Standards › ASF Health Standards v10 › Standard 39
Standard 39
Humanitarian and Emergency Operations
Humanitarian and emergency operations: needs assessment before services start, exit and handover, protection from exploitation and abuse, mass-casualty planning, and staff security and wellbeing..
Each criterion is shown in three settings: Humanitarian settings, Transition and fragile, and Standard. In standard settings, every criterion is Must.
Training colours: red means essential, green recommended, yellow optional. Each course shows its level for each setting: humanitarian, transition and fragile, and standard.
39.1Needs Are Assessed Before Services StartHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Before services start, the population’s health needs, the security situation, access, and the capacity of the local health system are assessed and documented.
Why it matters. Humanitarian teams that start services without knowing the health needs, the security situation and access often waste resources or put people at risk. An assessment before the start prevents that.
How the surveyor verifies this criterion
Sample. Review the pre-deployment assessments for 5 recent deployments.
1. Each deployment has a needs assessment covering health needs and the capacity of the local health system.
Method. Check each assessment for the health needs and local capacity recorded.
Evidence to show. Needs and capacity assessment record (HUM-FRM-001).
Pass when. Every deployment assessment covers health needs and local capacity.
Immediate fail (any one means the criterion is not met). A camp opened with no assessment of health needs and the nearest clinic unreachable.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Nurse (ISCO 2221) | Completes the Needs and capacity assessment record | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| HUM-FRM-001 · Needs and capacity assessment record | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Refugee & Migrant Health — Endorsement Course (H-09) | Manager; Nurse |
References
- WHO (2026). Emergency ready primary health care operational guide. Used for: Operational guide for emergency-ready primary care: needs and risk assessment, planning and transition. https://news.gmj.ge/guideline/emergency-ready-primary-health-care-operational-guide/
39.2Every Deployment Has a Defined Exit or HandoverHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Each deployment has a written plan for how it will end, either by handing over to the local health system or by a defined time limit. The handover is planned before the service starts.
Why it matters. Humanitarian services are often meant to be temporary. Without a planned exit, the population is left without care when the team leaves. A written handover makes the end of the service safe.
How the surveyor verifies this criterion
Sample. Review the exit plans and handover records for 5 deployments that have ended or are ending.
1. The handover is agreed with the local health system and recorded.
Method. Check each handover for the agreement and the date.
Evidence to show. Deployment exit and handover (HUM-POL-002).
Pass when. Every handover is agreed and recorded.
2. Service continuity after exit is tracked.
Method. Check the handover tracking register for the follow-up of each handed-over service.
Evidence to show. Handover tracking register (HUM-REG-001).
Pass when. Every handed-over service has continuity tracked.
Immediate fail (any one means the criterion is not met). A deployment ended with no handover and the services stopped overnight.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Deployment exit and handover policy | Must |
| Secretary (ISCO 3344) | Keeps the Handover tracking register | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| HUM-REG-001 · Handover tracking register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| HUM-POL-002 · Deployment exit and handover | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Refugee & Migrant Health — Endorsement Course (H-09) | Manager; Nurse |
References
In process of development. Will be available soon.
39.3Protection and Do-No-Harm Apply to Every ActivityHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Staff and volunteers are trained in protection from sexual exploitation and abuse. Community engagement is in place. Safe referral pathways exist for people who disclose abuse or violence.
Why it matters. In humanitarian settings, people who depend on aid are vulnerable to sexual exploitation and abuse by those who should protect them. Training, reporting routes and a do-no-harm approach protect them.
How the surveyor verifies this criterion
Sample. Review training records for 15 staff and volunteers, community engagement records, and referral pathway records for the last 12 months.
1. Staff and volunteers are trained in protection from sexual exploitation and abuse.
Method. Check the training record for each staff member and volunteer.
Evidence to show. Protection and do-no-harm (HUM-POL-003).
Pass when. Every staff member and volunteer has training recorded.
2. Community engagement is in place and recorded.
Method. Check each engagement record for the community involvement.
Evidence to show. Protection and do-no-harm (HUM-POL-003).
