The Interagency Emergency Health Kit
2006
Medicines and medical devices
for 10,000 people for
approximately 3 months.(COMPILED BY M FAKHAR QURESHI)

Acknowledgments
The following individuals and organizations contributed to the development of this revision
and their advice and support are gratefully acknowledged.

United Nations High Commissioner for Refugees (UNHCR): Nadine Ezard,
Tsegereda Assebe, Nadine Cornier
United Nations Children 's Fund (UNICEF): Murtada Sesay, Monique Supiot,
Hanne Bak Pedersen
Joint United Nations Programme on HIV/AIDS (UNAIDS): Françoise Renaud ]Théry
United Nations Population Fund (UNFPA): Wilma Doedens, Thidar Myint
United Nations Development Programme/Inter ]Agency Procurement Services Office
(UNDP/IAPSO): Jack Gottling
World Bank: Yolanda Tayler, Juan Rovira
International Committee of the Red Cross (ICRC): Stephanie Arsac ]Janvier
International Federation of Red Cross and Red Crescent Societies (IFRC):
Hakan Sandbladh, Birgitte Olsen, Adelheid Marschang
International Organization for Migration (IOM): Sajith Gunaratne, Daniel Grondin,
Stéphanie Krause
International Pharmaceutical Federation (FIP): Xuan Hao Chan, Satu Tainio
WHO/Roll Back Malaria (RBM): Andrea Bosman, Charles Delacollette, Peter Olumese,
Aafje Rietveld, Maryse Dugué, David Bell (WHO Regional Office for the Western Pacific)
WHO/Contracting and Procurement Services (CPS): Françoise Mas, Paul Acriviadis
WHO/Health Action in Crises (HAC): Elisabeth Pluut, Christine Chomilier
WHO/Reproductive Health and Research: Margaret Usher ]Patel
WHO/Making Pregnancy Safer (MPS): Rita Kabra
WHO/Medicines Policy and Standards (PSM): Hans Hogerzeil, Marthe Everard,
Sophie Logez, Shalini Jayasekar, Clive Ondari, Willem Scholten
WHO/Child and Adolescent Health and Development (CAH): Olivier Fontaine,
Shamim Qazi, Martin Weber
WHO/Control of Neglected Tropical Diseases (NTD): Pamela Mbabazi, Michelle Gayer
Médecins Sans Frontières: Myriam Henkens, Olivier Raemdonck, Christa Hook,
Jean ]Marie Kindermans, Michel van Herp
Save the Children (UK): Elizabeth Berryman
John Snow, Inc. (JSI): Carolyn Hart, Paula Nersesian .The Interagency Emergency Health Kit 2006
iv
Ecumenical Pharmaceutical Network (EPN): Eva Ombaka
Merlin: Elizabeth Berryman (previously with Save the Children, UK)
IDA Foundation: Connie van Marrewijk, Michiel de Goeje
Missionpharma: Jens Rasmussen
Centrale Humanitaire Médico ]Pharmaceutique (CHMP): Alasanne Ba
The Medical Export Group BV: Klaas ]Jan Koning

Special thanks are due to Dr Robin Gray (WHO/PSM) who until his retirement was the focal
point for coordinating the content updates of the last two emergency health kits.
.Contents
v
Contents
Acknowledgments ..............................................................................................................iii
Introduction ...........................................................................................................................1
Chapter 1: Essential medicines and medical devices in emergency situations.........3
What is an emergency? ..................................................................................................................3
Principles behind the IEHK 2006..................................................................................................3
Composition of IEHK 2006............................................................................................................4
Referral system5
Immunization and nutrition in emergency.................................................................................5
Reproductive health .......................................................................................................................6
Malaria .............7
HIV, AIDS, tuberculosis and leprosy...........................................................................................7
Procurement of IEHK 2006............................................................................................................7
Post ]emergency needs....................................................................................................................7
Chapter 2: Selection of medicines and medical devices included in IEHK 2006......9
Selection of the medicines for IEHK 2006 ...................................................................................9
Medicines not included in IEHK 2006 .......................................................................................10
Selection of medical devices for IEHK 2006..............................................................................10
Selection of equipment.................................................................................................................11
Medical devices not included in IEHK 2006 .............................................................................11
Major changes in content since the 1998 edition of the emergency health kit .....................12
Chapter 3: Content of IEHK 2006 .....................................................................................13
10 basic units ] for health care workers with limited training................................................13
One supplementary unit ] for physicians and senior health care workers...........................13
Basic unit (for 1,000 people for 3 months).................................................................................14
Supplementary unit (for 10,000 people for 3 months).............................................................16
Annex 1: Basic unit: treatment guidelines......................................................................23
Anaemia.........23
Pain.................24
Diarrhoea .......24
Fever ...............27
Respiratory tract infections .........................................................................................................28
Measles...........28
"Red eye " condition ......................................................................................................................28
Skin conditio29
Sexually transmitted and urinary tract infections....................................................................29
Preventive care in pregnancy......................................................................................................29
Annex 2: Assessment and treatment of diarrhoea ........................................................31
A ]2.1 Assessment of diarrhoeal patients for dehydration................................................31
A ]2.2 Treatment of acute diarrhoea (without blood) ........................................................32
Treatment Plan A: treat diarrhoea at home..............................................................32
Treatment Plan B: oral rehydration therapy for children
with some dehydration...............................................................................................34
Treatment Plan C: for patients with severe dehydration .......................................37.The Interagency Emergency Health Kit 2006
vi
Annex 3: Management of the child with cough or difficult breathing.....................39
A ]3.1 Assess the child............................................................................................................39
A ]3.2 Decide how to treat the child .....................................................................................39
A ]3.3 Child less than two months old .................................................................................40
A ]3.4 Child two months to five years old...........................................................................41
A ]3.5 Treatment instructions ................................................................................................42
Annex 4: Sample data collection forms...........................................................................45
Annex 5: Sample health card ............................................................................................49
Annex 6: Guidelines for suppliers...................................................................................51
Specifications for medicines and medical devices ...................................................................51
Packaging.......51
Packing list.....52
Information 52
Annex 7: Other kits for emergency situations ...............................................................55
Immunization55
Nutrition ........55
Reproductive health .....................................................................................................................56
Annex 8: Guidelines for Drug Donations ......................................................................59
Selection of drugs .........................................................................................................................59
Quality assurance and shelf ]life .................................................................................................60
Presentation, packing and labelling ...........................................................................................61
Information and management ....................................................................................................62
Annex 9: Model Regulatory Aspects of Exportation and Importation of
Controlled Substances .....................................................................................63
Introduction...63
Standard procedure for international transfer of narcotic and psychotropic substances...64
Procedure to be followed in disaster relief................................................................................64
Outline of standard agreement between supplier and control authorities of exporting
countries.........66
Shipment request/notification form for emergency supplies of controlled substances......68
Annex 10: References..........................................................................................................71
Medicines.......71
Medicine management.................................................................................................................71
Communicable diseases...............................................................................................................71
General public health ...................................................................................................................72
Child health ...72
HIV and STIs .72
International travel and health ...................................................................................................72
Malaria ...........72
Mental health.73
Nutrition ........73
Reproductive health .....................................................................................................................73
Tuberculosis ..73
Annex 11: Useful addresses...............................................................................................75
Partners ..........75
Suppliers ........78
Feedback form .....................................................................................................................81
.Introduction
1
Introduction
The organizations and agencies of the United Nations system and international and
nongovernmental organizations are called upon to respond to an increasing number of large ]
scale emergencies and disasters, many of which pose a serious threat to health. Much of the
assistance provided in such situations is in the form of medicines and medical devices
(renewable and equipment).

During the 1980s, the World Health Organization (WHO) took up the question of how
emergency response could be facilitated through effective emergency preparedness
measures. The aim was to encourage the standardization of medicines and medical supplies
needed in emergencies to permit a swift and effective response with medicines and medical
devices using standard, pre ]packed kits that could be kept in readiness to meet priority
health needs in disaster situations.

The Interagency Emergency Health Kit 2006 (IEHK 2006) is the third edition of the WHO
Emergency Health Kit which was the first such kit when it was launched in 1990. The second
kit, "The New Emergency Health Kit 98 " was revised and further harmonized by WHO in
collaboration with a large number of international and nongovernmental agencies. This
updated third edition takes into account the global HIV/AIDS epidemic, the increasing
parasite resistance to commonly available antimalarials and the field experience of agencies
using the emergency health kit.

Over the years the concept of the emergency health kit has been adopted by many
organizations and national authorities as a reliable, standardized, affordable, and quickly
available source of the essential medicines and medical devices (renewable and equipment)
urgently needed in a disaster situation. Its content is based on the health needs of 10,000
people for a period of three months.

This document provides background information on the composition and use of the
emergency health kit. Chapter 1 describes supply needs in emergency situations and is
intended as a general introduction for health administrators and field officers. Chapter 2
explains the selection of medicines and medical devices ] renewable and equipment ] which
are included in the kit and also provides more technical details intended for prescribers.
Chapter 3 describes the composition of the kit, consisting of the basic and complementary
units. The annexes provide more details on treatment guidelines, sample forms, a health
card, guidelines for suppliers, other kits for emergency situations, guidelines for medicines
donations, a standard procedure for importation of controlled medicines, references, and
useful addresses. A feedback form is also included to report on experiences when using the
emergency health kit and to encourage comments and recommendations on the contents of
the kit from distributors and users for consideration when updating the contents.
.The Interagency Emergency Health Kit 2006
2
The WHO Department of Medicines Policy and Standards (formerly known as the
Department of Essential Drugs and Medicines Policy) has coordinated the review process
and has published this interagency document on behalf of all collaborating partners.
.Essential medicines and medical devices in emergency situations
3
Chapter 1:
Essential medicines and medical devices in
emergency situations
What is an emergency?
The term “emergency” is applied to various situations resulting from natural, political and
economic disasters. The Interagency Emergency Health Kit 2006 (IEHK 2006) is designed to
meet the initial primary health care needs of a displaced population without medical
facilities, or a population with disrupted medical facilities in the immediate aftermath of a
natural disaster or during an emergency. It must be emphasized that, although supplying
medicines, medical devices (renewable and equipment) in standard pre ]packed kits is
convenient early in an emergency, specific local needs must be assessed as soon as possible
and further supplies must be ordered accordingly.
Medicine and medical device needs in the context of an emergency
situation
The practical impact of many well ]meaning donations and support sent in emergencies has
often been diminished because the supplies did not reflect real needs or because
requirements were not adequately assessed. Often this resulted in donations of unsorted,
unsuitable, inadequately labelled and expired medicines and other medical devices which
could not all be used at the receiving end. The Interagency Guidelines for Drug Donations,
revised in 1999, describe "good donation practices " and promote the principles necessary for
improved quality medicine donations. More detailed information is provided in Annex 8.

Morbidity patterns may vary considerably between emergencies. For example, in
emergencies where malnutrition is common, morbidity rates may be very high. For this
reason an estimate of medicine requirements can only be approximate, although certain
predictions can be made based on previous experience.
Principles behind the IEHK 2006
IEHK 2006 is designed principally to meet the first primary health care needs
of a displaced population without medical facilities. Its content is a
compromise and there will always be some items which do not completely
meet requirements. An ideal kit can only be designed with an exact
knowledge of the population characteristics, disease prevalence, morbidity
patterns and level of training of those using the kit.
.The Interagency Emergency Health Kit 2006
4
IEHK 2006 consists of two different sets of medicines and medical devices, named a basic unit
and a supplementary unit. To facilitate distribution to smaller health facilities on site, the
quantities of medicines and medical devices in the basic unit have been divided into
10 identical units for 1,000 people each.
Terminology
Confusion has arisen over the words "kit " and "unit ". In this context, a kit refers to 10 basic
units plus one supplementary unit as explained in Figure 1.

Figure 1: Composition of IEHK 2006

1,000 1,000 1,000 1,000 1,000 Total:
1,000 1,000 1,000 1,000 1,000 }
10 x 1 basic unit
for 10 x 1,000 people
10,000
}
1 supplementary unit
for 1 x 10,000 people
}
1 emergency
health kit for
10,000 people
for 3 months
Basic unit
The basic unit contains essential medicines and medical devices for primary health care
workers with limited training. It contains oral and topical medicines, none of which are
injectable. Combination therapy for the treatment of uncomplicated falciparum malaria is
provided unless there is a specific request not to include it in the kit.

Standard treatment guidelines, based on symptoms, have been developed to help primary
health care personnel use the medicines rationally and these can be found in Annexes 1 to 3.
Two printed copies of this publication in English, French and Spanish are included in each
basic unit. Additional printed copies can be obtained from the Department of Medicines
Policy and Standards, WHO, Geneva, see Annex 10. Electronic copies can be downloaded
from the web site: www.who.int/medicines/.
Supplementary unit
The supplementary unit contains medicines and medical devices for a population of 10,000
and is to be used only by professional health workers or physicians. It does not contain any
medicines or devices from the basic unit and can therefore only be used when these are
available as well. Modules for malaria and for patient post ]exposure prophylaxis (Patient
PEP) are provided unless there is a specific request not to include them in the kit.

The supplementary unit does not contain any medicines or medical devices
from the basic units. The supplementary unit should only be used together
with one or more basic units.
Selection of medicines
The selection of medicines in the kit has been based on treatment recommendations from
technical units within WHO. A manual describing the standard treatment guidelines for .Essential medicines and medical devices in emergency situations
5
target diseases was developed through collaboration between Médecins Sans Frontières
(MSF) and WHO. Two copies of the manual in English, French and Spanish are included in
each supplementary unit. Additional printed copies can be obtained from MSF, see
Annex 11.
Quantification of medicines
The estimation of medicine requirements in the kit has been based on:

1. the average morbidity patterns among displaced populations;
2. the use of standard treatment guidelines;
3. figures provided by agencies with field experience.

The quantities of medicines supplied will therefore only be adequate if prescribers follow the
standard treatment guidelines.
Referral system
Health services can be decentralized by the use of basic health care clinics (the most
peripheral level of health care) providing simple treatment using the basic units. Such
decentralization will: (1) increase the access of the population to curative care; and (2) avoid
overcrowding of referral facilities by treating common health problems at the most
peripheral level. Standard treatment guidelines included in the kit will provide primary
health care workers with information to enable them to take the right decision on treatment
or referral, according to the symptoms.

The first referral level should be staffed by professional health care workers, usually medical
assistants or doctors, who will use medicines and medical devices from both the basic and
supplementary units.

It should be stressed here that the basic and supplementary units are not intended to enable
these health care workers to treat rare diseases or major surgical cases. For such patients a
second level of referral is needed, usually a district or general hospital. Such facilities are
normally part of the national health system and referral procedures should be arranged with
the local health authorities.
Immunization and nutrition in emergency situations
IEHK 2006 is not designed for immunization or nutritional programmes: kits
covering immunization and nutritional requirements may be ordered after an
assessment of needs (see Annex 7).

Experience in emergencies involving displaced populations has shown that measles is one of
the major causes of death among young children. The disease spreads rapidly in
overcrowded conditions, and serious respiratory tract infections are frequent, particularly in
malnourished children.
.The Interagency Emergency Health Kit 2006
6
Measles vaccine administration should therefore be given a high priority, with all children
between six months and five years old being immunized. Children immunized before nine
months should be re ]immunized as soon after nine months as possible. All children in the
target age group should be immunized, irrespective of history.

Children with clinical measles should be treated promptly for complications, enrolled in a
supplementary feeding programme and given appropriate doses of vitamin A.
Reproductive health
IEHK 2006 is not designed for reproductive health services: reproductive
health kits for emergencies may be ordered after a basic assessment of needs
(see Annex 7).

A number of priority reproductive health interventions have been defined as essential for a
displaced population during an emergency. The Minimum Initial Service Package for
Reproductive Health (MISP) is a coordinated set of activities, including the provision of:
emergency obstetric care to prevent excess neonatal and maternal morbidity and mortality;
provisions to reduce HIV transmission; and activities to prevent and manage the
consequences of sexual violence.

Professional midwifery care is an essential service for which the necessary instruments and
medicines are included in the kit. A small quantity of magnesium sulfate for severe pre ]
eclampsia and for eclampsia is included in the supplementary unit for use as a "holding "
measure prior to referral.

