HUMANITY IN ACTION

Rapid Multi-Sector Needs

Assessment
Country, Date

1. General information
Country Programme: Assessment date:
Governorate District Municipality

Village/
Latitude (Y) Longitude (X)
Settlement

3. Background:
Describe the region affected, the type of emergency and the major impacts of the emergency. (i.e.:
What happened? Who and how many people were affected? Where was the damage? Response to
the emergency to date?

Reason for Assessment:

Summary of Assessment:

Safety Considerations:

Constraints (logistics, legal, etc):

Is a HUMANITY IN ACTION Intervention Recommended?

Is a Follow Up Assessment Recommended?

Assessment team members (name and position):

Informants (key informants, groups consulted, households). Should include, Government, UNHCR,
IOM, large NGOs intervening, and if possible, Focus Group Discussions with Beneficiaries if
allowed:

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Sources of secondary information:

4. Population data
Affected population (count)
Families Female Male Children under 5 Total population

IDPs present?  Yes  No if Yes how many (HH): ___________________________

Refugees present?  Yes  No if Yes how many (HH): ___________________________

Village/
Country Governorate District
Settlement
IDPs
If yes,
what is
their Refugees
origin? (Primary
displacement)
Refugees
(Secondary
displacement)
4.1 Vulnerable groups
Pregnant Female
Unaccompani Unaccompanied Severe Chronically Acute
and lactating headed
Count ed elders minors disability ill PTSD
women households
of
persons

5. Access
Accessible by road  No By:  Car  4WD  5 MT Truck  25 MT Truck
Travel time to municipality administrative center:
Government permit required:  Yes No

6. NFI
General assessment:

Which of the below are needed

 Mattresses  Clothes (winter)
 Buckets  Hygiene kits
 Jerry can  Plastic Sheeting
 Heating stoves (winter)  Blankets
 Cooking stoves  Cooking sets

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7. Shelter and Accommodation
General assessment:

Total number of families

Unfinished
Collective
In the open In tents /Abandoned With host families
Shelters
building

Collective shelter condition: Very good Good Moderate Poor Extremely poor
Host family shelter condition: Very good Good Moderate Poor Extremely poor

8. Food Security and Livelihoods

General assessment:

Average expected duration of household food stocks

0  1 day  1 week  1 month
Sources of food available in village
 Humanitarian distribution  Household garden/farm  Community support
 Household stocks  Shops or market

9. Water supply
General assessment:

Availability to population:  0%  25%  50%  75%  100%

Primary village water source: Condition:
 Well  Working
 Stream/river  Damaged
 Storage container  Contaminated
 Piped water system  Destroyed
 Humanitarian Supplies Time necessary to fetch water in hrs:
 Other ____________

10. Sanitary facilities

General assessment:

Population with access to functioning sanitary facilities:  0%  25%  50%  75%

100%
Functioning sanitary facilities: Access to facilities:
 Inside toilets  Adequate
 Latrines  Inadequate
 None

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11. Health
General assessment:

Main health concerns: Availability of medicines/medical supplies:

 Diarrhea  Infections  Adequate
 Vomiting  Dehydration  Basic
 Respiratory  Inadequate
 Trauma
Functioning health facilities:
 Primary Health Care without Doctor  Hospital
 Primary Health Care with Doctor  None

13. Main needs of the affected population - Please prioritise needs for each sector.
Shelter Nutrition Health
 High  Med  Low  High  Med  Low  High  Med  Low
Protection WASH NFI
 High  Med  Low  High  Med  Low  High  Med  Low

14. Recommendations for programming (short description)

TARGET GROUP:
(Criteria, size, location.)

SECTOR OBJECTIVE:
(Protection, water & sanitation, food
security, shelter & NFIs, construction,
MRE and clearance etc)

ACTIVITIES: 1.
2.
3.
4.
RESOURCES REQUIRED:
(Human resources, material resources,
logistic means, agreements needed,
budget.)
RISKS AND ASSUMPTIONS: