NNN Resource Guide for Conflict and Humanitarian Emergencies

The Neglected Tropical Disease NGO Network (NNN) resource guide for conflict and humanitarian emergencies was developed by the NNN Conflict and Humanitarian Emergency Cross Cutting Group to support NGOs to learn more about neglected tropical disease (NTD) programming in areas affected by conflict and humanitarian emergencies.

The NNN resource guide for conflict and humanitarian emergencies aims to highlight the challenges and risks associated with working in areas affected by conflict and humanitarian emergencies and to make resources on this topic more accessible.

The resources included in this guide specifically relate to conflict and humanitarian emergency settings and were compiled by the NNN Conflict and Humanitarian Cross Cutting Group. The resource guide is not comprehensive and other resources, including the NNN beginner’s guide to field communications, ILEP/NNN stigma guides and WHO/NNN WASH/NTD toolkit will also benefit organisations working in these settings and should be used.

This resource guide will be updated periodically by the NNN Conflict and Humanitarian Emergency Cross Cutting Group. If you have any questions or would like to add resources to this resource guide please contact Angelia Sanders (angelia [dot] sanders [at] cartercenter [dot] org) or Tim Jesudason (ictccomms [at] gmail [dot] com).

1. Getting started

Working in areas affected by conflict and humanitarian emergencies requires tailored and targeted approaches that are often considered to be a major hurdle for NGOs. Settings can vary significantly across refugee camps, internally displaced persons camps, protection of civilian camps, unofficial camps and other post conflict or emergency situations. When getting started, organisations should identify the setting and its physical and health system structures, conduct a situational analysis, contact key stakeholders, and identify what formal agreements are required to work in the targeted setting.

Identify the setting you are considering working in

Settings can vary significantly. Refugee camps, internally displaced persons camps, protection of civilian camps, unofficial camps or a combination of these will have different structures that will influence the partnerships needed and the appropriate design of NTD activities. The reason behind the formation of the camp (i.e. conflict versus natural disaster) can also affect the structure and permissions needed to work within the setting.

Conduct a situational analysis

Understanding disease prevalence is critical to determine the interventions needed. Organisations should identify whether disease prevalence surveys have been conducted and what further evidence needs to be generated in order to move forward with disease intervention strategies.
In many settings, other programmes will be operational, providing opportunities to share data and potentially integrate interventions into existing programmes. Organisations should identify whether any integrated health programmes are active in the targeted area.
Organisations should identify whether implementing NTD activities could undermine more critical activities by inadvertently redirecting financial, human or logistical resources away from critical work.
In many settings, health systems might already be in place to support affected communities. Organisations should identify whether a health system is in place, how it operates, and what restrictions exist that would affect implementation.

Engage key stakeholders

In many humanitarian emergencies, settings will be managed by a UN agency. Organisations should identify and contact the managing UN agency (UN cluster lead) in order to identify themselves and learn what permissions must be obtained and what processes must be followed in order to implement NTD activities. Organisations should not assume that all settings/camps will be managed the same way.
Identify which government ministries are involved in conflict and humanitarian emergency settings as this is likely different from the NTD department working in typical village environments. The government may have specific rules governing the work done with displaced populations, especially in camp settings.
In many settings, other programmes will already be operating. Organisations should identify and contact lead NGO organisations to share information, gain insights about working in these settings, ensure programmes do not undermine each other. Based on the information gathered, organisations should determine if a coordinated approach would be ideal.
Identify and contact other non-governmental groups that work within these settings. Gaining their permission may be required before work can safely and effectively be conducted. This might include rebel groups, community groups, tribal councils, religious leaders, etc.

Identify formal agreements needed to work in each setting

It is important to understand that an organisation’s desire to implement activities does not guarantee that permission will be given by relevant agencies and/or ministries.
Organisations should identify what formal agreements are required and with what partners/agencies/ministries and produce a flexible timeline to complete these important administrative tasks.
In some cases, a Memorandum of Understanding will be required prior to commencing work. This can be time consuming and should be factored into programme planning.