The use of emergency contraception is a personal choice that can only be made by the
woman herself. Women should be offered counselling on this method so as to reach an
informed decision. A health worker who is willing to prescribe ECPs should always be
available to prescribe them to rape survivors who wish to use them.1

In the context of patient post ]exposure prophylaxis (Patient PEP), a limited quantity of
medicines for: (1) presumptive treatment of sexually transmitted infections, including N.
gonorrhoea and C. trachomatis; for (2) prevention of transmission of human immunodeficiency
virus (HIV); and (3) prevention of pregnancy (emergency contraception) for survivors/
victims of sexual assault (rape), is included in the kit.

Supplies for routine and general treatment of sexually transmitted infections and
contraception will have to be ordered separately according to need (see Annex 7).

Comprehensive reproductive health services need to be integrated into the primary health
care system as soon as possible and a referral system for obstetric emergencies must be made
accessible to the population. It is also recommended that a qualified and experienced person
be appointed as reproductive health coordinator.

1 Clinical management of rape survivors. Developing protocols for use with refugees and internally
displaced persons. Revised edition. Geneva: World Health Organization; 2004..Essential medicines and medical devices in emergency situations
7
To assist the implementation of a reproductive health programme, the Inter ]Agency
Working Group on Reproductive Health in Emergencies (IAWG) has designed a number of
reproductive health kits for all levels of the health care system during an emergency (see
Annex 7). The kits can be ordered through the United Nations Population Fund (UNFPA).

IEHK 2006 will always be supplied with a Patient PEP module unless there is a
specific request not to include these items at the time of ordering.
Malaria
In recent years, the pace of parasite resistance against the safest and least expensive
antimalarials has been accelerating. A new approach to combat malaria is combination
therapy. Artemether + lumefantrine is the first fixed ]dose antimalarial combination contain ]
ing an artemisinin derivative and is included in the kit for the treatment of malaria due to
Plasmodium falciparum, including Plasmodium falciparum in areas with significant drug
resistance. It is not recommended for prophylaxis and should not be used by women in the
first trimester of their pregnancy, since safety in pregnancy has not yet been established.
Rapid diagnostic tests (RDTs) are included in the malaria modules for the confirmation of
suspected malaria cases.

IEHK 2006 will always be supplied with malaria modules unless there is a
specific request not to include these items at the time of ordering.
HIV, AIDS, tuberculosis and leprosy
IEHK 2006 does not include any medicines against communicable diseases
such as HIV, AIDS, tuberculosis or leprosy. Supplies for prevention and/or
treatment of these communicable diseases will have to be ordered separately
after an assessment of needs.
Procurement of IEHK 2006
Pharmaceutical suppliers who may supply the IEHK should ensure that (1) the content of the
IEHK is updated according to the following kit and (2) manufacturers comply with the
international guidelines for quality, packaging and labelling of medicines and medical
devices. Pharmaceutical suppliers should follow the general instructions given in Annex 6.
Some suppliers may have a permanent stock of IEHK ready for shipment within 24 hours.
Post emergency needs
IEHK 2006 is for use only in the early phase of an emergency. The kit is not
designed and not recommended for re-supplying existing health care
facilities.

After the acute phase of an emergency is over and basic health needs have been covered by
the basic and supplementary units, specific needs for further supplies and equipment should
be assessed as soon as possible. .The Interagency Emergency Health Kit 2006
8
.Selection of medicines and medical devices included in IEHK 2006
9
Chapter 2:
Selection of medicines and medical devices
included in IEHK 2006
The contents of IEHK 2006 are based on epidemiological data, population profiles, disease
patterns and certain assumptions based on experience gained in emergency situations.
These assumptions are:
.
The most peripheral level of the health care system will be staffed by health care
workers with limited medical training, who will treat symptoms rather than diagnosed
diseases using the basic units, and refer patients who need more specialized treatment
to the next level.
. Half of the population is under 15 years of age.
. The average number of patients presenting themselves with the more common
symptoms or diseases can be predicted.
. Standard treatment guidelines will be used to treat these symptoms or diseases.
. The rate of referral from the most peripheral to the next level of health services is 10%.
. The first referral level of health care is staffed by experienced nurses, midwives,
medical assistants or physicians, with no or limited facilities for inpatient care. They
will use the supplementary unit in conjunction with one or more basic units.
. If both the most peripheral and first referral health care facilities are within reasonable
reach of the target population, every individual will, on average, visit such facilities
four times per year for advice or treatment. The supplies in the kit therefore serve a
population of 10,000 people for a period of approximately 3 months.
Selection of medicines for IEHK 2006
Injectable medicines
There are no injectable medicines in the basic unit as most common diseases in their
uncomplicated form do not require injectable medicines. Any patient who needs an injection
must be referred to the first referral level. Injectable medicines are provided in the
supplementary unit and are intended for use by professional health care workers at first
referral level.
Antibiotics
Infectious bacterial diseases are common at all levels of health care, including the most
peripheral, and basic health care workers should therefore have the possibility to prescribe
an antibiotic. However, many basic health care workers have not been trained to prescribe
antibiotics in a rational way. Amoxicillin is the only antibiotic included in the basic unit, and .The Interagency Emergency Health Kit 2006
10
this will enable the health care worker to concentrate on making the right decision between
prescribing an antibiotic or not, rather than on choosing between several antibiotics.
Amoxicillin is active against bacterial pneumonia and otitis media. The risk of increasing
bacterial resistance must be reduced by rational prescribing practice.
Medication for children
Paediatric formulations included in the kit are paracetamol 100 mg tab, the fixed ]dose
antimalarial combination artemether + lumefantrine 20 mg + 120 mg tab for the weight group
5 ]14 kg, artemether injection 20 mg/ml, zinc sulfate 20 mg dispersible tab, ORS (oral
rehydration salts) solution for children can be prepared with the sachets included in the kit.

Syrups for children are not included because of their instability, their short shelf ]life after
reconstitution and their volume and weight. Instead, for children, half or quarter adult
tablets may be crushed and administered with a small volume of fluid or with food.
Medicines not included in IEHK 2006
As indicated before, the kit includes neither the common vaccines nor any medicines against
communicable diseases such as AIDS, tuberculosis 2 or leprosy.

No specific medicines are included for the treatment of sexually transmitted infections other
than a small quantity as presumptive treatment of gonococcal infection, chlamydia and
prevention of HIV infection in the context of post ]exposure prophylaxis. Supplies for regular
contraception and condoms are not included in the kit.
Selection of medical devices for IEHK 2006
Syringes, needles and safety boxes
Unsafe injection leads to the risk of transmission of bloodborne pathogens including,
hepatitis B, hepatitis C virus and HIV. Injection associated risks for patients and health
workers should be limited by:
.
limiting the number of injections;
. using disposable syringes and needles only;
. using safety boxes designed for the collection and incineration of used syringes,
needles and lancets;
. strictly following the destruction procedures for disposable material.

Only disposable syringes and needles are provided in the supplementary unit. Estimates of
needs are based on the number of injectable medicines included in the supplementary unit,
which are to be used in line with the treatment guidelines provided.

2 The general prerequisites for the establishment of a tuberculosis control programme for refugees and
displaced persons are: 1) the emergency phase is over; 2) security in and stability of the camp or site is
envisioned for at least six months; 3) basic needs of water, adequate food and sanitation are available;
and 4) essential clinical services and medicines are available..Selection of medicines and medical devices included in IEHK 2006
11
Gloves
Disposable protective gloves are provided in the basic unit and the supplementary unit to
protect health workers against possible infection during dressings or handling of infected
materials. Sterile disposable surgical gloves are supplied in the supplementary unit to be
used for deliveries, sutures and minor surgery, all under medical supervision.
Selection of equipment
Sterilization
A complete sterilization set is provided in the kit. The basic units contain two small drums
each to be used as containers for sterile dressing materials. Two drums are included to allow
sterilization of one while the other is being used. The supplementary unit contains one steam
sterilizer, drums for steam sterilization, TST indicators, timer and kerosene stove.
Dilution and storage of liquids
The kit contains several plastic bottles to dilute and store liquids (e.g. chlorhexidine, benzyl
benzoate and gentian violet solution).
Water supply
The kit contains several items to help provide clean water at the health facility. Each basic
unit contains a collapsible water container and two plastic pails with bail. The
supplementary unit contains a water filter with candles and tablets of sodium
dichloroisocyanurate (NaDCC) to chlorinate the water.
Medical devices not included in IEHK 2006
Resuscitation/major surgery
The kit has been designed to meet the first primary health care needs of a displaced
population without medical facilities, and for that reason no equipment for resuscitation or
major surgery has been included. In situations of war, earthquakes or epidemics, specialized
teams with medicines and medical devices will be required.

IEHK 2006 does not contain equipment for resuscitation or major surgery.
.The Interagency Emergency Health Kit 2006
12
Major medicine and medical device changes since the 1998
edition of the emergency health kit
Basic unit
albendazole tab replaces mebendazole tab
aluminium hydroxide + magnesium hydroxide tab replaces aluminium hydroxide tab
amoxicillin tab replaces co-trimoxazole tab
artemether + lumefantrine tab replaces chloroquine tab
ibuprofen tab partially replaces acetylsalicylic acid tab
paracetamol 500mg tab partially replaces acetylsalicylic acid tab
rapid diagnostic tests for malaria are added
thermometer clinical, digital replaces clinical mercury thermometer
zinc sulfate dispersible tab is added
Supplementary unit
artemether inj is added
atenolol tab is added
ceftriaxone inj replaces chloramphenicol inj
clotrimazole pessary replaces nystatin vaginal tablet
cloxacillin tab is added
doxycycline tab and amoxicillin tab replace chloramphenicol tab
levonorgestrel tab replaces ethinylestradiol + levonorgestrel tab
miconazole tab replaces nystatin tab
miconazole cream replaces benzoic acid + salicylic acid ointment
azithromycin tab is added as part of Patient PEP
cefixime tab for gonococcal infection is added as part of Patient PEP
zidovudine + lamivudine tab is added as part of Patient PEP
disposable syringes and needles replace all sterilizable syringes and needles.Content of IEHK 2006
13
Chapter 3:
Content of IEHK 2006
IEHK 2006 consists of 10 basic units and one supplementary
unit.
10 basic units - for health care workers with limited training
Each basic unit contains medicines, medical devices renewable and equipment, for a population of
1,000 people for 3 months.

To facilitate identification in an emergency, one green sticker should be placed on each parcel. The
word “BASIC” should be printed on stickers for basic units.

One basic unit contains:
. medicines
. medical devices, renewable
. medical devices, equipment
. module: malaria items (uncomplicated malaria)3
One supplementary unit - for physicians and senior health
care workers
A supplementary unit contains medicines, medical devices renewable and equipment for a population
of 10,000 people for 3 months and is packed in cartons of a maximum weight of 50 kg.

To be operational, the supplementary unit should be used together with at least one or more basic
units.
One supplementary unit contains:
. medicines
. essential infusions
. medical devices, renewable
. medical devices, equipment
. module: patient PEP 3
. module: malaria items 3

1,000 1,000 1,000 1,000 1,000 Total:
1,000 1,000 1,000 1,000 1,000 }
10 x 1 basic unit
for 10 x 1,000 people
10,000
}
1 supplementary unit
for 1 x 10,000 people
}
1 emergency
health kit for
10,000 people
for 3 months

One IEHK 2006 weighs approximately 1000 kg and occupies 4 m 3 space.

3 These items are automatically provided unless a specific request is made not to include them in the kit..The Interagency Emergency Health Kit 2006
14
Basic unit (for 1,000 people for 3 months)
Items Unit Quantity
Medicines
albendazole, chewable tab 400 mg tab 200
aluminium hydroxide + magnesium hydroxide, tab 400 mg + 400 mg 4 tab 1,000
amoxicillin, tab 250 mg tab 3,000
benzyl benzoate, lotion 25%5 bottle, 1 litre 1
chlorhexidine gluconate, solution 5%6 bottle, 1 litre 1
ferrous sulfate + folic acid, tab 200 mg + 0.4 mg tab 2,000
gentian violet, powder 25 g 4
ibuprofen, scored tab 400 mg tab 2,000
ORS (oral rehydration salts)7 sachet for 1 litre 200
paracetamol, tab 100 mg tab 1,000
paracetamol, tab 500 mg tab 2,000
tetracycline, eye ointment 1% tube, 5 g 50
zinc sulfate, dispersible tab 20 mg 8 tab 1,000
Malaria module (can be withheld from the order upon request)
artemether + lumefantrine, tab 20 mg + 120 mg tab
Weight group Treatments by weight
5-14 kg 6 x 1 tab box, 30 treatments 5
15-24 kg 6 x 2 tab box, 30 treatments 1
25-35 kg 6 x 3 tab box, 30 treatments 1
> 35 kg 6 x 4 tab box, 30 treatments 6
quinine sulfate, tab 300 mg tab 2,000
rapid diagnostic tests unit 800
lancet for blood sampling (sterile) unit 1,000
safety box for used lancets, 5 litres unit 2


4 WHO recommends aluminium hydroxide and magnesium hydroxide as single antacids. The Interagency
Group agreed to include in the kit the combination of aluminium hydroxide + magnesium hydroxide tab.
5 WHO recommends benzyl benzoate, lotion 25%. The use of 90% concentration is not recommended.
6 WHO recommends chlorhexidine gluconate 5% solution. The use of 20% solution needs distilled water
for dilution, otherwise precipitation may occur. Alternative: the combination of cetrimide 15% and
chlorhexidine gluconate 1.5%.
7 The updated information about the ORS formulation is provided in the 2005 WHO Model List of Essential
Medicines.
8
In addition to ORS for the treatment of acute diarrhoea in children..Content of IEHK 2006
15
Items Unit Quantity
Medical devices, renewable
bandage, elastic, 7.5 cm x 5 m, roll unit 20
bandage, gauze, 8 cm x 4 m, roll unit 200
compress, gauze, 10 cm x 10 cm, non-sterile unit 500
cotton wool, 500 g, roll, non-sterile unit 2
gloves, examination, latex, medium, disposable unit 100
soap, toilet, bar, approximately 110 g, wrapped unit 10
tape, adhesive, zinc oxide, 2.5 cm x 5 m unit 30
Stationery
book, exercise, A4 size, 100 pages, hard cover 9 unit 4
envelope, plastic, 10 cm x 15 cm unit 2,000
health card 10 unit 500
pad, note, plain, A6 size, 100 sheets unit 10
pen, ball-point, blue unit 12
plastic bag, for health card, 11 cm x 25 cm, snap-lock fastening unit 500
Treatment guidelines for basic unit users 11
- IEHK2006, English version unit 2
- IEHK2006, French version unit 2
- IEHK2006, Spanish version unit 2
Medical devices, equipment
basin, kidney, stainless steel, 825 ml unit 1
bottle, plastic, 1L, with screw cap unit 3
bottle, plastic, 250 ml, wash bottle unit 1
bowl, stainless steel, 180 ml unit 1
brush, hand, scrubbing, plastic unit 2
drum, sterilizing, approximately 150 mm x 150 mm unit 2
forceps, artery, Kocher, 140 mm, straight unit 2
pail, with bail, handle, polyethylene, 10L or 15L unit 2
scissors, Deaver, 140 mm, straight, sharp/blunt unit 2
surgical instruments, dressing set 12 unit 2
thermometer, clinical, digital, 32-43 Celsius unit 5
tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1
water container, PVC/PE, collapsible, 10L or 15L unit 1

9 It is recommended that one exercise book be used for recording daily medicine dispensing and another
for daily basic morbidity data, see Annex 4.
10 For a sample health card, see Annex 5.
11 For standard treatment guidelines, see Annexes 1, 2 and 3.
12 Surgical instruments, dressing set (3 instruments + box):
• 1 forceps, artery, Kocher, 140 mm, straight
• 1 forceps, dressing, standard, 155 mm, straight
• 1 scissors, Deaver, 140 mm, straight, sharp/blunt
• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover..The Interagency Emergency Health Kit 2006
16
Supplementary unit (for 10,000 people for 3 months)
Items Unit Quantity
Medicines
Anaesthetics
ketamine, inj 50 mg/ml 10 ml/vial 25
lidocaine, inj 1%13 20 ml/vial 50
Analgesics 14
morphine, inj 10 mg/ml 15 1 ml/ampoule 50
Recall from basic unit
ibuprofen, tab 400 mg (10 x 2,000) 20,000
paracetamol, tab 100 (10 x 1000) 10,000
paracetamol, tab 500 mg (10 x 2,000) 20,000
Antiallergics
hydrocortisone, powder for inj 100 mg vial 50
prednisolone, tab 5 mg tab 100
epinephrine (adrenaline) see “respiratory tract”
Antidotes
calcium gluconate, inj 100 mg/ml 16 10 ml/ampoule 4
naloxone, inj 0.4 mg/ml 17 1 ml/ampoule 20
Anticonvulsants/antiepileptics
diazepam, inj 5 mg/ml 2 ml/ampoule 200
magnesium sulfate, inj 500 mg/ml 10 ml/ampoule 40
phenobarbital, tab 100 mg tab 500
Anti-infective medicines
benzathine benzylpenicillin, inj 2.4 million IU/vial
(long-acting penicillin) vial 50
benzylpenicillin, inj 5 million IU/vial 18 vial 250
ceftriaxone, inj 1 g vial 800
cloxacillin, caps 500 mg 19 caps 1,000
clotrimazole, pessary 500 mg pessary 100
doxycycline, tab 100 mg tab 3,000
metronidazole, tab 500 mg tab 2,000

