More than 900 Families in Sardashti area atop Sinjar Mountain, the majority in self-made tents. ©Medair

Multi-Sector Rapid Needs Assessment

among Conflict-affected Populations on

Sinjar Mountain

Snuny Sub-District, Ninewa Governorate

Iraq 5th – 7th November 2015

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Table of Contents: Executive Summary……………………………………………………………………………………………………………3 Background Context…………………………………………………………………………………………………………..3 Assessment Methodology………………………………………………………………………………………………….4 Profile of Target Area…………………………………………………………………………………………………..…….5 Population Demographics………………………………………………………………………………………………….5 Key Findings………………………………………………………………………………………………………………………..6 Safety and Security…………………………………………………………………………………………………………….7 Food Security………………………………………………………………………………………………………………….….7 Health…………………………………………………………………………………………………………………………….…..8 WASH……………………………………………………………………………………………………………………………....10 Shelter…………………………………………………………………………………………………………………………...…11 NFIs and Markets…………………………………………………………………………………………………………...…12 Key Programmatic Challenges…………………………………………………………………………..………………13 Military Activity………………………………………………………………………………………………….…………….13 Humanitarian Tensions…………………………………………………………………………………………………....13 Recommendations…………………………………………………………………………………………………………...14 Annex 1: Priority Needs By Location…………………………………………………………………………………..16 Annex 2: Photos of Sinjar City Health Facilities……………………………………………………………….….18

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Executive Summary On November 5-7

th, a rapid multi-sector needs assessment (RNA) was conducted of conflict-affected

households living among informal settlements on Sinjar Mountain. The assessment teams identified Food Security and access to Health Services as the two highest priority unmet needs from respondents across four separate locations assessed. In the context of the subsequent military campaign to recapture Sinjar city, and looking at both the current and projected needs from an increasing population in the Snuny Sub-District, Medair recommends immediate Health interventions to address critical gaps in service. Specifically, Medair has identified opportunities, with support from the Directorate of Health-Ninewa (DoH-Ninewa), to operate mobile medical units to support current health posts on Sinjar Mountain and assist with the rehabilitation of Primary Health Care Centers (PHCCs) north of Sinjar Mountain to resume healthcare services in the area. In addition, Medair also seeks to support and augment DoH services resuming in Sinjar City and its neighboring villages with mobile medical support and the rebuilding of critical health care facilities in the heavily damaged area.

Background Context In August 2014, Islamic State (IS) forces attacked and took control of Sinjar city and neighbouring villages, an area located 2km-5km south of Sinjar Mountain and at the time home to the largest concentration of ethnic Yazidi minorities in Iraq, as well as Arab and Assyrian communities. While an estimated 20,000-30,000 Yazidis were initially reported to have sought refuge atop Sinjar mountain, the move of most families further East into formal and informal IDP settlements across Duhok Governorate has left between 1,300-2,000 displaced households living in critical need both in tented communities on the mountain itself and to a smaller degree among villages on the north side of the mountain. While villages along the more northern foothills of the mountain are comprised of a mix of returnees and IDPs, the population living on the mountain itself is almost entirely IDPs displaced from Sinjar proper and the villages and towns running along the south of the mountain. The population’s relative isolation from markets and basic services, extreme exposure to harsh weather conditions, and recent perceived neglect by the larger humanitarian response has fuelled frustrations among these communities towards aid agencies who themselves must navigate the complexities of the politicized environment. The various militias and Kurdish political parties present on and around Sinjar mountain have created a microcosm of intra-Kurdish relations with Yazidi militia, the Kurdistan Democratic Party (PDK), Turkey-based Kurdistan Worker’s Party (PKK), and Syria-based People’s Protection Units (YPG) all actively fighting IS to the South. While the mountain itself is not of considerable value economically or politically, Sinjar proper lies on a key supply line for IS that runs between Raqqa and Mosul. Additionally, Sinjar is part of a corridor of disputed territories claimed by both the KRG and the Iraqi Central Government. It’s recent recapture by KRG forces on November 12, and the subsequent remarks made by Masoud Barzani, current president of the Kurdistan Region of Iraq (KR-I), suggestive of Kurdistan’s claim to the area may further invite political or military clashes with opposing Iraqi militias.

