Form ICSC/HRPD/H/1/2012

TO BE USED FOR ALL DUTY STATIONS

International Civil Service Commission

Classification of Duty Stations

According to Conditions of Life and Work

Questionnaire

Country Duty station Date(dd/mm/yyyy)

                 
Capital City? Yes No

2020
 Instructions

1. Submit a completed questionnaire ONLY when one of the following situations apply:
a) When requested by ICSC; or
b) When there are international UN staff members assigned for one year or longer to a duty station
that has not previously been formally classified; or
c) Conditions at the duty station have changed to such an extent that the staff member/Resident
Coordinator believes a review is warranted.

2. One questionnaire is to be completed for each duty station.

3. The Resident Coordinator designates appropriate official(s) to complete the form (should be someone
actually residing in the duty station). It is particularly important that Part II (General Information) and Part
III (Detailed Information) of the questionnaire be completed by international staff member(s) and
spouse(s) at the duty station. International staff members from all organizations of the United Nations
common system at the duty station are encouraged to actively participate in the completion of the
questionnaire.

4. Complete all sections of the questionnaire; if a section or question does not apply mark it "N/A".

5. The section on Security (Part III F) contains two parts. The first part must be completed by security
officers in the United Nations Security Management System (UNSMS) and the second part must be
completed by staff members and/or their spouses.

6. The section on Health (Part III G) also contains two parts. The first part must be completed by either a
WHO representative or a UN examining physician. This part should be completed in PDF version (see
memorandum from ICSC for further information). The second section must be completed by staff
members and/or their spouses.

7. Space is provided under every section for additional comments. Such comments are important and are
therefore encouraged provided they relate directly to that section of the questionnaire and are pertinent
to classification of the duty station. These additional comments should be of a quantitative nature, but
should not relate to cost considerations which are dealt with through the post adjustment system.

8. News articles and photographs that support clarity in description of conditions at the duty station may be
attached.

9. CERTIFICATIONS AND COMMENTS BY THE RESIDENT REPRESENTATIVE/ COORDINATOR

ARE ESSENTIAL FOR REVIEW OF THE CLASSIFICATION OF THE DUTY STATION (Part I, and in
particular Part I Section C).

NOTE: Resident Representatives/Coordinators are requested to ensure timely submissions of

questionnaires to ensure that staff members receive all applicable entitlements.

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 Part I
CERTIFICATIONS AND COMMENTS BY RESIDENT REPRESENTATIVE/COORDINATOR
A. To be completed by official(s) designated by the Resident Coordinator to fill in the
questionnaire.
1. Part II (General Information) of this questionnaire was completed by:
Name and title:       Agency:      

Duty station:       Date prepared:       Signature: ________________

2. Parts III (Detailed Information) Section A through F were completed by:
Name and title:       Agency:      

Duty station:       Date prepared:       Signature: ________________

3. Part III Section G of this questionnaire regarding health factors was completed by a Medical Doctor:
Name and title:       Agency:      

Duty station:       Date prepared:       Signature: ________________

B. To be completed by cooperating colleagues and/or spouses.

Name and title:      

Agency:       Signature: ________________ Date:      

Name and title:      

Agency:       Signature: ________________ Date:      

Name and title:      

Agency:       Signature: ________________ Date:      

Name and title:      

Agency:       Signature: ________________ Date:      

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C. Resident Coordinator's Comments
To be completed by the Resident Coordinator or UNDP Resident Representative. (Please attach additional sheets, if
necessary, to provide complete answers to any items below.)
PLEASE NOTE:THIS SECTION IS EXTREMELY IMPORTANT AS IT PROVIDES THE OVERALL CONTEXT FOR THE
QUESTIONNAIRE AS WELL AS THE RELATIVITIES BETWEEN DUTY STATIONS WITHIN THE COUNTRY.
1. Overall Trends: State whether the conditions relating to any individual factors such as Housing, Other Local
Conditions, and so on, (Part III: Detailed Information) have changed substantially since the last questionnaire and, if
so, for which factors and in which direction. Also provide supporting details including news articles and photographs,
if appropriate.
     

2. Relative hardship: Indicate, on an overall basis or by separate factors, how this duty station compares, in terms of
hardship, with other duty stations in the country and with other duty stations where you have served (please identify).
If in your opinion, hardship elements at the duty station affect women differently from men, please explain.
     

3. Security factor: Of the cases of security-related incidents mentioned in Part III-F of the questionnaire, indicate how
many have been reported to the Security Coordinator at U.N. Headquarters. Comments on the general security
situation of the country as well as the specific security situation at the duty station would be most helpful.
     

4. Travel: If there have been any administrative or other restrictions on travel other than normal customs and
immigration formalities upon entering or leaving the country, including travelling within country, please describe the
restrictions.
     

5. Medical evacuations: If there have been any medical evacuations from the duty station since the last questionnaire
was completed or within the last 3 years (whichever is shorter) please provide details (i.e. number of evacuations,
dates, problems, if any, in effecting evacuations, and reasons for the evacuation).
     
6. Actions to alleviate hardship: Describe below actions taken by UN system agencies, bilateral agencies and others
to alleviate hardship conditions at the duty station. Include, inter alia, comparisons of standards of housing, officially
maintained recreational and/or social facilities, commissaries, bonded stores, and/or bulk import schemes operated
for the benefit of expatriate staff by such organizations.
(a) Actions taken by UN system agencies, other than normal entitlements available under the common system:
     

(b) Actions taken by non-UN organizations:

     

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7. Other comments: Additional factors/comments that should be considered when classifying the duty station.
     