13 20 ml vials are preferred, although 50 ml vials may be used as an alternative.
14 Alternative injectable analgesics, such as pentazocine and tramadol, are not recommended by WHO. It is
however recognized that these may be practical alternatives to morphine in situations where opioids
cannot be sent.
15 See Annex 9 for more details.
16 For use as an antidote to magnesium sulfate overdose in case of severe respiratory depression or arrest.
17 Naloxone is an opioid antagonist given intravenously for the treatment of morphine overdose and to
reverse the effects of therapeutic doses of morphine.
18 Benzylpenicillin inj 5 million UI/vial is provided for diseases requiring high dosage treatment. The vials
are not intended for multiple use because of concerns over contamination.
19 Alternative: cloxacillin tablet 250 mg and doubling the quantity is acceptable..Content of IEHK 2006
17
Items Unit Quantity
miconazole, muco-adhesive tab 10 mg 20 tab 350
procaine benzylpenicillin, inj 3-4 million IU/vial 21 vial 200
Recall from basic unit:
albendazole, tab 400 mg (10 x 200) 2,000
amoxicillin, tab 250 mg (10 x 3,000) 30,000
Malaria module (can be withheld from the order upon
request)
artemether, inj 20 mg/ml 22 1ml/ampoule 200
artemether, inj 80 mg/ml 22 1ml/ampoule 72
quinine dihydrochloride, inj 300 mg/ml 23 2 ml/ampoule 100
Recall from basic unit: malaria module
artemether + lumefantrine, tab 20 mg+120 mg (10 x 6,120 tab) 61,200
quinine sulfate, tab 300 mg (10 x 2,000) 20,000
rapid diagnostic tests (10 x 800) 8,000
lancet for blood sampling (sterile) (10 x 1000) 10,000
safety box for used lancets, 5 litres (10 x 2) 20
Medicines affecting the blood
folic acid, tab 5 mg tab 1,000
Recall from basic unit:
ferrous sulfate + folic acid, tab 200 mg + 0.4 mg (10 x 2,000) 20,000
Cardiovascular medicines
atenolol, tab 50 mg tab 1,000
hydralazine, powder for inj 20 mg 24 ampoule 20
methyldopa, tab 250 mg 25 tab 1,000
Dermatological medicines
polyvidone iodine, solution 10% bottle, 200 ml 10
silver sulfadiazine, cream 1% tube, 50 g 30
miconazole, cream 2% tube, 30 g 25
Recall from basic unit:
benzyl benzoate, lotion 25% (10 x 1L) 10
gentian violet, powder 25 g (10 x 4) 40
tetracycline, eye ointment 1% (10 x 50) 500


20 WHO recommends nystatin, tablet, lozenge and pessary as an antifungal agent. The Interagency Group
agreed to include in the kit miconazole muco-adhesive tablets as they are more agreeable for patients
than oral nystatin.
21 The combination of procaine benzylpenicillin 3 million IU and benzylpenicillin 1 million IU (procaine
penicillin fortified) is used in many countries and may be included as an alternative.
22 Alternative: artesunate, 60 mg for inj, 300, and 5 ml of glucose 5% or NaCl 0.9% inj, 300, is acceptable.
Before using, inject the added 1 ml sodium bicarbonate 5% injection solution into the artesunate vial,
dissolve and then add 5 ml of glucose 5% or NaCl 0.9% inj. Tuberculin syringe, disposable, 1 ml, sterile,
200, needs to be included too for administration purposes.
23 Intravenous injection of quinine must always be diluted in glucose 5%, bag 500 ml.
24 For the acute management of severe pregnancy-induced hypertension only.
25 For the management of pregnancy-induced hypertension only..The Interagency Emergency Health Kit 2006
18
Items Unit Quantity
Disinfectants and antiseptics
sodium dichloroisocyanurate (NaDCC), tab 1.67 g 26 tab 1,200
Recall from basic unit:
chlorhexidine, solution 5% (10 x 1L) 10
Diuretics
furosemide, inj 10 mg/ml 2 ml/ampoule 20
hydrochlorothiazide, tab 25 mg tab 200
Gastrointestinal medicines
promethazine, tab 25 mg tab 500
promethazine, inj 25 mg/ml 2 ml/ampoule 50
atropine, inj 1 mg/ml 1 ml/ampoule 50
Recall from basic unit:
aluminium hydroxide + magnesium hydroxide, tab 400 mg + 400 mg (10 x 1,000) 10,000
Oxytocics
oxytocin, inj 10 IU/ml 27 1 ml/ampoule 200
Psychotherapeutic medicines
chlorpromazine, inj 25 mg/ml 2 ml/ampoule 20
Respiratory tract, medicines acting on
salbutamol, tab 4 mg tab 1,000
epinephrine (adrenaline), inj 1 mg/ml 1 ml/ampoule 50
Solutions correcting water, electrolyte and acid-base
disturbances 28
compound solution of sodium lactate (Ringer's lactate), inj
solution, with IV giving set and needle 500 ml bag 200
glucose 5%, inj solution, with IV giving set and needle 29 500 ml bag 100
glucose 50%, inj solution (hypertonic) 50 ml/vial 20
water for injection 10 ml/plastic vial 2,000
Recall from basic unit:
oral rehydration salts, sachets (10 x 200) 2,000
Vitamins
retinol (vitamin A), caps 200,000 IU caps 4,000
ascorbic acid, tab 250 mg tab 4,000


26 Each effervescent tablet containing 1.67g of NaDCC releases 1g of available chlorine when dissolved in
water.
27
For prevention and treatment of postpartum haemorrhage.
28 Because of the weight, the quantity of infusions included in the kit is minimal.
29 Glucose 5%, bag 500 ml, for administration of quinine by infusion..Content of IEHK 2006
19
Items Unit Quantity
Patient PEP module, 50 treatments (can be withheld
from the order upon request)
azithromycin, tab 250 mg 30 tab 200
cefixime, tab 200 mg 31 tab 100
pregnancy test unit 50
levonorgestrel, tab 1.50 mg 32 tab 50
zidovudine (AZT) + lamivudine (3TC), tab 300 mg +150 mg 33 tab 3,000
Guidelines
MSF Essential Drugs, practical guide (latest edition)
- English version unit 2
- French version unit 2
- Spanish version unit 2
MSF Clinical Guidelines, diagnostic and treatment manual (latest
edition)
- English version unit 2
- French version unit 2
- Spanish version unit 2
Medical devices, renewable
cannula, IV short, 18G (1.3 x 45 mm), sterile, disposable unit 100
cannula, IV short, 22G (0.8 x 25 mm), sterile, disposable unit 50
cannula, IV short, 24G (0.7 x 19 mm), sterile, disposable unit 50
needle, disposable, 19G (1.1 x 40 mm), sterile 34 unit 2,000
needle, disposable, 21G (0.8 x 40 mm), sterile unit 1,500
needle, disposable, 23G (0.6 x 25 mm), sterile unit 1,500
needle, disposable, 25G (0.5 x 16 mm), sterile unit 100
needle, scalp vein, 21G (0.8 x 19 mm), sterile, disposable unit 100
needle, scalp vein, 25G (0.5 x 19 mm), sterile, disposable unit 300
needle, spinal, 20G (0.9 x 90 mm), sterile, disposable unit 25
needle, spinal, 22G (0.7 x 40 mm), sterile, disposable unit 25
syringe, disposable, 20 ml, sterile 35 unit 100
syringe, disposable, 10 ml, sterile unit 600
syringe, disposable, 5 ml, sterile unit 2,000
syringe, disposable, 2 ml, sterile unit 700
syringe, disposable, 1 ml, sterile 36 unit 200

30 For presumptive treatment of sexually transmitted infections (Clamydia infection) by sexual assault
(rape). Alternative: azithromycin tab 500 mg and halving the quantity is acceptable.
31 For presumptive treatment of sexually transmitted infections (Gonococcal infection) by sexual assault
(rape). It may be used in pregnancy.
32 For women who seek help within 72 hours of rape and wish to use emergency contraception to prevent
pregnancy, they should take one tablet of levonorgestrel 1.50 mg. Alternative: levonorgestrel 0.75 mg
tablets and doubling the quantity is acceptable.
33 For presumptive treatment to reduce the chances of HIV infection by sexual assault (rape) and by
needle stick.
34 Included mainly for reconstitution purposes.
35 Included for the administration of magnesium sulfate only.
36 Included for the administration of artemether in children only..The Interagency Emergency Health Kit 2006
20
Items Unit Quantity
safety box for used syringes/needles, 5 litres 37 unit 50
syringe, feeding, 50 ml, conical tip, sterile 38 unit 10
syringe, feeding, 50 ml, Luer tip, sterile 38 unit 10
tube, aspirating/feeding, CH16, L125 cm, conical tip, sterile, disposable unit 10
tube, feeding, CH08, L40 cm, Luer tip, sterile, disposable unit 50
tube, feeding, CH05, L40 cm, Luer tip, sterile, disposable unit 20
catheter, Foley, CH12, sterile, disposable unit 10
catheter, Foley, CH14, sterile, disposable unit 5
catheter, Foley, CH18, sterile, disposable unit 5
bag, urine, collecting, 2000 ml unit 10
gloves, examination, latex, large, disposable unit 100
gloves, examination, latex, medium, disposable unit 100
gloves, examination, latex, small, disposable unit 100
gloves, surgical, 6.5, sterile, disposable, pair unit 50
gloves, surgical, 7.5, sterile, disposable, pair unit 150
gloves, surgical, 8.5, sterile, disposable, pair unit 50
compress, gauze, 10 cm x 10 cm, sterile unit 1,000
gauze, roll, 90 cm x 100 m, non-sterile 39 unit 3
razor blade, double-edged, disposable (for use with razor, see p.21) unit 100
scalpel blade, No. 22, sterile, disposable unit 100
suture, absorbable, synthetic, braided DEC2 (3/0), curved needle 3/8
circle, 26 mm, triangular point unit 144
tape umbilical, 3 mm x 50 m, non-sterile unit 2
tongue depressor, wooden, disposable unit 500
indicator, TST (Time, Steam, Temperature) control spot unit 300
indicator, TST (Time, Steam, Temperature) control strip unit 100
masking tape, 2 cm x 50 m 40 roll 1
Recall from basic unit:
Medical devices, renewable
bandage, elastic, 7.5 cm x 5 m, roll (10 x 20) 200
bandage, gauze, 8 cm x 4 m, roll (10 x 200) 2,000
compress, gauze, 10 cm x 10 cm, non-sterile (10 x 500) 5,000
cotton wool, 500 g, roll, non-sterile (10 x 2) 20
gloves, examination, latex, medium, disposable (10 x 100) 1000
soap, toilet, bar, approximately 110 g, wrapped (10 x 10) 100
tape, adhesive, zinc oxide, 2.5 cm x 5 m (10 x 30) 300
Stationery
book, exercise, A4 size, 100 pages, hard cover (10 x 4) 40
envelope, plastic, 10 cm x 15 cm (10 x 2,000)
20,000
health card (10 x 500) 5,000
pad, note, plain, A6 size, 100 sheet (10 x 10) 100
pen, ball-point, blue (10 x 12) 120
plastic bag, for health card, 11 cm x 25 cm, snap-lock fastening (10 x 500) 5,000

37 WHO/UNICEF standard E10/IC2: boxes should be prominently marked.
38 Alternative: the two types of feeding syringes 50 ml may be replaced by, syringe, feeding, 60 ml, with
Luer and conical connector, unit, 20.
39 Alternative: gauze, roll, 60 cm x 100 m, non-sterile.
40 To secure small paper parcels of instruments for sterilization allowing contents and date to be written..Content of IEHK 2006
21

Items Unit Quantity
Medical devices, equipment
apron, protection, plastic, reusable 41 unit 2
drawsheet, plastic, 90 cm x 180 cm unit 2
brush, hand, scrubbing, plastic unit 2
towel, Huck, 430 mm x 500 mm unit 2
stethoscope, binaural, complete unit 4
sphygmomanometer, (adult), aneroid unit 4
stethoscope, fetal, Pinard unit 1
otoscope set, cased 42 unit 2
spare battery R6 alkaline AA size, 1.5 V (for otoscope) unit 12
scale, electronic, mother-and-child, 150 kg x 100 g unit 1
scale, (only) infant spring, 25 kg x 100 g unit 3
weighing trousers for scale infant spring, set of 5 unit 3
razor, safety, metal, 3 piece 43 unit 2
tape measure, vinyl-coated, 1.5 m unit 5
tape measure, arm circumference, MUAC (mid-upper arm
circumference) unit 50
tourniquet, latex rubber, 75 cm 44 unit 2
thermometer, clinical, digital, 32-43 Celsius unit 10
sterilizer, steam, approximately 21 L or 24 L unit 1
stove, kerosene, single-burner, pressure unit 1
timer, 60 minutes unit 1
basin, kidney, stainless steel, 825 ml unit 2
bowl, stainless steel, 180 ml unit 2
drum, sterilizing, approximately 150 mm x 150 mm unit 2
forceps, artery, Kocher, 140 mm, straight unit 2
scissors, Deaver, 140 mm, straight, sharp/blunt unit 2
tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm unit 1
surgical instruments, suture set 45 unit 2
surgical instruments, dressing set 46 unit 5

41 Alternative: apron, protection, plastic disposable, unit, 100, may be supplied.
42 Spare bulb must be included within the otoscope set.
43 Alternative: razor, safety, disposable, unit, 100, may be supplied.
44 Alternative: tourniquet with Velcro, unit, 2, may be supplied.
45 One suture set should be reserved for repair of postpartum vaginal tears.
Abscess/suture set (7 instruments + box)
• 1 forceps, artery, Halsted-mosquito, 125 mm curved
• 1 forceps, artery, Kocher, 140 mm, straight
• 1 forceps, tissue, standard, 145 mm, straight
• 1 needle holder, Mayo-Hegar, 180 mm, straight
• 1 probe, double-ended, 145 mm
• 1 scalpel handle, No. 4
• 1 scissors, Deaver, 140 mm, curved, sharp/blunt
• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover.
46 Dressing set (3 instruments + box)
• 1 forceps, artery, Kocher, 140 mm, straight
• 1 forceps, dressing, standard, 155 mm, straight
• 1 scissors, Deaver, 140 mm, straight, sharp/blunt
• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover..The Interagency Emergency Health Kit 2006
22
Items Unit Quantity
Medical devices, equipment
surgical instruments, delivery set 47 unit 1
filter, drinking, candle, 10-80 L per day unit 3
Recall from basic unit:
Medical devices, equipment
basin, kidney, stainless steel, 825 ml (10 x 1) 10
bowl, stainless steel, 180 ml (10 x 1) 10
drum, sterilizing, approximately 150 mm x 150 mm (10 x 2) 20
forceps, artery, Kocher,140 mm, straight (10 x 2) 20
scissors, Deaver,140 mm, straight, sharp/blunt (10 x 2) 20
thermometer, clinical, digital 32-43 Celsius (10 x 5) 50
tray, dressing, stainless steel, 300 mm x 200 mm x 30 mm (10 x 1) 10
surgical instruments, dressing set (10 x 2) 20


47
Delivery set (3 instruments + box)
• 1 scissors, Mayo, 140 mm, curved, blunt/blunt
• 1 scissors, gynaecological, 200 mm, curved, blunt/blunt
• 1 forceps, artery, Kocher, 140 mm, straight
• 1 tray, instruments, stainless steel, 225 mm x 125 mm x 50 mm, with cover.
.Basic unit: treatment guidelines
23
Annex 1: Basic unit: treatment guidelines
These treatment guidelines are intended to give simple guidance for primary health care
workers using basic units. In these guidelines, five age groups have been distinguished,
except for the treatment of diarrhoea with oral rehydration fluid where six age and weight
categories are used.

When dosage is shown as "1 tab x 2 ", one tablet should be taken in the morning and one
before bedtime. When dosage is shown as "2 tab x 3 ", two tablets should be taken in the
morning, two tablets should be taken in the middle of the day and two tablets before
bedtime.

The treatment guidelines contain the following diagnostic/symptom groups:
.
anaemia
. pain
. diarrhoea (see detailed diagnosis and treatment schedules in Annex 2)
. fever
. respiratory tract infections (see detailed diagnosis and treatment schedules in Annex 3)
. measles
. "red eye " condition
. skin conditions
. sexually transmitted and urinary tract infections
. preventive care in pregnancy
. worms.
Anaemia
Weight
0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ¡Ý35 kg
Age
Diagnosis/ Symptom
0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ¡Ý15 yrs
Severe anaemia
(oedema, dizziness,
shortness of breath)
REFER
Moderate anaemia
(pallor and
tiredness)
REFER ferrous sulfate
+ folic acid
1 tab daily, for
at least 2
months
ferrous sulfate
+ folic acid
2 tab daily, for
at least 2
months
ferrous sulfate
+ folic acid
3 tab daily, for
at least 2
months
ferrous sulfate
+ folic acid
3 tab daily, for
at least 2
months.The Interagency Emergency Health Kit 2006
24
Pain
Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ¡Ý35 kg
Age
Diagnosis/ Symptom
0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ¡Ý15 yrs
Pain
(headache, joint
pain, toothache)
paracetamol
tab 100 mg
½ - 1 tab x 4
paracetamol
tab 100 mg
1 - 2 tab x 4
or ibuprofen
tab 400 mg
½ tab x 4
paracetamol
tab 500 mg
1 tab x 4
or ibuprofen
tab 400 mg
1 tab x 4
paracetamol
tab 500 mg
2 tab x 4
or ibuprofen
tab 400 mg
2 tab x 4
Stomach pain REFER
Al + Mg
hydroxide tab
½ tab x 3 for
3 days
Al + Mg
hydroxide tab
1 tab x 3 for 3
days
Diarrhoea
Weight 0 - <>30 kg
Age*
Diagnosis/ Symptom
<4 mths 4 - 11 mths 12 - 23 mths 2 - 4 yrs 5 - 14 yrs ¡Ý15 yrs
Quantity of ORS 200-400 ml 400-600 ml 600-800 ml 800 ml-1.2 L 1.2 - 2.2 L 2.2 - 4 L
Diarrhoea with no
dehydration
Treatment Plan A
(see Annex 2)
Give more fluids than usual to prevent dehydration and zinc sulfate 20 mg dispersible tab
and continue to feed.
Advise that the patient returns to the health worker in case of frequent stools, increased
thirst, sunken eyes, fever or when the patient does not eat or drink normally, or does not
get better within three days, or develops blood in the stool or repeated vomiting.
Diarrhoea with
some dehydration
Treatment Plan B
(see Annex 2)
Approximate amount of ORS solution to give in the first 4 hours. In addition, give zinc
sulfate 20 mg dispersible tab as soon as the child is able to eat.
Diarrhoea with
severe dehydration
Treatment Plan C
(see Annex 2)
REFER patient for nasogastric tube and/or IV treatment.
Diarrhoea lasting
more than two
weeks or in
malnourished or
poor condition
patient
Give ORS according to dehydration stage and zinc sulfate 20 mg dispersible tab and
REFER.
Bloody diarrhoea
(check the presence
of blood in stools)
Give ORS according to dehydration stage and zinc sulfate 20 mg dispersible tab and
REFER.

* Use the patient 's age only when you do not know the weight. The approximate amount of ORS required (in ml)
can also be calculated by multiplying the patient’s weight in kg by 75.

All children should be given supplemental zinc (20 mg) daily for 10 - 14 days.
.Basic unit: treatment guidelines
25
Confirmed malaria diagnosis

In low malaria transmission areas Parasite-based diagnosis 48 for all patients of all age
groups before treatment is started.
In high malaria transmission areas Parasite-based diagnosis 48 for all adult patients,
including pregnant women, and children > 5 years
before treatment is started.
For children < 5 years, fever or history of fever or
evidence of high temperature (feeling hot or temp. >
37.5C), to be treated on the basis of having had a
clinical diagnosis of malaria before treatment is
started.

Performing the test

Things to remember when using a rapid diagnostic test (RDT):
• prior instruction in the use and interpretation of the particular product is vital;
• a management plan for results must be in place;
• blood-safety precautions should be followed;
• product instructions should be strictly followed;
• RDT should be discarded if the envelope is punctured or badly damaged;
• test envelope should be opened only when it has reached ambient
temperature, and the RDT used immediately after opening;
• result should be read within the time specified by the manufacturer;
• RDT cannot be re-used if preparation is delayed after opening the envelope,
humidity can damage the RDT.

48 By microscopy or RDTs..The Interagency Emergency Health Kit 2006
26
Figure 2: Sample decision chart for treatment of malaria based on the results of a
malaria rapid diagnostic test

Derived from model in National Treatment Guidelines for Malaria (2002), Ministry of Health,
Kingdom of Cambodia.
Suspected cases
(clinical criteria)
RDT/Microscopy
Positive Negative
Falciparum Non-falciparum High suspicion
of malaria
Treatment
protocol
Treat while
excluding
other illnesses
Uncomplicated
malaria
Severe
malaria
Treatment
protocol
Treatment
protocol
Look for other
illness
Review/Refer
Suspected cases
(clinical criteria)
RDT/Microscopy
Positive Negative
Falciparum Non-falciparum High suspicion
of malaria
Treatment
protocol
Treat while
excluding
other illnesses
Uncomplicated
malaria
Severe
malaria
Treatment
protocol
Treatment
protocol
Look for other
illness
Review/Refer.Basic unit: treatment guidelines
27
Fever
Weight 0 - <10 kg 10 - <15 kg 15 - <25 kg 25 - <35 kg ¡Ý35 kg
Age
Diagnosis/ Symptom
0 -<1 yr 1 - <5 yrs 5 - <10 yrs 10 - <15 yrs ¡Ý15 yrs
Fever
in malnourished or
poor condition
patient or when in
doubt
REFER
Fever with chills
in confirmed
uncomplicated malaria
REFER
artemether/
lumefantrine
tab 20mg
A+120mg L
1 tab at once,
followed by 5
doses of 1 tab
after 8h, 24h,
36h, 48h and
60 hours
artemether/ lumefantrine
tab 20mg
A+120mg L
2 tab at once,
followed by 5
doses of 2 tab
after 8h, 24h,
36h, 48h and
60 hours
artemether/ lumefantrine
tab 20mg
A+120mg L
3 tab at once,
followed by 5
doses of 3 tab
after 8h, 24h,
36h, 48h and
60 hours
artemether/ lumefantrine
tab 20mg
A+120mg L
4 tab at once,
followed by 5
doses of 4 tab
after 8h, 24h,
36h, 48h and
60 hours
Pregnant women:
Fever with chills
in confirmed
uncomplicated malaria
quinine
sulfate tab
300 mg
2 tab x 3,
for 3 days
Fever with cough REFER See respiratory tract infections below.
Fever (unspecified) REFER
paracetamol
tab 100 mg
1-2 tab x 4,
for 1 to 3 days
paracetamol
tab 100 mg
2-3 tab x 4,
for 1 to 3 days
or ibuprofen
tab 400 mg
½ tab x 4,
for 1 to 3 days
paracetamol
tab 500 mg
1 tab x 4,
for 1 to 3 days
or ibuprofen
tab 400 mg
1 tab x 4,
for 1 to 3 days
paracetamol
tab 500 mg
2 tab x 4,
for 3 days
or ibuprofen
tab 400 mg
2 tab x 4,
for 1 to 3 days.The Interagency Emergency Health Kit 2006
28
Respiratory tract infections
Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ¡Ý35 kg
Age
Diagnosis/ Symptom
0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ¡Ý15 yrs
Severe pneumonia
Annex 3
Give the first dose of amoxicillin (see pneumonia) and REFER.
Pneumonia
Annex 3
REFER amoxicillin tab
250 mg
½ - 1 tab x 2,
for 5 days
amoxicillin tab
250 mg
1- 1½ tab x 2,
for 5 days
amoxicillin tab
250 mg
1½ -2 tab x 2,
for 5 days
amoxicillin tab
250 mg
4 tab x 2,
for 5 days
Reassess after 2 days; continue (breast) feeding, give fluids, clear
the nose; return if breathing becomes faster or more difficult, or not
able to drink or when the condition deteriorates.
No pneumonia:
cough or cold
Annex 3
REFER Paracetamol 49
tab 100 mg
½ tab x 4, for
1 to 3 days
paracetamol
tab 100 mg
1 tab x 4,
for 1 to 3 days
or ibuprofen
tab 400 mg
½tab x 3,
for 1 to 3 days
paracetamol
tab 500 mg
1 tab x 4,
for 1 to 3 days
or ibuprofen
tab 400 mg
1 tab x 3,
for 1 to 3 days
paracetamol
tab 500 mg
2 tab x 4,
for 1 to 3 days
or ibuprofen
tab 400 mg
2 tab x 3,
for 1 to 3 days
Supportive therapy; continue (breast) feeding, give fluids, clear the
nose; return if breathing becomes faster or more difficult, or not
able to drink or when the condition deteriorates.
Prolonged cough
(30 days)
REFER
Acute ear pain
and/or ear
discharge for less
than 2 weeks
REFER amoxicillin tab
250 mg
½ - 1 tab x 2,
for 5 days
amoxicillin tab
250 mg
1- 1½ tab x 2,
for 5 days
amoxicillin tab
250 mg
1½ -2 tab x 2,
for 5 days
amoxicillin tab
250 mg
4 tab x 2,
for 5 days
Ear discharge for
more than 2 weeks,
no pain or fever
Clean the ear once daily by syringe without needle using lukewarm clean water.
Repeat until the water comes out clean. Dry repeatedly with clean piece of cloth.
Measles
Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ¡Ý35 kg
Age
Diagnosis
Symptom
0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ¡Ý15 yrs
Measles Treat respiratory tract disease according to
symptoms.
Treat conjunctivitis as “Red eyes”.
Treat diarrhoea according to symptoms.
Continue (breast) feeding, give retinol (vitamin A).
"Red eye" condition
Red eyes
(conjunctivitis)
Apply tetracycline eye ointment 3 times a day for 7 days. If not improved after 3 days
or if in doubt, REFER.

49 If fever is present..Basic unit: treatment guidelines
29
Skin conditions
Wounds: extensive,
deep or on face
REFER
Wounds: limited
and superficial
Clean with clean water and soap or diluted chlorhexidine solution.50 Gently apply
gentian violet solution 51 once a day.
Severe burns
(on face or
extensive)
Treat as for mild burns and REFER.
Mild moderate
burns
Immerse immediately in cold water, or use a cold wet cloth. Continue until pain
eases then treat as wounds.
Severe bacterial
infection (with
fever)
REFER
Mild bacterial
infection
Clean with clean water and soap or diluted chlorhexidine solution.50
If not improved after 10 days refer.
Fungal infections Apply gentian violet solution 51 once a day for 5 days.
Infected scabies Bacterial infection: clean with clean water and soap or diluted chlorhexidine solution.50
Apply gentian violet solution 51 twice a day.
When infection is cured:
Apply diluted benzyl benzoate 52
once a day for 3 days.
Apply non diluted benzyl benzoate
25% once a day for 3 days.
Non-infected
scabies
Apply diluted benzyl benzoate 52
once a day for 3 days.
Apply non diluted benzyl benzoate
25% once a day for 3 days.
Sexually transmitted and urinary tract infections
Suspicion of sexually
transmitted or urinary
tract infection
REFER
Suspicion of sexual
violence
REFER
Preventive care in pregnancy
Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ¡Ý35 kg
Age
Diagnosis/ Symptom
0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ¡Ý15 yrs
Anaemia
for treatment see
under anaemia
ferrous sulfate +
folic acid
1 tab daily,
throughout pregnancy
Hookworm in
endemic areas:
albendazole can be
safely given in the
second and third
trimesters of
pregnancy
albendazole
chewable tab
400 mg,
1 tab once

50 Chlorhexidine 5% must always be diluted before use: 20 ml in 1L of water. Take the 1L plastic bottle
supplied with the kit; put 20 ml of chlorhexidine solution into the bottle using the 10 ml syringe supplied
and fill up the bottle with boiled or clean water. Alternative: chlorhexidine 1.5% + cetrimide 15%
solution should be used in the same dilution.
51 Gentian violet 0.5% concentration = 1 teaspoon of gentian violet powder/1L of boiled/clean water.
Shake well, or use warm water to dissolve all powder.
52 Dilute by mixing ½L benzyl benzoate 25% solution with ½L clean water in the 1L plastic bottle supplied
with the kit..The Interagency Emergency Health Kit 2006
30
Worms
Weight 0 - <4 kg 4 - <8 kg 8 - <15 kg 15 - <35 kg ¡Ý35 kg
Age
Diagnosis/ Symptom
0 -<2 mths 2 mths - <1 yr 1 - <5 yrs 5 - <15 yrs ¡Ý15 yrs
Roundworm Pinworm Threadworm Hookworm
Hookworm in
pregnant women:
see above
albendazole
tab 400 mg
½ -1 tab once
albendazole
tab 400 mg
1 tab once
albendazole
tab 400 mg
1 tab once.Assessment and treatment of diarrhoea
31
Annex 2:
Assessment and treatment of diarrhoea 53
A-2.1 Assessment of diarrhoeal patients for dehydration
Table 1: Assessment of diarrhoea patients for dehydration
A B C
1. Look at:
Condition a
Eyes b
Thirst
Well, alert
Normal
Drinks normally, not
thirsty
Restless, irritable
Sunken
Thirsty, drinks eagerly
Lethargic or unconscious
Sunken
Drinks poorly or not able to
drink
2. Feel:
Skin pinch c Goes back quickly Goes back slowly Goes back very slowly
3. Decide: The patient has
no signs of
dehydration
If the patient has two or
more signs in B, there is
some dehydration
If the patient has two or
more signs in C, there is
severe dehydration
4. Treat: Use Treatment Plan A Weigh the patient, if
possible, and use
Treatment Plan B
Weigh the patient and use
Treatment Plan C
Urgently
a Being lethargic and sleepy are not the same. A lethargic child is not simply asleep: the child's
mental state is dull and the child cannot be fully awakened; the child may appear to be drifting
into unconsciousness.
b In some infants and children the eyes normally appear somewhat sunken. It is helpful to ask
the mother if the child’s eyes are normal or more sunken than usual.
c The skin pinch is less useful in infants or children with marasmus or kwashiorkor or in obese
children.

53 Department of Child and Adolescent Health and Development. The treatment of diarrhoea - a manual for
physicians and other senior health workers. Geneva: World Health Organization; 2005..The Interagency Emergency Health Kit 2006
32
A-2.2 Treatment of acute diarrhoea (without blood)
Treatment Plan A: treat diarrhoea at home
Use this plan to teach the mother how to:
.
prevent dehydration at home by giving the child more fluid than usual;
. prevent malnutrition by continuing to feed the child, and why these actions are
important;
. recognize signs indicating that the child should be taken to a health worker.

The four rules of Treatment Plan A:
Rule 1:
Give the child more fluids than usual, to prevent dehydration
. Use recommended home fluids. These include: ORS solution, salted drinks (e.g. salted
rice water or a salted yogurt drink), vegetable or chicken soup with salt.
. Avoid fluids that do not contain salt, such as: plain water, water in which a cereal has
been cooked (e.g. unsalted rice water), unsalted soup, yoghurt drinks without salt,
green coconut water, weak tea (unsweetened), unsweetened fresh fruit juice. Other
fluids to avoid are those with stimulant, diuretic or purgative effects, for example:
coffee, some medicinal teas or infusions.
. Be aware of fluids that are potentially dangerous and should be avoided during
diarrhoea. Especially important are drinks sweetened with sugar, which can cause
osmotic diarrhoea and hypernatraemia. Some examples are: commercial carbonated
beverages, commercial fruit juices, sweetened tea.
. Use ORS solution for children as described in the box below. (Note: if the child is under
6 months and not yet taking solid food, give ORS solution or water.)

Give as much as the child or adult wants until diarrhoea stops. Use the amounts shown
below for ORS as a guide. Describe and show the amount to be given after each stool is
passed, using a local measure.