Resources for getting started

Resource	Author	Key sections
UNHCR emergency handbook: setting strategy	United Nations High Commissioner for Refugees (2015)	The setting strategy is a component of the UNHCR Emergency Handbook. It includes sections such as accountability to affected people, evaluations of emergency operations, and inter-agency refugee response plans.
Information management toolkit	United Nations High Commissioner for Refugees (2015)	The Information Management Toolkit provides information and data management advice and tools meant to inform a coordinated humanitarian response during the first two to four months of a refugee emergency. The guidance provided is relevant and useful in a broader range of operational settings.
Disaster summary sheet armed conflict	acaps (2012)	This disaster summary sheet (DSS) provides a general profile of the potential impact of an armed conflict on important development issues, including health and WASH. The DSS helps understand what the actual impact and priority needs during an armed crisis may be, based on experience and lessons learnt from previous crises.
Malaria control in humanitarian emergencies: an inter-agency field handbook	World Health Organization (2013)	This handbook includes best practices for malaria programmes in humanitarian emergencies. Components of the handbook include coordination. mechanisms, assessment and operational planning, surveillance, outbreaks, case management, prevention, community participation, operational research and associated routine monitoring.
UNHCR emergency handbook coordination and partnerships	United Nations High Commissioner for Refugees (2015)	Coordination and partnerships is a component of the UNHCR Emergency Handbook. It includes sections such as civil - military coordination, coordination skills, methods and good practices, international humanitarian and development coordination architecture and MoUs and LoUs with UN agencies and NGOs.
Lessons learnt from coordinating emergency health response during humanitarian crises: a case study of implementation of the health cluster in northern Uganda	Journal Article: Olu et al. 2015. Conflict and Health.	This journal article explores issues which are important for strengthening health coordination during humanitarian crises.
Humanitarian negotiations revealed: the MSF experience	Medecins Sans Frontieres (2012)	This article explores the negotiation process to operate health services during the Sri Lankan civil war.
Tuberculosis: care and control in refugee and displaced populations	World Health Organization/United Nations High Commissioner for Refugees (2007)	This manual provides guidance to humanitarian agencies on the implementation of effective TB programmes for refugee and displaced populations.

2. Understanding the context

Implementing NTD programmes in areas affected by conflict and humanitarian emergencies requires tailored approaches that allow partners to adapt and respond to local contexts. All organisations exploring programmes in these settings should identify key factors that might inform programme design and implementation. This might include developing a calendar of events that affect targeted populations with information about daily routines such as work, school and travel. Other programmes, such as food distributions or vaccine campaigns, should also be identified. Furthermore, seasonal factors, religious holidays and school holidays can also affect usual routines and may impact programme implementation.

Organisations should identify existing “implementation systems” for health and welfare services. In many settings, particularly refugee or internally displaced persons camps, NTD activities might be required to work within existing systems. This could provide an opportunity to integrate with other programmes or benefit from data already gathered.

Lastly, when determining the context in which your organisation will be implementing the NTD programme, it is important to consider any implementation challenges that could be connected to local and external politics, security, infrastructure, supply chain changes, and financial costs. Identifying these challenges during the programme conception stage and in conjunction with others already operating in the environment will improve the likelihood of success.

Local Context

Develop a calendar of events since daily routines of people in areas affected by conflict and humanitarian emergencies will affect how programmes are implemented. Organisations should identify common daily routines, such as work, school and travel hours.
Other programmes might be operating among the same target populations, which will likely affect planned NTD activities. Other programmes and the timing of their implementation, including health or food distribution programmes, should be identified to either avoid interference or identify opportunities to coordinate.
Different groups might have different religious or cultural events that will affect if/when the group is available. This should be considered in the programme design.

External context

External factors, such as the wet or rainy season, can cause significant changes to the daily routine of the target populations. Organisations should consider all seasonal factors and other external events that might affect implementation.
Organisations may want to consider adding in political uprisings/elections/overall security of the area where the programme is to be implemented.

