.int/about/licensing/copyright_form/en/index.html).
Thedesignationsemployedandthepresentationofthematerialinthispublicationdonot
implytheexpressionofanyopinionwhatsoeveronthepartoftheWorldHealth
Organizationconcerningthelegalstatusofanycountry,territory,cityorareaorofits
authorities,orconcerningthedelimitationofitsfrontiersorboundaries.Dottedlineson
mapsrepresentapproximateborderlinesforwhichtheremaynotyetbefullagreement.
Thementionofspecificcompaniesorofcertainmanufacturersproductsdoesnotimplythat
theyareendorsedorrecommendedbytheWorldHealthOrganizationinpreferenceto
othersofasimilarnaturethatarenotmentioned.Errorsandomissionsexcepted,thenames
ofproprietaryproductsaredistinguishedbyinitialcapitalletters.
AllreasonableprecautionshavebeentakenbytheWorldHealthOrganizationtoverifythe
informationcontainedinthispublication.However,thepublishedmaterialisbeing
distributedwithoutwarrantyofanykind,eitherexpressedorimplied.Theresponsibility
fortheinterpretationanduseofthemateriallieswiththereader.Innoeventshallthe
WorldHealthOrganizationbeliablefordamagesarisingfromitsuse.
EachagencycollaboratinginthedistributionanduseoftheInteragencyEmergencyHealth
Kitwillsupporttheimplementationoftheinterventionsrecommendedinthisbookletonly
insofarastheyareconsistentwiththeexistingpolicyandmandateofthatagency.
This document has been produced with the financial assistance of the European
Community. The views expressed herein are those of the authors and can therefore in no
waybetakentoreflecttheofficialopinionoftheEuropeanCommunity.
PrintedinFrance
First edition 1990, Reprinted 1992, Second edition 1998, Third edition 2006, Fourth edition
2011.
Contents
Contents
Acknowledgements ............................................................................................................. v
Abbreviationsandacronyms ...........................................................................................vii
Introduction ...........................................................................................................................1
Chapter1:Essentialmedicinesandmedicaldevicesinemergencysituations.........3
Whatisanemergency? ...............................................................................................................3
PrinciplesbehindtheInteragencyEmergencyHealthKit2011 ............................................3
Referralsystem.............................................................................................................................5
Immunizationandnutritioninemergencysituations............................................................5
Reproductivehealth ....................................................................................................................6
Malaria ..........................................................................................................................................7
HIV/AIDS,tuberculosisandleprosy.........................................................................................7
PsychotropicmedicinesintheInteragencyEmergencyHealthKit2011.............................7
ProcurementoftheInteragencyEmergencyHealthKit2011................................................8
Postemergencyneeds.................................................................................................................8
Chapter2:Selectionofmedicinesandmedicaldevicesincludedinthe
InteragencyEmergencyHealthKit2011 ...................................................................9
SelectionofmedicinesfortheInteragencyEmergencyHealthKit2011..............................9
MedicinesnotincludedintheInteragencyEmergencyHealthKit2011 ...........................10
SelectionofmedicaldevicesfortheInteragencyEmergencyHealthKit2011..................11
MedicaldevicesnotincludedintheInteragencyEmergencyHealthKit2011.................12
Majormedicineandmedicaldevicechangessincethe2006editionof
theInteragencyEmergencyHealthKit...................................................................................12
Chapter3:ContentsoftheInteragencyEmergencyHealthKit2011 ........................13
Tenbasicunitsforusebyhealthcareworkerswithlimitedtraining .............................13
Onesupplementaryunitforusebyphysiciansandseniorhealthcareworkers...........13
Contentsofonebasicunit(for1000peopleforthreemonths)............................................14
Contentsofonesupplementaryunit(for10000peopleforthreemonths)......................16
References.............................................................................................................................25
Annex1:Usefulresources .................................................................................................27
Medicines ....................................................................................................................................27
Medicinemanagement..............................................................................................................27
Communicablediseases............................................................................................................27
Generalpublichealth ................................................................................................................28
Childhealth ................................................................................................................................28
HIVandsexuallytransmittedinfections................................................................................28
Internationaltravelandhealth.................................................................................................28
Malaria ........................................................................................................................................28
Mentalhealth..............................................................................................................................29
Nutrition .....................................................................................................................................29
Reproductivehealth ..................................................................................................................29
Tuberculosis................................................................................................................................30
iii
Annex2:Sampledatacollectionforms...........................................................................31
Annex3:Samplehealthcard ............................................................................................35
Annex4:Guidelinesforsuppliers...................................................................................37
Specificationsformedicinesandmedicaldevices ................................................................37
Packaging....................................................................................................................................37
Packinglist..................................................................................................................................38
Informationslips........................................................................................................................38
Annex5:Otherkitsforemergencysituations ...............................................................41
Nutrition .....................................................................................................................................41
Reproductivehealth ..................................................................................................................44
Annex6:Modelregulatoryaspectsofexportationandimportationof
controlledsubstances .................................................................................................47
Introduction................................................................................................................................47
Standardprocedureforinternationaltransferofnarcoticandpsychotropic
substances ...................................................................................................................................48
Proceduretobefollowedindisasterrelief.............................................................................48
Outlineofstandardagreementbetweenthesupplierandcontrolauthoritiesof
exportingcountries....................................................................................................................50
Shipmentrequest/notificationformforemergencysuppliesof
controlledsubstances ................................................................................................................53
Annex7:Usefuladdresses.................................................................................................55
Partners .......................................................................................................................................55
Suppliers .....................................................................................................................................56
Feedbackform .....................................................................................................................59
iv
Acknowledgements
Acknowledgements
Thefollowingindividualsandorganizationscontributedtothedevelopmentofthisrevision
andtheiradviceandsupportaregratefullyacknowledged.
HealthNetTPO:PeterVentevogel
InternationalCommitteeoftheRedCross(ICRC):StephanieArsacJanvier,
ElisabethLeSaout
InternationalFederationofRedCrossandRedCrescentSocieties(IFRC):SelmaBernardi,
TammamAloudat
InternationalMedicalCorps(IMC):LynneJones
MarieStopesInitiative
MedicosdelMundoEspaa(MdME,DoctorsoftheWorldSpain):PauPerezSales
MdecinsSansFrontires:MyriamHenkens
UnitedNationsPopulationFund(UNFPA):WilmaDoedens,TomoCalain
UnitedNationsHighCommissionerforRefugees(UNHCR):HervleGuillouzic
UNHCR,PublicHealthandHIVSection:MarianSchilperoord
UnitedNationsChildrensFund(UNICEF):AtienoOjoo,EdithChueng,HenrikNielsen,
MoniqueSupiot,HanneBakPedersen
WHOCollaboratingCentreforResearchandTraininginMentalHealth,Universityof
Verona,Italy:CorradoBarbui
WHO/ContractingandProcurementServices(CPS):AhmedBellah
WHO/ControlofNeglectedTropicalDiseases(NTD):MichelleGayer,JohnWatson
WHO/EssentialMedicinesandPharmaceuticalPolicies(EMP):HansHogerzeil,Clive
Ondari,SuzanneHill,HeleneMoller
WHO/HealthActioninCrises(HAC):JonCarver,JulesPieters,OlexanderBabanin,Michel
Tomaszek
WHO/InjectionSafety:SelmaKhamassi
WHO/MakingPregnancySafer(MPS):MatthewsMatthai
WHO/DepartmentofMentalHealthandSubstanceAbuse(MSD/NMH):Markvan
Ommeren
WHO/ReproductiveHealthandResearch:MetinGulmezoglu
WHO/RollBackMalaria(RBM):AndreaBosman
vi
Acquiredimmunodeficiencysyndrome
EPI
ExpandedProgrammeonImmunization
FAO
FoodandAgricultureOrganization
HIV
Humanimmunodeficiencyvirus
IASC
InterAgencyStandingCommittee
IAWG
InterAgencyWorkingGroup
IEHK2006
InteragencyEmergencyHealthKit2006
IEHK2011
InteragencyEmergencyHealthKit2011
INCB
InternationalNarcoticsControlBoard
IUD
Intrauterinedevice
MISP
MinimumInitialServicePackage
MSF
MdecinsSansFrontires
ORS
Oralrehydrationsalts
PEP
Postexposureprophylaxis
RDT
Rapiddiagnostictest
SAM
Severeacutemalnutrition
TST
Time,steam,temperature
UN
UnitedNations
UNFPA
UnitedNationsPopulationFund
UNHCR
UnitedNationsHighCommissionerforRefugees
UNICEF
UnitedNationsChildrensFund
WFP
WorldFoodProgramme
WHO
WorldHealthOrganization
vii
viii
Introduction
Introduction
UN agencies and international and nongovernmental organizations are increasingly called
upon to respond to largescale emergencies to prevent and manage serious threats to the
survivalandhealthoftheaffectedpopulations.Medicinesandmedicaldevices(renewable
andequipment)havebeensuppliedbyreliefagenciesfordecades.Inthe1980s,theWorld
Health Organization (WHO) facilitated a process to encourage the standardization of
medicines and medical devices needed in emergencies to allow efficient and effective
responsestotheneedformedicinesandmedicaldevices.Thisinitialworkledtothesupply
ofstandard,prepackedkitsthatcouldbekeptinreadinesstomeetpriorityhealthneedsin
emergencies.
The first WHO Emergency Health Kit was launched in 1990. After revision and further
harmonization, the contents of the second kit, The New Emergency Health Kit 98 were
endorsed by WHO in collaboration with international and nongovernmental agencies. The
third kit, the Interagency Emergency Health Kit 2006 (IEHK 2006), accommodated:
emergency prophylaxis to prevent human immunodeficiency virus (HIV) infection after
sexualviolence;theincreasingantimicrobialresistancetocommonlyavailableantimalarials
andantibiotics;injectionsafetypolicy;andtheexperienceofagenciesusingtheemergency
healthkitinthefield.
Overtheyears,thecomplexityinupdatingthekitgrewasthenumberofpartnersrose.Asa
result, the WHO secretariat proposed a process to formalize future revisions. An agreed
procedurewaspublishedinthereportofthe2007meetingoftheWHOExpertCommitteeon
SelectionandUseofEssentialMedicines(1).TheprocedurewasexpandeduponinJuly2008
duringthefirstmeetingofthereviewcommitteeoftheInteragencyEmergencyHealthKit,
andfurtherimprovedduringthereviewprocessthatfollowedthemeeting.Thecurrentkit,
the Interagency Emergency Health Kit 2011 (IEHK 2011), further improves the kit content
andtakesintoaccounttheneedformentalhealthcareinemergencysettingsandthespecial
needsofchildren.