8. Source(s) of information: ( Click the appropriate box for Yes/No response)
a) Resident at duty station Yes No Resident since:      
b) Personal visit to duty station Yes No Date of visit:      
c) Discussions with staff who reside at the duty Yes No Date of discussion:      
station
d) Discussions with staff who recently visited the Yes No Date of discussion:      
duty station
e) Other reports Yes No Date(s) of report(s):      
9. Certification
I have reviewed Parts II and III of the questionnaire and certify that to the best of my knowledge the answers are
reasonable.

_________________________            

Signature Name and title Date

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 Part II
GENERAL INFORMATION

1. Number of married and single internationally recruited staff members at the duty Married Single
station (NOTE: EXCLUDE dependants, UNVs, National Officers/National Experts,
Associate Experts/JPO's/APO's, consultants, contractors, local staff, international M F M F
staff on assignments for less than one year and those staff on travel status):
                   
   

2. Number of married and single Associate Experts/JPO's/APO's at duty station: Married Single

M F M F
                   
   

3. At the time of completing this questionnaire, is the duty station designated as a non-family duty station?
Yes No
If No, please continue to question 4 and 5.
If Yes, please continue to Part III Detailed Information.

4. Concerning spouses of UN international staff members at duty station:

a) Number of spouses residing at the duty station:      

b) Number of spouses residing elsewhere in the country of the duty station:      
Briefly state where:      

c) Number of spouses residing outside the country of the duty station:      
Briefly state where:      

5. Concerning dependent children of UN international staff members:

a) Number of dependent children residing at the duty station:      

b) Number of dependent children of school-age residing elsewhere in the      
country of the duty station:
If known, indicate reason for different residence:      
c) Number of dependent children of school-age residing outside the      
country of the duty station:
If known, indicate reason for different residence:      

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 d) Total number of dependent children of staff members:      

6. Additional comments, if any, regarding the reasons why spouses and/or children are residing outside the duty
station (i.e. lack of employment opportunities or schooling)      
Part III
DETAILED INFORMATION
A. Educational Factors
PLEASE NOTE: Questions concerning the Educational Factors are no longer applicable as they related to the
Additional Education Grant Travel which has been discontinued with the introduction of the revised education grant
scheme as of the school year in progress on 1 January 2018.

B. Climatic and Environmental Factors

Climatic Factors
10. Please note that information on climatic factors such as average or extreme temperatures, humidity, or precipitation
levels for each month of the year over a period of 10 years will be collected by the ICSC Secretariat from official
published sources.

11. Additional comments on mitigation measures: Please list any mitigation measures (i.e., heating and cooling
systems) that are used at the duty station to reduce the impact of extreme climatic conditions (e.g., extreme
heat/cold).      

Environmental Factors
12. If any extreme environmental conditions occur at the duty station during the past 3 years, please provide the
information requested below:
Altitude of 2,440 meters/8,000 feet above Yes No
sea level or higher
Drought during the past 3 years Yes No
Sandstorms or Dust storms during the Yes No
past 3 years
Volcanic activity during the past 3 years Yes No If Yes, specify when:      
Major flooding during the past 3 years Yes No If Yes, specify when:      
Major earthquakes (over 5 on Richter Yes No If Yes, specify number of earthquakes and Richter
Scale) during the past 3 years Scale rating(s):      
Heavy rainfall during the past 3 years Yes No If Yes, specify amount (in mm or inches) and
duration of rainfall:      
Heavy snowfall during the past 3 years Yes No If Yes, specify amount (in mm or inches) and
duration of snowfall:      
Tornado, cyclone, typhoon, or hurricane Yes No If Yes, specify type and number experienced:      
during the past 3 years

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 Pollution Yes No If Yes, specify type of pollution:      
Other (Please specify):      

13. Additional comments: please also identify any climatic conditions (e.g. humidity, dust, sand, salty water, and wind)
which result in more rapid than normal deterioration of clothing, leather goods, and electrical/electronic products and
equipment.      

C. Housing Factors
PLEASE NOTE: Questions about housing and facilities in this section refer to the current accommodation at the duty
station for internationally recruited staff members who are assigned for 1 year or longer, NOT housing and facilities that
may be available to local population.

Types of Accommodation
14. Are international staff members who are assigned for 1 year or longer at the duty station residing in accommodation
provided by:
Private/commercial renters?
Government of the host country?
UN agency?
Other (please specify)      

15. Please specify what is/are the type(s) of accommodation the majority of international staff members reside in.
a) Separate houses/apartments Yes No b) Separate houses/apartments Yes No
within a UN compound or UN
troops compound
c) Shared separate Yes No d) Shared separate houses Yes No
houses/apartments with shared (including kitchen/dining and/or
facilities (including kitchen, living bathroom facilities) within a UN
room, and bathroom) compound or UN troops
compound
e) UN guesthouses Yes No f) Hotels/guesthouses Yes No

g) Containers or equivalent Yes No h) Office space Yes No

i) Tents Yes No j) Other:      

16. If international staff members reside in more than one type of accommodation (i.e., more than one option from the
above are checked Yes), please explain why and provide details, including the number of international staff members
residing in each type of accommodation.      