Age Amount of ORS to be given
after each loose stool
Amount of ORS to
provide for use at home
≤24 months 50-100 ml 500 ml/day
2 - 10 years 100-200 ml 1L/day
≥10 years as much as wanted 2L/day

Show the mother how to mix ORS and show her how to give ORS.
.
Give a teaspoonful every 1 ]2 minutes for a child under 2 years.
. Give frequent sips from a cup for older children. .Assessment and treatment of diarrhoea
33
. If the child vomits, wait 10 minutes. Then give the solution more slowly (for example, a
spoonful every 2 ]3 minutes).
. If diarrhoea continues after the ORS packets are used up, tell the mother to give other
fluids as described in the first rule above or return for more ORS.
Rule 2:
Give supplemental zinc sulfate 20 mg tab to the child, every day for 10
to 14 days
Zinc sulfate can be given as dispersible tablets. By giving zinc sulfate as soon as diarrhoea
starts, the duration and severity of the episode as well as the risk of dehydration will be
reduced. By continuing zinc sulfate supplementation for 10 to 14 days, the zinc lost during
diarrhoea is fully replaced and the risk of the child having new episodes of diarrhoea in the
following 2 to 3 months is reduced.
Rule 3:
Continue to feed the child, to prevent malnutrition
. Breastfeeding should always be continued.
. The infant 's usual diet should be continued during diarrhoea and increased afterwards;
. Food should never be withheld and the child 's usual food should not be diluted;
. Most children with watery diarrhoea regain their appetite after dehydration is
corrected;
. Milk:
• Infants of any age who are breastfed should be allowed to breast ]feed as often and
as long as they want. Infants will often breastfeed more than usual, encourage this;
• Infants who are not breastfed, should be given their usual milk feed (formula) at
least every three hours, if possible by cup.
• Infants below 6 months of age who take breast milk and other foods should
receive increased breastfeeding. As the child recovers and the supply and the
supply of breast milk increases, other foods should be decreased.
• A child who is at least 6 months old or is already taking soft foods should be
given cereals, vegetables and other foods, in addition to milk. If the child is over 6
months and such foods are not yet being given, they should be started during the
diarrhoea episode or soon after it stops.
• Recommended food should be culturally acceptable, readily available. Milk should
be mixed with a cereal and if possible, 1 ] 2 teaspoonfuls of vegetable oil should be
added to each serving of cereal. If available, meat, fish or egg should be given.
• Foods rich in potassium, such as bananas, green coconut water and fresh fruit juice
are beneficial;
-offer the child food every three or four hours (six times a day);
-after the diarrhoea stops, continue to give the same energy ]rich food, and
give one more meal than usual each day for at least two weeks. .The Interagency Emergency Health Kit 2006
34
Rule 4:
Take the child to a health worker if there are signs of dehydration or
other problems
The mother should take her child to a health worker if the child:
.
Starts to pass many watery stools
. Vomits repeatedly
. Becomes very thirsty
. Is eating or drinking very poorly
. Develops a fever
. Has blood in the stool; or
. Does not get better in three days ]
Treatment Plan B: oral rehydration therapy for children with some
dehydration
Table 2:
Guidelines for treating children and adults with some dehydration
Approximate amount of ORS solution to give in the first 4 hours
Age* <4 mths 4-11 mths 12-23mths 2-4 years 5-14 years ¡Ý15 years
Weight < 5 kg 5-7.9 kg 8-10.9 kg 11-15.9 kg 16-29.9 kg ¡Ý30 kg
Quantity 200-400 ml 400-600 ml 600-800 ml 800 ml-1.2 L 1.2-2 L 2.2-4 L
In local
measure
Use the patient's age only when you do not know the weight. The approximate amount of
ORS required (in ml) can also be calculated by multiplying the patient’s weight in kg by 75.
• If the patient wants more ORS than shown, give more.
• Encourage the mother to continue breastfeeding her child.
NOTE: during the initial stages of therapy, while still dehydrated, adults can consume up to
750 ml per hour, if necessary, and children up to 20 ml per kg body weight per hour.

How to give ORS solution
. Teach a family member to prepare and give ORS solution.
. Use a clean spoon or cup to give ORS solution to infants and young children. Feeding
bottles should not be used.
. Use droppers or syringes to put small amounts of ORS solution into mouths of babies.
. Children under 2 years of age, should get a teaspoonful every 1 ]2 minutes; older
children (and adults) may take frequent sips directly from a cup.
. Check from time to time to see if there are problems.
. If the child vomits, wait 5 ]10 minutes and then start giving ORS again, but more
slowly, for example, a spoonful every 2 ]3 minutes. .Assessment and treatment of diarrhoea
35
. If the child’s eyelids become puffy, stop the ORS and give plain water or breast milk.
Give ORS according to Plan A when the puffiness is gone.
Monitoring the progress of oral dehydration therapy
. Check the child frequently during rehydration.
. Ensure that ORS solution is being taken satisfactorily and the signs of dehydration are
not worsening.
. After four hours, reassess the child fully following the guidelines in Table 1 and decide
what treatment to give.
. If signs of severe dehydration have appeared, shift to Treatment Plan C.
. If signs indicating some dehydration are still present, repeat Treatment Plan B. At the
same time offer food, milk and other fluids as described in Treatment Plan A, and
continue to reassess the child frequently.
. If there are no signs of dehydration, the child should be considered fully rehydrated.
When rehydration is complete:
ƒ skin pinch is normal;
ƒ thirst has subsided;
ƒ urine is passed;
ƒ child becomes quiet, is no longer irritable and often falls asleep.
. Teach the mother how to treat her child at home with ORS solution and food following
Treatment Plan A. Give her enough ORS packets for 2 days.
. Also teach her the signs that mean she should bring her child back to see a health
worker.
If oral rehydration therapy must be interrupted
If the mother and child must leave before the rehydration with ORS solution is completed:
. Show her how much ORS to give to finish the 4 ]hour treatment at home.
. Give her enough ORS packets to complete the four hour treatment and to continue oral
rehydration for two more days, as shown in Treatment Plan B.
. Show her how to prepare ORS solution.
. Teach her the four rules in Treatment Plan A for treating her child at home.
When oral rehydration fails
. If signs of dehydration persist or reappear, refer the child.
Giving zinc sulfate
. Begin to give supplemental zinc sulfate tablets, as in Treatment Plan A, as soon as the
child is able to eat following the initial four hour rehydration period.
Giving food
. Except for breast milk, food should not be given during the initial four ]hour
rehydration period. .The Interagency Emergency Health Kit 2006
36
. Children continued on Treatment Plan B longer than four hours should be given some
food every 3 ]4 hours as described in Treatment Plan A.
. All children older than 6 months should be given some food before being sent home.
This helps to emphasize to mothers the importance of continued feeding during
diarrhoea. .Assessment and treatment of diarrhoea
37
Treatment Plan C: for patients with severe dehydration
Follow the arrows. If the answer is “yes” go across. If “no” go down.
Can you give intravenous
(IV) fluids immediately? Yes .
Start IV fluids immediately. If the patient can drink,
give ORS by mouth while the drip is set up. Give
100 ml/kg Ringer’s Lactate Solution (or if not
available normal saline), divided as follows:
Age First give
30 ml/kg in:
Then give
70 ml/kg in:
Infants
(under 12 months) 1 hour* 5 hours
Older 30 minutes* 2 ½ hours
No * Repeat once if radial pulse is still very weak or non-
detectable.
. Reassess the patient every 1-2 hours. If
hydration is not improving, give the IV drip
more rapidly.
. Also give ORS (about 5 ml/kg/hour) as soon
as the patient can drink: usually after 2-4
hours (infants) or 1-2 hours (older patients).
. After 6 hours (infants) or 3 hours (older
patients), evaluate the patient using the
assessment chart. Then choose the
appropriate Plan (A, B or C) to continue
treatment.
Is IV treatment available
nearby
(within 30 minutes)?
Yes . . Send the patient immediately for IV
treatment.
.
If the patient can drink, provide the mother
with ORS solution and show her how to give it
during the trip to receive IV treatment.
No
Are you trained to use a
naso-gastric tube (NG) for
rehydration?
Yes . . Start rehydration by tube with ORS solution:
give 20 ml/kg/hour for 6 hours (total of
120 ml/kg).
. Reassess the patient every 1-2 hours:
• if there is repeated vomiting or increased
abdominal distension, give the fluid more slowly.
• if hydration is not improved after 3 hours, send
the patient for IV therapy.
No . After 6 hours, reassess the patient and
choose the appropriate treatment plan.
Can the patient drink? Yes . . Start rehydration by mouth with ORS
solution, giving 20 ml/kg/hour for 6 hours
(total of 120 ml/kg).
. Reassess the patient every 1-2 hours:
• if there is repeated vomiting, give the fluid more
slowly - if hydration is not improved after 3 hours
send the patient for IV therapy.
No . After 6 hours, reassess the patient and choose
the appropriate treatment plan.
Urgent: send the patient
for IV or NG treatment.
NB: If possible, observe the patient for at least six hours after rehydration to be sure the mother
can maintain hydration giving ORS solution by mouth. If the patient is over two years old and there
is cholera in your area, give an appropriate oral antibiotic after the patient is alert. .The Interagency Emergency Health Kit 2006
38.Management of the child with cough or difficult breathing
39
Annex 3:
Management of the child with cough or difficult
breathing
A-3.1 Assess the child
Ask
• How old is the child?
• Is the child coughing? For how long?
• Is the child able to drink (for children age 2 months up to 5 years)?
• Has the young infant stopped feeding well (for children less than 2 months)?
• Has the child had fever? For how long?
• Has the child had convulsions?

Look and listen (the child must be calm)
• Count the breaths in a minute.
• Look for chest indrawing.
• Look and listen for stridor.
• Look and listen for wheeze. Is it recurrent?
• See if the child is abnormally sleepy, or difficult to wake.
• Feel for fever, or low body temperature (or measure temperature).
• Look for severe undernutrition.
A-3.2 Decide how to treat the child
The child aged less than two months: ˜ see Annex 3.3
The child aged two months up to five years:
• who is not wheezing ˜ see Annex 3.4
• who is wheezing ˜ Refer
Treatment instructions: ˜ see Annex 3.5
• give an antibiotic
• advise mother to give home care
• treatment of fever.The Interagency Emergency Health Kit 2006
40
A-3.3 Child less than two months old
Signs: No fast breathing
(LESS than 60 a
minute)
and
No severe chest
indrawing
Fast breathing
(60 per minute or
MORE)
or
Severe chest
indrawing
Not able to drink
Convulsions
Abnormally sleepy or
difficult to wake
Stridor in calm child
Wheezing
or
Fever or low body
temperature
Classify as: No pneumonia -
cough or cold
Severe pneumonia Very severe disease
Advise mother to give
following home care:
keep infant warm
Breastfeed frequently
Clear nose if it
interferes with
feeding
Refer URGENTLY to
hospital
Give first dose of an
antibiotic
Refer URGENTLY to
hospital
Give first dose of an
antibiotic
Treatment:
Advise mother to
return quickly if:
Illness worsens
Breathing is difficult
Breathing becomes
fast
Feeding becomes a
problem
Keep infant warm
(If referral is not
feasible, treat with
an antibiotic and
follow closely)
Keep infant warm
(If referral is not feasible,
treat with an antibiotic
and follow closely).Management of the child with cough or difficult breathing
41
A-3.4 Child two months to five years old
Signs: No chest
indrawing and
No fast
breathing (less
than 50 per
minute if child
2 ]12 months of
age or 40 per
minute if child
1 ]5 years)
No chest indrawing
and
Fast breathing (50
per minute or
MORE if child 2 ]12
months of age or 40
per minute if child
1 ]5 years)

Chest indrawing Not able to
drink
Convulsions
Abnormally
sleepy or
difficult to
wake
Stridor in calm
child or
Severe
undernutrition
Classify
as:
No
pneumonia:
cough or cold
Pneumonia Severe
pneumonia

Very severe
disease
If coughing
more than 30
days, refer for
assessment
Advise mother to
give home care
Refer
URGENTLY to
hospital
Refer
URGENTLY to
hospital
Treat ]
ment:
Assess and
treat ear
problem or
sore throat if
present
Give an antibiotic

Give first dose of
antibiotics
Give first dose
of antibiotics
Assess and
treat other
problems
Treat fever if
present
Treat fever if
present
Treat fever if
present

Advise mother
to give home
care
Treat fever if
present
Advise mother to
return in 2 days for
reassessment, or if
the child is getting
worse
(If referral is not
possible, treat
with an antibiotic
and follow
closely)
If cerebral
malaria is
possible, give
an antimalarial
medicine
È

Reassess in 2 days a child who is taking an antibiotic for pneumonia

Signs: Improving

Less fever
Eating better
Breathing slower
The same Worse

Not able to drink
Has chest indrawing
Has other danger
signs

Treatment: Finish 5 days of
antibiotics
Change antibiotic
or
Refer
Refer URGENTLY to
hospital
.The Interagency Emergency Health Kit 2006
42
A-3.5 Treatment instructions
A-3.5.1 Give an antibiotic
• Give first dose of antibiotic in the clinic.
• Instruct mother on how to give the antibiotic for five days at home
(or to return to clinic for daily procaine ]penicillin injection).

Amoxicillin tab 250 mg Age or (Weight)
Twice daily for 5 days
< 2 mths (< 6 kg)* ¼ tab
2 - 12 mths (6-9 kg) ½ tab
12 mths - 5 yrs (10-19 kg) 1 tab

* Give oral antibiotic for five days at home if referral is not feasible.
A-3.5.2 Advise mother to give home care
(for child age 2 months up to 5 years)
• Feed the child
-feed the child during illness
-increase feeding during illness
-clear the nose if it interferes with feeding
• Increase fluids
-offer the child extra to drink
-increase breastfeeding
-soothe the throat and relieve cough with a safe remedy
• Most important: for the child classified as having no pneumonia, cough or cold,
watch for the following signs and return quickly if they occur:
-breathing becomes difficult
-breathing becomes fast
-child not able to drink
-child becomes sicker
} This child may have pneumonia.Management of the child with cough or difficult breathing
43
A-3.5.3 Treat Fever (see also page 27)
Malaria is not confirmed:
Give paracetamol, see table below.
Fever is high:
(> 39°C)
Parasite-based
diagnosis 54 for all
patients of all age
groups Malaria is confirmed:
Give artemether/lumefantrine
treatment see Fever on page 27(or
follow national malaria treatment
recommendations).
Malaria is not confirmed: Advise
the mother to give more fluids.
In low
malaria transmission areas
Fever is not high:
(38-39°C)
Parasite-based
diagnosis 54 for all
patients of all age
groups Malaria is confirmed:
Give artemether/lumefantrine
treatment see Fever on page 27 (or
follow national malaria treatment
recommendations).
Malaria is not confirmed:
Give paracetamol, see table below.
Parasite based
diagnosis 54 for all
adult patients and
children > 5 years
Malaria is confirmed:
Give artemether/lumefantrine
treatment see Fever on page 27 (or
follow national malaria treatment
recommendations).
In high
malaria transmission areas
All cases of fever
For children < 5
years, to be treated
on the basis of a
clinical diagnosis of
malaria
Give artemether/lumefantrine
treatment see Fever on page 27 (or
follow national malaria treatment
recommendations).
Fever alone is not a reason to give an antibiotic, except in a young infant (age less than
2 months). Give first dose of an antibiotic and Refer URGENTLY to hospital.