Pass when. Every activity has community engagement recorded.
Immediate fail (any one means the criterion is not met). A volunteer engages in sexual exploitation of a beneficiary with no reporting route.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Protection and do-no-harm policy | Must |
| Manager (ISCO 1342) | Checks the criterion at each review | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| HUM-POL-003 · Protection and do-no-harm | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Refugee & Migrant Health — Endorsement Course (H-09) | Manager; Nurse |
References
- IASC Six Core Principles Relating to Sexual Exploitation and Abuse (Inter-Agency Standing Committee, 2019)
- Humanitarian Charter and Minimum Standards in Humanitarian Response (The Sphere Handbook) (Sphere Association, 2018)
39.4A Mass-Casualty Plan Is Written and TestedHumanitarian settings: MinimumTransition and fragile: MediumStandard: Must
A surge and mass-casualty plan is written, covers triage and coordination with local authorities, and is tested on a defined schedule.
Why it matters. A sudden mass casualty event in a humanitarian setting can overwhelm the team in minutes. A written plan, with triage and coordination with local services, and a tested drill, is what makes the response work.
How the surveyor verifies this criterion
Sample. Review the mass-casualty plan and the rehearsal records for the last 12 months.
Immediate fail (any one means the criterion is not met). A mass-casualty event occurs with no plan and no staff trained in triage.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Checks the criterion at each review | Medium |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| HOS-PLN-001 · Mass-casualty and utility failure plan | Chief executive (ISCO 1120) | Governing body members | Manager (ISCO 1342) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
| HOS-REG-004 · Rehearsal and drill record | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Emergency Preparedness and Fire Safety (T-10) | Manager; Nurse |
References
- WHO (2020). Hospital Emergency Response Checklist. Used for: Hospital emergency response checklist: mass-casualty planning, staff roles and exercises. https://news.gmj.ge/guideline/hospital-emergency-response-checklist/
- WHO (2020). Best Practice Guidelines on Emergency Surgical Care in Disaster Situations. Used for: Emergency surgical care in disaster situations: mass-casualty response, planning and testing. https://news.gmj.ge/guideline/best-practice-guidelines-on-emergency-surgical-care-in-disaster-situations/
39.5Staff Security and Wellbeing Are ManagedHumanitarian settings: MinimumTransition and fragile: MustStandard: Must
Staff have a security plan, rotation schedule and access to psychosocial support. Incidents affecting staff are recorded and reviewed.
Why it matters. Staff working in emergencies face danger, stress and exhaustion. A security plan, rotation and psychosocial support keep them safe enough to keep working, and keep the service running.
How the surveyor verifies this criterion
Sample. Review staff security plans, rotation schedules and incident records for the last 12 months.
1. Each deployment has a staff security plan.
Method. Check each deployment for the security plan dated before the start.
Evidence to show. Staff security, rotation and psychosocial support (HUM-POL-004).
Pass when. Every deployment has a security plan.
2. Staff rotation is scheduled and kept.
Method. Check the rotation schedule against the actual rotations.
Evidence to show. Staff security, rotation and psychosocial support (HUM-POL-004).
Pass when. Rotation is scheduled and kept for every sampled staff member.
3. Each incident affecting staff is recorded and reviewed.
Method. Check the incident register for each entry and its review.
Evidence to show. Staff incident register (HUM-REG-002).
Pass when. Every incident is recorded and reviewed.
Immediate fail (any one means the criterion is not met). A staff member attacked on the route with no security plan and no follow-up support.