The concept of the emergency health kit has been adopted by many organizations and
nationalauthoritiesasareliable,standardized,affordableandquicklyavailablesourceofthe
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
threemonths.Thisdocumentprovidesbackgroundinformationonthecompositionanduse
oftheemergencyhealthkit.Chapter1describessupplyneedsinemergencysituationsandis
intended as a general introduction for health administrators and field officers. Chapter 2
explains the selection of medicines and medical devices renewable and equipment that
are included in the kit, and also provides more technical details intended for prescribers.
Chapter 3 describes the composition of the kit, which consists of basic and supplementary
units.
The annexes provide references for treatment guidelines, sample forms, a health card,
guidelines for suppliers, other kits for emergency situations, a standard procedure for
importationofcontrolledmedicines,andusefuladdresses.Afeedbackformisalsoincluded
toreportonexperienceswhenusingtheemergencyhealthkit,andtoencouragecomments
andrecommendationsonthecontentsofthekitfromdistributorsandusersforconsideration
whenupdatingthecontents.
TheWHODepartmentofEssentialMedicinesandPharmaceuticalPolicies(formerlyknown
as the Department of Medicines Policy and Standards) has coordinated the review process
andispublishingthisinteragencydocumentonbehalfofallcollaboratingpartners.
Chapter 1:
Essential medicines and medical devices in
emergency situations
What is an emergency?
Thetermemergencyisappliedtovarioussituationsresultingfromnatural,politicaland
economicdisasters.TheIEHK2011isdesignedtomeettheinitialprimaryhealthcareneeds
ofadisplacedpopulationwithoutmedicalfacilities,orapopulationwithdisruptedmedical
facilitiesintheimmediateaftermathofanaturaldisasterorduringanemergency.Itmustbe
emphasized that, although supplying medicines and medical devices (renewable and
equipment) in standard prepacked 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
Thepracticalimpactofmanywellmeaningdonationsandsupportsentinemergencieshas
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 WHO Guidelines for drug donations describe
good donation practices and promote the principles necessary for improved quality
medicinedonations(2).
TheIEHK2011consistsoftwodifferentsetsofmedicinesandmedicaldevices,namedabasic
unitandasupplementaryunit.Tofacilitatedistributiontosmallerhealthfacilitiesonsite,the
quantities of medicines and medical devices in the basic unit have been divided into
10identicalunitsfor1000peopleeach.
Terminology
Confusionhasarisenoverthewordskitandunit.Inthiscontext,akitrefersto10basic
unitsplusonesupplementaryunitasexplainedinFigure1.
Figure 1: Composition of the Interagency Emergency Health Kit 2011
1 000
1 00 0
1 000
1 00 0
1 000
1 000
1 00 0
1 000
1 00 0
1 000
10 000
}
}
10 x 1 basic unit
for 10 x 1 000 people
1 supplementary unit
for 1 x 10 000 people
Total
1 emergency
health kit for
10 000 people
for three months
Basic unit
Thebasicunitcontainsessentialmedicinesandmedicaldevices,andcanbeusedbyprimary
healthcare workers with limited training. It contains oral and topical medicines, none of
which are injectable. Combination therapy for the treatment of uncomplicated falciparum
malariaisprovidedunlessthereisaspecificrequestnottoincludeitinthekit.
Two printed copies of this booklet describing the contents and use of the kit in English,
French and Spanish are included in each basic unit. Additional printed copies can be
obtainedfromtheWHOPress([email protected]).Electroniccopiescanbedownloaded
fromthewebsite:www.who.int/medicines.
Supplementary unit
Thesupplementaryunitcontainsessentialmedicinesandmedicaldevicesfor10000people,
andistobeusedonlybyprofessionalhealthworkersorphysicians.Itdoesnotcontainany
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 postexposure prophylaxis (patient
PEP)areprovidedunlessthereisaspecificrequestnottoincludetheminthekit.
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
Theselectionofmedicinesinthekitisbasedontreatmentguidelinesrecommendedbythe
WHOExpertCommitteeonSelectionandUseofEssentialMedicines.Referencestocurrent
treatment guidelines are included in Annex 1. Two copies of a manual describing the
standard treatment guidelines for target diseases, developed by Mdecins Sans Frontires
(MSF)andWHO,areincludedinEnglish,FrenchandSpanishineachsupplementaryunit.
AdditionalprintedcopiescanbeobtainedfromMSF(seeAnnex7).
Quantification of medicines
Theestimationofmedicinerequirementsinthekitisbasedon:
1.
theaveragemorbiditypatternsamongdisplacedpopulations;
2.
theuseofstandardtreatmentguidelines;
3.
figuresprovidedbyagencieswithfieldexperience.
Thequantitiesofmedicinessuppliedwillthereforeonlybeadequateifprescribersfollowthe
standardtreatmentguidelines.
Referral system
Health services can be decentralized by the use of basic healthcare clinics (the most
peripheral level of health care) to provide simple treatment using the basic units. Such
decentralizationwill:(1)increasetheaccessofthepopulationtocurativecare;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
healthcareworkerswithinformationtoenablethemtotaketherightdecisionontreatment
orreferral,accordingtothesymptoms.
Thefirstreferrallevelshouldbestaffedbyprofessionalhealthcareworkers,usuallymedical
assistants or doctors, who will usemedicines and medicaldevices from both thebasic and
supplementaryunits.
It should be stressed that the basic and supplementary units are not intended to enable
healthcareworkerstotreatrarediseasesormajorsurgicalcases.Forsuchpatientsasecond
levelofreferralisneeded,usuallyadistrictorgeneralhospital.Suchfacilitiesarenormally
partofthenationalhealthsystemandreferralproceduresshouldbearrangedwiththelocal
healthauthorities.
Experienceinemergenciesinvolvingdisplacedpopulationshasshownthatmeaslesisoneof
the major causes of death among young children. Measles and serious respiratory tract
infectionsspreadrapidlyinovercrowdedconditions,particularlyinmalnourishedchildren.
Measles vaccine administration should therefore be given a high priority, with all children
between six months and five years old being immunized, irrespective of history. Children
immunized before nine months should be reimmunized as soon after nine months as
possible.Inthefuture,morevaccinesmaybeaddedtothevaccinationprotocolapplicableto
emergencyresponse.
Children with clinical measles should be treated promptly for complications, enrolled in a
feedingprogrammeandgivenappropriatedosesofvitaminA.
Reproductive health
IEHK 2011 is not designed for reproductive health services: reproductive
health kits for emergencies may be ordered after a basic assessment of needs
(see Annex 5).
Anumberofpriorityreproductivehealthinterventionshavebeendefinedasessentialfora
displaced population during an emergency. The Minimum Initial Service Package (MISP)1
for Reproductive Health is a coordinated set of activities, including the provision of:
emergencyobstetriccaretopreventexcessneonatalandmaternalmorbidityandmortality;
provisions to reduce HIV transmission; and activities to prevent and manage the
consequencesofsexualviolence.
Professionalmidwiferycareisanessentialserviceforwhichthenecessaryinstrumentsand
medicines are included in the kit. A small quantity of magnesium sulfate for severe pre
eclampsiaandforeclampsiaisincludedinthesupplementaryunittostarttreatmentpriorto
referral.
Comprehensivereproductivehealthservicesneedtobeintegratedintotheprimaryhealth
care system as soon as possible, and a referral system for obstetric emergencies must be
made accessible to the population. It is recommended that a qualified and experienced
personbeappointedasreproductivehealthcoordinator.
IEHK 2011 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.
1
6
Seehttp://misp.rhrc.org
Malaria
In recent years, parasite resistance against the safest and least expensive antimalarials has
been increasing. The current recommended treatment for malaria is combination therapy.
Artemether + lumefantrine is a fixeddose antimalarial combination containing an
artemisinin derivative and is included in the kit for the treatment of malaria due to
Plasmodium falciparum. It is not recommended for prophylaxis and should not be used by
women in the first trimester of pregnancy for uncomplicated malaria, since safety in
pregnancyhasnotyetfullybeenestablished.Rapiddiagnostictests(RDTs)areincludedin
themalariamodulesfortheconfirmationofsuspectedmalariacases.
IEHK 2011 will always be supplied with malaria modules unless there is a
specific request not to include these items at the time of ordering.
FluoxetineandamitriptylinearetheonlyantidepressantmedicinesontheWHOModelList
ofEssentialMedicines(5).Followingareviewoftheadvantagesanddisadvantagesofthese
two similarly effective medicines (6), amitriptyline was selected for inclusion in the IEHK
2011 as it was considered to be more frequently in line with the recommended treatment
guidelinesinrecipientcountries.
Peoplepresentingwithnondisordered,acuteanxietyarecommonintheearlyphasesofall
emergencies.Nonpharmacologicalmeasures[e.g.psychologicalfirstaid(4)]shouldbeused
asfirstlinecare,asbenzodiazepinesmayslowdownrecoveryfromtraumaticstress(7)and
canproducedependence.However,thereareoccasionswhenanxiolyticsareindicated,such
as in cases of severe agitation or sleeplessness that interfere with the persons ability to
address their own and their familys survival needs, and who do not respond to non
pharmacological interventions. A small supply of diazepam tablets was therefore added to
the2011versionoftheIEHKtoreducetheneedforusingtheinjectableformofdiazepam.
Injectablediazepamisalsoindicatedforthemanagementofstatusepilepticus.
Inthe2011versionoftheIEHK,chlorpromazineinjectionisreplacedbyhaloperidoltablets
and injections. The addition of a tablet form of antipsychotic medication was proposed as
oral administration is preferred in chronic psychosis, which may occur throughout an
extended humanitarian emergency. Tablets also have the advantage that they can be
provided by family members after prescription by busy health staff. Haloperidol injection
replacedchlorpromazineinjection.Thelatterhasanumberofsideeffectsincludingactingas
alocalirritantifgivenintramuscularly.Biperidenwasincludedtotreatthesideeffectsofthe
antipsychotics.
Post-emergency needs
IEHK 2011 is intended for use only in the early phase of an emergency. The kit
is neither designed nor recommended for re-supplying existing health-care
facilities.
Aftertheacutephaseofanemergencyisoverandbasichealthneedshavebeencoveredby
thebasicandsupplementaryunits,specificneedsforfurthersuppliesandequipmentshould
beassessedassoonaspossible.
Chapter 2:
Selection of medicines and medical devices
included in the Interagency Emergency Health
Kit 2011
ThecontentsoftheIEHK2011arebasedonassumptionsderivedfromepidemiologicaldata,
populationprofiles,diseasepatternsandexperiencegainedfromusingthekitinemergency
situations.Theseassumptionsareasfollows.