1

Media coverage of the escape of 30,000 Yazidis from their homes to the top of Sinjar mountain following an IS ground assault helped to bring global attention to the larger displacement crisis facing Iraq in 2014. However, while NGOs and INGOs rushed to serve the critical needs of a growing IDP and refugee community in Duhok Governorate, few organizations (with notable exception of JEN, Mission East, and Samaritan’s Purse) have managed to conduct sustained long-term programming to assist those stranded on and around Sinjar Mountain. Now, more than one year since seeking refuge in the area, the estimated 1,350 families living in tents on the mountain itself are dependent on outside assistance for much of their basic needs.

1 Such clashes over disputed territories are currently taking place in Tooz District, Salah al-Din between Kurdistan Regional Government Special Forces (KRG-SF) and Iraqi Shi’a militia.

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Methodology Between November 5-7

th 2015, a rapid multi-sector needs assessment was conducted among villages and

informal settlements on, and along the north face of, Sinjar Mountain. The assessment was able to access locations in Snuny sub-district prior to permissions being suspended on November 11

th as military forces

prepared for an offensive on Sinjar. Local individuals from these locations were employed and trained to conduct the surveys using Open Data Kit (ODK) on smartphone tablets, allowing survey information to be collected electronically and sent to Medair’s support office in Duhok instantly. The decision to use local enumerators from the assessed communities was made to ensure the use of local knowledge where few assessments have been previously made as well as to increase Medair’s acceptance among the settlements who have been critical of the humanitarian presence in the past. Two Medair national staff travelled to Sinjar Mountain to train local enumerators to conduct the needs assessment over the course of several days. Due to reports of increased military movements in the area and the coordinated large scale offensive to retake Sinjar proper, the training and assessment timeline were condensed for security purposes. Medair staff trained 12 enumerators on November 5

th who went on to interview 142 households across four locations on November

6th

and 7th

. Key features of the rapid needs assessment were:

Areas assessed were Kursi village, Kolka and Sumi Hester villages (known collectively as “Kolka”), Sardashti and Chelmera areas(known collectively as “Sardashti”) and Sharafdeen areas. See map below for details

12 male enumerators, divided into two teams, were trained and equipped with Samsung tablets

This survey was based on the MIRA questionnaire as its template with further input from assessment templates used by the Rapid Response Mechanism (RRM) in Iraq

142 households were assessed in total. Though the original design of the assessment sought to assess 300 HH for an estimated population of 1,350 HHs, the buildup of military forces and the impact this had on the timeframe allowed for the assessment limited the number of HHs that could be covered by the assessment teams

Household-level survey completed using random selection of every 8th household during a planned walk through each of the defined target areas

Desk research conducted with Snuny government officials, the INGOs JEN, Samaritan’s Purse and Mission East, as well as local residents provided additional data for this report

The locations assessed were selected because of the concentration in these areas of displacement-affected households and the assertions from humanitarian actors presently working on Sinjar Mountain that no multi-sector assessments were recently conducted.

KURSI VILLAGE

KOLKA VILLAGE

SHARFADEEN

SARDASHTI

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Profile of Target Area

Sinjar is a district located in the Northwest of Ninewa Governorate and 120 km West of Mosul City. Its GPS coordinates are (36°19'14.19"N, 41°51'37.56"E). Snuny is one of Sinjar’s sub-districts, located 10km North of Sinjar Mountain and Southwest of Duhok by 160 km. Its GPS coordinates are (36°27'56.05"N, 41°42'31.99"E). Sinjar City and Sinjar Mountain fall within the coundaries of Snuny sub-district. NGO access to Snuny sub-district requires approval and written permission from the Duhok Governorate’s Office and the Asayish. This was obtained after providing staff names, vehicle registration numbers, and a brief description of the purpose of the visit. Permissions commonly take one week to process. See annexed map for the route used by the Medair assessment team.

