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Multi/cluster-sector initial & rapidassessment (MIRA)

Community level assessment

Assessment Form & Instructions

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I. Description Module

The description module needs to be filled in by all team members - collectively - before the assessment starts. It provides a description of the site and community assessed. This information is essential to compare the humanitarian situation across different affected areas or communities and establish humanitarian priorities.

CAUTION: In some instances, assessment teams will visit sites where different communities coexist. A village may for example be composed of both host and displaced communities. Whenever feasible, communities of interest should be assessed independently (using different investigation forms). Standard definitions are provided in Annex I.

Assessment Code:

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D1. Characteristics of the assessmentDate:Team name/code:Team leader/organization :Assessment code*:

* assign an arbitrary code (for example use the 2 initials of the district of the assessment and the time (hour.mn) of the assessment: “AD1530”) and replicate this code on the front page of each of the modules of the assessment before distributing to team members

D2. Administrative and geographical location of the siteGovernorate:District:Sub district:Village:Place code (if available):Latitude:Longitude:

D3. Type of setting□ Urban□ Rural□ Other (specify):

D4. Type of settlement

Private or individual accommodation

□ Individual homes (non-hosted)□ Non host□ Others (specify):

Camp or camp-like settlement

□ Planned camp or settlement□ Self-settled camp or settlement□ Collective center□ Reception or transit site

D4a. In the case of a camp or camp-like settlement: is there a site leader/manager?

□ YesName:Contact (tel.):Organization:

□ No□ Do not know

D5. Are people moving from or to the site in ways that may significantly influence the population(tick all that apply)?□ People are coming in the site□ People are moving out the site□ People are returning to the site□ There are no significant population movements

D6. Characteristics of the community assessed *

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Level 1 Level 2 Level 3

□ Affected

□ Non displaced□ Host□ Non host

□ Displaced

□ IDPs□ Refugees and/or asylum seekers□ Migrants□ Others of concern

□ Returnees□ Returning from IDP situation□ Returning from refugee situation

*to the extent possible, the assessment team should assess only one group (level 3) at a time as different groups - even when living in the same site - may have different needs. When groups cannot be assessed independently (e.g. lack of representative Key Informant) tick allthat apply. Definitions of each group are provided in Annex I.

D7. What is the estimated size of the population on site (total)?

D8. What is the estimated size of the community assessed?

D9. If any – which are the other characteristics of the site or the community assessed that may have a significant influence on affected people’s ability to cope with the crisis or that may influence the type of interventions required? (e.g. important sex and/or age and/or ethnic unbalance within the community, etc.)?

□ Female □ MaleSocial background / position:Function:Age:

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II. Generalist Key Informant Module

The Generalist Key Informant Module can be filled in by the different team members independently. It is composed of 2 sections:

Section 1 allows for the identification of serious problems faced by communities and their main causes.It is based on affected communities’ perception of the situation.

Section 2 allows respondents to rank their top 3 problems and identify for each of the priority problems, sub-groups within the community that are more impacted.

It is recommended to interview 4 generalist key informant in each community assessed: two male and two female. If different communities need to be assessed in one site, it is recommended to start assessing those simultaneously to mitigate possible resentment among affected communities.

CAUTION: Ensure that the assessment code (defined in D1 of the Description Module) is reported on the front page of each module of the Investigation Form before distributing them to team members.

Assessment Code:

Key Informant profile:

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SECTION IIdentification of “serious problems” and their potential causes

G1. WATER: Is there a serious problem in your community because people do not have enough water that is safe for drinking or cooking?□ Yes □ No □ Do not know

G1a. If yes, what are the main concerns related to water (choose up to 3)?There is not enough water/water points availableThe water available is not safe for drinking or cooking (e.g. due to contamination by excreta)There is not enough water sanitation/treatment capacity (e.g. filters, chlorine tabs)There are not enough recipients (jerry cans, buckets) - there is not enough water storage capacityThere is not enough access to water due to physical/logistical constraints*There is not enough access to water due to security constraintsThere is not enough access to water due to limited economic resourcesOther(s) – specify:

*for example: unavailable transportation, damaged infrastructure (roads, bridges) etc.

