DRAFT: Multi Cluster Rapid Assessment Template* MULTI CLUSTER RAPID ASSESSMENT Natural Disaster Scenario, Natural Disaster

Scenario
1. Assessment team information
Organizations participating

Version 13 May 2011

Date(s) of assessment (DD-MM-YYYY) Contact Details: Email: Contact details Email(s):

Name of team leader/member: Phone number(s): Number of days since emergency event occurred: ________ Name of enumerator Phone number(s)

2. Geographic information
Province Barangay/sitio/purok Person interviewed ( tick all that apply): Local Official specify:____________ Camp /Evacuation Center Director Local Health/Nutrition Worker Name of Person interviewed: Municipality/City GPS Coordinate (Decimal Degree)

Community Member Informal leader Local Social Worker

Local Police Official School Teacher Volunteer Contact Details:

Other: ___________________

3. Demographic data
3.1 Total population of site Barangay or location visited/assessed/inspected
Individuals Households Children (<5) M F Children (5-17) M F Adult (18-59) M F Adults (>60) M F

3.2 Number of affected population with this Barangay or location

Individuals Households Children (<5) M F Children (5-17) M F Adult (18-59) M F Adults (>60) M F

3.3.1 Number of Affected Families Inside the ECs: ______________ 3.3.2 Number of Affected Persons Inside the ECs:_______________ 3.4 Number of Vulnerable and Displaced groups: Vulnerable Groups Number Affected 1. Pregnant Women 2. Persons with Disability 3. Elderly 4. Children 5. Indigenous Peoples 6. Other 3.5. Number of people that are dead, missing, or injured due to the disaster event Deaths Adults Male Female Children Male Female Adults Male Female Missing Children Male Female Adults Male Female Injured Children Male Female

Multi-Cluster Rapid Assessment as of 2 September 2011

4. Relief Effort \ Assistance

4.1 Has the community received any assistance? Yes if yes, Kind of assistance provided When provided Item Qty Source
(in days)

No

____________ ____ Blankets Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Cooking Utensils Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Clothes Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Food Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Hygiene Kit(s) Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Medicine Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Mosquito Nets Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Tents Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Water Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Water Kit(s) Govt NNGO INGO International Org. PRC Church Private Entities ____________ ____ Govt NNGO INGO International Org. PRC Church Private Entities Voucher/Cash ____________ ____ Govt NNGO INGO International Org. PRC Church Private Entities Others ____________ 4.2 Items/areas of Assistance Perceived to be Needed/required: Blankets Cooking Utensils Clothes Food Hygiene Kit(s) Medicine Mosquito Nets Tents Water Water Kit(s) Psychosocial services Others ___________

5. Shelter/ CCCM
5.1 Housing Damage 5.1. 1 Number or Percentage of totally damaged houses 5.1. 2 Number or Percentage of partially damaged houses ___________# ___________% ___________# ___________%

Habitable Inhabitable 5.1.3 Number or Percentage of severely damaged houses (Walls, roof and column collapsed, hanging wall etc.) _____#______% _____#______% 5.2 Indicate the type and number of facilities used as evacuation centers within the immediate barangay/municipality: School _____________ Barangay Hall _____________Evacuation Center _____________ Warehouse _____________ Other: _____________ 5.3 Total Capacity: (how many people can be adequately accommodated guided by SPHERE; total capacity should be assessed together with the management of the community shelter) Narrative:

6. Food security
6.1 Do people still have food stocks in their households? Yes No 6.2 What percentage of the households still has food stocks? ________ 6.3 How long are the foods stocks expected to last? Less than a week One week Two weeks A month 6.4 Do people still have access to the local market? Yes No, No (If No, SKIP to Q7) 6.5 What is the percentage of the households that still has access to the local market? ________ 6.6 What are the reasons why people no longer have access to the local market? No money to buy foods Prices of commodities have increased No available supplies of commodities Market was destroyed/physically inaccessible Others, specify______________ 6.7 What are the prices per kilogram of the staple foods in the area before and after the disaster? Staple Food Price/kg before disaster Price/kg after disaster Rice Corn Camote (Sweet Potato) Cassava Gabi 6.8 Have livelihoods in the area been affected? Yes No (If NO, SKIP to Q10)
Multi-Cluster Rapid Assessment as of 2 September 2011 2

6.9 To what extent have the livelihood been affected? Extent of Effect/Destruction Livelihood 0% 25% 50% 75% 100% Agriculture Fishing Livestock Labor Others, specify: __________ 6.10 Are pregnant women, children, persons with disability and the elderly prioritized for food distribution? Yes No 6.11 What food have they received in the last 24 hours? Pregnant Women Children (under 5 years old) Persons with Disability Elderly