Population Demographics The areas assessed consist almost entirely of Yazidi households who had fled in August 2014 from the villages and towns in Snuny sub-district that had been captured by IS. The most densely populated communities are scattered among informal tent settlements, small villages, farms and temples across Sinjar Mountain and along its northern foothills. The total population of the areas is estimated to be between 1,300-2,000 households, though there is a significant gap of reliable data on displacement-affected populations. Estimates were dependent on discussions with local community members, Snuny government officals and direct observation by the assessment teams. The table below summarizes population figures and the number of assessed households in each location. Where informal settlements near to one another and without clear demarcations between them were assessed, the larger settlement’s name was used, ex. Chelmera area with 25 estimated households was included under “Sardashti” in this assessment. Efforts were taken to assess locations separately where known shelter conditions and WASH services indicated the likelihood of different priority needs. Population increases by households returning to their sub-district of origin over the last few months have been reported by 77% of respondents across all four assessed locations. Discussions with healthcare staff and IDPs in Dohuk Governorate point to increasingly difficult conditions among non-camp displaced populations in the governorate, particularly the increasing incidence of evictions observed in Zakho where landowners are seeking to resume work on abandoned/unfinished buildings occupied by refugee and IDP households. It is expected that the recent recapture of Sinjar city and surrounding villages will see an increase in returnees, not just for those returning to their homes among the villages to the north of the mountain, but also as families eager to resettle in Sinjar and its nearby villages begin to move closer to their homes to await clearance and permission to move back. All interviewed households identified as Yazidi and though other ethnic minority groups may also be represented on Sinjar Mountain, the overwhelming majority of IDPs in these locations are ethnic Yazidi. The assessment team interviewed 142 heads of households of which 19 were female. The difficulty of identifying female enumerators able to travel unaccompanied across Sinjar Mountain led to lower than desired survey results for female respondents and is a key lesson learnt for future assessments.

AREA/ VILLAGE (Est. Population)

HH SURVEYED

INDIVIDUAL CHILDREN <5

INDIVIDUALS >60

MEN WOMEN GPS

Lat. Long.

Kursi (180-200 HH)

34 337 62 (18%)

12 (3%) 172 (51%) 165 (49%)

36°22'32.36"N 41°41'14.81"E

Kolka (200 HH)

19 208 51 (25%)

6 (3%) 105 (51%) 103 (49%)

36°22'10.57"N 41°43'25.84"E

Sardashti (900-1000 HH)

79 773 125 (17%)

37 (5%) 390 (51%) 383 (50%)

36°22'23.73"N 41°45'59.09"E

Sharfadeen (90-100 HH)

10 97 13 (13%)

2 (2%) 56 (58%) 41 (42%)

36°25'41.57"N 41°52'6.17"E

TOTAL 142 1415 251 (18%)

57 (4%)

723 (51%)

692 (49%)

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Household size data shows an average HH to have 9 members, exceeding the national average of 6. Though households may often include extended family members or those recently married, critical shelter conditions also force multiple families to share tents or rooms in unfinished buildings. This was accounted for when determining HH-size, focusing rather on the family size as reported in government-issued “family books” which each HH carried.

Key Findings Only 48% of households surveyed reported having received some form of assistance in the last 3 months, suggesting that ongoing assistance efforts are not managing to cover the most urgent priority needs for this population.

Respondents were asked to identify their top three unmet needs in order of priority. The chart below illustrates that Food Security was the overwhelming top priority need for the majority of the households surveyed in these villages and informal encampments, with Medical Assistance, Shelter, Water, and Household Items (NFIs) also being reported as concerns.

The summary graph above includes responses from all of the assessed locations, in aggregate, with little deviation in the prioritization of need across each of the four locations analyzed seperately; 89% of those surveyed rated Food as one of their top three priority unmet needs with each of the four locations showing similar concerns: Kursi (91%), Kolka (95%), Sardashti (91%), Sharfadeen (100%).

Medical Assistance, the second most frequently-cited unmet need among the communities surveyed was identified by 55% of respondents as one of their top three concerns. Shelter needs, with harsh winter weather fast approaching the Sinjar mountain area, was identified as a need by 39% of households. With the exception of Sharfadeen area where Shelter (60%)was more frequently cited as a concern than Medical Assistance or access to Water, all locations followed similar trends of prioritization of need as that expressed by the summary graph above. (See annex for village/area specific need prioritization).

0 20 40 60 80 100 120 140

Sanitation

Residency permit

Rental

Other (Kerosene)

Household items

Water

Shelter improvement

Medical assistance

Food

Priority Needs on Sinjar Mountain

Unmet Need1

Unmet Need2

Unmet Need3

0

10

20

2 3 4 5 6 7 8 9 1011121314151617192021

# H

ou

seh

old

s

Individuals/HH

Household Size

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SAFETY and SECURITY

91% of respondents reported feeling fairly safe or very safe in their current location at the time of the survey. This figure, along with the reported increases in population, may suggest an increased feeling of security as military forces have shown a sustained ability to maintain a static frontline along the south of Sinjar Mountain. However, 62% of respondents listed Safety and Security as the most important general need, citing it as a prerequisite to concerns over food, shelter, or water. Indeed, considering the history of oppressions faced by the Yazidi community in Sinjar, as well as their alleged abandonment by Kurdish Peshmerga forces in August 2014, this need for assurances in regards to protection as an ethnic minority in Iraq is understood and may play a considerable role in forecasting population movements and resettlement behavior in the coming year.

