Sanitation in Emergency Situations: Proceedings of An International Workshop, Held in Oxford, December 1995
Sanitation in Emergency Situations: Proceedings of An International Workshop, Held in Oxford, December 1995
Emergency Situations
Proceedings of an
International Workshop,
held in Oxford, December 1995
A catalogue record for this publication is available from the British Library.
All rights reserved. Reproduction, copy, transmission, or translation of any part of this publication
may be made only under the following conditions:
This publication is copyright, but may be reproduced by any method without fee for teaching
purposes, but not for resale. Because Oxfam wants to know how widely its materials are
disseminated, formal permission is required for all such uses, but will be granted immediately. For
copying in any other circumstances, or for re-use in other publications, or for translation or
adaptation, prior written permission must be obtained from the publisher, and a fee may be payable.
Available in Ireland from Oxfam in Ireland, 19 Clanwilliam Terrace, Dublin 2 (tel. 01 661 8544).
Published by Oxfam (UK and Ireland), 274 Banbury Road, Oxford OX2 7DZ, UK
during the final sessions of the workshop, in thought of many of the people most involved in
summary form. the field of emergency sanitation and indicate
The working papers presented during the substantial agreement between agencies on most
workshop are given in Section 2. They have been issues. They should provide a good basis for
edited and appear in a shortened form. They developing ideas on a range of subjects, either by
provide many ideas and insights, but were not individual agencies or through inter-agency
intended to present a comprehensive review of collaboration.
the issues, but rather to promote discussion in the Finally, Section 4 gives a complete version of
working groups. the list of recommendations and action points
Presentations from the working groups are in drawn up in the plenary session at the end of the
Section 3. These represent the experience and workshop.
Section 1 Executive summary
It seems that nobody wants to deal with sanitation, and Guidelines are needed on implementing the
people working in the sector seem to have failed to bring technical options already available.
sanitation to the attention of key decision makers. A
crucial problem is how to give sanitation more priority in / think that if you look at the basic technical options,
emergency responses. there are actually very few. The problem is the way in
which you implement those options, not the options
One answer is promoting sanitation with core themselves.
messages, media strategies, and lobbying, but
there are also some fundamental reasons why few Implementing is very site specific.
Sanitation in emergency situations
8
Executive summary
emergency teams but not given the resources to It comes back to a problem of training, particularly at the
do their job. Greater commitment is needed level at which major decisions are taken. There seems to
from agencies for involving communities in be a lack of confidence among people deciding about
emergency sanitation. emergency sanitation programmes, which is not seen in
other sectors. If institutions and courses could be
John did mention a situation where two health identified and developed for all sorts of people involved
education people got squeezed out by the engineers and in sanitation, that would be a major resource.
this happens more or less every time as far as I can see.
So we need some commitment from us as agencies, that Currently training specifically for emergency
these things are important and that we won't squeeze sanitation is done in an ad hoc way, with different
people out. agencies arranging courses, internally or
through training institutions.
Better project management tools
Part of the reason for the variable quality of What you want is a coordinated training programme
sanitation work in emergencies is the lack of available to all.
suitable project management tools to enable imp-
lementing agencies, co-ordinating bodies, and Agencies currently running their own training
funders to measure and control the quality of programmes do try to make them available to
work done and to allow objective evaluation of others but there is no central register of courses
performance and impact. available.
More on-the-job training of inexperienced
In the sanitation sector my feeling is that we lack staff is needed, to increase the pool of exper-
goalposts. We all know that we are specialists and we ienced people.
know basically how it works but concretely we lack tools.
From the very beginning we need to be tools for You will always be dealing with a situation where you
assessment, formulation of the project, implementation, have a significant proportion ofpeople operational in a
monitoring and then reassessment and so on. crisis situation who have not got very much or any
experience. That is because in non-crisis situations
Recruitment and training agencies take only the most experienced people they can
Sanitation in emergencies requires a distinct set get hold of. They don't pay enough attention to the fact
of skills which cross the boundaries of traditional that they should try to build for the future.
disciplines such as civil engineering, public
health, and community work. There is a need to Early warning systems and information
look at the type of skills required to design and for project planning
manage emergency sanitation programmes. A number of agencies are involved in large-scale
emergencies, and the quality of their work,
Do we want to use the existing range ofpeople and skills particularly in sanitation, can be very dependent
that we have got, or people from a different type of on the information they gather on the situation.
background? ...Engineers are probably not the best At present there is no effective mechanism for
people to do sanitation and the sort of people we are gathering relevant data and disseminating this
looking for have to have a wider base. Maybe we should widely to agencies for early warning, planning,
be looking for environmental health officers ... and monitoring. (See paper and working group
discussion on the environmental impact of emer-
Indeed, sanitation in emergencies often gency sanitation programmes.) Several recom-
suffers from management by people with very mendations were made on this issue.
few relevant skills.
More and better directed funding
So far, sanitation has been done by the botchers. They Money is needed for training, technical develop-
can't get any otherjob, so they go off and do sanitation. ment and community mobilisation to produce
We are now trying, as a profession, to become more better sanitation programmes with more
professional. effective and sustainable outcomes.
Donors, coordinating bodies and implem-
It may be that people with a different back- enting agencies should understand that good
ground are needed. On the other hand, more sanitation cannot be done cheaply.
could be done by training existing staff.
Sanitation in emergency situations
10
Section 2 Working paper summaries
11
Sanitation in emergency situations
children, exist to promote and sustain sanita- tion (particularly excreta disposal) concerns
tion improvements. taking away a daily production of unwelcome
10 Create demand: Sanitation programmes and unpleasant human excreta. Talking about
should be based upon generating demand, the subject is difficult, even for professionals in
with all of its implications for education and the field (witness die number of euphemisms
participation, rather than provision of free or commonly used for human shit), and agencies
subsidised infrastructure. Government sanita- usually try to deal widi it on the cheap.
tion policy should facilitate and enhance Many current attitudes display a tendency to
partnership among the private sector, NGOs, excuse bad engineering by over-stressing the
community-based organisations and local 'software' side of sanitation, which is only of use
authorities in the achievement of improved when supporting a well-prepared physical
sanitation. engineering input.