PARACETAMOL
Every six hours, for 1 to 3 days
Age or Weight 100 mg tab 500 mg tab
3 - 12 mths (6-<10 kg) ½ - 1
1- < 5 yrs (10-<15 kg) 1 - 2
5 - < 10 yrs (15-<25 kg) 2 - 3 ½
10-<15 yrs (25-<35 kg) 1



54 By microscopy or by RDTs.The Interagency Emergency Health Kit 2006
44.Sample data collection forms
45
Annex 4: Sample data collection forms
Daily morbidity data
Location: Clinic:

Date:
Children Children five years
under 5 years old and older, and adults
Total
Diarrhoea with blood
Diarrhoea without blood
Fever
Confirmed malaria
Malnutrition Measles Meningitis
Severe acute respiratory
infections/pneumonia
Sexually transmitted infections
Others Totals
Number of cases referred to other services:
Other information:.The Interagency Emergency Health Kit 2006
46
Weekly mortality statistics
Location: Total population:
Week:
Cause of death Children under 5
years
Children 5 years
and older, and
adults
Total
Male Female Male Female Male Female
ARI 55 /pneumonia
Diarrhoea
Diarrhoea with blood
Fever
Confirmed malaria
Malnutrition
Maternal deaths
Measles Meningitis Others Totals
Other information

55 ARI = Acute Respiratory Infection.Sample data collection forms
47
Daily medicine consumption form
Date: Location:
Item/medicine Quantities dispensed* Total
1. albendazole 400 mg chewable tab
2. aluminium hydroxide 400 mg +
magnesium hydroxide 400 mg tab
3. amoxicillin 250 mg tab
4. artemether + lumefantrine,
20 mg + 120 mg tab
6 x 1 tab
6 x 2 tab
6 x 3 tab
6 x 4 tab
5. benzyl benzoate 25%, lotion
6. chlorhexidine 5%, solution
7. ferrous sulfate + folic acid 200 mg +
0.4 mg tab
8. gentian violet, powder
9. ibuprofen 400 mg scored tab
10. ORS, sachets
11. paracetamol 100 mg tab
12. paracetamol 500 mg tab
13. tetracycline 1% eye ointment
14. quinine sulfate 300 mg tab
15. zinc sulfate 20 mg dispersible tab
* For example: 10 + 30 + 20….The Interagency Emergency Health Kit 2006
48
.Sample health card
49
Annex 5:
Sample health card
HEALTH CARD Card No.
Carte No.
CARTE DE SANTE Date of registration
Date d’enregistrement

Site
Lieu
Section/House No.
Section /Habitation No.
Date of arrival at site
Date d 'arrivée sur le lieu

Family name
Nom de famille
Given names
Prénoms

Date of birth or age
Date de naissance ou âge
Or
Ou
Years
Ans
Sex
Sexe
M/F Name commonly known by
Nom d’usage habituel

Mother’s name
Nom de la mère
Father’s name
Nom du père

Height
Taille CM
Weight
Poids

KG
Percentage weight/height
Pourcentage poids/taille

Feeding programme
Programme d’alimentation

Immunization Measles
Rougeole
Date 1 2 BCG
Date
Others
Autres

C H I L D R E
N
E N F A N T
S
Immunization Polio

Date DPT Polio
Date
DTC Polio
1 2 3
Pregnant
Enceinte
Yes/No
Oui/Non
No. of pregnancies
No. de grossesses
No. of children
No. d’enfants
Lactating
Allaitante
Yes/no
Oui/Non
Tetanus
Tétanos
Date 1 2 3 4 5
W O M E
N
F E M M E
S
Feeding programme
Programme d’alimentation


C O M M E N T
S
O B S E R V A T I O N
S
General (Family circumstances, living conditions etc.)
Générales (Circonstances familiales, condition de vie, etc.)

Health (Brief history, present condition)
Médicales (Résumé de l’état actuel)
.The Interagency Emergency Health Kit 2006
50
Health card (cont.)

DATE
CONDITION
(Signs/symptoms/diagnosis)

ETAT
(Signes/symptômes/diagnostic)
TREATMENT
(Medication/dose time)

TRAITEMENT
(Médication/durée de la dose)
COURSES
(Medication due/given)

APPLICATION
(Médication requise/effectuée)
OBSERVATIONS
(Change in condition)
NAME OF HEALTH WORKER

OBSERVATIONS
(Changement d’état)
NOM DE L’AGENT DE SANTE



.Guidelines for suppliers
51
Annex 6:
Guidelines for suppliers
Specifications for medicines and medical devices
1. Medicines, and medical devices ] renewable and equipment ] in the kit should comply
with specifications given in UNICEF web catalogue where items specifications are
updated on line, at:
http://www.supply.unicef.dk/Catalogue/

2. Suppliers should purchase as much as possible from manufacturers which are pre ]
qualified by WHO. The list of pre ]qualified manufacturers and products can be found
on http://mednet3.who.int/prequal/

3. Medicines, and medical devices ] renewable and equipment ] in the kit should comply
with specifications and advice given in Interagency guidelines for drug donations. Geneva:
World Health Organization; 1999. (WHO/EDM/PAR/99.4).

4. Suppliers should contact WHO/Procurement Services (Annex 11) for the latest
specifications of Rapid Diagnostic Tests (RDTs), and information on the
most appropriate tests for use in different regions (see also
http://www.who.int/malaria/).
Packaging
1. The tablets or capsules should be packed in sealed waterproof containers with
replaceable lids, protecting the contents from light and humidity.
2. There will be "no objection " against blister packaging provided it will be waterproof
and protecting the contents from light and humidity where applicable.
3. Liquids should be packed in unbreakable leak ]proof bottles or containers.
4. Containers for all pharmaceutical preparations must conform to the latest edition of
internationally recognized pharmacopoeial standards.
5. Ampoules must either have break ]off necks, or sufficient files must be provided.
6. Each basic unit should be packed in one carton with the malaria module packed
separately. The supplementary unit must be packed in cartons of a maximum weight
of 50 kg each.
7. Medicines, infusions, renewable medical devices and medical devices, and other
equipment should all be packed in separate cartons, with corresponding labels. The
cartons should preferably have two handles attached. .The Interagency Emergency Health Kit 2006
52
8. Each carton must be marked with labels permitting identification and classification of
each carton within the kit. The word “BASIC” must be printed on each label for the
basic unit.
Packing list
Each consignment must be accompanied by a list of contents, stating the total number of
cartons and for each carton, the following should be clearly specified:

1. name of each product;
2. batch number of each product;
3. quantity of each product; and
4. expiry date of each product, especially for pharmaceutical products.
Information slips
Each basic unit carton and a number of the supplementary unit cartons should contain an
information slip in, at least, three languages (English, French, Spanish) which reads as
follows:
English
"The Interagency Emergency Health Kit 2006 is primarily intended for displaced
populations without medical facilities; it may also be used for initial supply of
primary health care facilities where the normal system of provision has broken
down. It is not intended as a re ]supply kit and, if used as such, may result in the
accumulation of items and medicines which are not needed.

It is recognized that some of the medicines and medical devices contained in the
kit may not be appropriate for all cultures and countries. This is inevitable as it is
a standardized emergency kit, designed for worldwide use, which is prepacked
and kept ready for immediate dispatch.

The kit is not designed for immunization programmes, cholera, meningitis or
specific epidemics such as those caused by Ebola virus, SARS and avian flu
virus.”
French
<< Le Kit Sanitaire d’Urgence Inter ]institutions 2006 est principalement destiné
aux populations déplacées n’ayant pas accès à un système de soins médicaux. Il
peut également être utilisé pour donner des soins de santé primaires, partout où
le système habituel n 'est plus fonctionnel. Il ne doit en aucun cas servir de
réapprovisionnement car cela pourrait entraîner une accumulation inappropriée
de matériel médical et de médicaments.

Dans la mesure où ce kit est standardisé, destiné à être utilisé dans le monde
entier et préconditionné afin d 'être distribué immédiatement en cas de nécessité, .Guidelines for suppliers
53
il est inévitable qu’une partie du matériel médical et des médicaments qu’il
contient ne conviennent pas à tous les pays et à toutes les cultures.

Ce kit n’est ni conçu pour les programmes de vaccination, choléra, méningite, ni
pour des épidémies spécifiques comme celles dues au virus Ebola, SARS et le
virus de la grippe aviaire. >>
Spanish
<< El botiquín médico de emergencia interorganismos 2006 está destinado
principalmente a las poblaciones desplazadas carentes de servicios médicos;
podrá utilizarse también para la prestación inicial de servicios de atención
primaria de salud donde el sistema normal de prestación esté paralizado. No
tiene por objeto reabastecer el botiquín, pues si se utiliza con este fin ello puede
dar lugar a que se acumulen artículos y medicamentos innecesarios.

Se reconoce que algunos de los suministros y medicamentos contenidos en el
botiquín pueden no ser apropiados en todos los contextos culturales y países.
Esto es inevitable, ya que se trata de un botiquín estándar de emergencia
destinado para su uso en todo el mundo, preempaquetado y listo para su envío
inmediato.

El botiquín no está destinado a los programas de inmunización ni a combatir el
cólera, la meningitis o epidemias particulares como la provocada por el virus de
Ébola, SRAS y la gripe aviar. >> .The Interagency Emergency Health Kit 2006
54
.Other kits for emergency situations
55
Annex 7:
Other kits for emergency situations
The following additional kits covering immunization, nutrition and reproductive health may
be provided after assessment of needs. Please see Annex 11 for the addresses of Médecins
Sans Frontières (MSF), Oxfam, and the United Nations Population Fund (UNFPA).
Immunization
Immunization kit for 10,000 immunizations by 5 teams
The kit may be used for mass immunization campaigns for epidemic prevention or control (measles,
meningitis and yellow fever, etc...) It is composed of cold chain, logistic and medical devices divided
into 7 modules, including a generator, refrigeration, cold chain transport and equipment, logistics,
stationery, and medical device renewable items. Vaccines must be ordered separately.
MSF code: KMEDKIMM3 ]
Nutrition
Nutrition kits
Oxfam and MSF have developed kits for nutritional support. The nutritional kits contain the necessary
equipment to set up a nutritional programme. The MSF anthropometric kit is different from the one
from Oxfam (Kit 1). The other kits developed both by Oxfam and MSF have different codes but are
comparable. The nutrition kits will be packed and labelled by Oxfam.
Survey kits for measuring weight and height of children
This kit contains equipment for measuring weight and height of children to assess nutritional status and
materials needed for nutritional surveys by two teams.
OXFAM anthropometric kit ] Kit 1
MSF anthropometric kit code: KMEDKNUT4M ]
Registration kits
These kits contain material needed for registering children and record keeping for nutritional
programmes.
OXFAM registration kit for supplementary feeding (wet) ] Kit 2A
MSF registration kit for supplementary wet feeding, 250 beneficiaries
code: KMEDMNUT61 ]
OXFAM registration kit for supplementary feeding (dry) ] Kit 3A
MSF registration kit for supplementary dry feeding, 500 beneficiaries
code: KMEDMNUT71 ] .The Interagency Emergency Health Kit 2006
56
OXFAM registration kit for therapeutic feeding ] Kit 4A
MSF registration kit for therapeutic feeding, 100 severely malnourished children
code: KMEDMNUT51 ]
Supplementary feeding (wet) kit
Designed for 250 people, moderately malnourished children or other vulnerable groups and includes
feeding and cooking equipment. Recent guidelines discourage the use of wet supplementary feeding
programmes but do recommend that they are only implemented when populations have limited
access to fuel and water, where security conditions place people at risk when taking rations home, or
for groups who are in need of additional food but are unable to cook for themselves.
OXFAM Supplementary Feeding (wet) ] Kit 2
MSF Nutrition, supplementary wet feeding, 250 beneficiaries
code: KMEDMNUT62 ]
Supplementary feeding (dry) kit
Designed for 500 people, moderately malnourished children or other vulnerable groups and includes
equipment for mixing and distributing food. It is not intended for general food distribution of an
entire population in need of food aid.
OXFAM Supplementary Feeding (dry) ] Kit 3
MSF Nutrition, supplementary dry feeding, 500 beneficiaries
code: KMEDMNUT72 ]
Therapeutic feeding kit
Designed for therapeutic feeding of 100 severely malnourished children. The kit should only be used
by trained staff who are able to recognize and respond to the main health problems associated with
severe malnutrition. There should be access to medical care as the kit contains no medicines.
OXFAM Therapeutic Feeding ] Kit 4
MSF Therapeutic Feeding, 100 severely malnourished children
code: KMEDMNUT52 ]
Reproductive health
Interagency reproductive health kits for crisis situations
The reproductive health kits prepared by UNFPA provide the supplies needed to implement basic
reproductive health services during the early phase of a crisis.
The RH kits are designed for a varying population for 3 months
There are 12 kits divided into three blocks:
Block 1: Six kits for use at the community and primary health care level for a population
of 10,000 people for 3 months. They contain mostly disposable medical devices and
equipment.
Kit 0 ] Administration kit
To facilitate administration and training activities.
Kit 1 ] Condoms kit
120 gross (17,280) male condoms with 400 safe sex leaflets;
3.8 gross (540) female condoms with 25 use leaflets. .Other kits for emergency situations
57
Kit 2 ] Clean delivery kit
200 individual packets containing items and pictorial instruction sheet for home delivery plus
material for traditional birth attendants.
Kit 3 ] Rape treatment kit
Management of the immediate consequences of sexual violence with appropriate medicines
and supplies: basic treatment after a rape and PEP treatment for HIV (including treatment
for children).
Kit 4 ] Oral and injectable contraception
To respond to women 's needs for hormonal contraception.
Kit 5 ] Treatment of sexually transmitted infections
To diagnose and treat STIs in people presenting with complaints.
Block 2: Five kits for use at primary health care and referral hospital levels, designed for
a population of 30,000 people for 3 months
Kit 6 ] Clinical delivery kit
To perform normal deliveries, repair episiotomies and perineal tears under local anesthetics and
stabilize women with obstetric complications (eclampsia and haemorrhage) before transfer to a
referral unit, for trained personnel, midwives, nurses with midwifery skills and medical doctors.
Kit 7 ] Intra ]uterine device kit
To place IUDs either as contraception or as emergency contraception, and to remove IUDs and
provide preventive antibiotic treatment, for trained personnel.
Kit 8 ] Management of miscarriage and complications of abortion
To treat the complications arising from miscarriage and unsafe abortion, including sepsis,
incomplete evacuation and bleeding, for trained personnel.
Kit 9 ] Suture of tears vaginal/cervical and vaginal examination kit
To allow vaginal examination and suturing of cervical and vaginal tears, for trained personnel,
midwives, physicians, nurses with midwifery skills.
Kit 10 ] Vacuum extraction delivery kit
To assist in vaginal delivery by using manual vacuum extraction method to deliver the newborn.
Block 3: Two kits designed for referral surgical/obstetric level for 150,000 people for
3 months.
Kit 11 ] Referral level kit for reproductive health (part A+B)
Medical devices, renewable and equipment and medicines for use at the referral level for
caesarian sections, resuscitation of mothers and babies, treatment of complications of sexually
transmitted infections, and complications of pregnancy and delivery.
Kit 12 ] Blood transfusion kit
To perform safe blood transfusion after testing for HIV, syphilis and hepatitis B and C. .The Interagency Emergency Health Kit 2006
58
.Guidelines for Drug Donations
59
Annex 8:
Guidelines for Drug Donations 56
Selection of drugs
1. All drug donations should be based on an expressed need and be relevant to the
disease pattern in the recipient country. Drugs should not be sent without prior
consent by the recipient.

Justification and explanation
This provision stresses the point that it is the prime responsibility of the recipients to
specify their needs. It is intended to prevent unsolicited donations, and donations which
arrive unannounced and unwanted. It also empowers the recipients to refuse unwanted
gifts.
Possible exceptions
In acute emergencies the need for prior consent by the recipient may be waived,
provided the drugs are amongst those from the WHO Model List of Essential Drugs
that are included in the UN list of emergency relief items recommended for use in
acute emergencies (http://www.iapso.org/pdf/erc_vol2.pdf).

2. All donated drugs or their generic equivalents should be approved for use in the
recipient country and appear on the national list of essential drugs, or, if a national
list is not available, on the WHO Model List of Essential Drugs, unless specifically
requested otherwise by the recipient.
Justification and explanation
This provision is intended to ensure that drug donations comply with national drug
policies and essential drugs programmes. It aims at maximizing the positive impact of
the donation, and prevents the donation of drugs which are unnecessary and/or
unknown in the recipient country.
Possible exceptions
An exception can be made for drugs needed in sudden outbreaks of uncommon or newly
emerging diseases, since such drugs may not be approved for use in the recipient
country.
3. The presentation, strength and formulation of donated drugs should, as much as
possible, be similar to those of drugs commonly used in the recipient country.
Justification and explanation
Most staff working at different health care levels in the recipient country have been
trained to use a certain formulation and dosage schedule and cannot constantly change
their treatment practices. Moreover, they often have insufficient training in performing the
necessary dosage calculations required for such changes.

56 Reprinted from: Interagency guidelines for drug donations. Geneva: World Health Organization; 1999.
WHO/EDM/PAR 99.4..The Interagency Emergency Health Kit 2006
60
Quality assurance and shelf-life
4. All donated drugs should be obtained from a reliable source and comply with quality
standards in both donor and recipient country. The WHO Certification Scheme on the
Quality of Pharmaceutical Products Moving in International Commerce should be
used.
Justification and explanation
This provision prevents double standards: drugs of unacceptable quality in the donor
country should not be donated to other countries. Donated drugs should be authorized
for sale in the country of origin, and manufactured in accordance with international
standards of Good Manufacturing Practice (GMP).