FOOD SECURITY

Concern over food security was the most frequently cited overall need by respondents in this assessment with 89% facing critical barriers to access. Below, households were asked to voice what they believed were the top issues facing food security.

The main problems reveal limitations with both the availability of food (in terms of what markets can stock) as well as accessibility of food (in terms of limited purchasing power). However, the availability of markets supplying food does not appear to be the greatest constraint:, 61% of households identify that food markets selling basic food items are available, and half of these respondents claim to have access within 500 meters of their homes. That being said, few households are able to consistently access a sufficient diversity of food items as shown in the graph below. While 51% of households reported having access to eggs in the markets, less than 30% are accessing cooking oil, flour or legumes.

This says little of the range of items regularly available or the consistency with which stocks are maintained, however the majority of households surveyed (74%) reported that prices for food items have been increasing since 2014; a result of the dependence on Zakho markets to source goods and the need to transfer transportation costs on to the consumers. With regards to coping measures to deal with such restrictions, more than half of the families (55%) reported relying on purchasing food on

credit to feed their families.

0 20 40 60 80 100 120 140

No enough food

No money to buy food

No food available

Food is too expensive

Market not functional

Market not accessible

Hard to cook, missing cooking…

Food Security Constraints

Problem1

Problem2

Problem3

0% 10% 20% 30% 40% 50% 60%

Flour

Legumes

Oils & fats

Fruit & Vegetables

Dairy: milk, yoghurt,…

Eggs

Meat

Sugar

Tea, Coffee

HH Access to Food Items

% HH

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This increase in costs, coupled with a lack of livelihoods (80% identifying no source of regular income), means households have had to become more dependent on the assistance of humanitarian organizations to provide for their basic needs. The government-operated Public Distribution System (PDS) which normally distributes monthly rations of basic food items like flour, oil, and rice, is not distributing to families on Sinjar Mountain or in the villages along the northern foothills. Though 40% of households identified the PDS food rations as a source of their own food items, this comes from families who have either travelled to Duhok to claim their assistance, or who have family in Duhok who are travelling to Sinjar Mountain. As the PDS system normally operates through the use of “agents” who are given the food rations to then distribute to the households they are responsible for, the displacement of many of these agents to Duhok Governorate has effectively relocated the physical stock of these food rations beyond the reach of most households.

Barzani Charity Foundation has reportedly been conducting food distributions (along with baby formula, diapers, and winter shoes) in the area and have served 2,750 HH with plans for further blankets distributions of food in the coming weeks. Medair is in contact with Barzani Charity Foundation to better understand their coverage and selection criteria for assistance. Still, as evidenced by the assessment, 40% of households surveyed depend to some degree on food coming from NGO/INGO distributions and 68% on purchasing food themselves. However, as mentioned above, this is likely purchased on credit and further hindered by limited supplies of food available in the markets nearest to them.

The lack of available cooking sets and fuel were commonly shared by households with the assessment teams. 58% of households surveyed did not have a cooking stove of their own and 85% mentioned wood as their primary source of cooking fuel (in Sardashti, this figure was 92%). Most households were observed sharing a communal mud oven (“Tanoor” in Kurdish) or cooking over charcoal. Large piles of dry brush were observed near many of the shelters with family members regularly seeking to gather sufficient wood for cooking and, as the

weather becomes colder, for heating. Mission East has planned to distribute to 1,350 households kerosene and kerosene heaters, along with additional household NFIs, though it is unclear if kerosene distributions will continue throughout the winter months.

HEALTH

Health, was listed among the top three unmet priority needs by 55% of interviewed households. 66% of respondents did not have access to a functioning healthcare facility within 2 km. 23% mentioned a lack of health staff and 20% reported a lack of medicines.