Resources for understanding the context

Resource	Author	Key sections
Considerations for implementing mass treatment, active case‐finding and population-based surveys for neglected tropical diseases in the context of the COVID-19 pandemic	World Health Organization (2020)	This document provides a decision-making framework for implementation of mass treatment interventions, active case-finding campaigns and population-based surveys for neglected tropical diseases in the context of the COVID-19 pandemic
Operational portal: refugee situations	United Nations High Commissioner for Refugees	The refugees operational portal is a partners coordination tool for refugee situations provided by UNHCR.
COVID-19 and humanitarian crises	Johns Hopkins Center for Humanitarian Health Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine Geneva Centre of Humanitarian Studies, The Graduate Institute of International and Development Studies and the University of Geneva (2020)	Humanitarians in the field are creating new COVID-19 programmes, and adapting existing ones, to continue life-saving services in the safest manner possible while reducing COVID-19 transmission. This open-access web-based platform promotes the exchange of field-based COVID-19 programme adaptations and innovations, facilitating learning among organisations in different sectors and contexts.
Refugee/IDP algorithm: Zithromax requests for trachoma MDA	International Trachoma Initiative/Task Force for Global Health (2018)	This flow chart helps to determine inclusion of refugee & IDP communities in annual Zithromax® requests for trachoma Mass Drug Administration:
Project planning in UNHCR: a practical guide on the use of objectives, outputs, and indicators	United Nations High Commissioner for Refugees (2002)	This guide aims to provide practical guidance on the formulation of Objectives, Outputs and related Indicators that: are meaningful for field operations; focus team efforts on beneficiaries and changes in their conditions; respond to the main types of operational design problems UNHCR teams address; help UNHCR and its implementing partners manage the transition to more results-based programming; and integrate policy priorities into objectives, outputs, and indicators.
Humanitarian response plan 2020 - South Sudan	United Nations Office for the Coordination of Humanitarian Affairs (2019)	This document provides a shared understanding of the humanitarian crisis in South Sudan, including the most pressing humanitarian need and the estimated number of people who need assistance. It represents a consolidated evidence base and helps inform joint strategic response planning.

3. Community engagement

All health programmes must be appropriately adapted and made accessible to the needs of the people they are designed to benefit. Organisations should engage communities early in programme conception to ensure that interventions are sensitive to social and cultural practices and to understand the experience (good and bad) the target community has with past health campaigns and whether lessons can be learned. Community engagement is particularly important when implementing programmes in areas affected by conflict and humanitarian emergencies, where communities are particularly vulnerable.

Organisations should partner with community leaders to ensure that programmes are designed appropriately for the local context and to earn their trust and support. Organisations should also look for opportunities to engage community members. This could include training members from the community to assist in implementation in order to build local capacity.

It is essential that all materials are developed in the local languages of people targeted by the programme. Communities should be sensitised prior to implementation to ensure the planned interventions are understood and to dispel any rumours or distrust in the programme.

Develop relationships with local communities

Determine what the community prioritises in health programmes. Identify gaps in knowledge and develop culturally competent strategies to address them.
Partner with known key stakeholders such as chiefs, religious leaders, disability groups, local government officials, etc., to identify social and cultural factors that might affect implementation and community buy-in. This can be accomplished through community dialogues, brief interviews, etc.
Identify ways that the community can be involved in the programme. This might include routine sharing of information through dissemination workshops or ensuring that individuals from the community are trained and asked to play an active role in delivering interventions.
Ensure that all stakeholders are aware of and can provide input into programme planning if they chose to. Additionally, ensure that the community is informed of programme outcomes.

Identify challenges and barriers to implementation

Determine if factors such as temporary economic migration in and out of camps might affect the timeline for programme implementation.
Organisations should ensure that all printed materials are available in locally spoken languages and that recipients understand both what the programme entails and its expected outcomes. If required, oral translation should be provided.
Design strategies for sensitising the community that ensure maximum reach. This includes identifying local, preferred communication channels that may include radio announcements, town criers, announcements at religious services, written announcements at the health center, etc. Communication messages should be written in language that is clear, concise, and does not include significant jargon.
Be mindful of community distrust of “new” interventions, especially those involving drugs and surgery. Additional time might be required to fully explain the nature of your planned interventions and dispel any community fears. As with program implementation in traditional settings, no one should be pressured or forced to participate or engage if they do not want to.
Identify a neutral location for planned interventions. Be considerate of factors that may systematically exclude portions of the population from choosing to participate such as disability, gender, religion, tribe etc.