Possible exceptions
In acute emergencies the use of the WHO Certification Scheme may not be practical.
However, if it is not used, a justification should be given by the donor. When donors
provide funds to purchase drugs from local producers, those which comply with
national standards should not be excluded on the sole grounds that they do not meet
quality standards of the donor country.
5. No drugs should be donated that have been issued to patients and then returned to a
pharmacy or elsewhere, or were given to health professionals as free samples.
Justification and explanation
Patients return unused drugs to a pharmacy to ensure their safe disposal; the same
applies to drug samples that have been received by health workers. In most countries it is
not allowed to issue such drugs to other patients, because their quality cannot be
guaranteed. For this reason returned drugs should not be donated either. In addition to
quality issues, returned drugs are very difficult to manage at the receiving end because of
broken packages and the small quantities involved.
6. After arrival in the recipient country all donated drugs should have a remaining shelf-life
of at least one year. An exception may be made for direct donations to specific
health facilities, provided that: the responsible professional at the receiving end
acknowledges that (s)he is aware of the shelf-life; and that the quantity and
remaining shelf-life allow for proper administration prior to expiration. In all cases it
is important that the date of arrival and the expiry dates of the drugs be
communicated to the recipient well in advance.
Justification and explanation
In many recipient countries, and especially under emergency situations, there are
logistic problems. Very often the regular drug distribution system has limited
possibilities for immediate distribution. Regular distribution through different storage
levels (e.g. central store, provincial store, district hospital) may take six to nine months.
This provision especially prevents the donation of drugs just before their expiry, as in
most cases such drugs would only reach the patient after expiry. It is important that the
recipient official responsible for acceptance of the donation is fully aware of the
quantities of drugs being donated, as overstocking may lead to wastage. The argument
that short ]dated products can be donated in the case of acute emergencies, because
they will be used rapidly, is incorrect. In emergency situations the systems for
reception, storage and distribution of drugs are very often disrupted and overloaded,
and many donated drugs tend to accumulate..Guidelines for Drug Donations
61
Additional exception
Besides the possible exception for direct donations mentioned above, an exception
should be made for drugs with a total shelf ]life of less than two years, in which case at
least one ]third of the shelf ]life should remain.
Presentation, packing and labelling
7. All drugs should be labelled in a language that is easily understood by health
professionals in the recipient country; the label on each individual container should
at least contain the International Nonproprietary Name (INN) or generic name, batch
number, dosage form, strength, name of manufacturer, quantity in the container,
storage conditions and expiry date.
Justification and explanation
All donated drugs, including those under brand name, should be labelled also with their
INN or the official generic name. Most training programmes are based on the use of
generic names. Receiving drugs under different and often unknown brand names and
without the INN is confusing for health workers and can even be dangerous for patients.
In the case of injections, the route of administration should be indicated.
8. As much as possible, donated drugs should be presented in larger quantity units and
hospital packs.

Justification and explanation
Large quantity packs are cheaper, less bulky to transport and conform better to public
sector supply systems in most developing countries. This provision also prevents the
donation of drugs in sample packages, which are impractical to manage. In precarious
situations, the donations of paediatric syrups and mixtures may be inappropriate
because of logistical problems and their potential misuse.
9. All drug donations should be packed in accordance with international shipping
regulations, and be accompanied by a detailed packing list which specifies the
contents of each numbered carton by INN, dosage form, quantity, batch number,
expiry date, volume, weight and any special storage conditions. The weight per
carton should not exceed 50 kilograms. Drugs should not be mixed with other
supplies in the same carton.
Justification and explanation
This provision is intended to facilitate the administration, storage and distribution of
donations in emergency situations, as the identification and management of unmarked
boxes with mixed drugs is very time ] and labour ]intensive. This provision specifically
discourages donations of small quantities of mixed drugs. The maximum weight of
50 kilograms ensures that each carton can be handled without special equipment..The Interagency Emergency Health Kit 2006
62
Information and management
10. Recipients should be informed of all drug donations that are being considered,
prepared or actually under way.
Justification and explanation
Many drug donations arrive unannounced. Detailed advance information on all drug
donations is essential to enable the recipient to plan for the receipt of the donation and to
coordinate the donation with other sources of supply. The information should at least
include: the type and quantities of donated drugs including their International
Nonproprietary Name (INN) or generic name, strength, dosage form, manufacturer and
expiry date; reference to earlier correspondence (for example, the letter of consent by the
recipient); the expected date of arrival and port of entry; and the identity and contact
address of the donor.
11. In the recipient country the declared value of a drug donation should be based upon
the wholesale price of its generic equivalent in the recipient country, or, if such
information is not available, on the wholesale world-market price for its generic
equivalent.
Justification and explanation
This provision is needed solely to prevent drug donations being valued in the recipient
country according to the retail price of the product in the donor country. This may lead
to elevated overhead costs for import tax, port clearance and handling in the recipient
country. It may also result in a corresponding decrease in the public sector drug budget
in the recipient country.

Possible exception
In the case of patented drugs (for which there is no generic equivalent) the wholesale price
of the nearest therapeutic equivalent could be taken as a reference.
12. Costs of international and local transport, warehousing, port clearance and
appropriate storage and handling should be paid by the donor agency, unless
specifically agreed otherwise with the recipient in advance.
Justification and explanation
This provision prevents the recipient from being forced to spend effort and money on the
clearance and transport of unannounced consignments of unwanted items, and also
enables the recipient to review the list of donated items at an early stage.
.Model regulatory aspects of exportation and importation of controlled substances
63
Annex 9:
Model Regulatory Aspects of Exportation and
Importation of Controlled Substances
Introduction
Organizations involved in the provision of medical supplies in emergency situations are
often faced with serious difficulties in providing narcotic and psychotropic medicines
because of the regulatory requirements concerning their exportation and importation. The
lack of these medicines results in additional human suffering by depriving those in need of
adequate pain relief and sedation. This makes these medicines an essential part of medical
supply in emergency situations.

The Basic Unit of the Interagency Emergency Health Kit 2006 does not contain any
substances that are regarded as narcotics or psychotropics, so they are not under
international control and will not require additional formalities for international transport.

However, the Supplementary Unit contains several substances under international control,
and other substances in it are under discussion for future control. Also, certain countries
have additional national regulations for medicines not under international control.

Substances from the Kit under international control are morphine injection
10 mg/ml, 1 ml-ampoule; diazepam injection 5 mg/ml, 2 ml-ampoule and
phenobarbital tablets 100 mg. Morphine requires import and export licences
in any case. For the two other substances this may vary with the country.
Some countries have brought additional substances under their national
regulations. This could be the case in some countries for ketamine injection
50 mg/ml 10 ml-vial, promethazine tablets 25 mg, promethazine injection
25 mg/ml, 2 ml-ampoule and chlorpromazine injection 25 mg/ml, 2 ml-ampoule.
At present there is an assessment going on, in order to decide whether
ketamine needs to be brought under international control.

There are three international treaties that control narcotic and psychotropic substances:

• UN Single Convention on Narcotic Drugs (1961, amended by protocol of 1972)
• UN Convention on Psychotropic Substances (1971)
• UN Convention against the Illicit Traffic in Narcotic Drugs and Psychotropic
Substances (1988).

These treaties are quite complex and it would go too far to go into details here. For the really
interested, their texts can be found at the website of the International Narcotics Control
Board (INCB) (www.incb.org). .The Interagency Emergency Health Kit 2006
64
Those who need to consult the most recent lists of scheduled substances can find them at this
website too.
Standard procedure for international transfer of narcotic and
psychotropic substances
The international transportation of narcotic medicines and psychotropic substances is
"exportation” from one country and "importation " to the other one. This requires an export
authorization from the authorities of the sending country as well as an import authorization
from the authorities of the receiving country. The export authorization is granted only after
the issue of the import authorization.

As such, the import/export authorization system makes the quick international
transportation of controlled medicines to sites of emergencies virtually impossible. In
addition, countries have to estimate their narcotic drug consumption in advance and send
the estimates to the INCB. Only after the INCB has received an estimate for a substance from
a receiving country, the sending country will grant an application for an export
authorization. It will be clear that the rigorous application of the estimate system can further
complicate the procedure, especially in situations of suddenly risen demands.

This procedure takes too long to meet the acute need for relief in emergency situations ]from several
weeks up to many months. This will be even more true when the control authorities in the receiving
country are struck themselves by the disaster.
Procedure to be followed in disaster relief
Model guidelines were prepared to enable adequate procurement of controlled substances in
disaster relief. The procedures would allow suppliers to ship controlled medicines
internationally in emergency situations at the request of recognized agencies providing
humanitarian assistance without prior export/import authorizations. The defined procedures
are acceptable to the control authorities and the INCB.

The INCB has advised control authorities that emergency humanitarian deliveries are
considered as being consumed in the exporting country. This makes that no additional
estimate has to be sent by the authorities of the receiving country. (As the sent amounts are
usually relatively small in comparison to the domestic use of the sending country, in most
cases the existing estimation is large enough to comprise the amount sent, and hence, the
sending country has no additional estimations to submit to the INCB either.)

The INCB recommends to limit control obligations in emergency situations to the authorities of
exporting countries.57

57 This principle was endorsed by the UN Commission on Narcotic Drugs in 1995, and was further
reinforced by its resolution entitled “Timely provision of controlled medicines for emergency care”
adopted at the 39th session in 1996. This and a similar resolution adopted by the 49th session of the
World Health Assembly requested WHO to prepare model guidelines to assist national authorities with
simplified regulatory procedures for this purpose, in consultation with the relevant UN bodies and
interested governments. (Model Guidelines for the International Provision of Controlled Medicines for
Emergency Medical Care, WHO/PSA/96.17)..Model regulatory aspects of exportation and importation of controlled substances
65
Who should do what?
The operator 58 should make a written request for emergency supplies of controlled substances
to the supplier 59 , using the attached model form. The operator is responsible for:
.
selection of suppliers;60
. information provided on the form;
. actual handling of controlled medicines at the receiving end or adequate delivery to
the reliable recipient;
. reporting to the control authorities of the receiving country (whenever they are
available) as soon as possible;
. reporting to the control authorities of the receiving country on unused quantities, if
any, when the operator is the end ]user or to arrange for the end ]user to do so;
. reporting to the control authorities of the exporting country through the supplier, with
copy to the INCB, any problems encountered in the working of emergency deliveries.

Before responding to the request from the operator, the supplier should be convinced that the
nature of the emergency justifies the application of the simplified procedure without
export/import authorizations. The supplier is also responsible for:
.
submitting immediately a copy of the shipment request to the control authorities of the
exporting country;
. submitting an annual report on emergency deliveries and quantities of medicines
involved as well as their destinations, with copy to the INCB;
. reporting to the control authorities of the exporting country, with copy to the INCB,
any problems encountered in the working of emergency deliveries.

The control authorities of the exporting country should inform their counterpart in the receiving
country (whenever they are available) of the emergency deliveries.

58 Operators: organizations engaged in the provision of humanitarian assistance in health matters
recognized by the control authorities of exporting countries.
59 Suppliers: supplier of medicines for humanitarian assistance at the request of an operator (either a
separate entity or a department of an operator).
60 Suppliers should be limited to those recognized by the control authorities of exporting countries. They
should at least have:
• adequate experience as a supplier of good quality emergency medical supplies;
• managerial capability to assess the appropriateness of requests for the simplified procedure from operators;
•
adequate level of stock and a responsible pharmacist;
• sufficient knowledge about the relevant international conventions;
• standard agreement with the control authorities of exporting countries (see attached document
with outlines for the agreement).
.The Interagency Emergency Health Kit 2006
66
The control authorities of the receiving country have the right to refuse the importation of such
deliveries.
Outline of standard agreement between supplier and control
authorities of exporting countries 61
The standard agreement should at least cover:
1. Criteria for acceptance of shipment requests from operators (a model form is
attached at the end).
The criteria for immediate acceptance of shipment requests from operators should at
least specify the essential information to be furnished to the supplier concerning:
a. credibility of the requesting operator
A pre ]determined list of credible operators ought to be prepared. A credible
operator should (i) be an established organization; (ii) have adequate experience
for international provision of humanitarian medical assistance; (iii) have
responsible medical management (medical doctor(s) or pharmacist(s)); and (iv)
appropriate logistic support.
b. nature of the emergency and the urgency of the request
A statement to the supplier on the nature of the emergency by the operator, or if
appropriate, by a UN agency.
c. availability of control authorities in the receiving country.
d. diversion prevention mechanism after delivery
Indicate if the requesting operator itself is the user of the supplies. If not, the name
and organization of the person responsible for receipt and internal distribution of
the supplies should be indicated. As far as possible, the recipients in the receiving
country should be identified.
2. Timing and mode of reporting to the control authorities and the INCB
When control authorities are available in the receiving country, they should be notified
as soon as possible by the control authorities of the exporting country and the operator
of a consignment of the emergency delivery, while their import authorization may not
have to be required under the circumstances of an emergency situation.

Suppliers should inform the control authorities of the exporting country of each
emergency shipment being made in response to a request from an operator so that the
control authorities can intervene if necessary.

Suppliers should submit to the control authorities of the exporting country an annual
report on emergency deliveries and quantities of medicines involved as well as their
destinations in duplicate, so that one copy can be forwarded to the INCB.


61 When an operator is also a supplier, the agreement will be between the operator and the control
authorities..Model regulatory aspects of exportation and importation of controlled substances
67
Suppliers, or operators through the suppliers, should inform the control authorities of
the exporting countries, with a copy to the INCB, of any problems encountered in the
working of emergency deliveries.
3. Other relevant matters
As appropriate, the agreement may include provisions on other relevant matters such
as inspection and guidance by the control authorities. Although the quantities involved
would be rather small, it may touch upon estimated/assessed requirements based on
the principle that the medicines provided should be regarded as having been
“consumed” in the exporting country. .The Interagency Emergency Health Kit 2006
68
Shipment request/notification form for emergency supplies
of controlled substances
Operator:
Name:.....................
Address:.................
Name of the responsible medical director/pharmacist: ..................................................................
Title:........................
Phone No. ............................................. Fax No. .................................................................................

Requests the supplier:62
Name:.....................
Address:.................
Responsible pharmacist: .....................................................................................................................
Phone No. ............................................. Fax No. ................................................................................

For an emergency shipment 63 of the following medicine(s) containing
controlled substances:
Name of product (in INN/generic name) and dosage form, amount of active ingredient per unit dose,
number of dosage units in words and figures

Narcotic medicines as defined in the 1961 Convention (e.g. morphine, pethidine, fentanyl)
[e.g. morphine injection 1 ml ampoule; morphine sulfate corresponding to 10 mg of morphine base per
ml; two hundred (200) ampoules]
.................................
.................................
.................................
.................................

Psychotropic substances as defined in the 1971 Convention (e.g. buprenorphine, pentazocine,
diazepam, phenobarbital)
.................................
.................................
.................................
.................................

Others (nationally controlled in the exporting country, if applicable)
.................................
.................................

62 If the operator is exporting directly from its emergency stock, it should be considered as a supplier.
63 Emergency deliveries do not affect the estimate of the recipient country since they have already been
accounted for in the estimate of the exporting country. .Model regulatory aspects of exportation and importation of controlled substances
69
To the following recipient (whichever applicable):
Country of final recipient: ...................................................................................................................
Responsible person for receipt: ..........................................................................................................
Name:.....................
Organization/A
Address:.................
Phone No. . ............................................ Fax No. .................................................................................

For use by/delivery to:
Location: .............................. Organization/Agency .........................................................................
................................................ .........................................................................
................................................ .........................................................................

Consignee (If different from above e.g. transit in a third country):
Name: ................................... Organization/Agency .........................................................................
Address:.................
Phone No. . ............................................ Fax No. .................................................................................

Nature of the emergency (Brief description of the emergency motivating the request):
.................................
.................................
.................................

Availability of, and action taken to contact the control authorities in the receiving country:
.................................
.................................

I certify that the above information is true and correct. My Organization will:

. Take responsibility for receipt, storage, delivery to the recipient/end ]user, or use for
emergency care (strike out what is not applicable) of the above controlled medicines;
. Report the importation of the above controlled medicines as soon as possible to the
control authorities (if available) of the receiving country;
. Report the quantities of unused controlled medicines, if any, to the control authorities of
the receiving country (if available), or arrange for the end ]user to do so (strike out what
is not applicable).

