Humanitarian and conflict · Sphere, WHO and IAWG guidance
The first 72 hours: setting up primary care in a crisis
In the first days of a crisis, the aim of the health response is simple: stop people dying from causes that can be prevented. That means safe triage and emergency care, a short list of life-saving services, the right kits ordered early, and a referral route that works day and night.
- For clinicians, clinic leads and health coordinators in humanitarian settings
- Reviewed October 2026
The aim in the first days
The Sphere Handbook (2018) puts it plainly: the main goal of a health response in a crisis is to prevent and reduce excess deaths and illness. Which illnesses matter most depends on the crisis: injuries after an earthquake, diarrhoea and measles in a crowded camp, interrupted treatment for people with long-term conditions everywhere.
Crises also break the things that keep people well: clean water, shelter, food, vaccination, and access to the clinic and its medicines. Mental distress rises, and violence, including sexual violence, becomes more likely.
Build on what is thereSupport the health services that already exist wherever you can. Duplicating them wastes resources and makes it harder for people to return to their usual facilities when temporary ones close (Sphere 2018).
First steps, in order
- Make the site safe for patients and staff, and agree who leads security.
- Set up triage at the door so the sickest are seen first (see below).
- Start counting: how many people, how many deaths each day, and the main causes of illness. See Rapid health assessment and surveillance.
- Start the priority services in the table below, including the Minimum Initial Service Package (MISP) for sexual and reproductive health.
- Order supplies: the Interagency Emergency Health Kit (IEHK), reproductive health kits, and an NCD kit if needed.
- Agree referral routes for emergencies, with transport and communication that work 24 hours a day.
- Tell the community what services exist, where, and when.
Triage and emergency care at the door
Every person who arrives should be looked at quickly by a trained health worker before they join the queue. Use the systematic ABCDE approach and the triage tool your team has been trained in, such as WHO Basic Emergency Care for adults and children.
| What you see | Priority | What to do |
|---|---|---|
| Problem with the airway or breathing; signs of shock; unconscious; convulsing; heavy bleeding | Emergency: treat now | Start emergency care at once (open the airway, oxygen if available, stop bleeding, fluids for shock, treat convulsions). Arrange urgent referral while you treat. |
| Very sick child: cannot drink or breastfeed, vomits everything, lethargic; severe dehydration; severe wasting or swelling of both feet | Emergency or priority | Treat following IMCI and refer as the chart booklet directs. Do not leave sick children waiting in the queue. |
| Pregnant woman with bleeding, convulsions, severe headache with blurred vision, fever or labour that is not progressing | Emergency: refer | Give first-line emergency care and refer to the nearest facility that provides emergency obstetric care. |
| Injury, severe pain, burns, poisoning, high fever, or someone who has run out of essential medicines (insulin, antiepileptics, ART) | Priority: see soon | See before routine patients. Restart essential medicines the same day. |
| Everyone else | Routine | Join the queue. Check vaccination status of children, screen children 6 to 59 months with MUAC, and ask "Do you take any medicine every day?" |
Source: WHO Basic Emergency Care, 2018; Sphere Handbook 2018; IAWG Inter-Agency Field Manual, 2018
Priority services to start in the first days
| Area | What to put in place | Based on |
|---|---|---|
| Emergency and trauma care | Triage, first-line emergency care, safe referral. Supplies for wound care and pain relief. | Sphere 2018; WHO Basic Emergency Care |
| Outbreak detection | An early warning, alert and response system: agreed priority diseases, case definitions and an alert reported within 24 hours. | Sphere 2018 (communicable diseases) |
| Measles | Mass vaccination for children aged 6 months to 15 years if coverage is under 90% or unknown, whatever their vaccination history. Give vitamin A to children 6 to 59 months at the same time. | Sphere 2018 (child health) |
| Sick children | IMCI at the clinic; community case management of malaria, pneumonia and diarrhoea by trained community health workers. ORS and zinc, malaria treatment and pneumonia care within 24 hours of the start of symptoms. | Sphere 2018 (child health) |
| Sexual and reproductive health (MISP) | Clean delivery kits for visibly pregnant women; a 24-hour referral system for obstetric and newborn emergencies; clinical care after sexual violence, including PEP; contraception; continuing ART; free condoms; standard precautions; safe blood transfusion. | IAWG MISP, 2018 |
| Long-term conditions | Find people on insulin, antiepileptics, ART, TB treatment and antipsychotics, and keep them on treatment. | Sphere 2018; UNHCR and IRC NCD guide 2020 |
| Mental health | Psychological first aid from all staff; basic clinical mental health care in every facility; an uninterrupted supply of essential psychotropic medicines. | Sphere 2018; mhGAP-HIG 2015 |
| Nutrition | MUAC and oedema screening of young children, with referral to feeding programmes. | Sphere 2018 (nutrition) |
Kits to order early
Interagency Emergency Health Kit (IEHK)
- Designed to meet the expected primary care needs of about 10,000 people for 3 months, made up of basic units for 1,000 people each and a supplementary unit for larger facilities.