7. WASH
7.1 Water Supply 7.1.1 Availability of total clean water requirement (15 liters /person/day) ?: 0-24% 25-49% 50-74% How long will the available potable water can support and sustain the requirement of the evacuees? _________days 7.1.2 Alternate water source available? (can be made available for primary use) Yes No 75-100%

7.1.4 Condition: 7.1.3 Primary water source: (protected or safe) Open Well : Protected Safe Working Bore hole /Hand pump : Protected Safe Damaged (Repair required for minimum supply) Stream/river : Protected Safe Contaminated (or at risk of contamination) Storage/collection container : Protected Safe Destroyed Piped water system : Protected Safe Water Turbid Water stations (refilling stations) Other 7.1.5 Number of families in need of water kits: ___________________ 7.1.6 Do affected families have water container with lid available at HH level used for water storage? Yes No 7.2 Sanitary Facilities 7.2.1 Affected population with access to functioning sanitary facilities (e.g. Latrines): 0-24% 25-49% 50-74% 75-100% Facilities available for women/men 1) Are separate latrines for Women and Men have locks? Yes No 2) Are bathing facilities have privacy? Yes No 7.2.2 Number of families in need of sanitation tools: __________ 7.2.4 Adequate personal hygiene supplies available (soap, sanitary cloth/napkins) Yes No 7.2.3 Number of families in need of hygiene kits __________ 7.2.5 What is the level of knowledge of hygiene practices?: Good Fair Poor

7.2.6 Are provisions and facilities for water and sanitation available in the evacuation centers/community shelters? Yes No

8. Protection
8.1 What are the major protection concerns (select all that apply):

Lack of sense of safety and/or security Lack of adequate physical protection by national authority Breakdown of law and order (i.e. looting, criminality) Presence of unlawful group(s) on arms Absence of civilian character (presence of armed personnel) Extortion/Illegal taxation Presence of UXO/IEDs/landmines Violence(s) between members of displaced community and/or host community Threat from host community Presence or risk of Sex and Gender Based Violence Incidents of child abuse and exploitation

Presence or risk of human trafficking Discrimination (i.e., religion, gender, ethnicity, IDP status) Missing persons Forced return or relocation Persons in severe distress Split families (family members separated from other family members) Separated/Unaccompanied children Lack of adequate communication between family members and/or to emergency response (i.e., ambulance, fire brigade) Loss of legal document(s) Persons with special needs (i.e., disabilities, elderly, single-headed household, single women) No arrangements for the remains of the deceased Other: _____________________________________________

Multi-Cluster Rapid Assessment as of 2 September 2011

If yes to any of above please provide details on extent and location(s) of problem: _____________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ 8.2 Are there indigenous populations who may have special needs? Yes No; If yes, specify: _______________________________ 8.3. If indigenous populations are present, do they feel they are meaningfully represented in the committees? Yes No 8.4 Were the population displaced prior to this present displacement? Yes No If yes, state cause: 8.5 Are confidential GBV response services available for survivors? Yes No 8.6 Are there organizations (aside from UN) providing protection-related interventions? Yes No 8.7 Are there unaccompanied and separated children (including orphans)? Yes No; _____ if yes, how many?_____ 8.8 Are there people with disabilities? Yes No; _____ if yes, how many?_____

9 Nutrition
Existing Capacities and activities 9.1 Is there information on infants that are exclusively breastfed? Yes No If yes, please specify percentage of infants: ___________ 9.2 Have infant milk products (e.g. milk formulas) and/or baby bottles/teats been distributed since the emergency\disaster? Yes No If yes, by whom? ___________________________ 9.3 What percentage of infants in the area are formula fed/formula dependent? None <10% 10-25% >25% Do not know 9.4 Has the community/health staff identified any problems in feeding children less than 2 years of age since the emergency\disaster started? Yes No If yes, what problem/s? Loss of appetite Taste fatigue due to non-variation in food supply/non-appropriate supply of complementary food Presence of sickness (diarrhea, fever, coughs etc.) Underfeeding Vomiting Dehydration Others, specify _______________ 9.5 Is there any existing capacities and activities on the following Micronutrient Supplementation Programs? Yes No 9.5.1 Vitamin A Yes No 9.5.3 Iron Syrup/Drops or Micronutrients Powders Yes No Activity specification 9.6 Is there any existing capacities and activities on the management of children with moderate & severe acute malnutrition (facility or community based)? In patient therapeutic feeding (TF) only Regular health system Emergency health system In and out-patient TF Regular health system Emergency health system Out-patient TF only Regular health system Emergency health system Targeted Supplementary feeding Blanket supplementary feeding 9.5.2 Iron Folic Acid Yes No Organization(s) or person(s) implement these programs # enrolled Geographic coverage