Sinjar Mountain Health Posts

Of those who do have access to a healthcare facility, the majority identify one of four health posts on the mountain operated by the Directorate of Health- Ninewa (DoH Ninewa). These locations are in Karse, Sardashti, Sharfadeen, and Wisva. DoH Duhok has an emergency center operating near the telecom tower at the highest point of the mountain (36°23'23.35"N, 41°48'36.31"E). These health posts are temporary structures created following the initial displacement in Sinjar District in 2014. Discussions with Dr. Mardan, Head of Primary Health Care in Sinjar, echoed the concerns of an insufficient stock of medicines, specifically analgesics and antibiotics, as well as difficulties with staffing the health posts, especially now with attention and resources needing to be allocated to the recently recaptured Sinjar City. Though it had been planned for 5 staff in each health post, a lack of sufficient support (staff housing, food, and transportation) as well as a lack of medicines has meant that the health posts on the mountain are unable to meet the needs of the displaced and returnee populations. Sardashti health post which serves the largest IDP population on Sinjar Mountain currently is staffed by one male medical assistant and one male nurse with rotations occurring weekly. There

0%

20%

40%

60%

80%

100%

Wood Kerosene Bottledgas

Electricity

Main Source of Cooking Fuel

% #HHs

Page | 9

are no female healthcare workers at the DoH Ninewa health posts and only one volunteer female medical assistant at the DoH Duhok emergency center.

The top constraints to accessing healthcare services shared by the 73% of respondents who identified significant obstacles were Distance, Lack of Medicines, and Lack of Transportation to the facilities.

Households listed Psychological Trauma as the top health concern among the population, consistent with the reported hardships faced by the sudden evacuation of Sinjar and surrounding villages in August 2014 during which thousands of individuals were either killed or taken by IS. Physical Trauma and Access to Safe Delivery for pregnant women were the next highest rated health needs reported by the communities. Disaggregated across the four assessed locations, respondents consistently rated these three health concerns as being the most pressing.

Snuny sub-district PHCCs

Following the rapid multi-sector needs assessment, Medair staff met with DoH Ninewa to further identify the gaps in services in Snuni sub-district. The Director General of Ninewa and the Assistant to the Director General of Duhok both stressed the priority to resume healthcare services in Sinjar city; the main hospital has been completely destroyed and two PHCCs have identified for immediate rehabilitation. DoH Ninewa additionally outlined concerns about the lack of functional Primary Health Care Centers north of Sinjar Mountain, specifically requesting assistance in the villages: Hitteen, Yarmook, Andalus, Orooba, Hardan and Qadisiya. The PHCCs in these locations are not functioning and have been damaged structurally and looted of equipment and medicines. Staff and resources originally allocated to healthcare services in these locations had been re-assigned to the IDP populations on Sinjar Mountain following the 2014 displacement, leaving a gap in service. While further assessment of population figures, needs and facilities available in the villages north of Sinjar Mountain would be required, initial discussions with DoH Ninewa suggest needs for PHCC support and structural rehabilitation of facilities that are currently unable to serve their communities; Khanasor PHCC, for example, is the only functioning pre-crisis PHCC in Snuny sub-district, seeing between 30-100 consultations a day depending on the availability of medicines. However, pre-crisis figures estimate that Khanasor PHCC saw 300-400 consultations per day, suggesting that if populations continue returning to Sinjar District, healthcare services currently in place will not be sufficient to meet their needs.

0 20 40 60 80 100

Distance

Lack of Medicines

Lack of Transportation

No Access for Disabled

Cost

Security Issues

Constraints to Healthcare Access

% HH

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WASH

Access to safe drinking water was listed as one of the top three priority unmet needs among the households assessed. Although humanitarian actors have been present on and around Sinjar Mountain

2 providing regular

water trucking services, drilling and rehabilitating boreholes, and improving the connections between wells and water tanks, households reported the biggest problems as being the Long Distance they must travel to reach a water point and the Lack of Storage at the household level. The quality of water that is available does not appear to be a concern, though further water testing would need be conducted to provide conclusive evidence for this.

In Kolka village and Sardashti, a significant number of respondents (63% for Kolka, 19% for Sardashti) reported distances of more than 500m to reach a water collection point as a main concern for their water access. Additionally, 25% of respondents in Sardashti and 47% of those in Kolka reported waiting more than 30 minutes to access water once at the collection point, raising some concern about the prevalence of water sources available on the mountain itself and highlighting the need for greater storage capacity at the household level. Across all locations, 62% of households surveyed have containers for collecting water, but only 42% have a separate container for its storage. Of those with separate containers for collection and storage, 77% were observed to have containers that were clean, narrow-mouthed, and covered.

In addition to water pumps that have been drilled and installed by Samaritan’s Purse, the households Medair interviewed reported regular access to water from trucking services, deep-drilled wells, and natural springs.