- It holds a few psychotropic medicines and very few NCD medicines: not enough for a programme that actively finds and treats psychosis, epilepsy, depression, diabetes or hypertension. Order more early.
Inter-Agency Reproductive Health (IARH) kits
- Community and health post kits (condoms, clean delivery, post-rape treatment, contraception, STI treatment) are designed for 10,000 people for 3 months.
- Health centre kits for basic emergency obstetric and newborn care are designed for 30,000 people for 3 months; hospital kits for about 150,000 people.
- Kits are not tailored to any one setting, so plan to move to routine procurement as soon as you can.
Source: mhGAP-HIG 2015; IAWG MISP reference, 2018; WHO NCD kit 2022
Planning numbers (Sphere 2018)
| Indicator | Minimum |
|---|---|
| Population within one hour's walk of primary care | 80% |
| Health facilities | About 1 per 10,000 people (in rural areas 1 per 50,000 may be more realistic, with mobile clinics and community case management) |
| District or rural hospital | 1 per 250,000 people |
| Inpatient beds (not counting maternity) | 18 per 10,000 people |
| Community health workers | 1 to 2 per 1,000 people |
| Skilled birth attendants (doctors, nurses, midwives) | 23 per 10,000 people |
| Basic emergency obstetric and newborn care | 5 facilities per 500,000 people |
| Comprehensive emergency obstetric and newborn care | 1 facility per 500,000 people |
These are planning guides, not guarantees of good coverage. In towns, a hospital may be the first point of care for far more than 10,000 people.
Organising the clinic
- One simple protocol per common condition, on the wall, so that nurses, clinical officers and community health workers treat the same way.
- A register and a patient-held card from day one: diagnosis, medicines, doses, vaccinations.
- Separate, private space for consultations about sexual violence, mental health and reproductive health.
- Infection prevention: handwashing stations, safe sharps disposal, standard precautions.
- Protect the data: store records safely and share only what is needed. Analyse data by sex, age and disability.
- Talk to the community, including women, older people, people with disabilities and minority groups, about what stops them using the service.
Checklist for the end of day 3
- Triage at the door, with a trained person and emergency supplies.
- Population estimate and a daily count of deaths started.
- Alert system agreed: who to tell about a suspected outbreak, and how, within 24 hours.
- Measles vaccination planned if coverage is low or unknown.
- Clean delivery kits and a 24-hour obstetric referral route in place.
- Clinical care after sexual violence available, in private, with PEP and emergency contraception.
- People on insulin, ART, TB treatment, antiepileptics and antipsychotics identified and supplied.
- IEHK and reproductive health kits ordered; extra NCD and mental health medicines requested.
Sources
- Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response, fourth edition (health chapter). 2018.
- World Health Organization. WHO/ICRC Basic Emergency Care: approach to the acutely ill and injured. 2018.
- Inter-Agency Working Group on Reproductive Health in Crises. Minimum Initial Service Package (MISP) for sexual and reproductive health: reference sheet, from the Inter-Agency Field Manual on Reproductive Health in Humanitarian Settings. 2018.
- World Health Organization and UNHCR. mhGAP Humanitarian Intervention Guide (mhGAP-HIG). 2015.
- World Health Organization. Noncommunicable diseases kit (NCDK) 2022. 2022.
- UNHCR and International Rescue Committee. Integrating non-communicable disease care in humanitarian settings: an operational guide. 2020.
Adapted from WHO guidance; not endorsed by WHO. This page paraphrases and adapts the WHO publications listed under Sources, which are licensed CC BY-NC-SA 3.0 IGO; the adapted text is shared under the same licence for non-commercial education. Reasoning GP is not affiliated with WHO or any other organisation named here. Use it alongside your national guidelines, essential medicines list and formulary, and your clinical judgement. Doses are given only where they come from a WHO source; otherwise follow your national guideline or formulary.