Emergencies: preparedness and response

Why it is important ?

• Emergencies such as conflicts, disasters or epidemics, expose families to risks that make them especially vulnerable to disease, malnutrition and violence. With the right information and support, families and communities can establish measures that map out what to do in an emergency.
• Girls, boys and women typically are the most affected by emergencies. An estimated 26 million people were displaced by armed conflicts and violence in 2007. Each year, up to 50 million people are displaced due to disasters. Climate change could increase these numbers.
• Displacement undermines families' livelihoods and social support mechanisms. This can lead to family separations and increase children's vulnerability to discrimination, abuse, violence, poverty and exploitation.
• Conflict and disasters put children at risk of disease and malnutrition. Access to health services is reduced, and food shortages are common. Water can become scarce, especially when access is limited by overcrowding and poor sanitary conditions. Children's access to education is often undermined, since schools are frequently targeted for attacks and abductions, and teachers and materials are in short supply. The risk of HIV transmission increases in such contexts.
• In situations of conflict, girls and boys are particularly vulnerable to forced recruitment by armed forces and groups. Along with women, they are also at risk of abduction, trafficking and sexual violence, including rape.
• Epidemics (or outbreaks) of diseases can be caused by emergencies or can by themselves cause an emergency. The emergency can arise because of the severe nature of the disease or the community's response to it.
• A pandemic is a widespread, usually global, epidemic. An influenza pandemic results from a new influenza virus against which the population has little or no immunity. It can spread rapidly across the world and is recurrent and unpredictable. The youngest children, under 2 years of age, are particularly vulnerable to influenza and other infectious diseases.
• Children and their family members have the right to protection and the information and support they may need to prepare for and cope with such complex situations.

What every family and community has a right to know ?

1. In emergencies, children have the same rights as in non-emergency situations. This is true whether the emergency is a conflict, disaster or epidemic.
2. Girls and boys and their families and communities should plan ahead and take simple steps to prepare for emergencies – at home, at school and in the community.
3. Measles, diarrhoea, pneumonia, malaria, malnutrition and neonatal complications are major causes of child deaths, particularly during emergencies.
4. An epidemic (or outbreak) of disease can cause an emergency because of the severity of the disease or responses to it. In the case of pandemic influenza and other diseases spread by close personal contact, those who are ill should be kept separated from others.
5. Mothers, even malnourished mothers, can still breastfeed even under the stressful conditions of emergencies.
6. Children have the right to be protected from violence in emergencies. Governments, civil society, international organizations, communities and families have the responsibility to protect them.
7. It is generally preferable for children to be cared for by their parents or other usual caregivers because it makes children feel more secure. If separation occurs, every effort should be made to reunite the child with his or her family, if it is in the child's best interest.
8. The disruption and stress caused by disasters and armed conflict can frighten and anger children. When such events occur, children need special attention and extra affection. They should be kept as safe as possible and supported in resuming normal activities. Children can be given age-appropriate opportunities to participate in the responses to and decisions regarding the emergency situation.
9. Children have the right to education, even during emergencies. Having children attend a safe, child-friendly school helps to reinforce their sense of normalcy and start the process of healing.
10. Landmines and unexploded devices are extremely dangerous. They can explode and kill or disable many people if touched, stepped on or disturbed in any way. Children and their families should stay only in areas that have been declared safe and avoid unknown objects.

Supporting information

Key Messages - In emergencies, children have the same rights as in non-emergency situations. This is true whether the emergency is a conflict, disaster or epidemic.