2 Samaritan’s Purse has drilled 2 boreholes on Sinjar Mountain and distributed 3,000 hygiene kits. JEN is

implementing water trucking to IDP locations on the mountain and has supplied latrines and showers to each of the health posts on the mountain.

0 20 40 60 80

Not enough water

Taste, smell, colour is bad

Expensive

Not enough storage

No water treatment

Suspended solids

Long distance to collect

% HH Surveyed

Primary Water Concerns

Problem 1

Problem 2

Problem 3

0%10%20%30%40%50%60%70%80%90%

100%

Water Sources

Piped water to dwelling

Shallow, hand dug well

Deep, drilled well (withpump)

Water tanker truck

Unprotected spring

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The lack of reported issues with the water quality itself (relatively little mention of suspended solids or foul odours from the drinking water) would appear consistent with the few reported incidents of diarrhoea and other water-borne diseases among respondents. 97% of respondents described the quality of water available as “good”, even as no central water treatment facility exists for the communities on Sinjar Mountain (Kursi receives some piped water directly as most residents are returnees, but even the central facility there does not currently treat the water supply).

The lack of latrines in the assessed areas is also of concern with only 24% of respondents claiming to have access to a latrine, and half of those shared with an average of 13 individuals. In Sardashti area, only 15% of households surveyed claimed to have access to a latrine, with the majority shared with between 4 and 20 individuals. The assessment team observed that what few latrines were visible in this location were simple homemade super structures of plastic sheeting and timber frame with no observable evidence of waste disposal systems or septic tanks. Similarly, there is a general lack of shower facilities in the assessed areas with 16% claiming to have some form of access. The largest absence of shower facilities in Sardashti where only 8.8% of respondents reported access raises concerns of poor hygiene practices and can be an initial indicator for further WASH assistance to be provided to these communities.

SHELTER

As there were several areas assessed with a variety of shelter types in each location, the related shelter needs were considered separately. Kursi and Kolka villages consist primarily of concrete and mud houses with a concentration of IDP families living along the periphery of the villages in self-made tents. To a larger degree in Sharfadeen, the majority of IDPs are residing in unfinished buildings with some living in the facilities of prominent Yazidi temples. However the largest populations are those of IDPs scattered across the Sardashti area in a combination of self-made and distributed tents collectively formed into groups of informal camps across the 3-4km long stretch of level ground on Sinjar Mountain. The chart below summarizes the shelter conditions, broadly, of those households surveyed during this assessment.

The majority of tents issued to these communities were provided following the initial displacement of Yazidis from Sinjar in August 2014, but the regular movement of families, including an increase in the population over recent months means that further shelter support may be required. When asked what kind of support would be most needed, 74% of respondents asked for additional tents. This may also be reflective of the larger than average household size (9 members/HH) observed, requiring additional covered living space to accommodate not only family members but also their belongings. 45% of households asked for assistance in rehabilitating or improving their current shelters; as many are living not only in tents but as well in unfinished buildings, there is need to winterize shelters to better protect against the elements. Mission East is planning a distribution this month of 1,350 shelter kits which will include tarpaulin, fixings, rope, and timber.

0%

20%

40%

60%

80%

100%

120%

Kursi Kolka Sardashti Sharfadeen

Shelter Types

Formal Camp

Informal Tent Settlement

Religious Building

Rented House

Unfinished Buildings

With Host Families

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NFI/ MARKETS

The basic household NFIs of clothing, bedding, and methods to heat a shelter or to cook food were frequently reported as critical and largely lacking by the respondents. The majority of the affected populations living on and around Sinjar Mountain are IDPs, and they reported having little of their own personal belongings with them due to the haste of their escape from Sinjar in 2014. 90% of the total assessed population identified a need for basic household items, especially in light of the upcoming harsh winter weather. In Sardashti, where the highest concentration of IDP families live, almost entirely in informal tent settlements, there is no power grid or electrical infrastructure to provide electricity for lighting, charging phones, or running electric heaters. Rather, households rely on small solar panels visible next to most tents, though it is unclear how many households have received solar panels in previous distributions. 52% of households surveyed identified solar lamps as a priority NFI need.

The most commonly requested items were Fuel for Cooking and Heating, Bedding and Warm Clothing. With winter expected to bring temperatures below -5 C, the importance of items that both serve to conserve body heat as well as produce additional warmth will be critical to households’ survival. Mission East is expecting to distribute kerosene heaters, thermal sleeping mats, and plastic sheeting to 1,350 HH on Sinjar mountain as part of their winterization response. JEN are additionally planning to distribute winter coats to the same families, though their exact timeline for this proposed activity has not been confirmed.

Access to markets, though difficult for the majority of IDP households who do not have a vehicle, is possible with the nearby markets in Snuni proper (approximately 15km from Sardashti). No markets exist in the Sardashti community, though basic food items can be found in Kursi, Kolka and Sharfadeen. However, only in the Snuni markets can households access clothing, construction material, kerosene and household items including heaters and bedding. A further assessment of stock availability, prices, and quality would need to be conducted, however the initial findings suggest that the conflict affected in the Sinjar mountain area may benefit from a cash-based modality of assistance to cover Shelter/NFI needs.

84%

83%

82%

62%

52%

0% 20% 40% 60% 80% 100%

Fuel for heating or cooking

Bedding

Clothing

Kitchen set

Solar Lamp

NFI Household Needs

Page | 13

Key Programmatic Challenges Risk of Diversion The common knowledge that many of the Yazidi households displaced on Sinjar Mountain have family members directly involved in military activity, whether as part of the Yazidi Militia or within the rank of Kurdish Peshmerga forces, will present a challenge to humanitarian programs seeking to remain neutral in this conflict. The risk of in-kind or cash-based assistance being diverted post-distribution to armed forces must be addressed in project planning and carefully monitored to ensure resources are not misused. Clear communication should take place with conflict affected-communities and relevant military forces surrounding the humanitarian principles we, as humanitarian actors, must abide by in order to ensure continued programming.

Military Activity On November 12

th 2015, following the completion of this assessment, the KRG-led offensive to recapture

Sinjar and a major access route for IS between Syria and Mosul began following a night of intensive coalition forces (CF) airstrikes. Humanitarian access to Snuny sub-district, including Sinjar Mountain, had been blocked and permissions from the Duhok Governorate to cross the necessary checkpoints to reach these areas were suspended. It is unclear following the recapture of Sinjar city and surrounding territories, how the frontline will stabilize and where, or how population movements will be affected in the coming winter months. Some have speculated that, assuming Sinjar is deemed safe to return following extensive IED clearance, a majority of the displaced Yazidis will move back, with assurance there is significant military protection provided to prevent its recapture by IS. Others, however, identify the villages north of Sinjar mountain as being the first to likely see an increase in returnees due to its relative safety and security in relation to IS forces and proximity to Snuny city. The ongoing military campaign to secure Sinjar will need to be monitored in order to better understand how it will affect displaced communities in the coming months, particularly ethnically Sunni Arab households who may face restrictions in their return to their home villages. Ultimately, humanitarian actors will need to be flexible in moving with the conflict affected communities, but how that movement will take place and over what length of time is still unknown.

Humanitarian Tensions

With significantly less humanitarian attention given to Sinjar Mountain during this overall humanitarian response, there is a valid sense of frustration among certain households towards the lack of assistance they have received since 2014. There have been reports of INGO staff detained and assaulted during distributions over their selection criteria and, during this assessment, some households had refused to partake in the survey out of a combination of distrust and fatigue. Moving forward, humanitarian actors must recognize this increased tension, especially if planning assessments with no simultaneous assistance. Related to this is the identification of households with various military and political parties; ensuring that assistance does not discriminate between IDP factions on the mountain, or mitigating the risks of beneficiary selection criteria, will help to avoid conflict. Better communication with, and involvement of, the local population in designing and implementing activities in the area is recommended to prevent feelings of neglect and the risk of security incidents.

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Recommendations

Taking into account the priority needs, the programmatic challenges, and following close coordination with other humanitarian actors to identify gaps, Medair recommends that Health activities be the focus of intervention on Sinjar Mountain, with the possibility to expand into areas of return as the population and needs becomes known.

Health: Following discussions with Dr. Mardan, the Head of Primary Health Care in Sinjar District, and the analysis of assessment data provided by the households, Medair has identified a current need for improved healthcare access to each of the four locations assessed with an emphasis on supporting the Sardashti Health Post and operating a Mobile Medical Unit to reach the remaining locations. Additionally, health posts previously serving populations north of Sinjar Mountain have suffered significant structural damage and looting requiring further support to rehabilitate the facilities in these locations and provide immediate medical assistance to the towns and villages in the interim. As the population has been increasing in Snuny sub-district and further returns are expected following the recapture of Sinjar, healthcare facilities that are already unable to serve their conflict-affected communities will have their resources considerably overburdened in the coming months. DoH Ninewa have reported that the hospital in Sinjar has been completely destroyed and what few facilities remain have been looted of all equipment. A mobile medical unit that can support the health posts currently operating on Sinjar Mountain as well as make trips to Sinjar city provided the security situation remains stable and with the approval of the Directorate of Health, will help to provide access to what households reported was their second most severe unmet need. The use of mobile medical clinics in the beginning will help with serving populations still residing in informal settlements, though transitioning to PHCC support will assist with more sustainable healthcare access in resettled villages and towns where populations have begun to return.