Neighborhood Characteristics
17. Do the majority of international staff members live:
a) close to public transport? Yes No
b) close to place of work? Yes No
c) close to primary or secondary schools? Yes No
d) close to local markets? Yes No

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 Basic Facilities
18. If the accommodation taken by international staff members normally lacks basic facilities, are any of the facilities
listed below either missing or need major refurbishment?
a) Toilets Yes No b) Sinks Yes No
c) Bathtubs/Showers Yes No d) Windows/Doors Yes No
e) Roofing Yes No f) Flooring Yes No
g) Electrical wiring Yes No h) Water piping Yes No
i) Water heaters Yes No j) Other (Please specify):      

19. Are heating or cooling systems (e.g., air conditioners, fans) required in accommodation? Yes No
20. If Yes to question 19, are they normally already installed in accommodation taken by Yes No
international staff members?
21. If heating or cooling systems are required in accommodation but are not already installed, can
the heating or cooling systems be purchased locally? Yes No

Home Maintenance and Repair Services

22. How do international staff members obtain home maintenance and repair services?
By themselves from the locality From the management of the accommodation providers

23. Which of the following home maintenance and repair services are available in the locality or provided by the
management of the accommodation providers?
Availability Quality
Usually Sometimes Never Adequate Inadequate
a) Electrical
b) Plumbing
c) Carpentry
d) Masonry
e) Painting

24. Additional comments, including restrictions from Department of Safety and Security (DSS), if any:      

D. Social and Physical Isolation Factors

PLEASE NOTE: Questions about isolation in this section are regarding what are being used by internationally recruited
staff members who are assigned for 1 year or longer, NOT facilities and services that may be available to local
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 population.

D.1. Social Isolation

Population Factors
25. Total population of the duty station:      
26. What is the size of the expatriate community, including the diplomatic community, at the duty station?
10 households or less 11 to 25 households 26 to 50 households Over 50 households

Cultural and Recreational Facilities

27. Check each cultural and recreational facility listed below that is available for the use of international staff members.
Availability Accessibility
a) Sport facilities Yes No Yes No
b) Social or recreational clubs Yes No Yes No
c) Restaurants Yes No Yes No
d) Cinemas or theatres Yes No Yes No
e) Public parks Yes No Yes No
f) Newspapers (in any UN working language) Yes No Yes No
g) Bookstores or libraries with international books and magazines Yes No Yes No
Usually Sometimes Never
28. Do cultural gender norms at the duty station prohibit female staff members from
equally accessing the available facilities in question 27?
29. Additional comments deemed useful in describing cultural and recreational facilities at the duty station:      

Restrictions
(i) Local Contacts and Restrictions
30. What is the local language at the duty station?      
31. What language is used to conduct local business, shopping, etc.?      
Usually Sometimes Never
32. Do language barriers prohibit interaction with the local community?
33. Are there formal or informal restrictions on establishing or maintaining contact
with the local community?
34. Are there formal or informal restrictions on women participating in the life of the
community at the duty station?
35. Are there formal or informal restrictions on staff members and their families
practicing their religion?

(ii) Travel Restrictions

36. Are there any administrative or other restriction, apart from visa, on international staff members’

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 travelling when:
a) entering the country Yes No
b) within the country Yes No
c) leaving the country Yes No
If Yes, please describe the restrictions:     

37. Are the movements of international staff members restricted by Department of Safety and Yes No
Security (DSS) to specific areas in the duty station due to security?

38. Additional comments, if any, that are deemed useful in describing restrictions including
difficulties experienced by staff and family members in adjusting to the local culture and
environment:      
Concerning Spouses
Usually Sometimes Never
39. Can spouses find paid work at the duty station?
40. Can spouses find unpaid volunteer work at the duty station?

41. Describe the types of work opportunities available and, if appropriate, the difficulties (including work permit)
encountered by spouses in finding work suited to their skills:      

Communication Services
42. Which of the following services are readily available at the duty station to communicate domestically and
internationally?

Availability Reliability

Yes No Adequate Inadequate

a) Telephones
b) Mobile/Cellular phones
c) Internet/e-mail at UN office
d) Internet services outside UN office
e) Postal service
f) Courier service (e.g. DHL, FedEx, etc.)
g) Fax
h) Radio (Communication radio)

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 43. Are there any restrictions in the use of the above communication facilities? Yes No
44. If Yes to question 43, what are those restrictions?      
45. Additional comments, if any, on social isolation factors:      

D.2. Physical Isolation

Physical Factors
46. If the duty station is not the capital city, list the distance between the duty station and the capital city:       km
47. Time it takes to reach the capital city from the duty station by land:       hours
48. Times during the year when such travel is not possible because of bad weather (if applicable):      
49. Time it takes to reach the capital city from the duty station by air (if applicable):       hours
50. Distance to the nearest DOMESTIC airport (if applicable):       km
51. Time it takes to reach the nearest domestic airport (if applicable):       hours
52. Total number of flights per week from the nearest domestic airport to the nearest international airport (if applicable):
      flights/week
53. Distance to the nearest INTERNATIONAL airport:       km

If the nearest international airport is not the one in the capital city, what is the name of the international airport being
used?      
54. Time it takes to reach the nearest by air (if applicable):       hours
international airport: by land (if applicable):       hours
55. Total number of flights per week from the nearest international airport to foreign destinations:       flights/week
56. Comment on the availability and reliability of flights from the nearest domestic or international airport (if applicable):
     

Access to Change of Scene

57. Indicate the nearest location(s) away from the duty station which provides a change of scene in terms of climate,
isolation, local conditions, or relief from other adverse factors:      
58. Considering response to question 57, give the total travel time needed and modes of transportation required:      
59. In practice, do UN international staff members have the opportunity to travel to the above Yes No
location (including for Rest & Recuperation breaks)?
60. If No to question 59, please explain:      
61. Additional comments, if any, on physical isolation factors:      

E. Other Local Conditions

PLEASE NOTE: Questions about local conditions in this section are regarding goods and services available to
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 internationally recruited staff members who are assigned for 1 year or longer, NOT goods and services that may
be available to local population.
Import Schemes
62. Are any schemes such as bonded stores, commissaries, or other commodity import schemes generally available to
UN international staff members at the duty station?
a) Commissary Yes No (c) Duty free shops Yes No
b) Bonded store Yes No (d) Other (please specify):      

Food Shopping Facilities

63. Which of the following types of food shopping facilities are available at the duty station:
a) Open/Closed local market(s) Yes No (c) Supermarkets Yes No
b) Small grocery stores Yes No (d) Other (please specify):      
64. Are there any restrictions on the importation of foreign goods? Yes No
65. If Yes to question 64, please explain:      

Availability of Food, Furnishings, and Other Necessities

66. Indicate availability of food, furnishings, and other necessities in local market where expatriates usually shop.
Availability Quality
Usually Sometimes Never Adequate Inadequate
a) Fresh fruits, vegetables, and eggs?
b) Staples (e.g. salt, sugar, rice, etc.) ?
c) Fresh meat?
d) Fresh fish/seafood?
e) Dairy products?
f) Imported food?
g) Bottled water & soft drinks?
h) Alcoholic beverages?
i) Household necessities (e.g. electric light
bulbs, candles, batteries, cleaning products,
toiletries, etc.)?
j) Fuel and lubricants for motor vehicles?
k) Primary fuel source used for cooking?
Identify source:      
l) Spare parts for vehicles?
m) Spare parts for household appliances?
n) Repair services for private vehicles?
o) Repair services for major household
appliances (i.e. refrigerators, stoves, air

13
 conditioners, etc.)?

67. If not available at the duty station, indicate place and distance (including time to get there) where items are
purchased by expatriate staff:      
Public Transportation
68. Indicate what public transportation is generally made use of by expatriate staff and their families at the duty station.
Available? Use strongly Reliable? Physically safe?
discouraged by DSS?
a) Bus Yes No Yes No Yes No Yes No
b) Taxi Yes No Yes No Yes No Yes No
c) Other (please specify): Yes No Yes No Yes No Yes No
________
69. If public transportation is unavailable or unsafe and/or unreliable or strongly discouraged by Department of Safety and
Security (DSS) from using it, what are the available modes of transport to international staff members?      

Emergency Services
70. Indicate what emergency services are available at the duty station.
Availability Quality
Usually Sometimes Never Adequate Inadequate
a) Fire
b) Ambulance
c) Police

Water Supply and Electricity

71. Provide information on the availability of water supply and electricity at the duty station
Water supply Electricity
a) Is public service available? Yes No Yes No
b) If no public service, what arrangements are in            
place to provide the service? Please specify:
c) Is available service (public/other arrangements) Yes No Yes No
subject to interruption?
d) If there is any interruption, what is the frequency? Daily Daily
Weekly Weekly
Monthly Monthly
In summer/winter In summer/winter
A few times per year A few times per year
Other:       Other:      
e) Comments on the quality of water/electricity supply at the duty station, if any:      

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 Heating and Cooling Systems
72. Are heating or cooling systems (e.g., air conditioners, fans) required in UN offices and other public Yes No
facilities?
73. If Yes to question 72,
a) Are they normally already installed in UN offices? Yes No

b) Are they normally already installed in other public facilities used Yes No
by international staff members?

Sanitary and Hygiene Conditions

74. Give your opinion of the level of hygiene at your duty station in the following areas:
Good Adequate Poor
a) Cleanliness of streets
b) Cleanliness of food markets and food items
c) Garbage collection
d) Disposal of refuse
e) Rodent infestation control
f) Insect infestation control

Financial Services
75. Describe factors related to banking facilities at the duty station.
Availability Quality
Usually Sometimes Never Adequate Inadequate
a) Use of credit cards
b) Banking services
c) Automated Teller Machines (ATMs)
76. Additional comments:      

15
F. Security Factors
F1.SECURITY FACTORS: Section 1
PLEASE NOTE: Answers to question 77-86 must be completed by security officers in the United Nations Security
Management System (UNSMS)
SECURITY THREATS, as defined under SLS and STA
77. Security Level at the Duty Minimal Low Moderate Substantial High Extreme
Station?

78. Threat level for: Minimal Low Moderate Substantial High Extreme
a) Armed Conflict
b) Terrorism
c) Crime
d) Civil Unrest
e) Hazards
79. Please explain causes of the prevailing      
hazards
SECURITY RISKS, as per Security Risk Assessment
80. Residual security risks associated with Very low Medium High Very
security threats: low high
a) Armed Conflict
b) Terrorism
c) Crime
d) Civil Unrest
e) Hazards
RESIDENCIAL SECURITY MEASURES
81. Whether UN Minimal Operating Residential Security Standards (MORSS) are required Yes No
and implemented at the Duty Station?
82. If the answer is YES, what specific MORSS elements are applicable?
a) physical reinforcement Yes No
b) security alarm system Yes No
c) security guards Yes No
d) specific measures for single female staff members Yes No
ACCIDENTS Yes No