The most peripheral level of the healthcare system will be staffed by healthcare
workerswithlimitedmedicaltraining,whowilltreatsymptomsratherthandiagnosed
diseasesusingthebasicunits,andreferpatientswhoneedmorespecializedtreatment
tothenextlevel.
Halfofthepopulationisunder15yearsofage.
The average number of patients presenting themselves with the more common
symptomsordiseasescanbepredicted.
Standardtreatmentguidelineswillbeusedtotreatthesesymptomsordiseases.
Therateofreferralfromthemostperipheraltothenextlevelofhealthservicesis10%.
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
willusethesupplementaryunitinconjunctionwithoneormorebasicunits.
Ifboththemostperipheralandfirstreferralhealthcarefacilitiesarewithinreasonable
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
populationof10000peopleforaperiodofapproximatelythreemonths.
Antibiotics
Infectious bacterial diseases are common at all levels of health care, including the most
peripheral,andbasichealthcareworkersthereforeshouldhavethepossibilitytoprescribe
an antibiotic. However, many basic healthcare workers have not been trained to prescribe
antibioticsinarationalway.Amoxicillinistheonlyantibioticincludedinthebasicunit,and
thiswillenablethehealthcareworkertoconcentrateonmakingtherightdecisionbetween
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
bacterialresistancemustbereducedbyrationalprescribingpractices.
Medication for children
Paediatricformulationsincludedinthekitareparacetamol(100mgtablets),thefixeddose
antimalarialcombinationartemether+lumefantrine(20mg+120mgtabletsforinfantsand
childrenweighing514kg),artemetherinjection(20mg/ml),zincsulfate(20mgdispersible
tablets),andoralrehydrationsalts(ORS)sachetsforthepreparationofORSsolution.
With the exception of two syrups included in the PEP module (as special consideration is
given to case of rape in children), syrups for children are not included because of their
instability, their short shelflife after reconstitution, and their volume and weight. Instead,
for children, half or quarter adult tablets may be crushed and administered with a small
volumeoffluidorwithfood.
TheIEHKreviewcommitteeconsideredtheuseofmoreappropriatepaediatricformulations
such as solid paediatric formulations. Where sufficient numbers of qualityassured sources
for these formulations were identified, dispersible tablets were recommended. A footnote
was added to those products that ideally should be supplied as dispersible formulations,
stating thatchange will be considered once adequate sources are identified. These changes
willbecoordinatedbetweensuppliersandusersofthekittofacilitatetransition.
Nospecificmedicinesareincludedforthetreatmentofsexuallytransmittedinfectionsother
than a small quantity as presumptive treatment of gonococcal infection, chlamydia and
preventionofHIVinfectioninthecontextofpostexposureprophylaxis.Suppliesforregular
contraceptionandcondomsarenotincludedinthekit.
10
limitingthenumberofinjections;
usingsingleusesyringesandneedlesonly;
using safety boxes designed for the collection and incineration of used syringes,
needlesandlancets;
strictlyfollowingthedestructionproceduresforsingleusematerial.
Onlysingleusesyringesandneedlesareprovidedinthesupplementaryunit.Estimatesof
needsarebasedonthenumberofinjectablemedicinesincludedinthesupplementaryunit,
whicharetobeusedinlinewiththetreatmentguidelinesprovided.
Gloves
Singleuse 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 singleuse surgical gloves are supplied in the supplementary unit to be
usedfordeliveries,suturesandminorsurgery,allundermedicalsupervision.
Sterilization
Acompletesterilizationsetisprovidedinthekit.Thebasicunitscontaintwosmalldrums,
eachtobeusedascontainersforsteriledressingmaterials.Twodrumsareincludedtoallow
sterilizationofonewhiletheotherisbeingused.Thesupplementaryunitcontainsonesteam
sterilizer,drumsforsteamsterilization,crepepapersheetsandmaskingtapeforsterilization
packs,TST(time,steam,temperature)indicators,atimerandakerosenestove.
Dilution and storage of liquids
Thekitcontainsseveralplasticbottlestodiluteandstoreliquids(e.g.chlorhexidine,benzyl
benzoateandpolyvidoneiodinesolution).
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 water scoops. The
supplementary unit contains a water filter with candles, and tablets of sodium
dichloroisocyanurate(NaDCC)tochlorinatethewater.
11
Supplementary unit
Dispersible tablets to replace adult-only formulations as soon as sufficient quality-assured
suppliers of products are available (see footnotes for selected products).
Mental health is addressed with the inclusion of one generic anti-psychotic, one antiParkinsonian drug (to deal with potential extra-pyramidal side-effects), one anti-convulsant/antiepileptic, one anti-depressant and one anxiolytic as oral formulations.
Miconazole cream moved to basic unit, to be recalled as needed.
Misoprostol 200 micrograms tablets added for management of incomplete abortion.
Patient PEP revised to include paediatric formulations of azithromycin, cefixime, zidovudine and
lamivudine tablets.
Phenobarbital strength reduced from 100 mg to 50 mg or 60 mg, pending availability of
products.
Promethazine, injection 25 mg/ml removed due to removal from WHO Essential Medicines
List (5).
Salbutamol tablets replaced with salbutamol inhalers.
12
Chapter 3:
Contents of the Interagency Emergency Health
Kit 2011
TheIEHK2011consistsof10basicunitsandonesupplementaryunit(seeFigure1).
Onebasicunitcontains:
medicines
medicaldevices,renewable
medicaldevices,equipment
module:malariaitems(uncomplicatedmalaria)1.
Onesupplementaryunitcontains:
medicines
essentialinfusions
medicaldevices,renewable
medicaldevices,equipment
module:patientPEP1
module:malariaitems1.
One IEHK 2011 weighs approximately 1000 kg and may occupy more than 4 m3 space.
Weightsandvolumesshouldbeconfirmedwiththesupplier.
Theseitemsareautomaticallyprovidedunlessaspecificrequestismadenottoincludetheminthekit.
13
Contents of one basic unit (for 1000 people for three months)
Items
Unit
Quantity
Medicines
albendazole, chewable tablets 400 mg
aluminium hydroxide + magnesium hydroxide,
tablets 400 mg + 400 mg1
amoxicillin, tablets 250 mg2
tablet
200
tablet
1000
tablet
3000
bottle, 1 litre
bottle, 1 litre
tablet
2000
tablet
2000
miconazole, cream 2%
30 g
20
tablet
1000
tablet
2000
200
bottle, 200 ml
12
tube, 5 g
50
tablet
1000
tablet
Treatments by weight
514 kg
6 dispersible tablets
dispersible tablet
900
1524 kg
12 dispersible tablets
dispersible tablet
360
2535 kg
18 tablets
tablet
540
> 35 kg
24 tablets
tablet
4320
unit
1000
tablet
2000
unit
800
unit
WHOrecommendsaluminiumhydroxideandmagnesiumhydroxideassingleantacids.TheInteragency
Groupagreedtoincludeinthekitthecombinationofaluminiumhydroxide+magnesiumhydroxide
tablets.
Achangetodispersibletabletswillbeconsideredonceadequatesourcesofqualityproductsareidentified.
Suppliersanduserswillbenotifiedaccordingly.
WHOrecommendsbenzylbenzoate,lotion25%.Theuseof90%concentrationisnotrecommended.
WHOrecommendschlorhexidinegluconate5%solution.Theuseof20%solutionneedsdistilledwaterfor
dilution,otherwiseprecipitationmayoccur.Alternative:thecombinationofcetrimide15%and
chlorhexidinegluconate1.5%.
Updatedinformationabouttheoralrehydrationsalts(ORS)formulationisprovidedinthe2011WHO
ModelListofEssentialMedicines(5).
Inadditiontooralrehydrationsalts(ORS)forthetreatmentofacutediarrhoeainchildren.
14
Items
Unit
Quantity
unit
20
unit
200
unit
500
unit
unit
100
unit
10
unit
30
Stationery
1
unit
envelope, plastic, 10 cm x 15 cm
unit
2000
health card2
unit
500
unit
10
unit
10
unit
500
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
Itisrecommendedthatoneexercisebookbeusedforrecordingdailymedicinedispensingandanotherfor
dailybasicmorbiditydata(seeAnnex2).
Forasamplehealthcard,seeAnnex3.
Surgicalinstruments,dressingset(3instruments+box):
1forceps,artery,Kocher,140mm,straight
1forceps,dressing,standard,155mm,straight
1scissors,Deaver,140mm,straight,sharp/blunt
1tray,instruments,stainlesssteel,225mmx125mmx50mm,withcover.
15
Unit
Quantity
Medicines
Anaesthetics
ketamine, injection 50 mg/ml
lidocaine, injection 1%
Analgesics
10 ml/vial
25
20 ml/vial
50
1 ml/ampoule
50
Anti-allergics
epinephrine (adrenaline) see respiratory tract
hydrocortisone, powder for injection 100 mg
prednisolone, tablets 5 mg
vial
50
tablet
100
2 ml/ampoule
200
Anticonvulsants/antiepileptics
diazepam, injection 5 mg/ml
magnesium sulfate, injection 500 mg/ml
phenobarbital, tablets 50 mg
10 ml/ampoule
tablet
40
1000
Antidotes
calcium gluconate, injection 100 mg/ml6
10 ml/ampoule
10
1 ml/ampoule
10
vial
50
vial
250
ceftriaxone, injection 1 g
vial
800
Anti-infective medicines
pessary
100
capsule
2000
20mlvialsarepreferred,although50mlvialsmaybeusedasanalternative.
Alternativeinjectableanalgesics,suchaspentazocineandtramadol,arenotrecommendedbyWHO.Itis
recognizedhoweverthatthesemaybepracticalalternativestomorphineinsituationswhereopioidscannot
besent.
Controlledsubstance(seeAnnex6formoredetails).
Achangetodispersibletabletswillbeconsideredonceadequatesourcesofqualityproductsareidentified.
Suppliersanduserswillbenotifiedaccordingly.
Interchangeablewith60mgformulationdependingonavailability.
Foruseasanantidotetomagnesiumsulfateoverdoseincaseofsevererespiratorydepressionorarrest.
Naloxoneisanopioidantagonistgivenintravenouslyforthetreatmentofmorphineoverdoseandtoreverse
theeffectsoftherapeuticdosesofmorphine.
Benzylpenicillininjection5millionUI/vialisprovidedfordiseasesrequiringhighdosagetreatment.The
vialsarenotintendedformultipleusebecauseofconcernsovercontamination.