• All children and their families and communities have the right to receive humanitarian assistance in emergencies.
• Children and their families who are forced from their homes by conflicts or disasters have the same rights as those living in their homes and communities in non-emergency situations.
• Communities can designate protected areas to shelter civilians and the sick. These areas must never be used for any military purposes.
• Humanitarian relief workers and supplies must always be respected and protected. Combatants should always allow all civilians access to humanitarian assistance.
• The particular needs of women and adolescent girls in emergency situations must be respected. Their specific needs of privacy, hygiene and protection must be taken into account. Unaccompanied children, pregnant women, mothers with young children, female heads-of-households, persons with disabilities and the elderly may require specific attention to address their particular needs.
• When children and families are displaced within a country, the national authorities have the primary responsibility to protect children's rights and assist children and families. The United Nations, non-governmental organizations and the International Committee of the Red Cross (ICRC), among others, also have a critical role to play in providing assistance and protection to children and families.
• Displaced persons have the right to safely return to their homes as soon as the reasons for their displacement are no longer an issue. The property rights of displaced persons must be respected so children and families can rebuild their lives.
• As communities begin to re-establish and reconstruct after an emergency, attention should be given to providing social services, including health and education, to children, women and families.
• Humanitarian workers who provide aid to civilians should minimize opportunities for violence, exploitation and abuse. Any activity by humanitarian workers that exploits the population should be reported immediately to the agency concerned and the authorities.

Key Messages - Girls and boys and their families and communities should plan ahead and take simple steps to prepare for emergencies – at home, at school and in the community.

Within the household, the whole family can prepare for an emergency brought about by a disaster or conflict. Everyone should be aware of the different dangers of fire, earthquakes, floods, storms and other hazards and the risks during conflicts. The response can be more effective when everyone in the family and community knows how to reduce their risks and understands their responsibilities.

The possible dangers and safe areas in and around a community should be identified. If possible they should be shown on a local map. Everybody in the community should be involved and informed. Plans should include how young children, older people and people who are unwell would be assisted.

Community warning systems and evacuation routes for escaping from danger should be well identified and communicated. Communities can hold simulated drills of safety measures with boys and girls in schools and with families in neighbourhoods.

Communities should ensure that health facilities are well built to withstand emergencies and function in their wake. Health-care staff must be trained so they are prepared to act in emergency situations.

It is important for schools to be located in a safe place, close to where children live and away from disaster-prone areas, such as where flooding or mudslides might occur. Schools should be well constructed to ensure the safety of children and teachers. They should be carefully organized to protect children from attacks, abduction or other forms of violence.

Teachers and school administrators can help children, their families and communities to:

• Understand natural hazards and other emergency risks
• Know how to prevent disaster
• Know what to do in an emergency.

Families, including children, should be encouraged to recognize a warning and understand what to do when they see or hear it. A warning or signal can be as simple as a whistle, horn or coloured flag. Safe locations where families can meet should be identified. Safe places for domestic animals should also be identified. These precautions help to prevent family separation.

Children can be trained to memorize their name and the names of their relatives and their village or town. They can be trained to identify geographical indicators or landmarks that might locate their community if they get separated from their families.

A family emergency bag prepared in advance can be life-saving. It should include a torch (flashlight), batteries, candles, matches, radio, water container and first aid kit. The packet should be checked periodically and ready at all times.

Birth certificates and other important family documents should be kept in a safe, easily accessible place. Storing them in plastic wrap helps protect them from water and damage.

Key Messages - Measles, diarrhoea, pneumonia, malaria, malnutrition and neonatal complications are major causes of child deaths, particularly during emergencies.

Infectious diseases spread easily in crowded emergency conditions. To reduce the risks:

• Ensure that all children 6 months to 15 years of age are appropriately immunized, especially against measles, at the first point of contact or settlement
• Continue to seek health-care services to prevent and treat illnesses.

Malnutrition is more common in emergencies due to shortages of food, increased disease and disruption of caring practices. It is therefore important to ensure that children:

• Breastfeed and receive adequate amounts of age-appropriate nutritious foods and drinks
• Receive micronutrient supplements in addition to fortified foods.

Children who are very thin and/or swollen (usually the feet and legs) need to be taken to a trained health worker or health facility for immediate assessment and treatment and further management in accordance with their status.

In emergencies, lack of safe water, sanitation and hygiene can cause disease that may turn into an epidemic. Cholera can occur where there is poor sanitation and overcrowding. Basic steps to follow include:

• Continue to wash hands frequently with soap and water or a substitute, such as ash and water
• Dispose of faeces and garbage safely
• Practice safe food preparation
• Use safe water sources or employ home-based water treatment, such as boiling, filtering, adding chlorine or disinfecting with sunlight
• Store safe water in clean, covered containers.