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 SECURITY INCIDENTS AND SAFETY ACCIDENTS
83. Please indicate the number of United Nations personnel and their eligible dependants affected by incidents and
accidents according to the categories and for periods below:
Categories of incidents and accidents/period Last 12 months 13 to 24 months
ago
Homicide - the killing of a human being, committed by another            

Murder - a form of criminal homicide, deliberate and premeditated            

Abduction - act of restraint by non-State actors through the use or threat of force            
or through fraudulent persuasion
Arrest or detention – act of restraint executed by state actors            

Sexual abuse - an unwanted sexual activity on a person as by the use of force,            
threats or coercion
Armed attack - violence committed with weapons (any instrument or            
instrumentality used in fighting)
Robbery - act or instance of unlawfully taking property by the use of violence or            
threat of violence
Aggravated assault - unlawful act which places personnel in fear of immediate            
bodily harm or battery
Arson - the criminal intent of setting a fire with intention to cause damage            

Break-in - unauthorized and forceful entry aggravated by use of force and/or            
physical assault
Burglary - unauthorized and forceful entry with intent to commit a felony or crime,            
including theft
Theft - a criminal act in which property belonging to another is taken without that            
person's consent
Intimidation - act of making timid or fearful or of deterring by threats            

Harassment - act of systematic and/or continued, unwanted and annoying            
actions which serve no legitimate purpose
Aviation accident - an unexpected occurrence with potential for harm associated            
with the operation of an aircraft
Road traffic accident - an unexpected occurrence with potential for harm            
associated with a moving motor vehicle
Fire accident - an unexpected fire occurrence with potential for harm to people or            
property damage
Other accidents - an unexpected occurrence associated with other            
circumstances with potential for harm

17
84. Please indicate the number of United Nations personnel and their eligible dependants affected by incidents and
accidents according to the categories and for periods below:
Categories of impact of incidents and accidents/period Last 12 months 13 to 24 months
ago
Critical impact, unnatural death - death caused by security incidents and safety            
accidents
Severe impact, injury - physical harm or body damage which require medical            
treatment
85. Please indicate the number of critical security incidents and safety accidents that did not affect United Nations
personnel but caused mass casualties or catastrophic damage at the Duty Station according to the categories and for
periods below:
Categories of impact of incidents and accidents/period Last 12 months 13 to 24 months
ago
Mass casualty incidents caused by armed conflict, terrorism, crime or public            
unrest
Catastrophic accidents associated with substantial damage to infrastructure            
caused by natural disasters or catastrophes
STAFF/DEPENDANTS NUMBERS
86. Please indicate the number of United Nations personnel and their eligible dependents in the Duty Station as per lists of
personnel included in Security Plan:
International National All International National All Total
personnel personnel personnel dependants dependants dependants
                                         

F.2.SECURITY FACTORS: Section 2

PLEASE NOTE: Answers to question 87-89 must be completed by staff members and their spouses, if applicable:
PERSONAL OBSERVATIONS OF UNITED NATIONS PERSONNEL
87. Do United Nations personnel in the Duty Station and their eligible dependants, if applicable, have significant
concerns related to their personal safety and security and under what specific circumstances?
At work places Whilst commuting At residences In public venues
Yes No Yes No Yes No Yes No
88. Do United Nations personnel and their eligible dependants, if applicable, undertake Yes No
additional personnel security measures?
89. How national law enforcement and other emergency services in the Duty Station respond to calls for assistance by
United Nations personnel and their eligible dependants, if applicable?
Promptly and efficiently Reasonably Slowly and Not
Well ineffectively responding

18
19
G. HEALTH FACTORS
G.1.HEALTH FACTORS: Section 1
The Resident Coordinator should ensure that this section of the questionnaire (item 90-118) is completed by either (1)
the WHO representative or (2) the UN examining physician. Only medical facilities frequented by international staff
should be reported on.
Please Note: Psychological stressors that are a consequence of overall conditions at the duty station will be factored
into the final health rating.
Name and address of WHO representative/UN Physician who completed this section:

If physician, please state:

- type of practice and specialty: UN Level I Clinic
- years of experience practicing (1) at duty station: (2) in country:
- United Nations agency affiliation: UNDP
I. MEDICAL FACILITIES
A. Hospitals
90. Names and addresses of hospitals or private medical facilities located in the duty station. ONLY name hospitals
most likely to be used by the international staff and their dependents. Indicate the approximate driving distance.
facility (a): UN Clinic      

facility (b): ASPEN Clinic      

facility (c): St. Joseph Catholic Hospital      

facility (d): JFK Hospital      

facility (e): Jahmale Medical Solutions      

For each facility, provide the following information:

91. Transportation/ambulances available?
If yes, what kind and how many of each.
facility (a): Yes No Ground Ambulance 1

facility (b): Yes No Ground Ambulance 1

facility (c): Yes No Ground Ambulance 1

facility (d): Yes No Ground Ambulance 3

facility (e): Yes No Ground Ambulance 1

92. Is there any established coordination between UN agencies and the local hospitals to facilitate the admission of
staff members?
facility a facility b facility c facility d facility e
Yes No Yes No Yes No Yes No Yes No

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93. Types of rooms
facility a Facility b facility c facility d facility e
Ward Yes No Yes No Yes No Yes No Yes No
-number of beds 5                        