16
Items
Unit
Quantity
Medicines
Anti-infective medicines (continued)
doxycycline, tablets 100 mg
tablet
3000
tablet
2000
tablet
350
vial
200
Cardiovascular medicines
atenolol, tablets 50 mg
tablet
1000
ampoule
tablet
20
1000
Dermatological medicines
silver sulfadiazine, cream 1%
tube, 50 g
30
(10 x 1 litre) 10
miconazole, cream 2% 30 g
tablet
1200
(10 x 1 litre) 10
Diuretics
furosemide, injection 10 mg/ml
2 ml/ampoule
hydrochlorothiazide, tablets 25 mg
tablet
20
200
Gastrointestinal medicines
atropine, injection 1 mg/ml
1 ml/ampoule
promethazine, tablets 25 mg
tablet
50
500
WHOrecommendsnystatin,tablet,lozengeandpessaryasanantifungalagent.TheInteragencyGroup
agreedtoincludemiconazolemucoadhesivetabletsinthekitastheyaremoreagreeableforpatientsthan
oralnystatin.
Thecombinationofprocainebenzylpenicillin3millionIUandbenzylpenicillin1millionIU(procaine
penicillinfortified)isusedinmanycountriesandmaybeincludedasanalternative.
Fortheacutemanagementofseverepregnancyinducedhypertensiononly.
Forthemanagementofpregnancyinducedhypertensiononly.
Eacheffervescenttabletcontains1.67gofNaDCCandreleases1gofavailablechlorinewhendissolvedin
water.
17
Items
Unit
Quantity
Medicines
Medicines affecting the blood
folic acid, tablets 5 mg
tablet
1000
Oxytocics
misoprostol, tablets 200 micrograms1
oxytocin, injection 10 IU/ml2
tablet
1 ml/ampoule
60
200
Psychotherapeutic medicines
amitriptyline, tablets 25 mg
tablet
4000
biperiden, tablets 2 mg
tablet
400
diazepam, tablets 5 mg
tablet
240
1 ml/ampoule
haloperidol, tablets 5 mg
tablet
20
1300
1 ml/ampoule
unit
50
50
500 ml bag
200
500 ml bag
100
50 ml/vial
10 ml/plastic vial
20
2000
Vitamins
ascorbic acid, tablets 250 mg
retinol (vitamin A), capsules 200 000 IU
tablet
4000
capsule
4000
Formanagementofincompleteabortiononly:singledoseof600micrograms(3tabletsof200micrograms)
orallyforwomenwithuterinesizelessthanorequalto12weeksgestation.
Forthepreventionandtreatmentofpostpartumhaemorrhage.
Spacerdevicesmadefromplasticsoftdrinkormineralwaterbottlescanbeusedasneeded.
Becauseoftheweight,thequantityofinfusionsincludedinthekitisminimal.
Glucose5%,bag500ml,foradministrationofquininebyinfusion.
18
Items
Unit
Quantity
1 ml/ampoule
1 ml/ampoule
75
2 ml/ampoule
100
200
(10 x 2) 20
Patient PEP module, 50 treatments (can be withheld from the order upon request)
azithromycin, suspension 200 mg/5 ml
bottle
tablet/capsule
5
200
bottle
10
tablet
100
tablet
360
tablet
50
unit
50
pregnancy test
zidovudine, capsules 100 mg
capsule
tablet
unit
840
3000
1
Alternative:artesunate,60mgforinjection,300;and5mlofglucose5%orNaCl0.9%injection,300,is
acceptable.Beforeusing,injecttheadded1mlsodiumbicarbonate5%injectionsolutionintotheartesunate
vial,dissolveandthenadd5mlofglucose5%orNaCl0.9%injection.Tuberculinsyringe,singleuse,1ml,
sterile,200,needstobeincludedtooforadministrationpurposes.
Intravenousinjectionofquininemustalwaysbedilutedinglucose5%,bag500ml.
Achangetodispersibletabletswillbeconsideredonceadequatesourcesofqualityproductsareidentified.
Suppliersanduserswillbenotifiedaccordingly.
Forpresumptivetreatmentofsexuallytransmittedinfections(gonococcalinfection)bysexualassault(rape).
Itmaybeusedinpregnancy.
Womenwhoseekhelpwithinfivedaysofrapeandwishtouseemergencycontraceptiontoprevent
pregnancy,shouldtakeonetabletoflevonorgestrel1.50mg.Alternative:levonorgestrel0.75mgtabletsand
doublingthequantityisacceptable.
ForpresumptivetreatmenttoreducethechancesofHIVinfectionbysexualassault(rape)andbyneedle
stick.
Protocolsandleafletsincludedinthemanual.
19
Items
Unit
Quantity
Guidelines
MSF clinical guidelines, diagnostic and treatment manual (latest
edition)
- English version
unit
- French version
unit
- Spanish version
unit
- English version
unit
- French version
unit
- Spanish version
unit
unit
10
unit
100
unit
50
unit
50
unit
10
unit
unit
unit
100
unit
1500
unit
2000
unit
100
unit
100
unit
100
unit
50
unit
150
unit
50
unit
300
masking tape, 2 cm x 50 m1
roll
unit
100
unit
300
unit
2000
unit
1500
unit
1500
unit
100
unit
25
unit
25
sheet
100
unit
100
unit
50
unit
100
Tosecuresmallpaperparcelsofinstrumentsforsterilizationallowingcontentsanddatetobewritten.
Includedmainlyforreconstitutionpurposes.
WHO/UNICEFstandardE10/IC2:boxesshouldbeprominentlymarked.
20
Items
Unit
Quantity
unit
144
unit
10
unit
10
unit
200
unit
700
unit
2000
unit
600
unit
100
unit
500
unit
10
unit
20
unit
50
(10 x 2) 20
Stationery
book, exercise, A4 size, 100 pages, hard cover
(10 x 4) 40
envelope, plastic, 10 cm x 15 cm
health card
unit
100
unit
unit
unit
unit
unit
unit
unit
unit
unit
unit
Includedfortheadministrationofartemetherinchildrenonly.
Includedfortheadministrationofmagnesiumsulfateonly.
Alternative:apron,protectionplastic,reusableunit,2,maybesupplied.
Sparebulbmustbeincludedwithintheotoscopeset.
21
Items
Unit
Quantity
unit
unit
12
unit
unit
unit
unit
unit
unit
unit
unit
unit
50
unit
unit
10
timer, 60 minutes
unit
unit
unit
unit
Deliveryset(3instruments+box)
1scissors,Mayo,140mm,curved,blunt/blunt
1scissors,gynaecological,200mm,curved,blunt/blunt
1forceps,artery,Kocher,140mm,straight
1tray,instruments,stainlesssteel,225mmx125mmx50mm,withcover.
Dressingset(3instruments+box)
1forceps,artery,Kocher,140mm,straight
1forceps,dressing,standard,155mm,straight
1scissors,Deaver,140mm,straight,sharp/blunt
1tray,instruments,stainlesssteel,225mmx125mmx50mm,withcover.
Onesuturesetshouldbereservedforrepairofpostpartumvaginaltears.
Abscess/sutureset(7instruments+box)
4
22
1forceps,artery,Halstedmosquito,125mmcurved
1forceps,artery,Kocher,140mm,straight
1forceps,tissue,standard,145mm,straight
1needleholder,MayoHegar,180mm,straight
1probe,doubleended,145mm
1scalpelhandle,No.4
1scissors,Deaver,140mm,curved,sharp/blunt
1tray,instruments,stainlesssteel,225mmx125mmx50mm,withcover.
Alternative:tourniquetwithVelcro,unit,2,maybesupplied.
Items
Unit
Quantity
(10 x 1) 10
(10 x 1) 10
(10 x 2) 20
(10 x 2) 20
(10 x 2) 20
(10 x 2) 20
(10 x 5) 50
(10 x 1) 10
23
24
References
References
1.
Theselectionanduseofessentialmedicines.ReportsoftheWHOExpertCommittees.Geneva,World
HealthOrganization.
(http://www.who.int/medicines/publications/essentialmeds_committeereports/en/index.html).
2.
Guidelinesfordrugdonations,revised2010.Geneva,WorldHealthOrganization,2011.
(http://www.who.int/medicines/publications/med_donationsguide2011/en/index.html).
3.
Clinicalmanagementofrapesurvivors.Developingprotocolsforusewithrefugeesandinternally
displacedpersons,reviseded.Geneva,WorldHealthOrganization,2004.
4.
IASCguidelinesonmentalhealthandpsychosocialsupportinemergencysettings.TheInterAgency
StandingCommittee(IASC),2007
(http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial
_june_2007.pdf).
5.
WHOModelListsofEssentialMedicines.Geneva,WorldHealthOrganization
(http://www.who.int/medicines/publications/essentialmedicines/en/index.html).
6.
GuaianaG,BarbuiC,HotopfM.Amitriptylineversusothertypesofpharmacotherapyfor
depression.CochraneDatabaseSystematicReview,2003(2)CD004186.
7.
FreemanC.Drugsandphysicaltreatmentaftertrauma.In:rnerR,SchnyderU,eds.
Reconstructingearlyinterventionaftertrauma,Oxford,OxfordUniversityPress,2003:16976.
8.
ConnollyMA,GayerM,OttmaniS,eds.Tuberculosiscareandcontrolinrefugeeanddisplaced
populations:aninteragencyfieldmanual(Secondedition).StopTBDepartmentandDisease
ControlinHumanitarianEmergenciesProgramme,WHOandUNHCR.Geneva,World
HealthOrganization,2007(WHO/HTM/TB/2007.377,
http://whqlibdoc.who.int/publications/2007/9789241595421_eng.pdf)
9.
Medicaldevicedonations:considerationsforsolicitationandprovision.Geneva,WorldHealth
Organization,2011(http://whqlibdoc.who.int/publications/2011/9789241501408_eng.pdf).
10.
Theinternationalpharmacopoeia,4thed.Geneva,WorldHealthOrganization,2011
(http://apps.who.int/phint/en/p/about/).
11.
Modelguidelinesfortheinternationalprovisionofcontrolledmedicinesforemergencymedicalcare.
Geneva,WorldHealthOrganization.
(WHO/PSA/96.17http://apps.who.int/medicinedocs/en/d/Jwho32e/).
25
26
Useful resources
Medicines
WHOModelListofEssentialMedicines.Geneva,WorldHealthOrganization
(http://www.who.int/medicines/publications/essentialmedicines/en/index.html).
WHOModelFormulary.Geneva,WorldHealthOrganization(www.who.int/selection_medicines/list).
Medicine management
Thelogisticshandbook:apracticalguideforsupplychainmanagersinfamilyplanningandhealthprograms.
JohnSnow,Inc./DELIVER.Arlington,Virginia,UnitedStatesAgencyforInternationalDevelopment
(USAID),2009(http://www.jsi.com/JSIInternet/Resources/Publications/healthlogistics.cfm).
