Providing for. Distribution of critical relief items to displaced people affected by violence in Bossangoa, Central African Republic.

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1 Providing for Essential Needs Distribution of critical relief items to displaced people affected by violence in Bossangoa, Central African Republic. 36 UNHCR Global Appeal 2015 Update

2 Despite the continuing generous support of the international community, the humanitarian needs of refugees today far outstrip the resources put at the disposal of UNHCR and other aid agencies. This has led the Office and its partners to innovate in pursuit of more costeffective and sustainable solutions for meeting the basic needs of people of concern, as described in this chapter. UNHCR / A. GRECO UNHCR Global Appeal 2015 Update 37

3 Staying healthy, clean and protected from the elements is essential for anyone forced into a situation of displacement. The paragraphs that follow illustrate some of UNHCR s current and planned activities to meet these basic needs. CARING FOR HEALTH UNHCR s Global Strategy for Public Health promotes refugees access to national health-care systems and new financing approaches, such as enrolling refugees in health-insurance schemes. Based on this approach, applied with encouraging results in some countries in West Africa, the Middle East, and Asia, UNHCR will extend its efforts in 2015 to other countries in these regions and also in Southern Africa, working closely with host governments. One novel financing model being tested is community-based health insurance for refugee populations, as an affordable and sustainable health-care financing mechanism. Such schemes can represent a feasible alternative to conventionally funded humanitarian assistance when integrated into a national or communal insurance framework, and when the number and contribution of members is balanced against their health expenditure. Experience gained in countries like the Islamic Republic of Iran, where the Government has enrolled nearly 350,000 refugees in the health-insurance scheme, provides UNHCR with the framework and knowledge to expand this initiative further. In 2014, UNHCR has carried out detailed evaluations of healthinsurance options in Jordan, Lebanon, Malaysia, Mali, Nepal, the Russian Federation, Rwanda, Senegal and Togo. IMPROVING WATER, SANITATION AND HYGIENE (WASH) In its ongoing efforts to identify innovative approaches to the overwhelming needs in this area, UNHCR is drawing on the expertise of a range of research institutes, NGOs and universities. Examples include cooperation with RedR in gathering indicators and monitoring 12 distinct operations; measures to improve the safety of camp water supplies in five countries with expertise from American universities, in order to decrease the risk of disease from contaminated sources; and working with the International Rescue Committee to assess more accurately the cost of water supplies as a means of increasing efficiency and ensuring the right level of investment. These various projects will be extended to additional operations in The most important factors affecting refugee health and wellbeing can sometimes be the simplest, beginning with awareness and changing habits. For example, as part of its hygiene promotion strategy, UNHCR and Buffalo University have developed a project to encourage handwashing with soap among refugees. UNHCR is currently mapping different approaches to handwashing by WASH actors in Principles of health insurance for refugees nintegration: essential health services, such as childhood vaccinations, antenatal and delivery care and communicable disease control (e.g. tuberculosis) should be free of charge, in line with national programmes, to all refugees during the post-emergency phase. 38 UNHCR Global Appeal 2015 Update nequity: while fees for other services depend upon the context, UNHCR advocates that they should be no higher than those charged to nationals. n Protection: vulnerable refugees should be identified, and suitable arrangements put in place to ensure their access to preventative and curative health services.

4 South Sudan, and identifying how to ensure effective implementation of programmes for improved hygiene. UNHCR and the US Center for Disease Control (CDC) are developing best-practice guidelines, training materials and core questions relating to WASH Knowledge, Attitude and Practice (KAP), to facilitate the implementation of KAP surveys in refugee settings. The training and sampling methodology stems from a regional workshop held in Kakuma camp in Kenya in 2013, designed to increase UNHCR s knowledge of the status of water supply, sanitation and current hygiene practices. USING TECHNOLOGY Since sustainable and adequate water resources are essential to meet the needs of large and sometimes growing refugee populations over time, satellite technology is being applied by UNHCR with the University of Neuchâtel to monitor one of the most exploited aquifers - the Merti Aquifer in Dadaab, Kenya. This innovative project is yielding positive results in terms of sustainable management of critical water resources, by ensuring that actors on the ground are not pumping more water than the aquifer can provide. Another new technological application to improve the availability of water for refugees is the hybrid solar and fuel-powered water system being developed by UNHCR and the Veolia Foundation in the Dollo Ado camps in Ethiopia, to increase access to clean water, which is particularly scarce in this area. Research and development can also provide new solutions to other longstanding challenges. For example, UNHCR and CDC are currently conducting field research in Ethiopia to determine the safety and acceptability of urinediversion dry toilets (UDDTs) in large refugee settings with a view to their potential use in humanitarian crises. UDDTs could be used in difficult environments where pit latrines are not possible due to rocky terrain, high water table and other constraints. GIVING SHELTER Providing refugees with a roof over their heads and energy to rebuild a home is highly symbolic of the principle of protection; but it is also an extremely concrete goal that requires significant investment and logistical support. UNHCR s Global Strategy for Settlement and Shelter is being introduced through the development of country-level strategies in key operations. Building technical capacity in the field is essential to its successful implementation. It also promotes innovative approaches to settlement and shelter, such as the Master Plan approach, which seeks to ensure that refugee settlements are anchored in the broader framework of national systems for the delivery of basic services. UNHCR is working with Stanford University and Ennead Architects International LLP to develop the Master Plan toolkit and pilot the concepts in the field. UNHCR s Global Strategy foresees both practical shelter solutions using locally-procured UNHCR Global Appeal 2015 Update 39