Private/semi-private Yes No Yes No Yes No Yes No Yes No

Rooms
-number of rooms       22 6      

94. Electrical supply

facility a facility b Facility c facility d facility e
Generator(s) Yes No Yes No Yes No Yes No Yes No
How many? 3 1 3 3 2
96. Number of staff
facility a facility b facility c facility d facility e
Full-time physicians 2 1 5 31 2
Part-time physicians 0 7       8
Full-time nurses 4 5 42 269 8
Part-time nurses                              

97. Services provided in medical facility

Facility a facility b facility c facility d facility e
(a) Emergency room Yes No Yes No Yes No Yes No Yes No
If yes, is it open 24 hours a Yes No Yes No Yes No Yes No Yes No
day?
(b) Pediatrics and post- Yes No Yes No Yes No Yes No Yes No
natal care
(c) Infectious diseases dept. Yes No Yes No Yes No Yes No Yes No
(d) ENT department Yes No Yes No Yes No Yes No Yes No
(e) Ophthalmology dept. Yes No Yes No Yes No Yes No Yes No
(f) OB/GYN Yes No Yes No Yes No Yes No Yes No
If yes, number of deliveries                        
yearly
possibility of Caesarian Yes No Yes No Yes No Yes No Yes No
section
possibility of Yes No Yes No Yes No Yes No Yes No
external fetal
monitoring during
labour

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 facility a facility b facility c facility d facility e
(g) Surgery Yes No Yes No Yes No Yes No Yes No
If yes, enumerate types of surgical features performed, and for each indicate the numbers performed yearly:
laparoscopy
      /       /       /       /      
year year year year /year

Appendectomy
      /       /       /       /      
year year year year /year

Tonsillectomy/
adenoidectomy       /       /       /       /      
year year year year /year

repair of inguinal, crural,

umbilical hernias       /       /       /       /      
year year year year /year

Cholecystectomy
      /       /       /       /      
year year year year /year

hysterectomy/ ovariectomy
      /       /       /       /      
year year year year /year

open reductions of fractures

      /       /       /       /      
year year year year /year

More complex surgical procedures (detail):

facility (a):      

facility (b):      

facility (c):     

facility (d):      

facility (e):      

facility a Facility b facility c facility d facility e

(h) Intensive care units Yes No Yes No Yes No Yes No Yes No
post-operative unit Yes No Yes No Yes No Yes No Yes No
medical including Yes No Yes No Yes No Yes No Yes No
cardiovascular
severe burns unit Yes No Yes No Yes No Yes No Yes No
- if answer to any of the above is YES:

-- are physicians Yes No Yes No Yes No Yes No Yes No

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 specifically
attached to this unit
on a 24
hour-a-day basis?
-- what is the nurse 1:2
to patient ratio in this
unit?
facility a facility b facility c facility d facility e
-- does it include a trauma Yes No Yes No Yes No Yes No Yes No
centre?
(i) Available equipment:
oxygen tanks Yes No Yes No Yes No Yes No Yes No
portable x-ray machine Yes No Yes No Yes No Yes No Yes No
ECG monitors Yes No Yes No Yes No Yes No Yes No
Defibrillator Yes No Yes No Yes No Yes No Yes No
EEG machine Yes No Yes No Yes No Yes No Yes No
Assisted ventilation equipment Yes No Yes No Yes No Yes No Yes No
facility a facility b facility c facility d facility e
(j) Laboratories Yes No Yes No Yes No Yes No Yes No
If yes, how many technicians?
full-time: 1                        

part-time:                              

Types of tests performed:

Facility a facility b facility c facility d facility e
routine hematology tests Yes No Yes No Yes No Yes No Yes No
routine biochemical tests Yes No Yes No Yes No Yes No Yes No
liver profile Yes No Yes No Yes No Yes No Yes No
kidney profile Yes No Yes No Yes No Yes No Yes No
thyroid profile Yes No Yes No Yes No Yes No Yes No
lipid profile Yes No Yes No Yes No Yes No Yes No
glycemia Yes No Yes No Yes No Yes No Yes No
urinalysis Yes No Yes No Yes No Yes No Yes No
routine bacteriological tests Yes No Yes No Yes No Yes No Yes No
blood cultures Yes No Yes No Yes No Yes No Yes No
urine cultures Yes No Yes No Yes No Yes No Yes No
stool cultures Yes No Yes No Yes No Yes No Yes No

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parasitological tests (describe which are routinely performed)
facility a facility b facility c facility d facility e
stool Yes No Yes No Yes No Yes No Yes No
urine Yes No Yes No Yes No Yes No Yes No
blood Yes No Yes No Yes No Yes No Yes No
facility a facility b facility c facility d facility e

anatomopathology – Yes No Yes No Yes No Yes No Yes No

Papanicolaou smears

Automated machinery Yes No Yes No Yes No Yes No Yes No

If yes, is there a maintenance Yes No Yes No Yes No Yes No Yes No

and spare parts
service?

Are quality control tests Yes No Yes No Yes No Yes No Yes No

carried out?

If yes, how often per year?

Twice                        

Is required laboratory Yes No Yes No Yes No Yes No Yes No

reagents easily
available?

Does department function 24 Yes No Yes No Yes No Yes No Yes No

hours a day?

facility a facility b facility c facility d facility e

(k) Blood bank Yes No Yes No Yes No Yes No Yes No

If yes, number of staff:             4 2      

Is blood systematically screened for:

HIV? Yes No Yes No Yes No Yes No Yes No

Hepatitis B? Yes No Yes No Yes No Yes No Yes No
Hepatitis C? Yes No Yes No Yes No Yes No Yes No
Malaria? Yes No Yes No Yes No Yes No Yes No

If applicable, what techniques are used to screen for HIV antibody?

facility (a):      

facility (b):

facility (c): HIV 1/2 Antibody test

facility (d): HIV 1/2 Antibody test

facility (e):      

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 facility a facility b facility c Facility d facility e

Can blood bank/hospital store

blood packs? Yes No Yes No Yes No Yes No Yes No

If yes, how many?                              