Guidelinesforthestorageofessentialmedicinesandotherhealthcommodities.JohnSnow,Inc./DELIVERin
collaborationwiththeWorldHealthOrganization.Arlington,Virginia,UnitedStatesAgencyfor
InternationalDevelopment(USAID),2003(http://apps.who.int/medicinedocs/en/d/Js4885e/1.html).
Communicable diseases
Communicablediseasecontrolinemergencies.Afieldmanual.Geneva,WorldHealthOrganization,2005
(http://www.who.int/infectiousdiseasenews/IDdocs/whocds200527/ISBN_9241546166.pdf).
Guidelinesforthecontrolofshigellosis,includingepidemicsduetoShigelladysenteriaetype1.Geneva,
WorldHealthOrganization,2005(http://whqlibdoc.who.int/publications/2005/9241592330.pdf).
Thetreatmentofdiarrhoeaamanualforphysiciansandotherseniorhealthworkers.Geneva,WorldHealth
Organization,2005(http://whqlibdoc.who.int/publications/2005/9241593180.pdf).
Controlofcommunicablediseasesandpreventionofepidemics.In:Environmentalhealthinemergencies
anddisasters.Apracticalguide.Geneva,WorldHealthOrganization,2002:168174
(http://www.who.int/water_sanitation_health/hygiene/emergencies/em2002chap11.pdf).
27
Rapidhealthassessmentofrefugeeordisplacedpopulations.MdecinesSansFrontires,2006
(http://www.refbooks.msf.org/msf_docs/en/Rapid_Health/Rapid_Health_en.pdf).
WisnerB,AdamsJeds.Environmentalhealthinemergenciesanddisasters:apracticalguide.Geneva,
WorldHealthOrganization,2003
(http://www.who.int/water_sanitation_health/emergencies/emergencies2002/en/index.html).
AguidanceforUNHCRfieldoperationsonwaterandsanitationservices.Geneva,UNHCRWaterand
SanitationUnit,2008(http://www.unhcr.org/49d080df2.pdf).
Child health
IntegratedManagementofChildhoodIllnesschartbookletstandard.Geneva,WorldHealthOrganization,
2008(http://whqlibdoc.who.int/publications/2008/9789241597289_eng.pdf).
IntegratedManagementofChildhoodIllnesschartbookletforhighHIVsettings.Geneva,WorldHealth
Organization,2008
(http://www.who.int/child_adolescent_health/documents/9789241597388/en/index.html).
TechnicalupdatesoftheguidelinesontheIntegratedManagementofChildhoodIllness(IMCI).Evidenceand
recommendationsforfurtheradaptations.Geneva,WorldHealthOrganization,2005
(http://www.who.int/child_adolescent_health/documents/9241593482/en/index.html).
Guidelinesforthemanagementofsexuallytransmittedinfections.Geneva,WorldHealthOrganization,2003
(http://whqlibdoc.who.int/publications/2003/9241546263.pdf).
Malaria
Guidelinesforthetreatmentofmalaria,2nded.Geneva,WorldHealthOrganization,2010
(http://www.who.int/malaria/publications/atoz/9789241547925/en/index.html)
Malariacontrolincomplexemergencies.Aninteragencyfieldhandbook.Geneva,WorldHealth
Organization,2005(WHO/HTM/MAL/2005.1107,
http://whqlibdoc.who.int/publications/2005/924159389X_eng.pdf).
28
Useful resources
Mental health
IASCguidelinesonmentalhealthandpsychosocialsupportinemergencysettings.Geneva,InterAgency
StandingCommittee(IASC),2007
(http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2
007.pdf).
Mentalhealthandpsychosocialsupportinhumanitarianemergencies:whatshouldhumanitarianhealth
actorsknow?Geneva,InterAgencyStandingCommittee(IASC)ReferenceGroupforMentalHealth
andPsychosocialSupportinEmergencySettings,2010
(http://www.who.int/mental_health/emergencies/what_humanitarian_health_actors_should_know.pdf).
mhGAPinterventionguideformental,neurologicalandsubstanceusedisordersinnonspecializedhealth
settings,mentalhealthGapActionProgramme(mhGAP).Geneva,WorldHealthOrganization,
2010(http://www.who.int/mental_health/evidence/mhGAP_intervention_guide/en/index.html).
Nutrition
Infantandyoungchildfeedinginemergencies(Version2.1).Operationalguidanceforemergencyreliefstaffand
programmemanagers.IFECoreGroup.Geneva,WorldHealthOrganization,2007
(http://www.who.int/nutrition/publications/emergencies/operational_guidance/en/index.html).
Atoolkitforaddressingnutritioninemergencysituations.InterAgencyStandingCommittee(IASC)
GlobalNutritionCluster.NewYork,UNICEF,2008
(http://oneresponse.info/GlobalClusters/Nutrition/publicdocuments/Global_Nutrition_Cluster_Nutriti
on_Emergencies_Toolkit_June_2008.pdf).
Guidingprinciplesforfeedinginfantsandyoungchildrenduringemergencies.Geneva,WorldHealth
Organization,2004(http://whqlibdoc.who.int/hq/2004/9241546069.pdf).
Reproductive health
Interagencyfieldmanualonreproductivehealthinhumanitariansettings:2010revisionforfieldtesting.Inter
agencyWorkingGrouponReproductiveHealthinCrises,2010
(http://www.iawg.net/resources/field_manual.html).
Interagencyreproductivehealthkitsforcrisissituations.UNFPAandtheInteragencyWorkingGroupon
ReproductiveHealthinRefugeeSituations.NewYork5thedition,UNFPA,2011
(http://www.iawg.net/resources/184151_UNFPA_EN.pdf).
Clinicalmanagementofrapesurvivors:Developingprotocolsforusewithrefugeesandinternallydisplaced
persons,reviseded.Geneva,WorldHealthOrganization,2004
(http://www.who.int/reproductivehealth/publications/emergencies/924159263X/en/).
Sexualandgenderbasedviolenceagainstrefugees,returnees,andinternallydisplacedpersons:guidelinesfor
preventionandresponse.Geneva,OfficeoftheUnitedNationsHighCommissionerforRefugees
(UNHCR),2003
(http://www.unhcr.org/cgibin/texis/vtx/refworld/rwmain?docid=3edcd0661&page=search).
29
Tuberculosis
Treatmentoftuberculosis:guidelinesfornationalprogrammes,4thed.Geneva,WorldHealthOrganization,
2009(WHO/HTM/TB/2009.420,
http://www.who.int/tb/publications/tb_treatmentguidelines/en/index.html).
ConnollyMA,GayerM,OttmaniS,eds.Tuberculosiscareandcontrolinrefugeeanddisplacedpopulations:
aninteragencyfieldmanual(Secondedition).StopTBDepartmentandDiseaseControlinHumanitarian
EmergenciesProgramme,WHOandUNHCR.Geneva,WorldHealthOrganization,2007
(WHO/HTM/TB/2007.377,http://whqlibdoc.who.int/publications/2007/9789241595421_eng.pdf).
TB/HIVaclinicalmanual,2nded.Geneva,WorldHealthOrganization,2004(WHO/HTM/TB/2004.329,
http://www.who.int/tb/publications/who_htm_tb_2004_329/en/index.html).
30
Clinic:
Date:
Children
under five years old
Total
Others
Totals
Number of cases referred to other services:
Other information:
31
Total population:
Week:
Cause of death
Children under
five years old
Male
Acute respiratory
infection/pneumonia
Diarrhoea
Diarrhoea with blood
Fever
Confirmed malaria
Malnutrition
Maternal deaths
Measles
Meningitis
Others
Totals
Other information
32
Female
Total
Male
Female
Location:
Item/medicine
1.
2.
3.
4.
artemether + lumefantrine,
20 mg + 120 mg tablets
Quantities dispensed*
Total
6 tablets
12 tablets
18 tablets
24 tablets
5.
6.
7.
8.
9.
miconazole 2% cream
* For example: 10 + 30 + 20
33
34
Annex 3:
Sample health card
CardNo.
CarteNo.
Dateofregistration
Datedenregistrement
Dateofarrivalatsite
Datedarrivesurlelieu
HEALTHCARD
CARTEDESANTE
Site
Lieu
Familyname
Nomdefamille
Dateofbirthorage
Or
Datedenaissanceouge
Ou
C
Mothersname
H
Nomdelamre
I
Height
Weight
L
Taille
CM Poids
D E Feedingprogramme
R N Programmedalimentation
E F Immunization
Measles
Date
N A
Rougeole
N Immunization
Polio
Date
T
S
W
O
M
E
N
F
E
M
M
E
S
C
O
M
M
E
N
T
S
O
B
S
E
R
V
A
T
I
O
N
S
Section/HouseNo.
Section/HabitationNo.
Givennames
Prnoms
Years
Sex
Ans
Sexe
KG
Namecommonlyknownby
Nomdusagehabituel
Fathersname
Nomdupre
Percentageweight/height
Pourcentagepoids/taille
DPTPolio
Date
DTCPolio
Pregnant
Yes/No
No.ofpregnancies
Enceinte
Oui/Non
No.degrossesses
Tetanus
Date
1
Ttanos
Feedingprogramme
Programmedalimentation
General(Familycircumstances,livingconditionsetc.)
Gnrales(Circonstancesfamiliales,conditiondevie,etc.)
M/F
BCG
Date
Others
Autres
2
No.ofchildren
No.denfants
2
Lactating
Allaitante
Yes/no
Oui/Non
4
Health(Briefhistory,presentcondition)
Mdicales(Rsumdeltatactuel)
35
DATE
36
COND ITION
(Signs/symptoms/diagnosis)
ETAT
(Signes/symptmes/diagnostic)
TREATMENT
(Medication/dosetime)
TRAITEMENT
(Mdication/duredeladose)
COURSES
(M edicationdue/given)
APPLICATION
(M dicationrequise/effectue)
OBSERVATIONS
(Changeincondition)
NAMEOFHEALTHW ORKER
OBSERVATIONS
(Changementdtat)
NOMDELAGENTD ESANTE
Medicinesandmedicaldevicesrenewableandequipmentinthekitshouldcomply
withspecificationsgivenintheUNICEFonlinesupplycatalogueat:
https://supply.unicef.org
http://www.supply.unicef.dk/Catalogue/
2.
Suppliersshouldpurchasemedicinesandmedicaldevicesfromqualityassured
sourcesfollowinginternationallyacceptedqualitystandards.Wherepossible,
medicinesanddevicesshouldbesourcedfrommanufacturersthatareprequalifiedby
WHO.Thelistofprequalifiedmanufacturersandproductscanbefoundat
http://mednet3.who.int/prequal/
3.