5 shelter materials, and innovation through research and development designed to improve quality and safety, while exploring prepackaged, storage and transport modalities. In 2014, UNHCR, IFRC and ICRC developed a prototype domeshaped family tent, following field trials in Burkina Faso, Burundi and the United Republic of Tanzania to test ventilation, resistance to extreme weather conditions, space and overall safety of three different designs. Refugees were closely involved in providing their detailed feedback, which has been positive. Further tests are planned in Burkina Faso and Pakistan. In the course of 2015, the results of the field tests will inform final modifications to the new tent, before it is manufactured and distributed. Other innovative shelter designs and materials have been tested in Ethiopia and Iraq with the Refugee Housing Unit AB of Sweden and the IKEA Foundation. In 2015, UNHCR will also review various locally produced prototypes in both East and West Africa that use local materials and building practices, in order to assess their technical suitability and potential. IMPROVING ACCESS TO FUEL AND ENERGY UNHCR s Global Strategy for Safe Access to Fuel and Energy (SAFE) sets the priorities for energy interventions in the coming five years. It also recognizes the close links and potential synergies between these requirements and areas such as protection and livelihoods, while also affecting the way refugees use technology and interact with their environment. With light at night, refugee children will be able to study at home and refugee families can feel safe when walking around camps. Powering a refugee camp allows livelihood activities to continue in the evening. Using clean fuels and fuel-efficient technologies means that refugees spend less time collecting firewood, reducing their exposure to the risk of assault. Clean fuels also reduce the risk of respiratory infections caused by harmful smoke when cooking. In 2014, the first year of implementation of the SAFE Strategy, efforts have focused on Burkina Faso, Chad, Ethiopia, Kenya and Rwanda, with the development of country-level and context-specific energy strategies to address fuel and energy needs using baseline assessments. In Bangladesh, an approach is being explored that links scarcity of energy to human waste in the refugee camps, through the production of biogas. UNHCR is piloting biodigesters that serve mainly to manage waste. The by-product is biogas: a renewable fuel that can serve to address vital gaps in energy needed for cooking and producing electricity. There are currently 15 bio-digesters providing fuel for cooking across two camps in Bangladesh. UNHCR will continue this pilot project and gather lessons learned, with support from the IKEA Foundation. Other new initiatives to be tested in 2015 include Liter of Light initiatives and micro-grids to allow more evening and night-time camp activities through new, appropriately designed lighting. UNHCR will also engage in research and development of biogas stoves that would allow refugees to make optimal use of biogas for family cooking needs. 40 UNHCR Global Appeal 2015 Update

6 Latest developments on cash-based interventions UNHCR continues to build the foundations for more systematic use of cash in refugee operations, developing operational guidance, standard procedures and training, deploying experts to field operations worldwide and establishing a dedicated unit at Headquarters to lead and coordinate these efforts. Particular efforts are underway to improve methodologies and tools for coordinated needs assessments, programme design, monitoring and communicating with refugees and other affected populations. The European Union has provided an Enhanced Response Capacity grant to UNHCR, which is coordinating a coalition of partner agencies to support these efforts. The project will focus on developing methodologies and tools needed to implement and evaluate multi-purpose grants, while mitigating protection risks. The Syria situation has provided an important testing ground for new and innovative operational approaches, including vulnerability assessment, socio-economic targeting and the use of common platforms for the delivery of cash programmes by multiple partners. UNHCR is expanding the use of cash-based interventions in Africa through new programmes in Ethiopia, Ghana, Sudan, Uganda and Zambia, and undertaking feasibility assessments in Djibouti and Tanzania. Strategic partnerships are an important feature of UNHCR s efforts. They namely include other UN agencies and NGOs, in close collaboration with the Cash Learning Partnership. A joint plan of action with WFP aims, in particular, to expand the use of cash-based programming to achieve food security among people of concern. In 2015, UNHCR will continue to expand and improve the quality of cash-based interventions through a strengthened network of technical specialists. Building on good practice, increased support will be provided to places where cash can be used to meet multi-sectoral, non-food needs, while ensuring the protection of refugees and others of concern. UNHCR will strengthen partnerships, in particular with host governments, to ensure synergies with existing cash-based programmes. Financial accountability will remain a key priority. UNHCR Global Appeal 2015 Update 41