For how long?                              

Where does the hospital's blood supply come from? Please check all that apply

Family/friend donation:
Voluntary donation program:
Paid donation:
facility a facility b facility c facility d facility e
Does blood supply include
rare blood groups? Yes No Yes No Yes No Yes No Yes No

Is the blood bank open 24

Yes No Yes No Yes No Yes No Yes No
hours a day?
facility a facility b facility c facility d facility e
(l) Radiology Yes No Yes No Yes No Yes No Yes No
If yes, list available equipment:
facility (a):      
facility (b): X-Ray, Ultrasonogram
facility (c): X-ray, Ultrasonogram, CT Scan, Mammogram
facility (d): X-Ray, Ultrasonogram, Endoscopy
facility (e): X-ray, Ultrasonogram, CT-Scan, Mammogram, MRI
facility a facility b facility c facility d facility e
general radiology and contrast Yes No Yes No Yes No Yes No Yes No
radiology
echography Yes No Yes No Yes No Yes No Yes No
angiography, coronary Yes No Yes No Yes No Yes No Yes No
arteriography
mammography Yes No Yes No Yes No Yes No Yes No
CT scan Yes No Yes No Yes No Yes No Yes No
radioisotope scanning Yes No Yes No Yes No Yes No Yes No
magnetic resonance imaging Yes No Yes No Yes No Yes No Yes No

Is there a maintenance and

spare parts service? Yes No Yes No Yes No Yes No Yes No

How many x-ray technicians       2 2            

on staff?
Does the radiology No No No No
Department function 24
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Hours a day?

facility a facility b facility c facility d facility e

98. Hospital care/hygiene
(a) Hospital care:       Yes Yes Yes      

(i) Nursing care:       Yes Yes Yes      

-- Nurse/patient ratio
2:6 1:8 1:1
in general wards:
-- Response time to
patient’s request immediate Immediate <1 minute Immediate
for attention/care:
(ii) Are the wards:
-- Well ventilated? Yes No Yes No Yes No Yes No Yes No
-- Routine maintenance
and upkeep of Yes No Yes No Yes No Yes No Yes No
wards:
(b) Hospital hygiene:
Does hospital provide linen? Yes No Yes No Yes No Yes No Yes No
- If answer is YES:
-- is linen changed daily? Yes No Yes No Yes No Yes No Yes No
-- is linen washed in
boiling water and Yes No Yes No Yes No Yes No Yes No
chlorine?
Are hospital beds vermin-
Yes No Yes No Yes No Yes No Yes No
infested?
Is food provided by hospital? Yes No Yes No Yes No Yes No Yes No
-- If yes, is it perceived as
Yes No Yes No Yes No Yes No Yes No
being safe to eat; or
-- If not, is it customary for
food to be
Yes No Yes No Yes No Yes No Yes No
provided by
patient's family?
How often are hospital floors
Twice a day 3 times daily 3 times daily Twice a day Twice a day
cleaned?
How are hospital floors swept and swept and swept and swept and swept and
cleaned? mopped mopped mopped mopped mopped

B. Medical and dental private practices

99. Number of private physicians?      

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How long does it take to get an appointment?      

House calls? Yes No

Available 24 hours a day? Yes No
Have they easy access to local hospitals/private medical facilities? Yes No

100. Dental care

Is such care available? Yes No
If yes, how many dentists?      

What services can be provided?

Extraction, fillings and surgery

Emergency treatment, e.g.:

treatment of traumatic lesions gum surgery (periodontal)
Extraction manufacture of dental
prosthesis
Fillings orthodontic treatment
Is radiological equipment available? Yes No
Is equipment for sterilizing instruments satisfactory and reliable? Yes No
How long does it take to get an appointment? 1-2 days
How high is the general standard of hygiene (on a scale of 1 to 5, 1 being the lowest, 5 the highest)? LOW
HIGH

1-Lowest

C. Supply of medications
101. List pharmacies, outpatient clinics and hospitals able to supply prescription and/or non-prescription medications
to non-hospitalized patients located within one hour driving distance.
Pharmacies Outpatient clinics Hospitals
B-Kay Pharmacy
Lucky Pharmacy
Bunty Pharmacy
Cherif Pharmacy
     

102. Are some of these facilities open 24 hours a day and on week-ends? Yes No
103. Are there chronic shortages of medication? If yes what categories of medication are affected? How critical is the
shortage? Please explain. There is a shortage of narcotic analgesics due to the ban on importation by
government.

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104. What kinds of medications can be purchased?
pain killers oral hypoglycemics
Antibiotics disposable needles and syringes
Antimalarial various types of contraceptives and condoms
Antidiarrheal pediatric milk formula
cold medicine pediatric solutions for rehydration
Antihypertensives Anti-retroviral
Insulin Other
Is the source of medication
domestic? Yes No Both Domestic and International
Is it reliable? (please explain)
Yes No

D. Physical Therapy Facilities

105. Is there a physical therapy facility at the Duty Station? Yes No
If yes, give name and address of the facility.
Facility a. SALT Rehab Center
If no, is there such a facility in the country/region. Yes No
If yes, give name and address of the facility(ies).
     