Medicinesandmedicaldevicesrenewableandequipmentinthekitshouldcomply
withspecificationsandadvicegiveninlatestversionsoftheinteragencyGuidelinesfor
drugdonations,publishedbyWHO(2)andinthedocumentMedicaldevicedonations:
considerationsforsolicitationandprovision(9).
4.
SuppliersshouldcontactWHO/ProcurementServices(seeAnnex7)forthelatest
specificationsofrapiddiagnostictests(RDTs)formalaria,andinformationonthe
mostappropriatetestsforuseindifferentregions(seealso
http://www.who.int/malaria/diagnosis_treatment/en/).
Packaging
1.
2.
Thereisnoobjectionagainstblisterpackagingprovideditiswaterproofandprotects
thecontentsfromlightandhumiditywhereapplicable.
3.
Liquidsshouldbepackedinunbreakableleakproofbottlesorcontainers.
4.
Containers for all pharmaceutical preparations must conform to the latest edition of
internationallyrecognizedpharmacopoeialstandards(10).
5.
Ampoulesmusteitherhavebreakoffnecks,orsufficientfilesmustbeprovided.
6.
Each basic unit should be packed in one carton, with the malaria module packed
separately. The supplementary unit must be packed in cartons with a maximum
weightof50kgeach.
37
7.
Medicines, infusions and medical devices (renewables and equipment) should all be
packed in separate cartons, with corresponding labels. The cartons should preferably
havetwohandlesattached.
8.
Each carton must be marked with labels permitting identification and classification.
ThewordBASICmustbeprintedoneachlabelforthebasicunit.
Packing list
Each consignment must be accompanied by a list of contents, stating the total number of
cartons.Foreachcarton,thefollowingshouldbeclearlyspecified:
1.
nameofeachproduct;
2.
batchnumberofeachproduct;
3.
quantityofeachproduct;
4.
expirydateofeachproduct,especiallyforpharmaceuticalproducts.
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
TheInteragencyEmergencyHealthKit2011isprimarilyintendedfordisplaced
populations without medical facilities; it may also be used for initial supply of
primary healthcare facilities where the normal system of provision has broken
down.Itisnotintendedasaresupplykitand,ifusedassuch,mayresultinthe
accumulationofitemsandmedicineswhicharenotneeded.
Itisrecognizedthatsomeofthemedicinesandmedicaldevicescontainedinthe
kitmaynotbeappropriateforallculturesandcountries.Thisisinevitableasitis
astandardizedemergencykit,designedforworldwideuse,whichisprepacked
andkeptreadyforimmediatedispatch.
38
Espaol
<< El botiqun mdico de emergencia interorganismos 2011 est destinado
principalmente a las poblaciones desplazadas carentes de servicios mdicos;
podr utilizarse tambin para la prestacin inicial de servicios de atencin
primaria de salud donde el sistema normal de prestacin est paralizado. No
tieneporobjetoreabastecerelbotiqun,puessiseutilizaconestefinellopuede
darlugaraqueseacumulenartculosymedicamentosinnecesarios.
Elbotiqunnoestdestinadoalosprogramasdeinmunizacinniacombatirel
clera,lameningitisoepidemiasparticularescomolaprovocadaporelvirusde
bola,SRASylagripeaviar.>>
Franais
<< Le Kit Sanitaire dUrgence Interinstitutions 2011 est principalement destin
auxpopulationsdplacesnayantpasaccsunsystmedesoinsmdicaux.Il
peutgalementtreutilispourdonnerdessoinsdesantprimaires,partouto
le systme habituel nest plus fonctionnel. Il ne doit en aucun cas servir de
rapprovisionnementcarcelapourraitentraneruneaccumulationinapproprie
dematrielmdicaletdemdicaments.
Dans la mesure o ce kit est standardis, destin tre utilis dans le monde
entieretprconditionnafindtredistribuimmdiatementencasdencessit,
il est invitable quune partie du matriel mdical et des mdicaments quil
contientneconviennentpastouslespaysettouteslescultures.
Cekitnestniconupourlesprogrammesdevaccination,cholra,mningite,ni
pour des pidmies spcifiques comme celles dues au virus Ebola, SARS et le
virusdelagrippeaviaire.>>
39
40
Nutrition
Nutrition kits
Nutrition kits are used by health workers for the assessment of the nutritional status of
populations, for therapeutic feeding programmes, and for supplementary feeding
programmes. These kits were initially produced by the Britishbased nongovernmental
organization Oxfam, and were known as Oxfam kits. In 2007, Mdecins Sans Frontires
(MSF) managed the production of the nutrition kits for partners while a review of the kit
compositionwasundertakenbytheNutritionCluster1.Therevisedrecommendationbythe
Nutrition Cluster includes a standard anthropometric kit containing weighing and
measuring equipment for children under five years of age, combined with additional
modulesdesignedspecificallyforinpatientandoutpatient(ambulatory)therapeuticfeeding
centresthatcanbeorderedseparately.Therevisedcompositiontakesintoaccounttheneed
for scalingup treatment of severe acute malnutrition (SAM) in some countries. Kits are
availablefromMSFandUNICEF.
Thefollowingkitsandmodulesareavailable:
Kit1.Nutritionkit,anthropometric
Kit2.Nutritionkitforaninpatienttherapeuticfeedingcentre
Kit3.Nutritionkitforanoutpatienttherapeuticfeedingcentre
Module1.Nutritionkit,inpatient,moduleregistration
Module2.Nutritionkit,inpatient,moduleequipment
Module3.Nutritionkit,inpatient,modulemedicalsupplies
Module4.Nutritionkit,inpatient,modulemedicaldevices
Module5.Nutritionkit,outpatient,moduleregistration
Module6.Nutritionkit,outpatient,moduleequipment
InDecember2005theInterAgencyStandingCommittee(IASC)designatedglobalclusterleadsfornine
sectorsorareasofactivity,whichinthepasteitherlackedpredictableleadershipinsituationsof
humanitarianemergency,orwheretherewasconsideredtobeaneedtostrengthenleadershipand
partnershipwithotherhumanitarianactors,e.g.agriculture(ledbyFAO),logistics(ledbyWFP),
refugees(ledbyUNHCR)andnutritionandeducation(ledbyUNICEF).See
http://oneresponse.info/Coordination/ClusterApproach/Pages/Cluster%20Approach.aspx.
41
Kit1.Anthropometricnutritionkit
This kit contains equipment for measuring weight and height, allowing two teams to
performanutritionalanthropometricsurveyamongchildrenunderfiveyearsofage.
Italsoprovidesthenecessarymeasuringequipmentforinpatientandoutpatienttherapeutic
feedingcentres.
MSFreference:KMEDKNUT4
UNICEFreference:S0114050
Kit2.Nutritionkitforaninpatienttherapeuticfeedingcentre
Thenutritionkitforaninpatienttherapeuticfeedingcentreconsistsofoneanthropometric
nutritionkit(seeabove:Kit1)plusmodules1to4asadditionalconsumablestobeordered
separately(seeFigure2).
Figure2:Nutritionkitforaninpatienttherapeuticfeedingcentre
Moduleregistration
SO114051
Moduleequipment
SO114052
Modulemedical
supplies
SO114053
Modulemedical
devices
SO114054
Thiskitissufficientforoneinpatienttherapeuticfeedingcentrecaringfor50severelyacute
malnourishedchildrenforaperiodofthreemonths.
Module1.Inpatientregistrationmodule
Module 1 contains medical stationery and identification equipment for an inpatient
therapeuticfeedingcentre.
MSFreference:KMEDMNUTI11
UNICEFreference:S0114051
Module2.Inpatientequipmentmodule
Module 2 contains cooking and distribution materials for an inpatient therapeutic feeding
centre.
MSFreference:KMEDMNUTI12
UNICEFreference:S0114052
Module3.Inpatientmedicalsuppliesmodule
Thismodulecontainsmedicalconsumables(renewables)foraninpatienttherapeuticfeeding
centreandconsistsoftwocartonsofsupplies.
MSFreference:KMEDMNUTI13
UNICEFreference:S0114053
42
Module4.Inpatientmedicaldevicesmodule
Module4containsaglucometerandhaemoglobinometerforuseinaninpatienttherapeutic
feedingcentre.Thismoduleconsistsofonecarton.
MSFreference:KMEDMNUTI14
UNICEFreference:S0114054
Kit3.Nutritionkitforanoutpatienttherapeuticfeedingcentre
The nutrition kit for an outpatient therapeutic feeding centre consists of three
anthropometric nutrition kits (see above: Kit 1) plus modules 5 and 6 as additional
consumablestobeorderedseparately(seeFigure3).
Figure3:Nutritionkitforanoutpatienttherapeuticfeedingcentre
Anthropometric
Kit
Anthropometric
Kit
SO114050
SO114050
SO114050
Moduleregistration
Moduleequipment
SO114055
SO114056
Thiskitissufficientforfiveoutpatienttherapeuticfeedingcentresintendedfor500severely
acute malnourished children for a period of three months. If more than five sites are to be
covered,supplementaryanthropometricequipmentkitsshouldbeorderedseparately.
Module5.Outpatientregistrationmodule
Module 5 contains medical stationery and identification equipment for an outpatient
therapeuticfeedingcentre,andconsistsoftwocartons.
MSFreference:KMEDMNUTO11
UNICEFreference:S0114055
Module6.Outpatientequipmentmodule
This module contains cooking and feeding material for an outpatient therapeutic feeding
centreandconsistsofonecarton.
MSFreference:KMEDMNUTO12
UNICEFreference:S0114056
43
Reproductive health
Interagency reproductive health kits for crisis situations
ThereproductivehealthkitspreparedbyUNFPAprovidethesuppliesneededtoimplement
basicreproductivehealthservicesduringtheearlyphaseofacrisis.
Thereproductivehealthkitsaredesignedforavaryingpopulationforthreemonths.
Thereare12kitsdividedintothreeblocks.
Block 1. Six kits for use at the community and primary health-care level for a population
of 10 000 people for three months. The kits contain mostly medical devices renewables
for single use, and equipment.
Kit0 Administrationkit
Tofacilitateadministrationandtrainingactivities.
Kit1 Condomskit
120gross(17280)malecondomswith400safesexleaflets
3.8gross(540)femalecondomswith25useleaflets.
Kit2 Cleandeliverykit
200individualpacketscontainingitemsandpictorialinstructionsheetsforhomedelivery
plusmaterialforusebytraditionalbirthattendants.
Kit3 Rapetreatmentkit
Managementoftheimmediateconsequencesofsexualviolencewithappropriatemedicines
andsupplies:basictreatmentafterarapeandPEPtreatmentforHIV(includingtreatmentfor
children).
Kit4 Oralandinjectablecontraception
Torespondtowomensneedsforhormonalcontraception.