10. Health
10.1 Main health concerns
<5 YO Fever Cough / colds Diarrhea Animal Bite Injuries / Wound Eye itchiness Yellow eyes / skin Out-patient >5 YO Fractures Difficulty of Breathing / Asthma Hypertension Diabetes <5 YO >5 YO Antibiotics ORS Antipyretics Dressing materials
Family planning commodities

10.2 Availability of medicines / supplies / equipment/services

Available Stocks Unavailable Tetanus Toxoid Measles Vaccine DPT Polio BCG Cold Chain
Mental Health Psychosocial Support Services

Available stocks

Unavailable

Total Number of Ill / Injured Admitted Admitted then Discharged

10.3 Availability of medical staff

Not Admitted (Awaiting Referral) Staff MD RN
4

Specialty

Number

Staff Social Worker Others

Specialty

Number

Multi-Cluster Rapid Assessment as of 2 September 2011

Midwife Local Health Officer

10.4 Status of health facilities in the affected areas

Type of facility DOH Hosp LGU Hosp Private Hosp Private Clinic RHU HC BHS Intact Structural Integrity Yes Partially No Yes Functional Partially No Accessible Y N Power Supply Y N Communication Y N Water Supply Y N

Psychosocial Service Providers

10.5 Presence of a focal person / team trained in Surveillance in Post Extreme Emergency and Disasters (SPEED) System Yes No

11. Education
11.1 Are classes being held and attended in the community: 11.2 Extent of damage on educational facilities Early learning centers (e.g. DCC) Type of Facility No. of Schools/DCCs
With major damage With minor damage Not affected

Yes

No

No. of affected* children

Male Female

No. of affected teachers/ DCWs/learning facilitators

Male Female

Remarks

Early learning centers (e.g. DCC) Elementary school building High School building Community learning centers (ALS) *Affected means having to stop schooling because learning facility was destroyed or used as evacuation center or simply stopped schooling 11.3 Extent of damage on school equip/furniture and learning materials (Please check) Insert remarks at the right side Type With major With minor Not affected Remarks damage/loss damage/loss Blackboards Furniture/fixture ICT equipment Office equipment (teachers/school heads_ Textbooks and other learning materials 11.4 Are schools being used as evacuation center? Yes No ____________# If yes: ________No. of classrooms still available for holding classes ________No. of children staying in the evacuation centers. _____ aged 3-5 yrs. _____ 6-11 yrs. ______12-15 yrs ______16 yrs & above

12. Emergency Telecoms

12.1 Is commercial power service disrupted/damage in the area? If yes, expected time/day/week to restore? ______________ 12.2 Is telephone working in the area? If not, expected time/day/week to restore? ______________ 12.3 Is there mobile phone and 3G/HSDPA/EDGE/GPRS signal from the Telecoms company? Smart Smart Bro Globe Globe Tattoo Sun Sun Broadband 12.4 Is there UHF/VHF/SSB/CB signal? Yes No Yes Yes No No

13. Logistics
13.1 What is the location and condition of main entry points to the affected area?
Multi-Cluster Rapid Assessment as of 2 September 2011 5

Location

Condition

Disaster Location can be reached by land: 2x4 Car 4x4 Car 6 Wheeler Truck 10 Wheeler Truck No access at all Disaster Location Can be Reached by sea: Nearest seaport to dock Disaster Location Can be Reached by air: Nearest airport to land

13.2 Best estimate (in number of days) when earliest the transport infrastructure can be recovered near to pre-disaster level. Roads ____________days Railway ____________days Air-transporter ____________days Other: ____________________________ 13.3. Storage facilities Location Coordinates Capacity(mt &m2) Condition Main Road Name and Distance Secured \ Guarded Remarks

13.4 If no permanent building can be used as a storage facility, where are possible locations to erect temporary storage facilities (wiikhalls)? Location Coordinates Space (m2) Condition (Surface, flood protection, etc) Main Road Name and Distance Secured \ Guarded Remarks

13.5 What are available usable transportation assets? Include number and capacity of trucks, boats, barges, helicopter (if any) Number Condition Capacity (mt) Trucks Boats Barges Helicopter Other: _________________________ 13.6 Security personnel/convoy requirements during transportation of relief: Banks/financial institutions: Gasoline stations: Morgues/Funeral Parlors: Granaries/Mills:

14 Other Facilities

Yes Yes Yes Yes

No No No No

Multi-Cluster Rapid Assessment as of 2 September 2011