11 Build on existing practices: Sanitation The answer lies in having well-thought-out
improvements should be incremental, based and tested sanitation equipment, to provide
on local beliefs and practices and working facilities which are welcomed by people in
towards small, lasting improvements that are emergencies. This is not available today. Because
sustainable at each step, rather than on the sanitation needs are very specific to, for example,
wholesale introduction of new systems. terrain, climate, culture, and duration of the
12 Understand consumers: Latrines are con- situation, there must be a wide range of technical
sumer products and their design and promo- options available.
tion should follow good marketing principles, There are examples of pre-prepared
including a range of options, designs attractive sanitation equipment from the past, such as die
to consumers and therefore based upon Oxfam Sanitation Unit, used in Bangladesh in
consumer preferences, affordable, and appro- 1972-80, and other examples of hard engineer-
priate to local environmental conditions. ing solutions used to overcome extreme sanita-
Market forces are best understood by the tion problems, such as sea-water flush sewerage,
private sector. used in Pulau Bidong, Malaysia in 1978-79.
13 Continually promote: As in all other public Some lessons learned from these experiences
health programmes aimed at preventing are:
disease, the promotion of sanitation should be
a continuous activity. This continuous promo- 1 Each situation is different, but several tech-
tion is necessary to sustain past achievements nical options are usually available.
and to ensure that future generations do not 2 People like, and will use, safe, pleasant, clean
become complacent as diseases decrease. and private latrine facilities.
3. The user need not be aware or involved in the
Apply these principles to developing: type of treatment or disposal system used, but
is very aware of die point of contact widi die
POLICY -PROGRAMMES - PRACTICE system. It is vital to make the facilities user-
friendly for men, women, and children.
4 It is important to ascertain and provide for the
anal cleansing habits of die affected popula-
tion. What can be provided - water, soap,
2.2 Excreta disposal kits paper?
5 More thought should be given to using mech-
Jim Howard anical means to prepare defecation areas and
trench latrines, so that trenches can be cut
deeper, widi more controlled widdi, suitable
Thinking on sanitation in emergencies is sur- for bridging widi lightweight, moveable
rounded by a lot of confusion and this is reflected latrine structures.
in the lack of prepared equipment and packages, 6 Oxfam-type water tanks could be used for
compared with other interventions such as water sewage containment or even treatment, either
supply and health care. lined or unlined, particularly where natural
The fundamental problem is that while the gradients exist on die site.
supply of food and water involves bringing in 7. More thought should be given to transporting
welcome inputs to the needy population, sanita- sewage off sites. Agencies often get involved
12
Working papers
with transporting water. The volumes of to provide facilities which are used, are safe, are
sewage to be moved would normally be much feasible, and can be set up quickly.
smaller and would have to be carried over far In the first phase of an emergency, it may not
shorter distances than water. Pumping of be possible to take all these considerations into
sewage, particularly if macerated, could also account, in the urgency of the need to install
overcome problems on certain sites facilities quickly, and a correction of such over-
8 The site collection of sewage via plastic buckets sights should be possible by the time second-
with lids supplied to each family is not beyond phase excreta disposal facilities are being
the realms of possibility and is already exten- installed.
sively used in different parts of the world.
Options for first-phase excreta disposal
It seems that as a part of good camp manage-
ment, as much human excreta and refuse as 1 Defecation fields may provide an emergency
possible should be removed and disposed of solution for containing excreta, particularly in
outside the camp area. hot dry climates and where there is enough
Fresh and more creative thinking on engin- space available.
eering preparedness is urgently needed from all 2 Trench latrines are a simple and quick way of
the agencies involved. disposing of excreta in a more hygienic way
than defecation fields, provided they are
properly built and maintained. The question
is whether trench latrines are necessary, or
should we move directly from defecation areas
2.3 First-phase excreta to family latrines?
3 Family latrines are a very hygienic way of
disposal disposing of excreta, where space and time
allow. They can be built for single families or
Martin Oudman, MSF Holland groups of families.
4 Communal latrines should only be consid-
Introduction ered in exceptional circumstances. The diffi-
culties connected with communal latrines
Excreta disposal in emergencies is an issue that outweigh any short term benefits in most
needs to be tackled from day one of an situations. It is usually necessary to hire a team
emergency in the same way as water and food are of workers for regular cleaning and mainten-
dealt with. Because of its lack of glamour, ance of communal facilities.
however, excreta disposal is often not given the
attention it deserves, even by well meaning All these options have advantages and disad-
health experts. As health experts in our various vantages and are more or less suitable for differ-
ways, we should aim at changing this attitude ent situations.
with all the vigour we can marshal. Most import-
ant is to ensure that competent expertise is Kits
available for excreta disposal and water supply
programmes at the same time. Managers of water Much effort has gone into preparing kits for
and sanitation programmes should bear full water supply, which can be installed in a matter of
responsibility for excreta disposal, as they do for hours in an emergency. This has not been the
water supply. The consequences of such neglect case with excreta disposal. There is a need to
as we have seen in the recent past, are appalling redouble our efforts to find suitable excreta
and unnecessary loss of life. disposal kits that are cheap, portable, quick and
easy to install. Kits already available include the
Aims of a first-phase excreta disposal MSF lightweight plastic squatting slab and latrine
programme kit, and the Oxfam sanitation unit.
13
Sanitation in emergency situations
extended to develop a kit including super- plates, and concrete slabs. Various issues have
structure. Research could be done in the use of to be considered when making concrete slabs,
the borehole latrine in combination with the such as procurement, manufacture and use of
squatting slab. the moulds, shape, size, reinforcement,
2 A great deal of environmental damage is done aggregates used, the concrete mix, curing,
by cutting wood for latrine construction. A and test loading.
pre-fabricated latrine kit could limit this. 4 Vent pipes: various materials may be used for
3 What is the role of health education and vent pipes. What diameter should they have?
community involvement in first-phase excreta What material should the vent pipe screen
disposal? have, and what mesh size?
4 In Eastern Europe, for example, facilities exist 5 Superstructure: What materials are normally
for excreta disposal. How can they be used in a used locally? Is plastic sheeting available? Are
more efficient way in emergencies, for roofs really needed or desirable? Considering
example, by constructing latrines over that many children are afraid to go into a small
existing sewer systems? dark room with a hole in the ground full of
5 The figures used to calculate the size of latrine gruesome mess, is it not better to have no roof
pits are usually based on long-term excreta and make the latrine airy and light, while a
accumulation rates. For the first phase of an loosely fitting cover for the squat hole could
emergency it might be necessary to increase keep the pit dark without obstructing the
the excreta accumulation rates by 50 per cent, downwardflowof air in VIP latrines?
as the latrine will be used for a short time only
and there will be very litde decomposition.
6 What criteria, based on safe excreta disposal,
should be used in the selection of the location
for a refugee camp? 2.5 Excreta disposal on
difficult sites
Yves Chartier, MSF France
2.4 Latrine construction
Woldu Mahary, Oxfam Problems encountered: High water table, hard,
compacted soil or rocks near the soil surface, lack
of space and urban situations.
Latrine design and construction has evolved over
many centuries, and the variety of designs and Technical options: Open, uncontrolled defe-
construction techniques have multiplied many cation areas, open, improved defecation areas,
fold since the earliest biblical reference to the shallow or deep trench latrines and raised
subject. However, the majority of people in the latrines, such as 50 to 200 litre emptying 'bucket'
world lack this basic facility, and in emergency latrines.
situations the lack of latrines has been and
continues to be the cause of untold suffering. Life of latrine pits in emergency situations:
Suggested solids accumulation rates are 0.5
Questions to be considered when planning litres/person/day (0.15 m3/person/year) in emer-
a latrine programme gencies, compared with 0.05 ms/ person/ year in
long-term situations.
1 Digging and building tools: what type,
quality, numbers and designs should be used? Logistics support needed: Transport, storage of
How should they be managed and what can be materials, heavy duty machinery if soil is too hard
done to minimise loss and breakage? to dig by hand.
2 Digging the hole: safety considerations, pit
size and shape Human resources needed: Sanitation teams,
3 Latrinefloors:options include logs and eardi, either volunteers or paid, to: set up the tech-
wooden slabs, plastic slabs (eg the MSF/ nology chosen, inform the community of the
Monarflex squatting plate), stainless steel importance of using the facilities, inform the
14
Working papers
users how to use the latrines, ensure mainten- dig and the camp was very densely settled.
ance and daily running of the facilities, ensure Operation and maintenance of the defecation
that users wash their hands, ensure general zones was very intensive and depended on
cleaning throughout the camp. trained and dedicated staff and users who are
comfortable with this kind of facility.
'Software' needed: The entire community
should be motivated and made aware by teams
working in the camp giving basic messages on
general hygiene and appropriate use of water
and sanitation facilities. 2.6 Emergency solid
Maintenance and hygienic facilities: Hand- waste management and
washing facilities, preferably with chlorinated disposal
water, should be available on site. Excreta in
open defecation fields should be disinfected, and Bob Reed, WEDC, Loughborough
removed. Latrine emptying equipment may be University
needed. Safe disposal off site should be chosen
with the local authorities
In the past, the collection and disposal of solid
Costs involved: This depends on the site and the waste has often been ignored. This is because in
urgency of the situation. For example, a cholera 'traditional' refugee camps, solid waste has not
outbreak may necessitate spending resources been a problem. Quantities of solid waste were
very quickly to bring it under control. small and consisted mainly of ash and other
inorganic waste.
Misunderstandings regarding difficult sites in Recent changes in the focus of refugee
emergencies: Lack of knowledge and exper- support to communities in Eastern Europe,
ience, use of inadequate technical solutions, lack however, have changed this situation and have
of adequate cleaning of short-term facilities, lack inevitably led to an increase in solid waste, partic-
of guidance in the literature on solutions for ularly plastics and organic waste. In addition, the
difficult sites, high-cost solutions needed may not provision of humanitarian support in a war zone
be considered worth doing, short-term solutions produces its own solid waste problems.
are often used, which create problems later on,
and a lack of general technical policy and Why collect solid waste ?
operational coordination in thefieldbetween the
organisations involved, Disease control: Decomposing organic waste
attracts animals, vermin and flies, which may act
Post-first-phase technical options: Alternating as reservoirs and vectors for many diseases, and
twin-pit family latrine, use of heavy equipment to reduce the quality of life. In times of famine,
dig deep trenches for rows of family latrines, people may be attracted to the waste to scavenge
raised family latrines, concrete slab workshops, for food, with the risk of gastro-enteritis,
simple pit latrines. dysentery, and other illnesses.
15
Sanitation in emergency situations
When is solid waste likely to be a problem? operation, but it may not be operating effectively
because of lack of resources. Building rubble may
Solid waste is likely to be a problem after natural be removed by householders or a central organ-
disasters causing widespread damage to prop- isation. In refugee camps, there may be no
erty and surrounding landforms (eg Kobe, existing effective refuse management organisa-
Japan); in an urban war zone (eg Kabul, tion. Historically, NGOs have not been involved
Afghanistan); in established refugee camps; and in this area, possibly because it has not been a
where displaced people are within easy reach of problem or they do not have the skills or maybe it
road communications with Western Europe or does not appear attractive.
North America (eg Central America, Eastern
Europe). Finance: Whatever solution is found must
ultimately become sustainable by the community
Principles of solid waste management in the longer term
Technologies and methodologies of the three Skills: If aid agencies are to become more
main areas of storage, collection and disposal are involved in solid-waste management, do they
well documented. have the skills? Organisations such as WHO may
be able to help but most agencies have little
Storage: Domestic and institutional waste should expertise and a significant training input may be
be stored awaiting collection no more than 50 required.
metres from the generation point and covered if
possible. Conclusions
Collection: Vehicles ranging from hand-carts to 1 The methodology of solid waste management
specialised compacting trucks may be used, is well documented and understood. The
depending on finance and local resources. main problem is its management and finan-
Where possible existing collection facilities cing.
should be supported rather than a separate 2 Waste management for field hospitals is well
system be set up. The period between collections understood and requires little further consid-
usually varies between one day and one week. eration here.
3 Large-scale management of solid waste,
Disposal: There are a number of ways that waste however, has only recently become a concern
can be disposed of, depending on the volume, because of the change in focus of humanit-
composition, the level of funding and available arian aid. Accordingly there is very little
technology. They include burial and landfill, expertise in the aid community in dealing with
incineration, composting, and recycling. it.
4 Waste management within existing com-
Problems munities is less of a problem because organisa-
tions usually existed prior to the emergency. It
Problems are primarily managerial and financial is likely that financial and technical support
rather than technical. will be needed to deal with the increase in
demand put on the service.
Responsibility: Responsibility for ensuring 5 Waste management within refugee camps is
wastes are collected and disposed of will depend more of a problem. Criteria are needed for
on the type of emergency, but responsibility is deciding when the problem should be con-
not always clear. sidered. Responsibilities for implementing,
managing and financing must be clarified,
Implementation: In existing urban areas there is and the implications for planning and training
normally a waste management system already in assessed.
16
Working papers
17
Sanitation in emergency situations
kits of appropriate equipment for emergency tides of water for washing, washing clothes and,
vector control. Insecticides used in emergencies eventually, bedding. The need to wash is possibly
should be standardised with supporting chem- greater than in a settled situation because con-
ical data made available. ditions are generally dirtier.
Without sufficient water, washing is restricted
Recommendations and 'water-washed' disease transmission is
bound to increase. Without sufficient safe water,
1 Existing technical material should be made people may be forced to use a secondary source,
available by NGOs to all field staff. with the risk of bringing in waterborne disease.
2 A standard training programme and a 'user The urge to wash in squalid conditions is strong,
friendly' field guide*should be developed for and if water is at all available, people will use it.
sanitation technicians. The lack of adequate water supply and facilities
3 All materials and equipment for vector control will not stop washing, but will merely force it to be
should be part of emergency response kits. done in an unsatisfactory way.
4 A standard stock of preferred chemicals If washing is carried out without some control
should be held, with information on applica- the activity creates pollution, by polluting water
tion for a range of vectors and the most sources (eg with guineaworm or other water-
common species, with the aim of streamlining borne disease), or because of the wastewater
the use of chemicals. flooding paths, and recreation and rest areas,
and eventually becoming breeding sites for pests.
(The paper continued with a section on the It is a constant aim of health promotion to
control of food pests in stores, which is an import- improve personal hygiene practices. It may be
ant issue. Factors to be considered when deciding difficult to get children and food handlers to
on control measures are similar to those for wash their hands after using the toilet, but
disease vectors.) generally people wash for comfort. Any inter-
ruption to personal hygiene soon gives rise to
increases of diseases such as scabies and food
poisoning. Soap is also very important for
hygiene. A sudden rise in the incidence of scabies
2.8 Personal hygiene, is a sure indicator of a lack of water or soap.
Washing facilities need plenty of water for
water collection and both washing and rinsing, soap, and provision
storage facilities for scrubbing and beating. The activity of wash-
ing introduces some semblance of stability into
Eddie Potts, Liverpool School of stressful conditions and provides valuable
Tropical Medicine stabilising social contacts. The official guidance
for the management of refugee settlements
seems to omit all reference to washing and clean-
A water supply for any group of people is a ing. It is presumably left to the community to
fundamental need. The quality of that water arrange this for themselves. In practice, without
must be safe enough not to cause waterborne some guidance, the need for cleaning short
disease, but in emergency conditions a safe water circuits other good programmes and creates
supply in sufficient quantity is what is required. unnecessary difficulties. Washing facilities
People need two to three litres per person per should be provided in similar number to sanitary
day for drinking and food preparation, but a facilities. Personal hygiene may well be incorpor-
minimum of 20 to 30 litres per person per day is ated in family latrines, while for laundry, more
required to allow essential cleaning and washing communal facilities with a drainage system are
for good health. At these minimum levels there is needed, together with drying areas.
a direct correlation between the quantity used Water collection and storage is another area of
and health. potential hazard, and the effort of protection of
Refugees and displaced people carry a small water supplies can be undermined by domestic
quantity of drinking water, if at all possible and collection. Domestic water containers may often
when they stop, they need more water to drink, be a source of biological and chemical contamina-
cook and replenish water containers. Given a tion, and during water collection, not only is
little time, they will then need increasing quan- there a risk to the family, but the whole water
supply may become contaminated. Clean and generated from these activities than waste water
safe containers, with a closure, are essential, and from excreta disposal, it does need to be disposed
at the water collection point, the family water of properly. Where soap is available and used the
containers must not be allowed to contaminate amount of pathogens in the waste water itself will
the water source. be low but as the water will be rich in nutrients, it
Refugees on the move soon realise that will provide a rich breeding ground for flies and
carrying some water for drinking is vital, and certain mosquitoes. Also it can become malod-
they need small containers, usually bottles. After orous.
the earthquake in Limon, Costa Rica, the Coca For all these types of waste water, try to localise
Cola company brought in large quantities of one- disposal of water and make use of natural ground
litre plastic bottles filled with water. These were slope where soil conditions dictate that water has
used as the initial emergency supply, then kept to be shed rather than absorbed. This water may
and replenished for a long time afterwards as be used for irrigating small vegetable gardens or
drinking water reserves. for watering animals.
Where it is desirable for this water to be
absorbed into the ground, it may be necessary to
dig soakaways with a channel connecting these to
the place where the activity that generates the
2.9 Drainage, and water is taking place. Simple tests exist to quantify
infiltration capacities and thus to design soak-
washing and bathing away pits and trenches. In some instances it may
areas and facilities be necessary to auger through a relatively
impermeable layer to get through to a more
Richard Luff, Oxfam permeable layer. Consider the use of a hand
auger if quantities of water are small.
The amount of water to be disposed of will
1 Drainage depend upon how much is available and what
level of washing is traditionally undertaken. In
Drainage must be considered for three kinds of some countries, for example, Sri Lanka, large
water: waste water, storm water, and existing quantities of water are used; while in others, very
surface water sources, which need to be drained little may be used. In the latter case it may be
to prevent disease-vectors breeding in them. useful, from a health point of view, to encourage
greater water use. The wastewater disposal facil-
Waste water ities may thus need to be over-designed initially
Waste water is generated from several sources, to cope with the quantities of water that it is
such as excreta disposal, personal bathing, hoped will be used in the longer term.
washing of cloths and utensils, and spillage from
water collection facilities. Spillage from water collection facilities: This
The main factors to consider are soil con- should be directed away from water collection
ditions, the provision of facilities to enhance points, to provide people with a serviceable area
health, and how the community will use these, by to collect water from. The provision of suitable
involving them. materials under the distribution points such as
gravel, or sand on a plastic membrane would be
Excreta disposal: The liquid load of the latrine an appropriate first phase construction. Later if
should not exceed the soil's capacity to absorb it, required it could be upgraded by constructing a
otherwise its design life will not be achieved or platform of either concrete or bricks laid in a
worse still it may overflow. Latrines should be herringbone fashion.
sited so that they do not contaminate ground
water sources. One particular problem that can Storm water
arise is latrines being used for bathing in and thus This is generated from rain water run-off,
the liquid load exceeding the design capacity. flooding of surface water sources after rain, and
waterlogging due to raising of water table.
Personal bathing, washing of clothes and
utensils for cooking and eating: Although there Rain water run-off: The main concern here is to
is a lower level of health risk from waste water ensure that rain water run off during periods of
19
Sanitation in emergency situations
rain does not flood shelters, pollute water sources 2 Washing and bathing areas and facilities
or damage latrines. Rain water that seeps into
latrines down the edge of a pit without lining
could cause soil to collapse into the pit. Another Washing activities include personal bathing of
concern is at the early stages of an emergency, body, and hand-washing by latrines, and the
when any open defecation site where solid waste washing of clothes and utensils for cooking and
is likely to be washed down slopes by rainfall will eating. Most of these washing activities will occur,
expose the population to great risk. even without the provision of special facilities.
If possible, a settlement should be located on However, there is a need to ensure two things:
sloping ground so that it will self-drain. Then
water run-off can be dealt with by building that they can be undertaken by all sections of
diversion channels to direct water away from the population (women and children as well as
vulnerable areas. These channels may need to be men) sufficiently easily and effectively to mini-
protected in areas of high rainfall. At changes of mise health risks associated with water-washed
direction, slope and width the channel may need disease, disease transmission from dirty
strengthening with concrete blocks or wood to cooking and eating utensils, and to eliminate
avoid scouring and collapse. The channels will lice in clothes;
need maintaining, repairing, and cleaning out to that the washing activities themselves do not
stop them becoming blocked and overflowing. constitute a risk to water sources by contamin-
ating these with the waste water produced.
Flooding of surface water-sources (rivers, lakes)
after rain: Again, this is most likely to occur Personal washing
during seasons of heavy rain. Clearly, flood Initially, bathing may be limited because of lack
plains of rivers and areas below high-level points of privacy and this in itself could be a health risk.
of lakes should be avoided; look for signs in It may be necessary to upgrade bathing facilities,
vegetation and debris, and use local knowledge both to improve personal hygiene and to prevent
to find out what is flood level. Then always leave contamination of existing water sources.
several metres above this where possible, in case Segregation of the sexes must be considered
of exceptionally high rains. wherever there are no family facilities and the
community shares facilities or areas. Special
Waterlogging due to raising of water table: Flat provision may have to made for children to wash.
land or areas of land in a natural bowl are prone Bathing within latrines is sometimes the only way
to waterlogging. Where possible the water table for privacy to be ensured, but this may create
should be at least 3 metres below the surface, problems with the liquid load in latrines. If this is
which is very important for latrine construction the case, then separate bathing cubicles may have
reasons. If this is not possible, 1 metre must be to be built.
considered as the absolute minimum depth. Where cubicles are required, a suggested ratio
Settlements should never be located in marshy is 1:50 people (assuming 1 wash per day and 2
areas. Rocky and impermeable soils may also toilet uses per day, and based on a ratio of 1:25 for
create flood-prone locations. latrines). It is better to locate these within easy
reach of water supplies, and reasonably near to
Existing surface water sources the people that will use them, to encourage a
sense of ownership.
In some cases it may be useful to consider The floors of bathing cubicles should be non-
draining or backfilling existing surface water slippery and easy to keep clean. They may be of
sources that may constitute a risk in terms of sloping soil or sand in the first instance and
potential vector breeding sites. How much is upgraded to cement mortar or concrete later on.
worth doing depends on how far infected The screen of cubicles could be constructed with
mosquitoes will fly. Small water courses may be temporary materials (local or imported), or with
diverted, while stagnant standing bodies of solid walls for more permanent structures.
water could perhaps be backfilled using either Bathing ponds to catch rainwater, or desig-
mass labour or mechanical plant. nated areas of the river may be an appropriate
alternative with or without screens located
nearby. However, the health risks of washing in a
surface water source (for example, bilharzia, or
20
Working papers
hookworm on banks) must be evaluated, and the ICRC, as well as some NGOs and religious
risk of pollution of drinking water sources. organisations are working in prisons. ICRC's
approach, in 15 different countries on four
Hand washing next to latrines continents, is to tackle problems in an integrated
This is rather a specialised form of washing way, using the concept of the 'Health pyramid',
intended solely for ensuring good hygiene where nutrition and water and sanitation are the
practices associated with toilet use. The benefits base pillars.
could be great in some situations but operating
the system will be very labour intensive and it Curative health
may not be possible on a community-run basis. If
this system operates at a household level, this Public health
would reduce the operational burdens, but
might also reduce the effectiveness for improved Nutrition Water supply
health, as it would be much less convenient. and sanitation
Again, the role of hygiene education is crucial, The objective of any intervention is to guarantee
particularly for women, otherwise this activity in living conditions which keep morbidity and
particular is likely to fail, given that it may be a mortality rates at the best possible level.
new, unfamiliar hygiene practice. The specific constraints related to enclosed
centres are generally the limited area, with no
Washing of cloths and cooking/eating possibility of expansion; security concerns;
utensils administrative problems; and the restricted
These activities may or may not happen in the interaction between inmates and the environ-
same area. Obviously privacy is not an issue and ment.
thus special facilities will not need to be provided
in most cases. Care must be taken to ensure that Current sanitation interventions in
waste water does not pollute water sources. It is enclosed centres
also important to consider how easily water can
be brought to the area and how the waste water Taking into account the specific constraints
will be disposed of. Clothes washing is often likely outlined above, and adding the usual constraints
to be undertaken in the vicinity of water sources encountered in open concentrations of large
thus constituting a pollution risk, and if so should populations, one can easily imagine the tremen-
be discouraged. dous potential health risks the inmates are
Making washing slabs may be an effective way confronted with if quick and efficient measures
to get people to undertake washing of clothes are not taken.
and cooking and eating utensils in a way that In refugee camps, one usually has the choice
does not constitute a health risk. A trial model between on-site and off-site sanitation, but in
involving the community in design and construc- enclosed centres, the answer is to get the human
tion would be a good way to test the usefulness and solid waste out as quickly as possible.
and acceptability of the design. To evacuate human waste, toilets should be
functioning and in sufficient numbers to cope
with demand. They should be built or modified
to be very simple and adapted to local tech-
niques. To transfer this waste from the toilets to
2.10 Sanitation in the exterior, channels and pipes must be clear of
solids big enough to block the system. Very often,
enclosed centres simple improvements in the profile of the section
Riccardo Conti, ICRC of the channels drastically improves the flow.
Finally, to move all this matter a few hundred
metres down the system, one needs water: lots of
water.
Programme approach
In an overcrowded prison, the only sanitary
system which will function is one driven by water.
Enclosed centres include prisons, detention Since water is generally scarce, its management is
centres, detention camps, and hospitals, where of paramount importance. Where possible,
work is restricted to a confined area. showers and washing places should be placed
21
Sanitation in emergency situations
Sludge disposal remains a problem and the Conflicting priorities and limited resources:
solutions are always ad-hoc and not sustainable. Priorities for funders, coordinating bodies, and
implementing agencies are to save lives in die
Key words: Overpopulation, area per inmate, short term, widiout giving enough attention to
vector control, infestation, bed-bugs, fleas, lice, longer-term environmental problems. Measures
mosquitoes, shigellosis, cholera, scabies, diarr- to minimise negative environmental impact may
hoea, malaria, maintenance, ventilation, light, cost more to implement and take more time.
water supply, septic tank, maturation pond,
soakaway pit, epidemics, standards. Short term planning and programme inertia:
During the emergency phase, the priorities of all
involved, most importantly die refugees and
displaced people themselves, are short-term.
Even after the emergency passes, diese situations
usually remain politically unstable, which makes
22
Working papers
governments, donors and implementing agen- Agencies may unwittingly create environmental
cies cautious about longer-term programmes hazards, or planners may create inappropriate
and funding. Even where there is scope for settlements because they are not fully aware of
longer-term planning, it is hard to change the the impact of their decisions. Baseline data may
direction of large programmes, in which inertia not exist, leading to problems, later on, in meas-
quickly sets in. uring the environmental impact of programmes
and reducing learning opportunities.
Political and security constraints: The situation
of refugees and displaced people is a political Poorly developed environmental impact monit-
issue at many levels. They have an impact on local oring and assessment: When looking at the
politics, they may be used by host governments as environmental impact of emergency water
a bargaining tool or for gaining revenue, they supply and sanitation projects, it is difficult to
have political significance for the countries or compare environmental costs with other project
areas they left, and the politics within settlements outcomes, particularly when human lives are
of refugees and displaced people are often part of the equation. The UNHCR have prod-
crucial to the outcome of programmes. The uced guidelines for environment-sensitive man-
security implications of significant numbers of agement of refugee programmes and for envir-
displaced people and refugees are many and onmental surveys and studies; other agencies
various, ranging from disputes with local people have produced guidelines as a result of specific
over water supplies to the creation of bases from studies. These need to be further developed to
which to launch attacks on the country from make them more generally useful in emergency
which the refugees came. situations, and have yet to be widely adopted by
implementing agencies.
Unsuitable sites: Decisions on where to settle
displaced people and refugees have critical sig- Suggested ways forward
nificance for subsequent environmental impacts,
and yet basic considerations such as a sustainable Programme integration: In order to appreciate
water supply and terrain suitable for installing the overall impact of an emergency programme
latrines are often outweighed by political and on the environment, planning, monitoring, and
security constraints or competition for better evaluation of the various programme elements
land. Refugees and displaced people are usually have to be brought together. This is most
settled on marginal land which, in many cases, is effectively achieved where there are few agencies
available only because it has not been intensively implementing broad programmes, rather than
settled by the indigenous population because of where there are a multitude of agencies with
lack of water. Whether settlements are large and different levels and areas of competence, with
concentrated or small and scattered has enor- overlaps and gaps in programme cover. This is
mous significance for the environment. true for programme quality as a whole and for
this reason among others, Oxfam is moving
Fragmented response: The growing tendency, towards a more integrated approach to refugee
when a massive displacement of people occurs, is programmes. Were there are many different
for a large number of agencies to become agencies involved in the same programme, effec-
involved, each with different responsibilities and tive consideration of environmental impact
objectives. The environmental impact of the demands strong coordination and a willingness
programme as a whole is the responsibility of on the part of the agencies to accept the role of
many different people, creating great difficulties coordination bodies.
for coordination and integration of activities.
Information and pre-planning: Very good
Inadequate information for planning: The information already exists on many places which
information usually available to agencies plan- are subject to large population influxes, in the
ning emergency environmental health interven- form of satellite images, aerial photographs,
tions is extremely limited, partly because of the maps, ground surveys, and so on. The data are
speed at which decisions have to be taken, but held by a variety of bodies, including government
partly because information needed for building ministries, universities and defence forces. It is
environmental impact considerations into emer- time-consuming and difficult to search out and
gency work is not accessible, or readily available. bring together the relevant data when it is needed.
23
Sanitation in emergency situations
Better site selection: So many of the factors The nature of large-scale humanitarian crises
which affect the health and welfare of displaced means that diere is a highly fluctuating demand
people and refugees relate to the site in which for relief workers. This demand means that, in
they live. The environmental impact of these order to supplement their own permanent staff,
people depends crucially on the location and size whether local or external, relief agencies fre-
of the setdements. The conditions for the people quently have to recruit large numbers of temp-
in camps could be used as an argument for settle- orary staff at short notice. In the early phases of a
ments which cause least environmental damage. large-scale emergency it can be difficult to recruit
Dispersed setdements, whilst being more such staff locally, and external staff are frequendy
difficult to service in some cases, are healthier required. As the relief effort continues, these
places for people to live in, and dieir environ- temporary external staff may be replaced by staff
mental impact is less concentrated. recruited locally.
24
Working papers
understanding the issues (political, social, Common property, 'free riders', and safety
technical, personal) involved in relief work factors: Relief workers on a common register are
and appreciating the range of agencies available to a wide range of relief agencies. As
involved in such work and their varying seen from the broad perspective of deploying
agendas; effective relief workers quickly, and indeed for
gaining skills which are particularly die long-term good of an individual agency, diis
important, be they specialist technical skills or is a good thing. However, there is litde incentive
generic personal and management skills; for one agency to invest in training of a member
personal preparation including discussions of such a register, as that investment does not
with family and employers (if working temp- guarantee a return to diat agency. Odier agen-
orarily in relief work), insurance, wills, field cies may appear to act as 'free-riders', benefiting
kits, etc; from any investment by dieir colleague agency.
familiarisation with the culture and procedures Only a proportion of relief workers on a
of the employing agency (induction) and with register will have the right skills and be available
the nature of the job and country in which the when needed. Experience suggests that such a
relief effort is being conducted (briefing). proportion may vary from under 10 per cent to,
in exceptional circumstances, 25 per cent of
25
Sanitation in emergency situations
members on a register being deployed in any one temporary staff from registers requires an
year. agreed approach. Such commitment could be
Both these factors combine to provide a major manifested by:
disincentive for any one agency to invest in requiring members of relief agencies to
training of register members, yet it is in the attend a minimum of training before being
interests of each individual agency to ensure that considered for deployment;
register members are trained properly. This committing significant resources to such
conundrum requires a common approach and a training according to some agreed system
long-term view on the development and utilisa- (e.g. in proportion to the number of
tion of such resources. temporary relief workers used in the
previous year);
Major themes for training: These include lobbying donors to fund central training of
orientation to relief work; development and register members.
adaptation of specific technical skills; and
development of key generic skills. 3 Individual preparation should be facilitated.
Relief workers should have access to up-to-
Methods of delivery: Attendance at training date reading materials covering agency
courses has many benefits over individual study, policies and procedures, and technical,
particularly in terms of experiential learning and personal and contextual issues.
shared experience. Therefore it is likely that
training courses will continue to form a central 4 A minimum amount of preparation and
plank in the strategy for preparing relief training is:
workers. attendance at an approved orientation
course;
Sources of training and accreditation: There is a attendance at short courses focusing on
need to ensure that information on training relevant technical skills;
materials and courses is collated and dissem- evidence as to why either or both of the
inated to those who need it. With the likely above is not required
increase in demand for training in relief work,
there is a need to maintain quality control. In the 5 When deciding on the funding of relief
short term it may be necessary to consider some projects, donors should take account of an
form of accreditation of training courses. In the agency's record on the management and
longer term, a 'competency-based approach' support of relief workers, including prepara-
may be the way ahead. Rather than evaluate the tion and training.
quality of training courses, in this approach the
competence of the individual is evaluated against 6 An interagency working party should be set
agreed criteria. However the development of up to co-ordinate the implementation and
such a system is a major undertaking. development of the above policy. Such a
working party could work with the inter-
Draft recommendations agency co-ordinator currently being recruited
to co-ordinate the management and support
1 All relief workers should be properly of relief and development workers. Such a
prepared for their work because: working party should take account of the
proper preparation enhances the effective- needs of relief agencies and those they serve,
ness with which humanitarian relief is the needs of relief workers and the needs of
delivered; donors.
relief workers have a right to proper prep-
aration.
26
Working papers
consulting the people affected on die direction Sanitation facilities should be correctly used to
and approach of die programme and listening have a benefit: Particularly in die early days of an
to their ideas about the design, progress and emergency, the sanitation facilities provided may
impact of die programme; be very different from diose people are used to.
giving people die knowledge to practise good People may need explanations of die way to use
hygiene and sanitation, given die constraints them.
of die situation in which they find themselves;
involving people in die implementation of Knowledge is power: People affected by emer-
emergency measures. gencies are generally vulnerable and powerless.
This paper looks at why community participa- Giving people die knowledge to improve dieir
tion may be necessary in emergency sanitation healdi has benefits beyond a contribution to
work, suggests a few ideas about how it can be healdi alone.
achieved, and notes some of its limitations.
Emergencies create extraordinary sanitary
Consultation risks: Completely new rules for safe living may be
needed in an emergency, where nodiing may be
Responsibility is empowering: People should die same as before. New knowledge is vital for
have some say in decisions affecting dieir lives. more vulnerable people to survive.
But remember that many people do not want to
get involved in sanitation, except as users of die Improved sanitation may not be a recognised
facilities provided. priority: There is a fundamental problem for
implementing sanitation projects in emergencies
Good sanitation depends on socially approp- and diat is that, in contrast to water supply,
riate engineering: Effective sanitation depends healdi and food, sanitation may not be seen as a
on people using facilities properly, so they should priority for healdi and well being. This problem
be consulted on such matters as die design and can be overcome partly by education and
siting of the facilities. promotion.
27
Sanitation in emergency situations
against mosquitoes, to reduce flies breeding in a Use existing structures: Use existing networks,
simple pit latrine by keeping the squat hole organisations and communications channels to
plugged, or to keep drainage channels clear get your messages across.
around a water point.
Receivers may need to be targeted: Again, think
Traditional practice is not always sacred: of who is at risk, whose practice involves risk for
Practice can be changed to fit engineering con- others, and try to target these people.
straints. But behaviour change should not be
used to compensate for bad engineering. Know your target population as far as possible:
Try to understand their situation, their possi-
Education may be the only tool available: For bilities and limitations for action. Are you talking
the first few days of an emergency, almost the to individuals, families or a community? Or a
only sanitation tool you are likely to have is your crowd?
influence on practice concerning such things as
defecation, washing, water storage and use. Staff are people too: Don't forget that staff, as
Messages may have to be very crude and users of water and sanitation facilities and as
directive. It is not always necessary to change influential people, are important targets for
people's hygiene beliefs to get them to change health education.
their practice.
Health education is a matter of life and death.
The source may be a long way from the target:
In early emergency work, outsiders tend to be Health education techniques can and should be
more closely involved in the practical field work learned: There are techniques for effective
than later on. It is likely that foreign aid workers health education which can be learned, and
will be the ones involved in giving people infor- which should be used. Don't ask busy engineers
mation and promoting better hygiene practice. or health staff to carry out health education. It
Be aware of the distance between the workers needs dedicated people.
and the people affected by the emergency. How
is your agency perceived? Do people trust you? Monitor health education work: The work
should be monitored to ensure that messages are
Effective messages are specific and simple: Base relevant, reaching their target, and having a
the messages on the health risks and risk-avoiding positive impact. There is no point in repeating
practices relevant to the situation. Don't embark useless messages or persuading people to do
upon a generalised health education programme something they already do or which is impossible
because most of the messages may be irrelevant because of the situation.
and you may not have had time to find out what
people's level of awareness already is. Participation in project implementation
Effective messages are appropriate to pre- Volunteer labour may be cheaper: Excreta
vailing conditions: Don't try to persuade people disposal in particular involves a lot of labour-
to do things they cannot do, like use more water intensive construction. Volunteer labour is often
if there is not more water available. cheaper than paid labour, though not always.
28
Working papers
29
Sanitation in emergency situations
30
Working papers
Keep in mind that usual statistics of the number Serviced water (from showers, kitchen,
of latrines constructed reveal very little about laundering areas) could be used to irrigate
improvements in the community's sanitary vegetable gardens provided that the detergent
habits. content of the said water does not exceed
permissible levels beyond which health of
Solid waste management potential consumers of diose vegetables is at risk.
Communal systems > > individual pits
Flexibility
Burying (sanitary landfilling) >> burning Above standards are to be applied whenever
(incineration). (Incinerators might be advisable possible. During emergencies various constraints
for clinics and health centres where medical and may prevent the implementation of these
other hazardous wastes are to be disposed of in standards. For instance, it may be advisable to
the safest possible manner.) phase the approach and construct, say 1 latrine
for every 100 persons in phase I, increase the
Minimum standards: coverage so as to bring the ratio of latrine to users
Storage: 1 refuse bin, 100 litre capacity, for 10 up to 1:50 during phase II and eventually reach
families or 50 persons; the standard of 1:20 in thefinalphase.
Transport: 1 wheelbarrow/ 500 persons; 1 Flexibility might also be required when
garbage tipper/5000 persons; deciding on which type of latrine to install.
Final Disposal: 1 pit (1 x L x D = 2m x 5m x 2m) Incremental sanitation should guide the
/50 persons; 1 incinerator + 1 deep pit for each designer of such latrines, which means that
clinic. rudimentary structures may be acceptable at the
outset of the emergency provided that gradual
Vector control improvement (e.g. ventilation, shift from pit to
Environmental measures (filling, drainage, etc.) pour-flush latrines if conditions permit,
> > chemical control (i.e. use of chemical connection to a small bore sewer network, etc.) is
pesticides) properly thought out and planned for from the
very beginning.