Key Messages - An epidemic (or outbreak) of disease can cause an emergency because of the severity of the disease or responses to it. In the case of pandemic influenza and other diseases spread by close personal contact, those who are ill should be kept separated from others.

The impact of a disease outbreak depends on the severity of the disease as well as the responses by governments, communities and individuals.

An influenza pandemic, involving a new virus, can spread rapidly through a population that has little or no immunity against the new virus. The influenza might be moderate or severe in terms of the illness and death it causes. The outbreak can come and go repeatedly over time. Its level of severity can change over the course of the pandemic, making it unpredictable. It generally has a greater impact than regular seasonal influenza outbreaks.

Annual or seasonal influenza causes most deaths in people over 65 years of age. An influenza pandemic causes more severe illness and deaths in younger age groups. In both seasonal and pandemic influenza, pregnant women and children under 2 years old are at increased risk of complications and death. Older children have the highest rates of infection but tend not to have severe outcomes.

Influenza symptoms include high fever, cough, sore throat, body aches, headache, chills, fatigue, vomiting and diarrhoea. In some cases, influenza can lead to pneumonia and breathing difficulties.

During an outbreak of influenza or other infection, some general steps to help protect children and families include:

• Stay home if sick, and stay apart from others
• Know the symptoms and danger signs, and what to do and where to go to get help if the illness becomes severe
• Wash hands with soap and water often, and keep surfaces clean
• Cough or sneeze into an elbow or a tissue, and dispose safely of tissues
• Do not spit near children or in public.

In an outbreak of an infection that has serious consequences, it is important to reduce close contact with others:

• Stay at least one metre apart from others, especially if they are coughing or sneezing or look unwell
• Stay at home as much as possible and avoid public gatherings and travel.

In an extensive outbreak, some individuals may need to be isolated in a hospital setting for treatment or to prevent the spread of the infection. But for many people access to care may be limited.

To care for sick people at home and to prevent the spread of the infection in the household:

• Give sick people a separate space at home
• Assign a single caregiver to a sick person
• Give plenty of fluids and foods to the sick person.

Key Messages - Mothers, even malnourished mothers, can still breastfeed even under the stressful conditions of emergencies.

• People often believe that during emergencies many mothers can no longer breastfeed due to stress or inadequate nutrition. This is a misconception – it is not correct. Mothers who lack food or who are undernourished can still breastfeed adequately. They should be given extra fluids and foods to protect their health and well-being and that of the child. Fathers and other family members can support breastfeeding mothers with food preparation and childcare.
• Stress can temporarily interfere with the flow of breast milk. But it does not need to stop breast milk production, if mothers and infants remain together and are supported in initiating and continuing breastfeeding. Safe havens, as in refugee camps and shelters, can be established where women can go to receive support.
• In some cases breastfeeding is not possible. These include children temporarily or permanently separated from their mothers, mothers who are very sick, mothers who have stopped breastfeeding for some time, mothers who have not been able to restart breastfeeding, and HIV-positive mothers who have chosen not to breastfeed.
• In these situations, for children under 12 months, the most appropriate food is a high-quality breast milk substitute (infant formula). Safe preparaton of the breast milk substitute requires fuel, safe water and equipment, and preferably the guidance of a trained health worker. The breast milk substitute should be stored and prepared under hygienic conditions with water from a safe source, using a cup, not a bottle.
• Breast milk substitutes should never be distributed in an uncontrolled manner alongside food aid and without attention to the conditions required for safe preparation. They should not displace breastfeeding, a baby's best protection against illness in an emergency situation.

Key Messages - Children have the right to be protected from violence in emergencies. Governments, civil society, international organizations, communities and families have the responsibility to protect them.