Staff responsible
| Role | Responsibility | Level |
|---|---|---|
| Manager (ISCO 1342) | Maintains the Staff security, rotation and psychosocial support | Must |
| Secretary (ISCO 3344) | Keeps the Staff incident register | Must |
Documents: who does each step
| Document | Writes | Approves | Fills in | Checks and signs | Files and uploads |
|---|---|---|---|---|---|
| HUM-REG-002 · Staff incident register | Secretary (ISCO 3344) | Chief executive (ISCO 1120) | Secretary (ISCO 3344) | Manager (ISCO 1342) | Secretary (ISCO 3344) |
| HUM-POL-004 · Staff security, rotation and psychosocial support | Chief executive (ISCO 1120) | Governing body members | N/A | Chief executive (ISCO 1120) | Secretary (ISCO 3344) |
E-learning: who must take each course
| Course | Who must take it |
|---|---|
| Emergency Preparedness and Fire Safety (T-10) | Manager; Nurse |
References
- WHO (2022). Caring for those who care: Guide for the development and implementation of occupational health and safety programmes for health workers. Used for: Occupational health for health workers: staff wellbeing, support and assessment of staff needs. https://news.gmj.ge/guideline/caring-for-those-who-care-guide-for-the-development-and-implementation-of-occupational-health-and-safety-programmes-for-health-workers/
- World Health Organization (2021). Global Patient Safety Action Plan 2021–2030: Towards Eliminating Avoidable Harm in Health Care. Geneva: WHO. https://www.who.int/publications-detail-redirect/9789240032705 Used for: https://news.gmj.ge/guideline/global-patient-safety-action-plan-2021-2030-towards-eliminating-avoidable-harm-in-health-care/
Who is responsible for Standard 39
Each criterion names the positions responsible for it. Every position links to its own terms of reference.
| Criterion | Responsible | Supports |
|---|---|---|
| 39.1 Needs Are Assessed Before Services Start | Chief strategy and development officer Head of department (per specialty) |
Quality manager |
| 39.2 Every Deployment Has a Defined Exit or Handover | Chief strategy and development officer Chief operating officer (COO) |
Quality manager |
| 39.3 Protection and Do-No-Harm Apply to Every Activity | Risk manager Quality manager |
Occupational health nurse (staff) |
| 39.4 A Mass-Casualty Plan Is Written and Tested | Head of emergency department Risk manager |
Quality manager |
| 39.5 Staff Security and Wellbeing Are Managed | Security manager Occupational health nurse (staff) |
Chief human resources officer |
Role details: reporting, supervision and training
Training shown is the general recommendation. Role-specific training is set in the next improvement round.
Questions and answers
The criterion text is the authority. These answers summarise it.
Who does Standard 32 apply to?
Organisations that run health services in humanitarian and emergency operations, including deployments that hand over to the local health system.
What do the colours mean for this standard?
Red (Must) is required. Green (Medium) is recommended. Yellow (Minimum) is the lowest acceptable level in humanitarian settings. Standard setting is Must on every criterion.
Does a service start before needs are assessed?
No. Under 39.1 the health needs, security situation, access and local health system capacity are assessed and documented before services start.
Does every deployment need an exit plan?
Yes. Under 39.2 each deployment has a written exit or handover plan, and the handover is planned before the service starts.
How is protection from abuse handled?
Under 39.3 staff and volunteers are trained in protection from sexual exploitation and abuse, and safe referral pathways exist for people who disclose abuse or violence.
Is there a plan for mass casualties?
Under 39.4 a surge and mass-casualty plan is written, covers triage and coordination with local authorities, and is tested on a defined schedule.
How are staff security and wellbeing protected?
Under 39.5 staff have a security plan, a rotation schedule and access to psychosocial support, and incidents affecting staff are recorded and reviewed.
Guidelines for this standard
46 guideline(s) are held in the GMJ Guidelines Library and listed here. Each link opens the full guideline on news.gmj.ge. The complete library, grouped by standard, is at Guidelines.