Title:..................................................... Date: .....................................................................................
Location: ............................................. ......................................................................................
(Signature) .The Interagency Emergency Health Kit 2006
70
.References
71
Annex 10:
References
The books and documents referenced below may be obtained (some are priced others are
free of charge) from the respective organizations ] contact details are provided in Annex 11
or can be found on the organizations ' websites.
Medicines
WHO. Electronic Essential Medicines Library and WHO Model Formulary
http://mednet3.who.int/EMLib/wmf.aspx

WHO. WHO Model List of Essential Medicines.
http://www.who.int/medicines/publications/essentialmedicines/en/index.html
Medicine management
UNHCR. UNHCR Drug management manual 2006. Policies, guidelines, UNHCR List of Essential
Drugs. Geneva: UNHCR; 2006.
http://www.unhcr.org/cgi ]bin/texis/vtx/publ/opendoc.pdf?tbl=PUBL&id=43cf66132

John Snow, Inc./DELIVER. Logistics handbook: a practical guide for supply chain managers in
family planning and health programs. Arlington, VA: John Snow Inc./DELIVER; 2004.
http://portalprd1.jsi.com/portal/page?_pageid=93,3144386,93_3144425&_dad=portal&_schema=PORT
AL

John Snow, Inc./DELIVER in collaboration with WHO. Guidelines for the storage of essential
medicines and other health commodities. Arlington, VA: John Snow, Inc./DELIVER; 2003.
http://portalprd1.jsi.com/portal/page?_pageid=93,3144386,93_3144425&_dad=portal&_schema=PORT
AL
Communicable diseases
WHO. Communicable disease control in emergencies ] a field manual. Geneva: World Health
Organization; 2005. WHO/CDS/2005.27. ISBN 92 4 154616 6.
http://bookorders.who.int/bookorders/anglais/home1.jsp?sesslan=1 "

WHO. Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae
type 1. Geneva: World Health Organization; 2005. ISBN 92 4 159233 0.
http://whqlibdoc.who.int/publications/2005/9241592330.pdf

WHO. The treatment of diarrhoea ] a manual for physicians and other senior health workers.
Geneva: World Health Organization; 2005. ISBN 92 4 159318 0.
http://www.who.int/child ]adolescent ]
health/New_Publications/CHILD_HEALTH/ISBN_92_4_159318_0.pdf
.The Interagency Emergency Health Kit 2006
72
WHO. Environmental health in emergencies and disasters. A practical guide. Chapter 11, Control of
communicable diseases and prevention of epidemics. Geneva: World Health Organization; 2002.
http://www.who.int/water_sanitation_health/hygiene/emergencies/em2002chap11.pdf
General public health
MSF. Refugee health: an approach to emergency situations. London: Macmillan; 1997.
ISBN 0 333 72210 8.
http://www.msf.org/source/refbooks/msf_docs/en/Refugee_Health/RH1.pdf

WHO. Environmental health in emergencies and disasters: a practical guide. Geneva: World Health
Organization; 2002. ISBN 92 4 154541 0.
http://www.who.int/water_sanitation_health/emergencies/emergencies2002/en/index.html

UNHCR. Water manual for refugee situations. Geneva: Office of the United Nations High
Commissioner for Refugees; 1992.
Child health
WHO. Child health in emergencies. 2003.
http://www.who.int/child ]adolescent ]health/publications/pubemergencies.htm

WHO. Report of a Consultative Meeting to Review Evidence and Research Priorities in the
Management of Acute Respiratory Infections (ARI). Geneva 29 September ] 1 October 2003.
WHO/FCH/CAH/04.2.
http://www.who.int/child ]adolescent ]
health/New_Publications/CHILD_HEALTH/WHO_FCH_CAH_04.2.pdf
WHO. Technical updates of the guidelines on the Integrated Management of Childhood Illness
(IMCI). Evidence and recommendations for further adaptations. Geneva: World Health
Organization; 2005.
http://www.who.int/child ]adolescent ]health/New_Publications/IMCI/ISBN_92_4_159348_2.pdf
HIV and STIs
IASC. Guidelines for HIV interventions in emergency settings. Inter ]Agency Standing Committee.
Geneva: Joint United Nations Programme on HIV/AIDS; 2003.

WHO. Guidelines for the management of sexually transmitted infections. Geneva: World Health
Organization; 2003. ISBN 92 4 154626 3.
http://www.who.int/reproductive ]health/publications/rhr_01_10_mngt_stis/
International travel and health
WHO. International travel and health. Geneva: World Health Organization; 2005. ISBN 92 4 158036 4.
http://www.who.int/ith/en/
Malaria
WHO. Guidelines for the treatment of malaria. Geneva: World Health Organization; 2006.
ISBN 92 4 154694 8. WHO/HTM/MAL/2006.1108.
http://www.who.int/malaria/docs/TreatmentGuidelines2006.pdf
.References
73
WHO. Malaria control in complex emergencies. An Interagency field handbook. Geneva: World
Health Organization; 2005. ISBN 92 4 159389 X. WHO/HTM/MAL/2005.1107.
http://www.who.int/malaria/docs/ce_interagencyfhbook.pdf
Mental health
WHO. Tool: rapid assessment of mental health needs of refugees, displaced and other
populations affected by conflict and post ]conflict situations. Geneva: World Health
Organization; 2001. MNH/MHP/99.4 rev.1.
http://www.who.int/hac/techguidance/pht/7405.pdf
Nutrition
WHO. Guiding principles for feeding infants and young children during emergencies. Geneva:
World Health Organization; 2004. ISBN 92 4 154606 9.
http://whqlibdoc.who.int/hq/2004/9241546069.pdf
Reproductive health
UNFPA. Inter ]agency reproductive health kits for crisis situations, 3 rd edition. Draft April 2005.

WHO/UNHCR. Clinical management of survivors of rape. Developing protocols for use with
refugees and internally displaced persons. Revised edition. Geneva: World Health Organization;
2005. English: ISBN 92 4 159263 X.
French: ISBN 92 4 259263 3.
http://www.who.int/reproductive ]
health/publications/clinical_mngt_survivors_of_rape/clinical_mngt_survivors_of_rape.pdf

UNHCR. Sexual and gender ]based violence against refugees, returnees, and internally displaced
persons: guidelines for prevention and response. Geneva: Office of the United Nations High
Commissioner for Refugees; May 2003.
http://www.unhcr.ch/cgi ]bin/texis/vtx/protect/opendoc.pdf?tbl=PROTECTION&id=3f696bcc4

UNFPA. Reproductive health for communities in crisis. UNFPA Emergency Response, 2001.
http://www.unfpa.org/upload/lib_pub_file/78_filename_crisis_eng.pdf

UNFPA/UNHCR/WHO. Reproductive health in refugee situations: an interagency field manual.
Geneva: Office of the United Nations High Commissioner for Refugees; 1999.
http://www.unfpa.org/emergencies/manual/
Tuberculosis
WHO. TB/HIV a clinical manual 2004. Geneva: World Health Organization; 2004. 2 nd edition.
WHO/HTM/TB/2004.329.
http://www.who.int/tb/publications/who_htm_tb_2004_329/en/index.html

WHO. Treatment of tuberculosis: guidelines for national programmes. 3 rd edition. Geneva: World
Health Organization; 2003. WHO/CDC/TB/03.313.
http://whqlibdoc.who.int/hq/2003/WHO_CDS_TB_2003.313.pdf

WHO/UNHCR. Tuberculosis control in refugee situations: an interagency field manual. Geneva:
World Health Organization; 1997. WHO/TB/97.221.
http://whqlibdoc.who.int/hq/1997/WHO_TB_97.221.pdf .The Interagency Emergency Health Kit 2006
74
.Useful addresses
75
Annex 11:
Useful addresses
Partners
Ecumenical Pharmaceutical Network
Community Initiatives Support Services International
P.O. Box 73860
Nairobi
Kenya
Tel: +254 20 444 4832/5020
Fax: +254 20 444 5095/444 0306
E ]mail: epn@wananchi.com,
http://www.epnetwork.org/

International Committee of the Red Cross
19 Avenue de la Paix
CH ]1202 Geneva
Switzerland
Tel: +41 22 734 6001
Fax: +41 22 733 2057
E ]mail: www.icrc.org
http://www.icrc.org

International Federation of Red Cross and Red Crescent Societies
17 Chemin des Crêt
Petit ]Saconnex
P.O. Box 372
CH ]1211 Geneva
Switzerland
Tel: +41 22 730 4222
Fax: +41 22 733 0395
E ]mail: secretariat@ifrc.org
http://www.ifrc.org

International Organization for Migration
17 route des Morillons
P.O. Box 71
CH ]1211 Geneva 19
Switzerland
Tel: +41 22 717 9111
Fax: +41 22 7986150
E ]mail: info@iom.int
http://www.iom.int
.The Interagency Emergency Health Kit 2006
76
John Snow, Inc.
JSI Logistics Services
1616 N Fort Myer Drive, 11 th floor
Arlington VA 22209
United States of America
Tel: +1 703 528 7474
Fax: +1 703 528 7480
E ]mail: info@jsi.com
http://www.jsi.com or http://www.deliver.jsi.com

Médecins Sans Frontières
Belgium Office
94 rue Dupré
B ]1090 Brussels
Belgium
Tel: +32 2 474 7474
Fax: +32 2 474 7575
E ]mail: info@msf.be
http://www.msf.be/

Merlin
207 Old Street, 12 th floor
London EC1V 9NR
United Kingdom
Tel: +44 20 7014 1600
Fax: +44 20 7014 1601
E ]mail: www.merlin.org.uk
http://www.merlin.org.uk

OXFAM
Oxfam House
John Smith Drive
Cowley
Oxford OX4 2JY
United Kingdom
Tel: +44 1865 473 727
E ]mail: http://www.oxfam.org.uk/contact
http://www.oxfam.org.uk

United Nations Children’s Fund
UNICEF House
3 United Nations Plaza
New York, 10017
United States of America
Tel: +1 212 326 7000
Fax: +1 212 887 7465
E ]mail: www.unicef.org
http://www.unicef.org
.Useful addresses
77
United Nations High Commissioner for Refugees
Case Postale 2500
CH ]1211 Geneva 2 Dépot
Switzerland
Tel: +41 22 739 8111
Fax: +41 22 731 9546
E ]mail: http://www.unhcr.org
http://www.unhcr.org

World Council of Churches
Christian Medical Commission, Churches’ Action for Health
150 Route de Ferney
P.O. Box 2100
CH ]1211 Geneva 2
Switzerland
Tel: +41 22 791 6111
Fax: +41 22 791 0361
E ]mail: koa@wcc ]col.org;
http://www.wcc ]coe.org

United Nations Population Fund
UNFPA/HRU
11 Chemin des Anémones
CH ]1219 Geneva
Switzerland
Tel: +41 22 917 8315
Fax: +41 22 919 8016
E ]mail: hru@unfpa.org/
Website: www.unfpa.org

World Health Organization
20 Avenue Appia
CH ]1211 Geneva 27
Switzerland
Tel: +41 22 791 2111
Fax: +41 22 791 3111
E ]mail: info@who.int
Website: www.who.int .The Interagency Emergency Health Kit 2006
78
Suppliers
Centrale Humanitaire Médico ]pharmaceutique
4 voie militaire des Gravanges
F ]63100 Clermont ]Ferrand
France
Tel: +33 4 73982481
Fax: +33 4 73982480
E ]mail: contact@chmp.org
http://www.chmp.org

IDA Foundation
Slocherweg 35
1027 AA Amsterdam
PO Box 37098
NL ]1030 AB Amsterdam
The Netherlands
Tel: +31 20 403 3051
Fax: +31 20 403 1854
E ]mail: info@idafoundation.org
http://www.idafoundation.org

Missionpharma
Vassingeroedvej 9
3540 Lynge
Denmark
Tel.: +45 4816 3200
Fax: +45 4816 3248
E ]mail: info@missionpharma.com
http://www.missionpharma.com

MSF ] Supply
Preenakker 20
B ]1785 Merchtem
Belgium
Tel.: +32 52 2610 00
Fax: +32 52 2610 04
E ]mail: office ]msfsupply@msf.be
http://www.msfsupply.be

The Medical Export Group BV
Papland 16
P.O. Box 598
4200 AN Gorinchem
The Netherlands
Tel: +31 183 356 100
Fax: +31 183 356 122
E ]mail: sales@meg.nl
http://www.meg.nl
.Useful addresses
79
United Nations Children’s Fund ] Supply Division
UNICEF Plads
Freeport
DK ]2100 Copenhagen Ø
Denmark
Tel: +45 35 37 35 27
Fax: +45 35 26 94 21
E ]mail: supply@unicef.org
http://www.unicef.org/supply

UNFPA Nordic Office
Procurement Services
Midtermolen 3
DK ]2100 Copenhagen Ø
Denmark
Tel: +45 35 467 000
Fax: +45 35 467 018
E ]mail: nordic.office@unfpa.dk
http://nordic.unfpa.org/

World Health Organization
Procurement Services
20 Avenue Appia
CH ]1211 Geneva 27
Switzerland
Tel: +41 22 791 2111
Fax: +41 22 791 0746
http://www.who.int/

United Nations Development Programme
Interagency Procurement Services Office
Midtermolen 3
P.O. Box 2530
DK ]2100 Copenhagen Ø
Denmark
Tel: +45 35 46 7000
Fax: +45 35 46 7001
E ]mail: registry.iapso@undp.org
www.iapso.org/ .The Interagency Emergency Health Kit 2006
80.Feedback form
81
Feedback form
The purpose of this form is to seek your opinion about the contents of the Interagency
Emergency Health Kit 2006. Any remarks, suggestions or recommendations you may have
are welcomed. We will use your written feedback about the kit during the next revision of its
contents which is planned for 2008. Your input will be acknowledged.

Please send your feedback either by post to WHO, Department of Medicines Policy and
Standards, 20 Avenue Appia, CH ]1211 Geneva 27, Switzerland; or by fax: +41 22 791 4167 or
e ]mail: everardm@who.int

Feedback on the Interagency Emergency Health Kit 2006
Emergency situation
Please describe briefly the situation in which you used the Interagency Emergency Health
Kit 2006.

Date/period and year: ………………………………………………………………...
Country: ………………………………………………………………...
Kind of emergency situation: ………………………………………………………………...
……………………………………………………………………………………………………………
Your qualification and position: ………………………………………………………………...
……………………………………………………………………………………………………………

I. Content of the basic unit

Selected medicines
1. Are the contents of the basic unit appropriate for the needs of the displaced population
in terms of the selected medicines? Yes No
If no, which medicines are inappropriate?:
If no, which medicines are missing?:

Selected renewable medical supplies
2. Are the contents of the basic unit appropriate for the needs of the displaced population
in terms of the selected renewable medical supplies? Yes No
If no, which renewable medical supplies are inappropriate?:
If no, which renewable medical supplies are missing?:

Selected health equipment
3. Are the contents of the basic unit appropriate for the needs of the displaced
population in terms of the selected health equipment? Yes No
If no, which health equipment is inappropriate?:
If no, which health equipment is missing?: .The Interagency Emergency Health Kit 2006
82

II. Content of the supplementary unit

Selected medicines

4. Are the contents of the supplementary unit appropriate for the needs of the displaced
population in terms of the selected medicines? Yes No
If no, which medicines are inappropriate?:
If no, which medicines are missing?:
Selected renewable medical supplies

5. Are the contents of the supplementary unit appropriate for the needs of the displaced
population in terms of selected renewable medical supplies? Yes No
If no, which renewable medical supplies are inappropriate?:
If no, which renewable medical supplies are missing?:
Selected health equipment

6. Are the contents of the supplementary unit appropriate for the needs of the displaced
population in terms of selected health equipment? Yes No
If no, which health equipment is inappropriate?:
If no, which health equipment is missing?:
III. Information

7. Does the booklet IEHK 2006 provide appropriate information and instructions to
understand the emergency health kit 's guiding principles? Yes No
If no, why not?
8. Does the booklet IEHK 2006 provide appropriate treatment guidelines for the use of the
contents of basic units? Yes No
If no, why not?
9. Are all sections of the booklet IEHK 2006 relevant? Yes No
If no, what would you take out?:
If no, what would you like to see included?:
10. Are all annexes of the booklet IEHK 2006 relevant? Yes No
If no, what would you take out?:
If no, what would you like to see included?:
11. Was there any technically inaccurate or incomplete information? Yes No
If yes, what?:
12. What are your 3 suggestions to improve the contents of the kit and the booklet IEHK
2006 for the next update?
1.
2.
3.

Thank you for your feedback.