• Protecting girls and boys during conflicts or disasters is critical since they can be vulnerable to many kinds of violence.
• Some violence is directly related to the emergency. This includes abduction, torture, beating, harassment and injuries during fighting by soldiers or armed groups or fighting in communities over limited resources. Emergencies also increase the usual risks of violence in a community, such as domestic violence, violence in schools or violence among children themselves.
• Girls and women are at particular risk of trafficking and sexual violence, including rape, which is sometimes used as a tactic of war. This is unacceptable. All efforts should be taken by governments and local authorities to make sure this never happens. Girls and women who are subjected to this violence need health care, psychosocial support and counselling. Some will need support in relocating and reintegrating into their families.
• In armed conflicts, children must be protected. They must not be recruited by armed forces or armed groups or be allowed to take part in fighting. If children are arrested, they should not be harmed. They should be kept separate from adults (or with their family), and they must receive a fair trial. If girls or boys are victims of violence, they have the right to seek justice that takes their views into account.
• It is important for children and families to report violations against children's rights to the authorities when it is safe to do so. Serious violations of children's rights, including killing children, using children as soldiers, sexual violence against children and abduction of children, should be reported to international humanitarian agencies.

Key Messages - It is generally preferable for children to be cared for by their parents or other usual caregivers because it makes children feel more secure. If separation occurs, every effort should be made to reunite the child with his or her family, if it is in the child's best interest.

• In emergencies, it is the duty of the government or the authorities in charge to ensure that children are not separated from their parents or other caregivers.
• If separation occurs, the government or authorities in charge have the responsibility to provide special protection and care for these children. They should first register all unaccompanied, separated and orphaned children and make sure their essential needs are met.
• Every effort should then be made to find the child's family and to reunite the child with his or her family, if it is in the best interest of the child.
• Interim care must be provided for children separated from their families. Where possible this can be provided by the child's extended family or by a family from the child's community until the child is reunited with parents or relatives or placed with a foster family. Every effort should be made to keep siblings together.
• If a child is temporarily placed in a foster family, it is the duty of those responsible for the placement to follow up on the child's care and well-being. They should also ensure that the foster family is provided with the means to adequately care for the child.
• Children who have become separated from their parents in an emergency cannot be assumed to be orphans. They are not available for adoption. As long as the fate of a child's parents and/or other close relatives cannot be determined, each separated child must be assumed to have parents and/or close relatives who are still living.
• Long-term care arrangements should not be made during an emergency. After a suitable period of investigation, if parents or relatives cannot be traced or are not available to care for the child, a foster family or domestic adoptive family, preferably in the child's community, should be found for the child. Childcare institutions or orphanages should always be considered a temporary measure and a last resort.
• A move to a new community or country can be stressful, especially if the child's family has fled violence or a disaster. Displaced children sometimes may have to learn a new language and culture. Often, schools and community organizations can assist children and their families with the transition and integration into their new community.

Key Messages - The disruption and stress caused by disasters and armed conflict can frighten and anger children. When such events occur, children need special attention and extra affection. They should be kept as safe as possible and supported in resuming normal activities. Children can be given age-appropriate opportunities to participate in the responses to and decisions regarding the emergency situation.

It is normal for children's feelings and behaviours to be affected by frightening, painful or violent experiences. Children react differently – they may lose interest in daily life, become more aggressive or turn very fearful. Some children who appear to be coping well are hiding their emotions and fears.

Parents or regular caregivers, peers, teachers and community members are an important source of support and security for children. Families and communities can help children if they:

• Listen to both girls and boys and provide them opportunities to express their concerns, participate in decision-making and find solutions
• Provide children with age-appropriate information, reassurance and emotional support
• Maintain familiar routines in daily life and resume normal activities as soon as possible
• Provide enjoyable age-appropriate activities for children such as cultural activities, visits to friends and families, and sports
• Encourage children to continue to play and socialize with others
• Provide children with age-appropriate opportunities to participate in meaningful ways in everyday activities and in the emergency response, such as assisting with teaching and caring for young children
• Maintain clear rules for acceptable behaviour and avoid physical punishment
• Provide safe spaces where children and parents can socialize, learn life skills and access basic services
• Help children learn how to manage their stress.

When children's stress reactions are severe and last for a long time, they need help from a qualified professional such as a counsellor, psychologist or specialized nurse or doctor.

Key Messages - Children have the right to education, even during emergencies. Having children attend a safe, child-friendly school helps to reinforce their sense of normalcy and start the process of healing.

Regular routines, such as going to school and maintaining normal eating and sleeping schedules, give children a sense of security and continuity.

Child-friendly schools and spaces can provide a protective and safe learning environment for all children coping with an emergency.