Kit5 Treatmentofsexuallytransmittedinfections
Todiagnoseandtreatsexuallytransmittedinfectionsinpeoplepresentingwithcomplaints.
Block 2. Five kits for use at primary health-care and referral hospital levels, designed for
a population of 30 000 people for three months.
Kit6 Clinicaldeliverykit
Toperformnormaldeliveries,repairepisiotomiesandperinealtearsunderlocalanaesthetics
andstabilizewomenwithobstetriccomplications(eclampsiaandhaemorrhage)before
transfertoareferralunit.Forusebytrainedpersonnel,midwives,nurseswithmidwifery
skillsandmedicaldoctors.
Kit7 Intrauterinedevice(IUD)kit
ToplaceIUDseitherascontraceptionorasemergencycontraception,andtoremoveIUDs
andprovidepreventiveantibiotictreatment.Forusebytrainedpersonnel.
Kit8 Managementofmiscarriageandcomplicationsofabortion
Totreatthecomplicationsarisingfrommiscarriageandunsafeabortion,includingsepsis,
incompleteevacuationandbleeding.Forusebytrainedpersonnel.
Kit9 Sutureoftearsvaginal/cervicalandvaginalexaminationkit
Toallowvaginalexaminationandsuturingofcervicalandvaginaltears.Forusebytrained
personnel,midwives,physicians,andnurseswithmidwiferyskills.
44
Kit10 Vacuumextractiondeliverykit
Toassistinvaginaldeliverybyusingmanualvacuumextractionmethodtodeliverthe
newborn.
Block 3. Two kits designed for referral surgical/obstetric level for 150 000 people for
three months.
Kit11 Referrallevelkitforreproductivehealth(partsA+B)
Medicaldevicesrenewableandequipmentandmedicinesforuseatthereferrallevelfor
caesareansections,resuscitationofmothersandbabies,treatmentofcomplicationsof
sexuallytransmittedinfections,andcomplicationsofpregnancyanddelivery.
Kit12 Bloodtransfusionkit
ToperformsafebloodtransfusionaftertestingforHIV,syphilisandhepatitisBandC.
45
46
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
lackofthesemedicinesresultsinadditionalhumansufferingbydeprivingthoseinneedof
adequate pain relief and sedation. This makes these medicines an essential part of medical
suppliesinemergencysituations.
ThebasicunitoftheInteragencyEmergencyHealthKit2011doesnotcontainanysubstances
that are regarded as narcotics or psychotropics, so they are not under international control
anddonotrequireadditionalformalitiesforinternationaltransport.
However, the supplementary unit contains several substances under international control,
and other substances that are under discussion for future control. Also, certain countries
haveadditionalnationalregulationsformedicinesnotunderinternationalcontrol.
Substances from the kit under international control are morphine injection
10 mg/ml, diazepam tablets 5 mg and injection 5 mg/ml and phenobarbital
tablets 50 mg. Morphine and all products classified as C1 in the exporting
country require import and export licences. For the two other substances this
may vary by country.
Some countries have national regulations for some additional substances.
This could be the case in some countries for ketamine injection 50 mg/ml,
promethazine tablets 25 mg and haloperidol injection 5 mg/ml.
An assessment is under way to decide whether ketamine needs to be brought
under international control.
Therearethreeinternationaltreatiesthatcontrolnarcoticandpsychotropicsubstances:
UNSingleConventiononNarcoticDrugs(1961,amendedbyprotocolof1972);
UNConventiononPsychotropicSubstances(1971);
UNConventionagainsttheIllicitTrafficinNarcoticDrugsandPsychotropic
Substances(1988).
47
Texts of the treaties can be found on the web site of the International Narcotics Control
Board(INCB)atwww.incb.org.Themostrecentlistsofcontrolledsubstancescanbefound
onthesamewebsite.
Thisproceduretakestoolongtomeettheacuteneedforreliefinemergencysituationsfromseveral
weeks to many months. This limitation is more inappropriate when the control authorities in the
receivingcountryarethemselvesstruckbythedisaster.
The INCB has advised control authorities that emergency humanitarian deliveries are
considered as being consumed in the exporting country. This makes that no additional
estimatehastobesentbytheauthoritiesofthereceivingcountry.Asthesentamountsare
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
sendingcountryhasnoadditionalestimationstosubmittotheINCBeither.
The INCB recommends limiting control obligations in emergency situations to the authorities of
exportingcountries.1
48
ThisprinciplewasendorsedbytheUNCommissiononNarcoticDrugsin1995,andwasfurtherreinforced
byitsresolutionentitledTimelyprovisionofcontrolledmedicinesforemergencycareadoptedatthe39th
sessionin1996.This,andasimilarresolutionadoptedbythe49thsessionoftheWorldHealthAssembly,
requestedWHOtopreparemodelguidelinestoassistnationalauthoritieswithsimplifiedregulatory
proceduresforthispurpose,inconsultationwiththerelevantUNbodiesandinterestedgovernments(11).
selectionofsuppliers;3
informationprovidedontheform;
actualhandlingofcontrolledmedicinesatthereceivingendoradequatedeliveryto
thereliablerecipient;
reportingtothecontrolauthoritiesofthereceivingcountry(whenevertheyare
available)assoonaspossible;
reportingtothecontrolauthoritiesofthereceivingcountryonunusedquantities,if
any,whentheoperatoristheenduserortoarrangefortheendusertodoso;
reportingtothecontrolauthoritiesoftheexportingcountrythroughthesupplier,with
copytotheINCB,anyproblemsencounteredintheworkingofemergencydeliveries.
Beforerespondingtotherequestfromtheoperator,thesuppliershouldbeconvincedthatthe
nature of the emergency justifies the application of the simplified procedure without
export/importauthorizations.Thesupplierisalsoresponsiblefor:
submittingimmediatelyacopyoftheshipmentrequesttothecontrolauthoritiesofthe
exportingcountry;
submittinganannualreportonemergencydeliveriesandquantitiesofmedicines
involvedaswellastheirdestinations,withcopytotheINCB;
reportingtothecontrolauthoritiesoftheexportingcountry,withcopytotheINCB,
anyproblemsencounteredintheworkingofemergencydeliveries.
Operators:organizationsengagedintheprovisionofhumanitarianassistanceinhealthmattersrecognized
bythecontrolauthoritiesofexportingcountries.
Suppliers:suppliersofmedicinesforhumanitarianassistanceattherequestofanoperator(eitheraseparate
entityoradepartmentofanoperator).
Suppliersshouldbelimitedtothoserecognizedbythecontrolauthoritiesofexportingcountries.They
shouldatleasthave:
adequateexperienceasasupplierofgoodqualityemergencymedicalsupplies;
managerialcapabilitytoassesstheappropriatenessofrequestsforthesimplifiedprocedurefrom
operators;
adequatelevelofstockandaresponsiblepharmacist;
sufficientknowledgeabouttherelevantinternationalconventions;
astandardagreementwiththecontrolauthoritiesofexportingcountries(seepage50foroutlinesfor
theagreement).
49
Thecontrolauthoritiesoftheexportingcountryshouldinformtheircounterpartinthereceiving
country(whenevertheyareavailable)oftheemergencydeliveries.Thecontrolauthoritiesof
thereceivingcountryhavetherighttorefusetheimportationofsuchdeliveries.
Criteriaforacceptanceofshipmentrequestsfromoperators
The criteria for immediate acceptance of shipment requests from operators should at
least specify the essential information to be furnished to the supplier concerning the
following.
a. Credibilityoftherequestingoperator
A predetermined list of credible operators should 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)
haveappropriatelogisticsupport.
b. Natureoftheemergencyandtheurgencyoftherequest
Astatementtothesupplieronthenatureoftheemergencyshouldbewrittenby
theoperator,orifappropriate,byaUNagency.
c. Availabilityofcontrolauthoritiesinthereceivingcountry
d. Diversionpreventionmechanismafterdelivery
Itshouldbeindicatediftherequestingoperatoritselfistheuserofthesupplies.If
not,thenameandorganizationofthepersonresponsibleforreceiptandinternal
distributionofthesuppliesshouldbeindicated.Asfaraspossible,therecipients
inthereceivingcountryshouldbeidentified.
2.
TimingandmodeofreportingtothecontrolauthoritiesandtheInternational
NarcoticsControlBoard(INCB)
Whencontrolauthoritiesareavailableinthereceivingcountry,theyshouldbenotified
assoonaspossiblebythecontrolauthoritiesoftheexportingcountryandtheoperator
of a consignment of the emergency delivery, regardless of the fact that their import
authorizationmaynotberequiredunderanemergencysituation.
Suppliers should inform the control authorities of the exporting country of each
emergencyshipmentbeingmadeinresponsetoarequestfromanoperatorsothatthe
control authorities can intervene if necessary. Suppliers should submit to the control
authorities of the exporting country an annual report on emergency deliveries and
quantitiesofmedicinesinvolvedaswellastheirdestinationsinduplicate,sothatone
copycanbeforwardedtotheINCB.
1
50
Whenanoperatorisalsoasupplier,theagreementwillbebetweentheoperatorandthecontrolauthorities.
Suppliers,oroperatorsthroughthesuppliers,shouldinformthecontrolauthoritiesof
theexportingcountries,withacopytotheINCB,ofanyproblemsencounteredinthe
workingofemergencydeliveries.
3.
Otherrelevantmatters
Asappropriate,theagreementmayincludeprovisionsonotherrelevantmatterssuch
asinspectionandguidancebythecontrolauthorities.Althoughthequantitiesinvolved
would be rather small, the inspection may touch upon estimated/assessed
requirements,basedontheprinciplethatthemedicinesprovidedshouldberegarded
ashavingbeenconsumedintheexportingcountry.
51
52
Name:.....................................................................................................................................................................
Address: ................................................................................................................................................................
Responsiblepharmacist:...................................................................................................................................
PhoneNo. .................................................... FaxNo. ........................................................................................
Email:..........................................................................
Nameofproduct(inINN/genericname)anddosageform,amountofactiveingredientperunitdose,
numberofdosageunitsinwordsandfigures.
Narcoticmedicinesasdefinedinthe1961Convention(e.g.morphine,pethidine,fentanyl)
[e.g.morphineinjection1mlampoule;morphinesulfatecorrespondingto10mgofmorphinebaseperml;two
hundred(200)ampoules]
.................................................................................................................................................................
.................................................................................................................................................................
.................................................................................................................................................................
.................................................................................................................................................................
Psychotropic substances as defined in the 1971 Convention (e.g. buprenorphine, pentazocine, diazepam,
phenobarbital)
.................................................................................................................................................................
.................................................................................................................................................................
.................................................................................................................................................................
.................................................................................................................................................................
Others(nationallycontrolledintheexportingcountry,ifapplicable)
.................................................................................................................................................................
.................................................................................................................................................................
Iftheoperatorisexportingdirectlyfromitsemergencystock,itshouldbeconsideredasasupplier.
Emergencydeliveriesdonotaffecttheestimateoftherecipientcountrysincetheyhavealreadybeen
accountedforintheestimateoftheexportingcountry.
53
Consignee(ifdifferentfromabovee.g.transitinathirdcountry):
Name:........................................... Organization/Agency.................................................................................
Address: ................................................................................................................................................................
PhoneNo.. ................................................... FaxNo. .........................................................................................
Email:..........................................................................
Natureoftheemergency(briefdescriptionoftheemergencymotivatingtherequest):
.................................................................................................................................................................
.................................................................................................................................................................
.................................................................................................................................................................
Availabilityof,andactiontakentocontact,thecontrolauthoritiesinthereceivingcountry:
.................................................................................................................................................................
.................................................................................................................................................................
Icertifythattheaboveinformationistrueandcorrect.Myorganizationwill:
take responsibility for receipt, storage, delivery to the recipient/enduser, or use for
emergencycare(strikeoutwhatisnotapplicable)oftheabovecontrolledmedicines;
report the importation of the above controlled medicines as soon as possible to the
controlauthorities(ifavailable)ofthereceivingcountry;
reportthequantitiesofunusedcontrolledmedicines,ifany,tothecontrolauthoritiesof
thereceivingcountry(ifavailable),orarrangefortheendusertodoso(strikeoutwhat
isnotapplicable).
Title:.....................................................Date: .....................................................................................
Location: .............................................
......................................................................................
(Signature)
54
Useful addresses
Annex 7:
Useful addresses
Partners
JohnSnow,Inc.
JSILogisticsServices
1616NFortMyerDrive,11thfloor
ArlingtonVA22209
UnitedStatesofAmerica
Tel:+17035287474
Fax:+17035287480
Email:[email protected]
Website:http://www.jsi.comor
http://www.deliver.jsi.com
MdecinsSansFrontires
MdecinsSansFrontires
RuedeLausanne78
CP1161211Geneva21
Switzerland
Tel:+41228498400
Fax:+41228498404
Email:[email protected],
Website:http://www.msf.org
Merlin
207OldStreet,12thfloor
LondonEC1V9NR
UnitedKingdom
Tel:+442070141600
Fax:+442070141601
Website:http://www.merlin.org.uk
Oxfam
OxfamHouse
JohnSmithDrive
Cowley
OxfordOX42JY
UnitedKingdom
Tel:+441865473727
Website:http://www.oxfam.org.uk
EcumenicalPharmaceuticalNetwork
CommunityInitiativesSupportServices
International
P.O.Box73860
Nairobi
Kenya
Tel:+254204444832/5020
Fax:+254204445095/4440306
Email:[email protected]
Website:http://www.epnetwork.org/
InternationalCommitteeoftheRedCross
19AvenuedelaPaix
CH1202Geneva
Switzerland
Tel:+41227346001
Fax:+41227332057
Website:http://www.icrc.org
InternationalFederationofRedCrossand
RedCrescentSocieties
17ChemindesCrt
PetitSaconnex
P.O.Box372
CH1211Geneva
Switzerland
Tel:+41227304222
Fax:+41227330395
Email:[email protected]
Website:http://www.ifrc.org
InternationalOrganizationforMigration
17routedesMorillons
P.O.Box71
CH1211Geneva19
Switzerland
Tel:+41227179111
Fax:+41227986150
Email:[email protected]
Website:http://www.iom.int
55
UnitedNationsChildrensFund
UNICEFHouse
3UnitedNationsPlaza
NewYork,NY10017
UnitedStatesofAmerica
Tel:+12123267000
Fax:+12128877465
Website:http://www.unicef.org
UnitedNationsHighCommissionerfor
Refugees
CasePostale2500
CH1211Geneva2Dpot
Switzerland
Tel:+41227398111
Fax:+41227319546
Website:http://www.unhcr.org
UnitedNationsPopulationFund
UNFPA/HRU
11ChemindesAnmones
CH1219Geneva
Switzerland
Tel:+41229178315
Fax:+41229198016
Email:[email protected]
Website:http://www.unfpa.org
WorldCouncilofChurches
ChristianMedicalCommission,Churches
ActionforHealth
150RoutedeFerney
P.O.Box2100
CH1211Geneva2
Switzerland
Tel:+41227916111
Fax:+41227910361
Email:[email protected]
Website:http://www.oikoumene.org/
WorldHealthOrganization
20AvenueAppia
CH1211Geneva27
Switzerland
Tel:+41227912111
Fax:+41227913111
Email:[email protected]
Website:http://www.who.int
Suppliers
CentraleHumanitaireMdico
pharmaceutique
4voiemilitairedesGravanges
F63100ClermontFerrand
France
Tel:+33473982481
Fax:+33473982480
Email:[email protected]
Website:http://www.chmp.org
IDAFoundation
Slocherweg35
1027AAAmsterdam
POBox37098
NL1030ABAmsterdam
TheNetherlands
Tel:+31204033051
Fax:+31204031854
Email:[email protected]
Website:http://www.idafoundation.org
56
IMRESMedicalSolutions
Larserpoortweg26
8218NKLelystad
TheNetherlands
Tel:+31(0)320296969
Fax:+31(0)320296929
Email:[email protected]
Website:http://www.imres.nl
Missionpharma
Vassingeroedvej9
3540Lynge
Denmark
Tel.:+4548163200
Fax:+4548163248
Email:[email protected]
Website:http://www.missionpharma.com
Useful addresses
UNFPAProcurementServicesBranch(for
ReproductiveHealthKits)
Midtermolen3
DK2100Copenhagen
Denmark
Tel:+4535467000
Fax:+4535467018
Email:[email protected]
Website:http://www.unfpa.org/
WorldHealthOrganization
ProcurementServices
20AvenueAppia
CH1211Geneva27
Switzerland
Tel:+41227912111
Fax:+41227910746
Website:http://www.who.int/
MSFSupply
Preenakker20
B1785Merchtem
Belgium
Tel.:+3252261000
Fax:+3252261004
Email:[email protected]
Website:http://www.msfsupply.be/
TheMedicalExportGroupBV
Papland16
P.O.Box598
4200ANGorinchem
TheNetherlands
Tel:+31183356100
Fax:+31183356122
Email:[email protected]
Website:http://www.meg.nl
UnitedNationsChildrensFundSupply
Division
UNICEFPlads
Freeport
DK2100Copenhagen
Denmark
Tel:+4535373527
Fax:+4535269421
Email:[email protected]
Website:http://www.unicef.org/supply
57
58
Feedback form
Feedback form
The purpose of this form is to seek your opinion about the contents of the Interagency
Emergency Health Kit 2011. We welcome any remarks, suggestions or recommendations
that you may have. We will use your written feedback during the next revision of its
contentswhichisplannedfor2014.Yourinputwillbeacknowledged.
Please sendyour feedback either by post to WHO, Department of Essential Medicines and
Pharmaceutical Policies, 20 Avenue Appia, CH1211 Geneva 27, Switzerland; or by
fax:+41227914167oremail:[email protected]
Emergency situation
PleasedescribebrieflythesituationinwhichyouusedtheInteragencyEmergencyHealthKit2011.
Date/periodandyear:
...
Country:
...
Kindofemergencysituation:
...
.......
Yourqualificationandposition:
...
.......
I.
Selectedmedicines
1. Arethecontentsofthebasicunitappropriatefortheneedsofthedisplacedpopulationinterms
oftheselectedmedicines?
Yes
No
Ifno,whichmedicinesareinappropriate?
____________________________
Ifno,whichmedicinesaremissing?
____________________________
Selectedrenewablemedicalsupplies
2. Arethecontentsofthebasicunitappropriatefortheneedsofthedisplacedpopulationinterms
oftheselectedrenewablemedicalsupplies?
Yes
No
Ifno,whichrenewablemedicalsuppliesareinappropriate?
____________________________
Ifno,whichrenewablemedicalsuppliesaremissing?
____________________________
Selectedhealthequipment
3. Arethecontentsofthebasicunitappropriatefortheneedsofthedisplacedpopulationinterms
oftheselectedhealthequipment?
Yes
No
Ifno,whichhealthequipmentisinappropriate?
____________________________
Ifno,whichhealthequipmentismissing?
____________________________
59
II.
Selectedmedicines
4. Arethecontentsofthesupplementaryunitappropriatefortheneedsofthedisplaced
populationintermsoftheselectedmedicines?
Yes
No
Ifno,whichmedicinesareinappropriate?
____________________________
Ifno,whichmedicinesaremissing?
____________________________
Selectedrenewablemedicalsupplies
5. Arethecontentsofthesupplementaryunitappropriatefortheneedsofthedisplaced
populationintermsofselectedrenewablemedicalsupplies?
Yes
No
Ifno,whichrenewablemedicalsuppliesareinappropriate?
____________________________
Ifno,whichrenewablemedicalsuppliesaremissing?
____________________________
Selectedhealthequipment
6. Arethecontentsofthesupplementaryunitappropriatefortheneedsofthedisplaced
populationintermsofselectedhealthequipment?
Yes
No
Ifno,whichhealthequipmentisinappropriate?
____________________________
Ifno,whichhealthequipmentismissing?
____________________________
III.
Information
7. DoesthebooklettheInteragencyEmergencyHealthKit2011provideappropriateinformation
andinstructionstounderstandtheemergencyhealthkitsguidingprinciples? Yes
No
Ifno,whynot?
____________________________
8. DoesthebooklettheInteragencyEmergencyHealthKit2011providesufficientlinksto
appropriatetreatmentguidelinesfortheuseofthecontentsofbasicunits?
Yes
No
Ifno,whynot?
____________________________
9. AreallsectionsofthebooklettheInteragencyEmergencyHealthKit2011relevant?
Yes
No
Ifno,whatwouldyoutakeout?
____________________________
Ifno,whatwouldyouliketoseeincluded?
____________________________
10.AreallannexesofthebooklettheInteragencyEmergencyHealthKit2011relevant?
Yes
No
Ifno,whatwouldyoutakeout?
____________________________
Ifno,whatwouldyouliketoseeincluded?
____________________________
11.Wasthereanytechnicallyinaccurateorincompleteinformation?
Yes
No
Ifyes,what?
____________________________
12.Whatareyourthreesuggestionstoimprovethecontentsofthekitandthebookletthe
InteragencyEmergencyHealthKit2011forthenextupdate?
1.
2.
3.
Thankyouforyourfeedback.
60