G2. FOOD: Is there a serious problem in your community with food; for example because there is no food or because it is not possible to access or cook food?□ Yes □ No □ Do not know

G2a. If yes, what are the main concerns related to food (choose up to 3)?There is not enough food available (including in markets, etc.)There is not enough diversity in foodThere is not enough access to food sources (i.e. markets) due to physical/logistical constraintsThere is not enough access to food sources (i.e. markets) due to security constraintsThere is not enough access to food sources (i.e. markets) due to limited economic resourcesAgricultural production* is disrupted due to the loss of assets (seeds, boats, etc.)Agricultural production is disrupted due to physical/logistical constraintsAgricultural production is disrupted due to security constraintsAgricultural production is disrupted due to limited economic resourcesThere are not enough cooking facilitiesThere are not enough cooking utensilsThere is not enough cooking fuelOther(s) - specify:

*including fishing and livestock

G3. PLACE TO LIVE IN: Is there a serious problem in your community because people do not have an adequate place to live in?□ Yes □ No □ Do not know

G3a. If yes, what are the main concerns related to shelter (choose up to 3)?There is not enough shelter space availableThere is not enough shelter space available due to grievances on land issuesThere is not enough access to rented shelter space due to limited economic resourcesThere are not enough building/repair materials available locallyThere is not enough access to building materials due to physical/logistical constraintsThere is not enough access to building materials due to security constraintsThere is not enough access to building materials due to limited economic resourcesThere is a lack of skills to build/repair sheltersThere is a lack of basic household items in sheltersOther(s) - specify:

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G4. TOILETS: Is there a serious problem in your community because people do not have easy and safe access to clean toilets?□ Yes □ No □ Do not know

G4a. If yes, what are the main concerns related to toilets (choose up to 3)?There are not enough toilets availableThere are not enough family toilets availableThere are not enough separate toilets for men and womenThere is not enough privacyToilets are not clean enough (e.g. toilets are not maintained, no soap and water is available)There is not enough access to toilets due to security constraintsOther(s) - specify:

G5. KEEPING CLEAN: Is there a serious problem in your community because it is difficult for people to keep clean; for example because there is not enough soap, water or suitable place to wash (when interviewing women also propose the lack of “sanitary material” as an option)?□ Yes □ No □ Do not know

G5a. If yes, what are the main concerns related to keeping clean (choose up to 3)?There is not enough water availableThere is not enough soap availableThere are not enough places to washThere is not enough access to water, soap or places to wash due to security constraintsThere is not enough access to water or soap due to limited economic resourcesOther(s) - specify:

G6. CLOTHING, SHOES, BEDDING or BLANKETS: Is there a serious problem in your community because people do not have enough or good enough clothing, shoes, bedding or blankets (csbb)?□ Yes □ No □ Do not know

G6a. If yes, what are the main concerns related to csbb (choose up to 3)?There is not enough clothing, shoes, bedding or blankets available (including in markets, etc.)There is not enough access to csbb due to physical/logistical constraintsThere is not enough access to csbb due to security constraintsThere is not enough access to csbb due to limited economic resourcesOther(s) - specify:

G7. INCOME OR LIVELIHOODS: Is there a serious problem in your community because people do not have enough income, money or resources to live?□ Yes □ No □ Do not know

G7a. If yes, what are the main concerns related to income, money or resources to live (choose up to 3)?There are no livelihood opportunitiesLivelihood assets were lost (left behind, destroyed, looted)Livelihood activities are hindered by physical/logistical constraintsLivelihood activities are hindered by security constraintsLivelihood activities are hindered by limited economic resources (to start an activity, buy assets, etc.)Other(s) - specify:

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G8. PHYSICAL HEALTH: Is there a serious problem in your community regarding physical health; for example because people have physical illnesses, injuries or disabilities?□ Yes □ No □ Do not know

G8a. If yes, what are the main concerns related to physical health (choose up to 3)?Children < 5 years People > 5 years

There are numerous cases of diarrheaThere are numerous cases of feverThere are numerous cases of respiratory diseasesThere are numerous cases of pregnancy related diseases Not applicableThere are numerous injuredThere are numerous disabledOther(s) - specify:

G9. HEALTH CARE: Is there a serious problem in your community because people are not able to get adequate health care for themselves; for example treatment or medicines or health care during pregnancy or childbirth?□ Yes □ No □ Do not know

G9a. If yes, what are the main concerns related to health care (choose up to 3)?There are not enough health services availableThere is not enough access to health services due to physical/logistical constraintsThere is not enough access to health services due to security constraintsThere is not enough access to health services due to limited economic resourcesOther(s) - specify:

G10. DISTRESS: Is there a serious problem in your community because people feel distressed; for example very upset, sad, worried, scared or angry?□ Yes □ No □ Do not know

G10a. If yes, what are the main concerns related to distress?

G11. SAFETY: Is there a serious problem in your community because people are not safe or protected where they live now; for example because of conflict, violence or crime in your community, village or city?□ Yes □ No □ Do not know

G11a. If yes, what are the main concerns related to safety (choose up to 3)?Regular armed violence (bombing, attacks, combats or clashes between armed groups)Presence of landmines or explosive remnants of warCivilians are deliberately killed by the military or armed groupsCivilians disappear (forced or unforced disappearance)Civilians are abducted or taken hostageAdult civilians are recruited by force in the militaryChildren civilians are recruited by force in the militaryCivilians are arrests and imprisonedCivilians are maltreated (e.g. extortion, forced labour, physical abuse, torture)Girls and women are targets of violenceThere is a continuing threat from natural disasters (e.g. earthquake aftershocks, etc.)Other(s) - specify:

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G12. EDUCATION: Is there a serious problem in your community because children are not in school or are not getting a good enough education?□ Yes □ No □ Do not know

G12a. If yes, what are the main concerns related to education (choose up to 3)?There are not enough schools, teaching spaces, teachers or teaching materialsTeaching spaces are used for other purposes, including temporary (e.g. collective centers)There is not enough access to schools due to physical/logistical constraintsThere is not enough access to schools due to security constraintsThere is not enough access to schools due to limited economic resourcesOther(s) - specify:

G13. SEPARATION FROM FAMILY MEMBERS: Is there a serious problem in your community because people have been separated from family members?□ Yes □ No □ Do not know

G14. BEING DISPLACED FROM HOME: Is there a serious problem with people in your community because they have been displaced from their home country, city or village?□ Yes □ No □ Do not know

G14a. If yes, what are the main reasons why people are unable to return home (choose up to 3)?There are not enough basic services and goods (e.g. health services, food) in the place of originThere is not enough access to houses or housing/land propertiesDisaster conditions (e.g. flood waters) have not receded in the place of originConflict has not ceased in the place of originThere are not enough transportations means available to places of originThere is not enough access to transportation to places of origin due to physical/logistical constraintsThere is not enough access to transportation to places of origin due to security constraintsThere is not enough access to transportation to places of origin due to limited economic resourcesOther(s) - specify:

G14b. If yes, what are the main concerns regarding cohabitation (choose up to 3)?Unequal access to water that is safe for drinking or cookingUnequal access to foodUnequal access to adequate places to live inUnequal access to income and livelihood opportunitiesUnequal access to health servicesUnequal access to schoolsUnequal access to fuel or other basic goods (cooking utensils, clothes, etc.)Unequal access to humanitarian aidIncreased security threats, risks of physical, sexual or domestic violenceOther(s) - specify:

G15. INFORMATION: Is there a serious problem in your community because people do not have enough information; for example information about assistance operations or about the situation in their home country, city or village when displaced?□ Yes □ No □ Do not know

G16. THE WAY AID IS PROVIDED: Is there a serious problem in your community because of inadequate aid; for example because people have no information about the aid that is available or because people do not have fair access to the aid that is available?□ Yes □ No □ Do not know

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G16a. If yes, what are the main concerns related to the delivery of aid (choose up to 3)?There is not enough aid for all entitledAccess to aid is unequal among affected communities or households (incl. gender, age)Non-affected communities are also demanding aidThere are political interferences in distribution of aidThe aid provided does not address the actual needsThere is not enough information on aidThe community is not involved enough in the delivery of aidThe basic goods provided are physically too heavy or bulky for the vulnerable in the community to takeOther(s) - specify:

G17. RESPECT: Is there a serious problem in your community because people do not feel respected or because they feel humiliated; for example because of the situation in which they live; or because of the way other people, including aid workers, treat them?□ Yes □ No □ Do not know

G18. MOVING BETWEEN PLACES: Is there a serious problem in your community because people are not able to move between places; for example going to another city quarter, village or town?□ Yes □ No □ Do not know

G18a. If yes, what are the main problems resulting from restriction of movement (choose up to 3)?There is not enough access to water that is safe for drinking or cookingThere is not enough access to foodThere is not enough access to adequate places to live inThere is not enough access to income and livelihood opportunitiesThere is not enough access to health servicesThere is not enough access to schoolsThere is not enough access to fuel or other basic goods (cooking utensils, clothes, etc.)There is not enough access to humanitarian aidIncreased security threats, risks of physical, sexual or domestic violenceOther(s) - specify:

G19. TOO MUCH FREE TIME: Is there a serious problem in your community because people have too much free time in the day?□ Yes □ No □ Do not know

G20. LAW AND JUSTICE: Is there a serious problem in your community because of an inadequate system for law and justice; or because people do not know enough about their legal rights?□ Yes □ No □ Do not know

G21. SAFETY OR PROTECTION FROM VIOLENCE WITHIN THE COMMUNITY: Is there a serious problem for people in your community because of physical or sexual violence; either in the community or in their homes?□ Yes □ No □ Do not know

G22. ALCOHOL OR DRUG USE: Is there a serious problem in your community because people drink a lot of alcohol or use harmful drugs?□ Yes □ No □ Do not know

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G23. MENTAL ILLNESS: Is there a serious problem in your community because people have a mental illness?□ Yes □ No □ Do not know

G24. CARE FOR PEOPLE WHO ARE ON THEIR OWN: Is there a serious problem in your community because there is not enough care for people who are on their own? For example care for unaccompanied children, widows or elderly people, or unaccompanied people who have a physical or mental illness, or disability.□ Yes □ No □ Do not know

G25. OTHER SERIOUS PROBLEMS: Are there any other serious problems in your community which I have not yet asked you about?

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SECTION II

Ranking of most “serious problems” and identification of most affected groups within the communityassessed

Read out all the TITLES of the problem areas, which the respondent has rated answered “yes” to as well as any other serious problem listed under the“other serious problems” question.

Ask the respondent to list her/his 3 m o s t ser i o u s p r ob le m s in their order of importance and report them in the table below (report both the number of the question and its TITLE).

For each of the priority problems listed below ask the respondent to identify sub-groups within the community that are particularly affected by the problem(tick all that apply).

Add any additional comments made by the respondent that you feel are relevant in the space provided to that end.

RankProblem

(number and title) Most affected groups within the community Additional CommentsFi

rst p

riorit

yMenWomenBoysGirlsOlder personsPersons with disabilitiesParticular nationality, ethnic or religious groups (specify):Other (specify):All groups are affected in a similar wayDo not know

Seco

nd p

riorit

y

MenWomenBoysGirlsOlder personsPersons with disabilitiesParticular nationality, ethnic or religious groups (specify):Other (specify):All groups are affected in a similar wayDo not know

Third

prio

rity

MenWomenBoysGirlsOlder personsPersons with disabilitiesParticular nationality, ethnic or religious groups (specify):

Other (specify):All groups are affected in a similar wayDo not know

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III. First Level Analysis Module

The First Level Analysis Module is filled in by all members of the assessment team collectively, at the end of the assessment.

Similarly to Generalist Key Informants, team members are asked to collectively identify “serious problems”, rank top 3 priorities and most affected sub-groups. As such it contains 2 sections:

Section 1 allows for the identification of serious problems faced by communities and their main causes. It is based on the collective judgment of the assessment team.

Section 2 allows for the assessment team to rank top 3 problems and identify for each of the priority problems, sub-groups within the community that are more impacted.