With support from families and communities, teachers and school administrators can help:

• Provide a safe, structured place for children to learn and play
• Identify children who are experiencing stress, trauma or family separation and provide basic psychosocial support
• Provide a daily routine and a sense of the future beyond the emergency
• Ensure that children retain and develop basic literacy and numeracy skills
• Provide children with life-saving health and security information and skills to reduce their risks
• Provide a place for expression through play, sports, music, drama and art
• Facilitate integration of vulnerable children into the school and community
• Support networking and interaction with and among families
• Provide children with an understanding of human rights and skills for living in peace
• Build awareness with children on how to protect the environment and develop their skills to reduce disaster risks
• Encourage children to analyse information, express opinions and take action on particular issues important to them.

Teachers require support and training to understand and deal with children's and their own stressful experiences, losses and reactions to emergencies. They need to know how to give emotional, mental and spiritual support to students and guide families on how to do the same with their children.

Schools and communities can also help to organize fun activities for children outside of school time. Opportunities can be created for organized non-violent play, sports and other forms of recreation. Communication and interaction among peers should be encouraged and supported. Use of arts such as drawing, or playing with toys or puppets, can help young children express their concerns and adjust to stressful experiences.

Parents and other caregivers should keep children who become sick with the flu or other infectious disease at home or in their place of residence if displaced from their homes.

In case of a severe epidemic that spreads rapidly from person to person, local authorities and education personnel need to make appropriate decisions regarding how to protect children. As a public health measure, classes may be suspended to reduce spread of the disease. In such cases, education can still continue by using alternative strategies. This requires good planning and follow-up by education personnel in collaboration with the students' families.

Key Messages - Landmines and unexploded devices are extremely dangerous. They can explode and kill or disable many people if touched, stepped on or disturbed in any way. Children and their families should stay only in areas that have been declared safe and avoid unknown objects.

Landmines are victim-activated explosive devices intended to kill or injure people or destroy or damage vehicles. Unexploded ordnance (called UXO) are any munitions, such as bombs, shells, mortars or grenades, that were used but failed to detonate as intended.

Both landmines and UXO come in many different shapes, sizes and colours. They can be buried underground, placed above ground or hidden in grass, trees or water. They may be bright and shiny or dirty and rusty, but they are always dangerous and must be avoided at all times.

Landmines are usually not visible. Special caution is needed near areas of military action or abandoned or overgrown areas. Dangerous areas are often designated by a marking such as a picture of a skull and crossbones, red painted stones or other common markings that draw attention and are easily recognized as hazard warnings by the local population.

UXO are often easier to see than landmines. Their colour and shape make them attractive to children, but they are extremely dangerous and unstable. They can explode with the slightest touch or change in temperature. They kill more often than do landmines.

Children should be taught not to touch unfamiliar objects. They need to learn that if anything looks suspicious they should keep away and inform adults they know or the authorities.

Since some roads may be mined or littered with explosive remnants of war, it is important for families to ask local people which roads or paths are safe to travel. Generally it is safer to travel on commonly used roads and paths.

Places likely to have mines, UXO or abandoned weapons and ammunition include abandoned or destroyed buildings, unused paths or roads, untouched and overgrown fields, current or former military bases, outposts, checkpoints, trenches or ditches. Children and their families need to be informed to stay away from these areas. Measures should be put in place to keep them away.

Children and their families need to learn what to do if they see a mine or UXO. They should:

• Stand still and tell others nearby to do the same
• Avoid panicking
• Avoid movement
• Call for help
• If help does not come, carefully consider the options before moving to retrace the original steps backwards very slowly.

If a landmine or UXO injury occurs:

• Apply firm pressure to the bleeding area until the bleeding stops
• If the bleeding is not stopping, tie a cloth or piece of clothing (a tourniquet) just above or as close to the wound as possible and send for medical assistance
• If help is delayed more than one hour, loosen the tourniquet hourly to check the bleeding; remove the tourniquet when the bleeding stops
• If the person is breathing but unconscious, roll the person onto his or her side so the tongue does not block breathing
• Seek follow-up medical care, as needed.

Governments and local authorities have the responsibility to make communities safe for all children and families. Professional demining is the best solution to ensure the safety of all.

Source: UNICEF