106. Are the facilities equipped for rehabilitation of the following:

facility a facility b facility c facility d facility e
Lower Back Yes No Yes No Yes No Yes No Yes No
Upper Back Yes No Yes No Yes No Yes No Yes No
Shoulder Yes No Yes No Yes No Yes No Yes No
Elbow and Wrist Yes No Yes No Yes No Yes No Yes No
Hip Yes No Yes No Yes No Yes No Yes No
Knee Yes No Yes No Yes No Yes No Yes No
Ankle and Foot Yes No Yes No Yes No Yes No Yes No
Other Yes No Yes No Yes No Yes No Yes No

Comments, if necessary      

II. SANITARY CONDITIONS

107. Is piped water available for household use? Yes No

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108. Is it safe for human consumption without treatment? Yes No
109. Is it safe for consumption with treatment? Yes No
110. Is there a closed sewerage system? Yes No

If not, what arrangements exist?

     

111. Is garbage collected regularly? Yes No

If not, how is it disposed of?
     

112. Extermination of insects and rodents? Yes No

In town/city? How often?      

In living quarters? How often?      

Is use of repellents (including mosquito nets) widespread? Yes No

Are domestic animals vaccinated against rabies? Yes No
Are stray or semi-wild dogs and cats a problem at and around duty station? Yes No
III. EPIDEMIOLOGICAL DATA
113. On a scale of 0 to 3, indicate by circling appropriate number the risk of transmission of the following diseases:
(0 = nil, 1 = low risk, 2 = average risk, 3 = high risk)
yellow fever 0=nil Intestinal dysenteries:
dengue fever 0=nil - cholera 0=nil
viral encephalitis (specify types): - salmonella 0=nil
0=nil - shigellosis 0=nil
0=nil - giardiasis 0=nil
0=nil - typhoid fever 0=nil
amoebiasis 0=nil - viral dysentery 0=nil
schistosomiasis 0=nil Adult and infantile tetanus 0=nil
filariasis 0=nil Trypanosomiasis 0=nil
echinococcosis 0=nil Poliomyelitis 0=nil
leishmaniasis 0=nil rabies 0=nil

rickettsiosis: malaria: 0=nil

-exanthematic typhus 0=nil -P1 vivax 0=nil
-murine typhus 0=nil -P1 falciparum 0=nil

29
-other typhus 0=nil -other plasmodium (specify) 0=nil

tuberculosis 0=nil -state frequency of resistance to chloroquine      

hepatitis A 0=nil sexually transmitted diseases other than AIDS 0=nil

hepatitis B 0=nil non-sexually transmitted treponematosis 0=nil
hepatitis C 0=nil meningitis, all forms 0=nil
hepatitis D 0=nil other(s) (specify):
hepatitis E 0=nil 0=nil
other viral hepatitis 0=nil 0=nil
trachoma 0=nil 0=nil
HIV/AIDS
114. Estimated percentage of seropositive at duty station:       %

115. Does screening of blood donors take place throughout the whole country? Yes No
116. Has local government established preventive campaigns? Yes No
If yes, please describe:
     

117. Are anti-retroviral medications available? Check all that apply:

-- In regular pharmacies:
-- In specific clinics for treatment of HIV/AIDS:
-- Within special government programmes:
118. At the duty station, are there physicians specifically trained to treat and follow-up HIV patients? Yes No
If yes, please name the physician/facility:
     

119. At the duty station are the laboratories equipped for:

-- HIV testing Yes No
-- Viral load determination Yes No
If yes, please name the laboratory:
     

120. At the duty station, is there a voluntary confidential counseling and testing (VCCT)? Yes No
If yes, please name the centre:
     

30
IV. MEDICAL EVACUATIONS
121. Please indicate travel time from duty station to:
-the capital city:       total hours, by road

-nearest regional med-evac centre

(check on list below):       total hours, by road
Name the      
Nearest      
med-evac
     
centre as
     
indicated
in the
most
recent UN
STAI
122. Indicate frequency of plane flights from duty station:
-to capital city: daily
-to nearest med-evac centre: daily

123. State the conditions which in the past have given rise to medical evacuations:

     

124. Give description and numbers of evacuations in the last year for:
international staff:
     

their dependants:
     

local staff:
     

their dependants:
     

31
G.2. Health Factors: Section 2
PLEASE NOTE: Questions 125-130 should be answered by STAFF and/or their SPOUSES.
"Yes" or "No" answers without supporting statements will NOT receive credit.
Use separate pages, if necessary, to provide full explanations. Submit only ONE questionnaire containing the
composite response of ALL staff at the duty station.
125. At your duty station and in your experience, what is/are the medical facility/facilities used most by international staff
members and their dependants when they need medical assistance. Please name them.
     

126. How would you rate the overall medical skills of the physicians working at the above facility/facilities?
Good Adequate Below standard

127. How would you rate the overall nursing care at these same facilities?
Good Adequate Below standard

128. What is your perception of:

Good Adequate Below standard
a) The reliability of laboratory testing
b) The reliability of x-rays/evaluations
c) The reliability of the overall diagnostic ability

129. a) Are there chronic shortages of medication? Yes No

If Yes, which categories of medication are affected?
How critical is the shortage?      

b) Do you trust the quality of the medications that are available in the pharmacies at the duty station?
Yes No

     

130. Provide any other information which will assist in the evaluation of the health/medical facilities of the duty station.
     

32