The results recorded in this module should reflect the conclusions of a discussion among team members where both formal (those gathered through structured interviews and observations) and informal elements (observations led informally, informal discussion with community members) are brought into the picture.

Any additional relevant information should be highlighted in the “comments” section.

Assessment Code:

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SECTION IIdentification of “serious problems” and their potential causes

G1. WATER: Is there a serious problem in the community assessed because people do not have enough water that is safe for drinking or cooking?□ Yes □ No □ Do not know

G1a. If yes, what are the main concerns related to water (choose up to 3)?There is not enough water/water points availableThe water available is not safe for drinking or cooking (e.g. due to contamination by excreta)There is not enough water sanitation/treatment capacity (e.g. filters, chlorine tabs)There are not enough recipients (jerry cans, buckets) - there is not enough water storage capacityThere is not enough access to water due to physical/logistical constraints*There is not enough access to water due to security constraintsThere is not enough access to water due to limited economic resourcesOther(s) – specify:

*for example: unavailable transportation, damaged infrastructure (roads, bridges) etc.

G2. FOOD: Is there a serious problem in the community assessed with food; for example because there is no food or because it is not possible to access or cook food?□ Yes □ No □ Do not know

G2a. If yes, what are the main concerns related to food (choose up to 3)?There is not enough food available (including in markets, etc.)There is not enough diversity in foodThere is not enough access to food sources (i.e. markets) due to physical/logistical constraintsThere is not enough access to food sources (i.e. markets) due to security constraintsThere is not enough access to food sources (i.e. markets) due to limited economic resourcesAgricultural production* is disrupted due to the loss of assets (seeds, boats, etc.)Agricultural production is disrupted due to physical/logistical constraintsAgricultural production is disrupted due to security constraintsAgricultural production is disrupted due to limited economic resourcesThere are not enough cooking facilitiesThere are not enough cooking utensilsThere is not enough cooking fuelOther(s) - specify:

*including fishing livestock

G3. PLACE TO LIVE IN: Is there a serious problem in the community assessed because people do not have an adequate place to live in?□ Yes □ No □ Do not know

G3a. If yes, what are the main concerns related to shelter (choose up to 3)?There is not enough shelter space availableThere is not enough shelter space available due to grievances on land issuesThere is not enough access to rented shelter space due to limited economic resourcesThere are not enough building/repair materials available locallyThere is not enough access to building materials due to physical/logistical constraintsThere is not enough access to building materials due to security constraintsThere is not enough access to building materials due to limited economic resourcesThere is a lack of skills to build/repair sheltersThere is a lack of basic household items in sheltersOther(s) - specify:

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G4. TOILETS: Is there a serious problem in the community assessed because people do not have easy and safe access to clean toilets?□ Yes □ No □ Do not know

G4a. If yes, what are the main concerns related to toilets (choose up to 3)?There are not enough toilets availableThere are not enough family toilets availableThere are not enough separate toilets for men and womenThere is not enough privacyToilets are not clean enough (e.g. toilets are not maintained, no soap and water is available)There is not enough access to toilets due to security constraintsOther(s) - specify:

G5. KEEPING CLEAN: Is there a serious problem in the community assessed because it is difficult for people to keep clean; for example because there is not enough soap, water or suitable place to wash?□ Yes □ No □ Do not know

G5a. If yes, what are the main concerns related to keeping clean (choose up to 3)?There is not enough water availableThere is not enough soap availableThere are not enough places to washThere is not enough access to water, soap or places to wash due to security constraintsThere is not enough access to water or soap due to limited economic resourcesOther(s) - specify:

G6. CLOTHING, SHOES, BEDDING or BLANKETS: Is there a serious problem in in the community assessed because people do not have enough or good enough clothing, shoes, bedding or blankets (csbb)?□ Yes □ No □ Do not know

G6a. If yes, what are the main concerns related to csbb (choose up to 3)?There is not enough clothing, shoes, bedding or blankets available (including in markets, etc.)There is not enough access to csbb due to physical/logistical constraintsThere is not enough access to csbb due to security constraintsThere is not enough access to csbb due to limited economic resourcesOther(s) - specify:

G7. INCOME OR LIVELIHOODS: Is there a serious problem in the community assessed because people do not have enough income, money or resources to live?□ Yes □ No □ Do not know

G7a. If yes, what are the main concerns related to income, money or resources to live (choose up to 3)?There are no livelihood opportunitiesLivelihood assets were lost (left behind, destroyed, looted)Livelihood activities are hindered by physical/logistical constraintsLivelihood activities are hindered by security constraintsLivelihood activities are hindered by limited economic resources (to start an activity, buy assets, etc.)Other(s) - specify:

G8. PHYSICAL HEALTH: Is there a serious problem in the community assessed regarding physical health; for example because people have physical illnesses, injuries or disabilities?□ Yes □ No □ Do not know

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G8a. If yes, what are the main concerns related to physical health (choose up to 3)?Children < 5 years People > 5 years

There are numerous cases of diarrheaThere are numerous cases of feverThere are numerous cases of respiratory diseasesThere are numerous cases of pregnancy related diseases Not applicableThere are numerous injuredThere are numerous disabledOther(s) - specify:

G9. HEALTH CARE: Is there a serious problem in the community assessed because people are not able to get adequate health care for themselves; for example treatment or medicines or health care during pregnancy or childbirth?□ Yes □ No □ Do not know

G9a. If yes, what are the main concerns related to health care (choose up to 3)?There are not enough health services availableThere is not enough access to health services due to physical/logistical constraintsThere is not enough access to health services due to security constraintsThere is not enough access to health services due to limited economic resourcesOther(s) - specify:

G10. DISTRESS: Is there a serious problem in the community assessed because people feel distressed; for example very upset, sad, worried, scared or angry?□ Yes □ No □ Do not know

G10a. If yes, what are the main concerns related to distress?

G11. SAFETY: Is there a serious problem in the community assessed because people are not safe or protected where they live now; for example because of conflict, violence or crime in your community, village or city?□ Yes □ No □ Do not know

G11a. If yes, what are the main concerns related to safety (choose up to 3)?Regular armed violence (bombing, attacks, combats or clashes between armed groups)Presence of landmines or explosive remnants of warCivilians are deliberately killed by the military or armed groupsCivilians disappear (forced or unforced disappearance)Civilians are abducted or taken hostageAdult civilians are recruited by force in the militaryChildren (<18) civilians are recruited by force in the militaryCivilians are arrests and imprisonedCivilians are maltreated (e.g. extortion, forced labour, physical abuse, torture)Girls and women are targets of violenceThere is a continuing threat from natural disasters (e.g. earthquake aftershocks, etc.)Other(s) - specify:

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G12. EDUCATION: Is there a serious problem in the community assessed because children are not in school or are not getting a good enough education?□ Yes □ No □ Do not know

G12a. If yes, what are the main concerns related to education (choose up to 3)?There are not enough schools, teaching spaces, teachers or teaching materialsTeaching spaces are used for other purposes, including temporary (e.g. collective centers)There is not enough access to schools due to physical/logistical constraintsThere is not enough access to schools due to security constraintsThere is not enough access to schools due to limited economic resourcesOther(s) - specify:

G13. SEPARATION FROM FAMILY MEMBERS: Is there a serious problem in the community assessed because people have been separated from family members?□ Yes □ No □ Do not know

G14. BEING DISPLACED FROM HOME: Is there a serious problem with people in the community assessed because they have been displaced from their home country, city or village?□ Yes □ No □ Do not know

G14a. If yes, what are the main reasons why people are unable to return home (choose up to 3)?There are not enough basic services and goods (e.g. health services, food) in the place of originThere is not enough access to houses or housing or land propertiesDisaster conditions (e.g. flood waters) have not receded in the place of originConflict has not ceased in the place of originThere are not enough transportations means available to places of originThere is not enough access to transportation to places of origin due to physical/logistical constraintsThere is not enough access to transportation to places of origin due to security constraintsThere is not enough access to transportation to places of origin due to limited economic resourcesOther(s) - specify:

G15. COHABITING: Is there a serious problem in the community assessed because of cohabitation with other communities (IDPs with hosts, hosts with IDPs, etc.)?