7 AREAS OF INTERVENTION ANTICIPATED IN 2015 Basic needs and essential services Environment and energy Implement the UNHCR Global Strategy on SAFE effectively Increase knowledge of energy interventions through strengthened monitoring and evaluation Expand energy and environment expertise and capacity in field operations Test innovative approaches to energy provision Enhance research and development Shelter and settlements Roll out the Global Strategy for Settlement and Shelter Enhance capacity to deliver a combination of settlement options EXAMPLES Progressive implementation of country-based energy strategies will be developed in five countries in Country-based energy strategies will be developed in five additional countries. Baseline and feasibility studies will be undertaken in five additional countries. Monitoring and evaluation framework will be based on 2014 baseline assessments. Monitoring and evaluation plans will be part of the ten country-based strategies. Two new energy and environment positions will be established. Relevant staff in priority countries will be trained on energy and environment. The Liter of Light concept will be tested in one field location. The micro-grids will be tested in one field location. Efficiency of biogas stoves will be improved through new design. Number of partners engaged in R&D projects focusing on cookstoves will be increased. Comprehensive shelter and settlement strategies will be implemented in three additional priority countries. Technical support missions will be undertaken, including at the onset of emergencies. Consolidation of good practices of settlement and shelter designs will be available. Face-to-face training and e-learning on shelter and physical site planning will be enhanced. Invest in research and development for alternative shelter solutions Promote and implement the Master Plan concept Enhance monitoring of shelter and settlement responses Nutrition and food security Implement Standardized Expanded Nutrition Surveys (SENS) Implement Post-Distribution Monitoring (PDM) of food assistance Supply of potable water increased or maintained Provide technical guidance and criteria for WASH services Provide innovative approaches to ensure access to water and sanitation among refugees Water, sanitation and hygiene (WASH) Regularly monitor sanitation-related indicators Guidance on host-family support will be developed. Toolkit for physical site planners will be rolled out. Pool of qualified experts to be deployed to country operations will be expanded. Research and development efforts will be made to identify a variety of innovative and locally produced shelter solutions. Relevant tools will be tested in one additional context to calibrate the Master Plan Toolkit. Monitoring tools will be developed and disseminated. At least 10 SENS surveys using mobile data collection techniques will be conducted in % of all joint UNHCR and WFP food assistance programmes will be monitored through PDM at least once a year. A UNHCR manual will be published by end of Five agreements on innovative research and delivery projects will be signed and implemented with partners. By the end of 2015, a minimum of 5 countries will report regularly against the WASH Monitoring System (within TWINE). 42 UNHCR Global Appeal 2015 Update

8 NEWS AND VIEWS HIV/AIDS: Conflict in Central African Republic disrupts treatment This article is an adapted version of a UNHCR news story 3 SEPTEMBER 2014 BANGUI, September 2014 Conflict forced Nayo to flee her native South Sudan and seek shelter in neighbouring Central African Republic, but it has not prevented the 58-yearold refugee from receiving the medical treatment that keeps her alive. Nayo is a 58-year-old South Sudanese refugee living with HIV in the Central African Republic. UNHCR/A.KITIDI Fighting has forced me twice to leave South Sudan for the Central African Republic, once as a little girl and once as an adult, she tells UNHCR. I d love to see my country, even though it's at war. But I am tired of running. I am too old and too sick, she adds resignedly. Nayo is one of tens of thousands of people in the Central African Republic, including refugees, living with HIV. But while others now struggle to access treatment, she has access to vital free medicine thanks to a church organization in Bangui, the conflict-torn capital of the Central African Republic. Until 2012, when the current cycle of conflict began, UNHCR had helped refugees infected with the virus. They received monthly financial aid and medical assistance, as well as food support through the World Food Programme. But a vital database with information on these patients disappeared when offices belonging to UNHCR and its partners were ransacked in 2013, while many health facilities that treated those living with HIV with retroviral drugs were looted and medical staff were forced to flee. Moreover, the distribution of these drugs outside Bangui has been disrupted, affecting the treatment of refugees in remote rural areas. The already weak health system of the country almost broke down completely. This enormously reduced the access to treatment for people living with HIV, explained Heinz Henghuber, a health consultant to UNHCR. The situation got even worse after the violence escalated dramatically in December Access to care became even more difficult, increasing the risk of developing drug resistance due to the frequent interruption of treatment. The instability has also affected awareness-raising programmes in a country where discrimination against people living with HIV is prevalent. In response, UNHCR recently completed a verification process that will allow it to rebuild its database and resume full assistance in urban areas to refugees and asylum-seekers living with HIV in the Central African Republic. For Nayo, who has also suffered sexual violence and a beating by militiamen, this work by UNHCR and its partners is vital. But she turns to her church to give her strength and medicine to overcome the many hurdles she has faced and will continue to face. She prays for more years, strength and to see her grandchildren grow. UNHCR Global Appeal 2015 Update 43