- No dehydration (or maintenance therapy) — Management of a cholera epidemic — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Initial clinical assessment — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Principles of case management — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Outbreak response committees — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Vaccination strategies — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Organization of curative services in rural settings — MSF Management of a cholera epidemic (MSF)
- Organization of curative services in urban settings — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Health promotion — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Antibiotic prophylaxis in cholera epidemics — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- 42 CFR § 483.12 — Freedom from Abuse, Neglect, and Exploitation (US CMS / eCFR)
- Continuity and Coordination of Care: a Practice Brief to Support Implementation of the WHO Framework on Integrated People-Centred Health Services (WHO)
- The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response (Sphere)
- IASC Six Core Principles Relating to Sexual Exploitation and Abuse (IASC)
- A Global Response to Elder Abuse and Neglect: Building Primary Health Care Capacity (WHO)
- IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (IASC)
- IASC Six Core Principles Relating to Sexual Exploitation and Abuse (Inter-Agency Standing Committee (IASC))
- Exit Strategy for Humanitarian Actors in the Context of Complex Emergencies (Inter-Agency Standing Committee (IASC))
- Vaccination against cholera — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Sanitation activities (Management of a cholera epidemic) — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- MSF Management of a cholera epidemic: Case identification and management — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Investigation report — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Data analysis — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Data collection and organization — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Diagnosis confirmation — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Initial on-site investigation — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Cholera alerts — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Disease presentation and clinical course — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Introduction and epidemiology — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Standards and recommendations for burns care in mass casualty incidents (World Health Organization)
- Genital ulcers — MSF Clinical guidelines (Médecins Sans Frontières)
- Acute cystitis — MSF Clinical guidelines (Médecins Sans Frontières)
- Recommendations for Implementing the CICOM Methodology during the COVID-19 Response (Pan American Health Organization)
- Recommendations for medical surge capacity and deployment of emergency medical teams (Pan American Health Organization)
- Recommendations for the Preparation of Disinfectant Solutions (PAHO)
- Recommendations for the Management of Municipal Wastewater (PAHO)
- Crisis Management during an Epidemic: General guidelines for efficient response coordination by national regulatory authorities (Pan American Health Organization)
- COVID-19 Recommended Interventions in Mental Health and Psychosocial Support (MHPSS) during the Pandemic (Pan American Health Organization)
- Framework of a national program for preventing and controlling diseases caused by respiratory viruses with epidemic and pandemic potential (Pan American Health Organization)
- Key criteria for the ethical acceptability of controlled human infection studies during public health emergencies (World Health Organization)
- Compendium of practice to inform regional and national civilian-military collaboration for health emergency preparedness (World Health Organization)
- Emergency ready primary health care operational guide (World Health Organization)
- Public health advice on multisectoral action for social and economic protection of communities during Ebola and Marburg disease outbreaks (World Health Organization)
- Guidance for use of the Measuring Abortion Care Framework and Indicators (World Health Organization)
- Risk communication and community engagement readiness and response toolkit: cholera (World Health Organization)
- Recommendations on the delivery of health services for the prevention and care of sexually transmitted infections (World Health Organization)
- Guideline on public health and social measures for mitigating the risk and impact of epidemic and pandemic influenza (World Health Organization)
Also relevant to this standard:
- Strategies for water, hygiene and sanitation in cholera epidemic response — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Organization of the network of curative services (Management of a cholera epidemic) — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Refugee and migrant health: Global Competency Standards for health workers (WHO)
- Transition between inpatient hospital settings and community or care home settings for adults with social care needs (NG27) (National Institute for Health and Care Excellence)
- Hygiene — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Supply of safe water: Management of a cholera epidemic — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Estimation of treatment resource needs (Management of a cholera epidemic) — MSF Management of a cholera epidemic (Médecins Sans Frontières)
- Best Practice Guidelines on Emergency Surgical Care in Disaster Situations (World Health Organization)
- Caring for those who care: Guide for the development and implementation of occupational health and safety programmes for health workers (World Health Organization)
- Infection prevention and control and water, sanitation and hygiene measures for home care and isolation for mpox in resource-limited settings: interim operational guide (World Health Organization)
- Key Considerations for Integrating Gender Equality into Health Emergency and Disaster Response: COVID-19 (Pan American Health Organization)
- Recommendations for Adapting Emergency Medical Teams (EMTs) at Temporary COVID-19 Vaccination Sites (Pan American Health Organization)
- Framework and toolkit for infection prevention and control outbreak preparedness, readiness and response: implementation manual (World Health Organization)
- Global guidance on monitoring public health and social measures policies during health emergencies (World Health Organization)
- National Health Simulation Exercise Programme: implementation guidance to strengthen emergency preparedness, readiness and response (World Health Organization)