The introduction of a mobile medical unit on Sinjar Mountain to provide essential primary health care, including reproductive health care, would improve population access to essential health services and reduce morbidity and possibly mortality amongst the IDPs. The mobile medical unit would consist of male and female doctors, two nurses, a pharmacy assistant, and a community health officer for the purposes of health education and awareness, and provide assessment, diagnosis and prescription through basic point-of-care laboratory testing, the use of essential medical equipment, and reliable stocking of essential medicines. Primary Health Care Center support in Sinjar City and in villages north of Sinjar Mountain, beginning with Khanasor PHCC would be employed to augment and capacity-build the resources available there, with the provision of essential medicines, supportive supervision, training and assistance with accurate and timely health data reporting. This is essential considering the imminent return of the original population to Snuny sub-district. As mentioned earlier in the report, with Khanasor PHCC serving as the only pre-crisis PHCC still functional in all of Snuny sub-district, strengthening of this vital resource is crucial.

Food: Following discussions with Barzani Charity Foundation, the principal actor conducting food distributions on Sinjar Mountain, Medair feels that food assistance is sufficiently planned for, though feedback will be shared with World Food Programme (WFP) and Barzani Charity Foundation to further underline the concerns of the assessed communities.

Shelter/NFI: Mission East and JEN have coordinated to assist 1,350 households in Sinjar Mountain with blanket distributions of both shelter kits and winterization NFIs (winter clothing, thermal mats, heaters, and kerosene). Medair will continue to be in discussions with relevant NGOs and the Shelter Cluster to identify gaps and, where possible, assist with expected needs from returnee population to Sinjar city and its surrounding villages. Further market analysis will explore the current and projected capacity of vendors in Snuny sub-district to support future cash/voucher projects for IDP and returnee populations.

Medair is currently exploring expected residential shelter reconstruction needs in Sinjar city and its neighbouring villages with the intention of providing shelter support in line with Shelter Cluster technical standards and guidance.

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WASH: WASH needs, particularly in the form of latrines and showers, remain largely unmet for the IDP communities living in informal settlements. Medair will coordinate with the WASH Cluster and relevant actors to ensure that adequate coverage is planned for.

A further assessment will be conducted by Medair’s Duhok-based Health Project Manager in November to collect additional data on health post needs, their caseloads, and if specialized services are needed. This visit is supported by DoH-Ninewa who has mentioned that no other health actor to date has expressed an intention to provide these services.

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Annex 1: Priority Needs by Location on Sinjar Mountain

0% 20% 40% 60% 80%100%

Water

Medical assistance

Sanitation

Rental Support

Food

Shelter improvement

Household items

Residency permit

Other (Kerosene)

KURSI PRIORITY NEEDS

Unmet Need1

Unmet Need2

Unmet Need3

0% 20% 40% 60% 80%100%

Water

Medical assistance

Sanitation

Rental Support

Food

Shelter improvement

Household items

Residency permit

Other (Kerosene)

KOLKA PRIORITY NEEDS

Unmet Need1

Unmet Need2

Unmet Need3

0% 20% 40% 60% 80%100%

Water

Medical assistance

Sanitation

Rental Support

Food

Shelter improvement

Household items

Residency permit

Other (Kerosene)

SARDASHTI PRIORITY NEEDS

Unmet Need1

Unmet Need2

Unmet Need3

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0% 50% 100% 150%

Water

Medical assistance

Sanitation

Rental Support

Food

Shelter improvement

Household items

Residency permit

Other (Kersosene)

SHARFADEEN PRIORITY NEEDS

Unmet Need1

Unmet Need2

Unmet Need3

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Annex 2: Photos of Sinjar City Health Facilities

Sinjar Hospital, completely destroyed. Photo taken early November 2015 ©Medair

Sinjar Hospital, remaining hospital beds. Photo taken early November 2015 ©Medair

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Private Healthcare Facility of Dr. Kamal, completely destroyed. Photo taken early November 2015 ©Medair