Resources for community engagement

Resource	Author	Key sections
UNHCR emergency handbook: partnering with communities	United Nations High Commissioner for Refugees (2015)	This component of the UNHCR emergency handbook addresses partnering with communities. Components include accountability to affected people, age, gender and diversity, community based protection and social media in emergencies.
Promoting treatment adherence for refugees and persons of concern in healthcare settings: tips for health workers	United Nations High Commissioner for Refugees (2019)	This guide provides practical recommendations to improve adherence to treatment for chronic communicable diseases, NCDs and MNS disorders for refugees and other persons of concern to UNHCR.
Malaria checklist: quick distribution long-lasting insecticide treated nets in refugee situations	United Nations High Commissioner for Refugees (2018)	This checklist supports UNHCR operations to prevent and reduce malaria through the distribution of long-lasting insecticide treated nets.
Effective and respectful communication in forced displacement	United Nations High Commissioner for Refugees (2016)	This document provides guidance on dealing with and managing stress and emotions, enabling staff to treat persons of concern with dignity and empathy, and to further facilitate and strengthen effective communication.

4. Security and participant safety

The safety of staff and communities is important to all NTD programmes. All organisations must abide by safeguarding standards to protect children and vulnerable populations from any forms of exploitation. Working in areas affected by conflict and humanitarian emergencies can increase associated risks to the safety and security of staff and vulnerable communities. This must be considered at all parts of the programme cycle, from planning, implementation to monitoring and evaluation.

Different contexts will affect staffing challenges and security protocols. For example, organisations should consider whether the tribe of a staff member limits where they can go - this is especially important where there is fighting along ethnic lines. Organisations should also consider if the local language is understood by staff, as this can affect their ability to react to security challenges.

Safety protocols and emergency response plans should address consequences of severe adverse events during programme implementation; the impact of NGO branding on security either through affiliation of the organisation or perception of high value assets (people and objects). Organisations should also consider if there are colours or political language that should be avoided. Engaging communities will often be a key step in identifying this context specific knowledge.

Identify how the context will affect security

Different settings have associated risks for staff security. Areas affected by conflict might require an increase or decrease in the number of staff members, staff with specialized skills, staff of specific genders or tribes, etc.
Depending on the setting, it may be essential to engage local security forces or government officials in order to ensure staff members’ security. Additional training might be required to operate in higher risk environments.
Determine if the area is secure enough for programme planning. For example, if the humanitarian emergency is connected to extreme weather are additional after effects (flooding, aftershocks etc) expected? If there is active fighting, should implementation be delayed to a later time or location?

Staff security plan

Identify existing organisational protocols and determine if they need to be adapted for a conflict and humanitarian emergency setting.
Determine if security specific staff are needed to support the organisation and programmes.
Develop an emergency response plan before beginning activities.
Organisations should consider how severe adverse events might be perceived in areas affected by conflict and humanitarian emergencies and have detailed plans to ensure the security of staff.

Participant safety

NTD programmes have an obligation not only to provide benefits to populations, but also to minimise harm to individuals. Severe adverse events can significantly undermine the success of programmes and should be minimised through programming planning.
Due to population movement from areas with varying endemicity of NTDs, there may be increased potential for severe adverse events and protocols should be in place to ensure the safety of patients (most notably those traveling from Loa Loa endemic areas and receiving treatment for onchocerciasis).

Related resources for security and patient safety

Resource	Author	Key sections
UNHCR emergency handbook: civil - military coordination	United Nations High Commissioner for Refugees (2015)	This component of the UNHCR emergency handbook addresses humanitarian operations in areas affected by armed conflict and the essential interactions and dialogue that should take place with military forces in order to gain access to persons of concern and deliver vital humanitarian assistance.
IASC non-binding guidelines on the use of armed escorts for humanitarian convoys	Inter-Agency Standing Committee (2013)	This guide was created to assist a wide range of actors on when and how to use military or other forms of armed escorts to accompany humanitarian convoys.
UNHCR emergency handbook: staff well-being	United Nations High Commissioner for Refugees (2015)	This component of the UNHCR emergency handbook addressing staff well-being. Sections include addressing staff grievances, coping with stress, dealing with critical incidents and trauma and getting ready for deployment among others.
The heightened risk identification tool user guide	United Nations High Commissioner for Refugees (2008)	This tool was developed to enhance UNHCR’s effectiveness in identifying refugees at risk by linking community-based / participatory assessments and individual assessment methodologies.
Protection Starter Kit	United Nations High Commissioner for Refugees (2020)	This compilation of basic protection and protection-related documents brings together key documents that all staff who are undertaking protection activities on behalf of UNHCR should be familiar with.