G14b. If yes, what are the main concerns regarding cohabitation (choose up to 3)?Unequal access to water that is safe for drinking or cookingUnequal access to foodUnequal access to adequate places to live inUnequal access to income and livelihood opportunitiesUnequal access to health servicesUnequal access to schoolsUnequal access to fuel or other basic goods (cooking utensils, clothes, etc.)Unequal access to humanitarian aidIncreased security threats, risks of physical, sexual or domestic violenceOther(s) - specify:

G16. INFORMATION: Is there a serious problem in the community assessed because people do not have enough information; for example information about the situation in which they live now; or the situation in their home country, city or village?□ Yes □ No □ Do not know

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G17. THE WAY AID IS PROVIDED: Is there a serious problem in the community assessed because of inadequate aid; for example because people have no information about the aid that is available, because people do not have fair access to the aid that is available; or because aid agencies are working on their own without involving people in your community?□ Yes □ No □ Do not know

G16a. If yes, what are the main concerns related to the delivery of aid (choose up to 3)?There is not enough aid for all entitledAccess to aid is unequal among affected communities or households (including gender, age)Non-affected communities are also demanding aidThere are political interferences in distribution of aidThe aid provided does not address the actual needsThere is not enough information on aidThe community is not involved enough in the delivery of aidThe basic goods provided are physically too heavy or bulky for the vulnerable in the community to takeOther(s) - specify:

G18. RESPECT: Is there a serious problem in the community assessed because people do not feel respected or because they feel humiliated; for example because of the situation in which they live; or because of the way other people, including aid workers, treat them?□ Yes □ No □ Do not know

G19. MOVING BETWEEN PLACES: Is there a serious problem in the community assessed because people are not able to move between places; for example going to another city quarter, village or town?□ Yes □ No □ Do not know

G18a. If yes, what are the main problems resulting from restriction of movement (choose up to 3)?There is not enough access to water that is safe for drinking or cookingThere is not enough access to foodThere is not enough access to adequate places to live inThere is not enough access to income and livelihood opportunitiesThere is not enough access to health servicesThere is not enough access to schoolsThere is not enough access to fuel or other basic goods (cooking utensils, clothes, etc.)There is not enough access to humanitarian aidIncreased security threats, risks of physical, sexual or domestic violenceOther(s) - specify:

G20. TOO MUCH FREE TIME: Is there a serious problem in the community assessed because people have too much free time in the day?□ Yes □ No □ Do not know

G21. LAW AND JUSTICE: Is there a serious problem in the community assessed because of an inadequate system for law and justice; or because people do not know enough about their legal rights?□ Yes □ No □ Do not know

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G22. SAFETY OR PROTECTION FROM VIOLENCE WITHIN THE COMMUNITY: Is there a serious problem for people in the community assessed because of physical or sexual violence; either in the community or in their homes?□ Yes □ No □ Do not know

G23. ALCOHOL OR DRUG USE: Is there a serious problem in the community assessed because people drink a lot of alcohol or use harmful drugs?□ Yes □ No □ Do not know

G24. MENTAL ILLNESS: Is there a serious problem in the community assessed because people have a mental illness?□ Yes □ No □ Do not know

G25. CARE FOR PEOPLE WHO ARE ON THEIR OWN: Is there a serious problem in the community assessed because there is not enough care for people who are on their own? For example care for unaccompanied children, widows or elderly people, or unaccompanied people who have a physical or mental illness, or disability.□ Yes □ No □ Do not know

G26. OTHER SERIOUS PROBLEMS: Are there any other serious problems in the community assessed which I have not been listed above?

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SECTION II

Ranking of most “serious problems” and identification of most affected groups within the community assessed

Identify the 3 m o st ser i o u s p r o b l e m s in their order of importance and report them in the table below (report both the number of the question and itsTITLE).

For each of the priority problems listed below identify sub-groups within the community that are particularly affected by the problem (tick all that apply) and add any other information you feel may be relevant, based on observations made, informal discussions held, passed experience, etc. in the appropriate space.