5. Programme/research planning

The programme planning stage is a critical step for organisations seeking to work in areas affected by conflict and humanitarian emergencies. Utilising evidence generated in other steps, organisations should develop comprehensive programme plans. Planning should include a detailed budget plan, protocol to ensure participant safety, security, data processes, and communications.

Budget planning

NTD programmes in areas affected by conflict and humanitarian emergencies need to be flexible. Programme delays are common which can affect budget plans. This should be incorporated into budget planning.
In areas with other programmes operating, organisations should consider aligning salaries or other payments, such as per diems, with other organisations to avoid undermining partners or having dissatisfied short-term workers when those same workers support more than one programme. This should be clearly communicated before implementation of activities begin to avoid confusion or unrest once activities are scheduled to start.
Organisations should identify what resources are available in the setting and what resources might need to be provided by the programmes. For example, organisations should assess if consistent water sources are available close to implementation sites.
Banking systems and payment processes may be different in conflict and humanitarian emergency settings; therefore, it is important to identify how payments will be made in a timely manner before beginning activities.

Data sharing

A plan should be in place to ensure the security of data, especially where names of programme recipients are included. This is especially true in security settings where camp residents are at risk of violence.
Organisations should identify who programme reports should be shared with. This might be a UN health cluster, other UN organisations, or certain government ministries beyond the Ministry of Health.
All organisations should ensure data storage follows ethical data protocol.

Make a communications plan

Engage communications teams to identify any communications policies in place.
Organisations must gain consent prior to taking photographs or conducting interviews. This is often done through a consent form. Organisations should ensure consent forms or other processes are properly understood by the people being interviewed or photographed.
Organisations must consider the safety and well being of people being photographed or interviewed. Organisations should consider removing the names and locations of people and consider any unintended consequences of participating in communications activities so that participants are not endangered. People should be comfortable and know that treatment is not dependent on them participating in communications activities.

Resources for programme/research planning

Resource	Author	Key sections
Guidelines for implementing interagency health and nutrition evaluations in humanitarian crises	United Nations High Commissioner for Refugees (2007)	This document aims to improve the collective humanitarian response of agencies and other stakeholders in the health and nutrition sector.
UNHCR emergency handbook: information management	United Nations High Commissioner for Refugees (2015)	This component of the UNHCR emergency handbook addresses information management. Sections include: emergency information management strategy, operational data portal, records management and the ‘who’s doing what where’ 3W information management tool.
Information management toolkit	United Nations High Commissioner for Refugees (2015)	The information management toolkit is structured to present UNHCR information and data management advice and tools meant to inform a coordinated humanitarian response during the first two to four months of a refugee emergency. The guidance provided is relevant and useful in a broader range of operational settings.
Centre for Humdata Guidance	The Centre for Humanitarian Data	The Centre for Humanitarian Data is focused on increasing the use and impact of data in the humanitarian sector. This resource provides practical tips and guidance for data collection and use.
Field guide to humanitarian mapping	MapAction (2011)	This field guide was produced by MapAction to help humanitarian organisations to make use of mapping methods using Geographic Information Systems (GIS) and related technologies.
GPS for emergencies	MapAction (2010)	This document is a short guide for humanitarian field workers on collecting data using GPS.
Effective and respectful communication in forced displacement	United Nations High Commissioner for Refugees (2016)	This document provides guidance on dealing with and managing stress and emotions, enabling staff to treat persons of concern with dignity and empathy, and to further facilitate and strengthen effective communication.
UNHCR emergency handbook: Media	United Nations High Commissioner for Refugees (2015)	This component of the UNHCR emergency handbook addresses communications. Sections include: external updates and fact sheets, multimedia content gathering, social media in emergencies, video conferencing and live streaming.

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NNN Resource Guide for Conflict and Humanitarian Emergencies

1. Getting started

2. Understanding the context

3. Community engagement

4. Security and participant safety

5. Programme/research planning

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