RankProblem

(number and title) Most affected groups within the community Additional CommentsFi

rst p

riorit

y

MenWomenBoysGirlsOlder personsPersons with disabilitiesParticular nationality, ethnic or religious groups (specify):Other (specify):All groups are affected in a similar wayDo not know

Seco

nd p

riorit

y

MenWomenBoysGirlsOlder personsPersons with disabilitiesParticular nationality, ethnic or religious groups (specify):Other (specify):All groups are affected in a similar wayDo not know

Third

prio

rity

MenWomenBoysGirlsOlder personsPersons with disabilitiesParticular nationality, ethnic or religious groups (specify):

Other (specify):All groups are affected in a similar wayDo not know

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Annex I

The definitions provided here are based on the Guidelines on the Humanitarian Profile Common OperationalDataset - Inter-Agency Standing Committee (IASC) Task Force on Information Management.

Affected - The sum of Displaced and Non-Displaced persons

Non-Displaced - The sum of Host and Non-Host persons

Host - Persons who are part of a host community or family receiving affected people. Due to the stress placed on the host families and communities, they are considered part of the humanitarian caseload.

Non-Host - People requiring immediate assistance during a period of emergency who have not moved from their homes or places of habitual residence.

Displaced - The sum of Internally Displaced Persons, Refugees and Asylum Seekers, Migrants, andOthers of Concern

Internally Displaced Persons - “Persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border”6

Refugees and Asylum Seekers - A refugee is someone who “owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country.”7 An Asylum Seeker is someone who says he or she is a refugee, but whose claim has not yet been definitively evaluated.

Migrants – Migrants are persons, and family members, moving to another country or region to better their material or social conditions and improve the prospect for themselves or their family.

Others of Concern - Persons who have been displaced by the emergency and form part of the humanitarian caseload, but do not fall into either of the above categories

Each of the above 3 s u b - c las se s o f Di s p la c e d has the following potential sub-categories. Note that these lower- level classes may not be as universal as the higher level classes described above. The classes and their definitions may need to be adjusted to match operational realities.

Camp or Camp-like - The sum of Planned Camp or Settlement, Self-settled Camp, Collective Centre, andReception or Transit

Planned Camps - Planned camps are places where displaced populations find accommodation on purpose-built sites, and a full services infrastructure is provided, including water supply, food distribution, non-food item distribution, education, and health care, usually exclusively for the population of the site.9

Self-settled Camps - A displaced community or displaced groups may settle in camps, independent of assistance from local government or the aid community. Self-settled camps are often sited on state-

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owned, private or communal land, usually after limited negotiations with the local population or private owners over use and access.10

Collective Centres - This type of settlement is where displaced persons find accommodation in pre- existing public buildings and community facilities, for example, in schools, barracks, community centres, town halls, gymnasiums, hotels, warehouses, disused factories, and unfinished buildings. They are often used when displacement occurs inside a city itself, or when there are significant flows of displaced people into a city or town. Often, mass shelter is intended as temporary or transit accommodation.11

Reception and Transit Camps - Oftentimes, it is necessary to provide temporary accommodation for displaced persons. These camps might be necessary at the beginning of an emergency as a temporary accommodation pending transfer to a suitable, safe, longer term holding camp, or at the end of an operation as a staging point of return. Reception and transit camps are therefore usually either intermediate or short-term installations.12

Private or Individual Accommodation – the sum of Privately Hosted and Non-hosted

Hosted - living in someone's else home with them, sharing resources and a hearth with another household groupNon-hosted - living in someone else’s home with them, sharing resources and a hearth with anotherhousehold group

In addition to the breakdown proposed, it may be required in certain instances to gather information on

Casualties - The sum of Dead, Missing, and InjuredDead - Persons confirmed as dead and persons missing and presumed dead4Missing - Persons who’s status during or after an emergency is not knownInjured - Persons suffering from physical injuries, trauma or an illness requiring medical treatment.5 Note that while the other 2nd level classes (Dead and Missing) can be added to Affected to get the total # of victims of an emergency, Injured is not mutually exclusive of the Affected class and should not be included in any such summation.