Routine and indiscriminate insecticide spraying
should be resisted firmly. Pesticides should be
used only as a last resort, and their usage, dosage
and application carefully adjusted so as to
31
Section 3 Working group discussions and presenta-
tions
During the workshop, participants split into Group on the Promotion of Sanitation was not
working groups to discuss particular issues raised suitable for emergencies and not specific enough.
during the presentation of papers and plenary The group attempted to make the principles
discussions. The groups reported back in more specific to first-phase emergency sanitation
plenary sessions and the results of the group work, and to choose the words so as not to need
work and comments from the plenary sessions an explanatory paragraph beneath each prin-
are presented here. ciple. (The explanatory paragraphs included
Some of these working session summaries are here are to demonstrate how the working group
in the form of draft guidelines on technical arrived at each principle.) The two final prin-
subjects. The guidelines vary in their level of ciples (11 and 12) were not on the original list.
detail and practical usefulness. This reflects the These are the principles which sanitary
way in which questions for the groups were designers or planners should bear in mind when
framed, and the difficulty in producing technical they are developing a programme. The chances
guidelines for a subject area for which there are of being able to observe them all in a programme
many different situations for which solutions are small, but they should be considered when
have to be sought in emergency sanitation work. doing a sanitation plan.
During the plenary discussions it was felt that The plenary group made several comments
the main area in which agreement on on the wording of certain of the revised or
recommended technical approaches is hard to adapted principles, but no major fundamental
reach, where practical guidance is most lacking in changes were suggested.
the existing literature (most of which refer to
stable situations), and where loss of life because of 1 Recognise sanitation as an equal priority:
poor sanitation work is likely to be greatest, is the Sanitation is not 'water supply and sanitation'.
first phase of an emergency. This was loosely It is sanitation in its own right and should be
defined during the workshop as having more to treated as such. It should not receive any more
do with the state of the situation than time: the or any less priority than all the other priorities
'first phase' may continue for months if the in an emergency situation.
emergency is badly managed. Excess morbidity
and mortality due to excreta-related diseases 2 Accept that sanitation is the first barrier to
may define thefirstphase, or it could be said to be faecally transmitted disease: The first
the period before semi-permanent structures barrier, we believe, is not medicine. The first
and systems are put in place. barrier is sanitation, and that should be
accepted as beyond dispute.
32
Working group discussions
ignore the fact that you are working in a highly between what is provided in the camp and
political environment and you must allow for what local people have or do. Provision need
the fact in the decisions you make. not be the same, but you have to be aware that
there are normally other communities in the
5 Set sanitation objectives: Decide at the area, who were there before the camp was set
beginning what you are actually going to try to up, and will be there long after it has gone; and
do, rather than just go in and do whatever you it is important that you bear their needs and
can. It is important to define objectives and their problems in mind in whatever you do.
then develop a programme to achieve them.
12 Recognise the environmental impact of
6 Promote behaviours and facilities together.: sanitation: Recognize the environmental
Promote behaviours and facilities together so effects of sanitation, and try to minimise any
that the two are linked. It is no good negative impact and maximise positive effects.
developing behavioural changes if you do not
have the facilities to make use of those
changes. On the other hand, there is no point
in having facilities if people do not use them.
3.2 Objectives, techniques,
7 Continually promote sanitation at all levels:
Promotion of sanitation is not a one-off effort. tools, and equipment for
It is a continuous process, at all levels: within first-phase excreta disposal
the community that we are serving, but also at
a managerial level within aid agencies, and Experiences
with the management committees. Some experiences of members of the group are:
8 Build on traditional practices: Always try to Communal latrines are not used when they
build on traditional practices. This might not are dirty.
always be feasible, but in general, if you can Cultural differences have a big influence on
promote a practice that people have used the success (or failure) of the technique and
historically, then they will adopt it much more system used (eg some communities may refuse
easily. to use pit latrines).
Communal programmes may compromise
9 Recognise gender and age needs: Recognize potentially more successful family-based
the needs of different age groups and programmes.
genders. They make different demands on There may be official resistance to implem-
what you are providing and you should enting a programme or a system, or to the use
recognize that in what you provide. of a certain technique. A technique may also be
imposed by an authority.
10 Encourage user participation: Encourage First-phase emergency sanitation that uses
user participation, from the very beginning. some kind of communal system will need a
Remember that eventually we will all go away high level of continuous agency involvement
and somebody has to take over. It is important to maintain a certain degree of success.
that the the users - maybe not a community at Theft and vandalism may hamper the pro-
the beginning of an emergency - will have to gramme as long as other needs of the popula-
be involved in sanitation at some time in the tion are not met.
future, and the earlier you can get them People would often prefer to use latrine
involved the better, even if it is only in a very construction materials (particularly plastic
minor way atfirs.Sow the seed for the future. sheeting) for other things, such as housing.
Act, during the first phase, so as to avoid
11 Consider the needs of residents (local creating problems for later work.
people) as well as affected populations:
Consider the people who live around the Objectives
camp, as well as those who live within the camp Provide facilities, as soon as possible, that work
or settlement. Their needs are just as impor- technically, and are acceptable to the users. Some
tant. You must be sensitive to comparisons participants believed that defining objectives in
33
Sanitation in emergency situations
terms of toilets per 1000 people by a certain time responsibility for the excreta-disposal
as a global guideline is not strictly relevant, as programme.
numbers of people per toilet is just one of a Promote the health and welfare rewards of
number of factors affecting access to facilities. good sanitation, and promote community
Success can be measured in terms of incidence responsibility for operation and maintenance.
of excreta-related disease; walking distance to a Develop a team of sanitation workers in the
latrine (including defecation field etc); percent- community who can take the programme
age of the population using the facilities. forward and ensure sustainability.
During the first phase, avoid working in a way
Techniques to be used (in order of priority) which will make the second phase more
1 Repair of existing infrastructure. difficult (e.g. by creating too much depend-
2 Improvements on what people already do (as ency on external inputs).
long as it is practical and appropriate in the Consult the community to find out what is
new situation). culturally acceptable; how much awareness of
3 Any of the following: controlled open defeca- sanitation and hygiene the community
tion; family latrines (pit/bucket etc); trench already has; what techniques people are used
latrines; package system. to; and how sanitation provision was managed
previously.
Tools and equipment needed Use as many community resources as possible
1 Packs of simple tools to help you and the and place as much responsibility for maintain-
people to do what you want to do more ing latrines as possible onto the community.
quickly. Assign the care of latrines to a clearly identified
2 Packs of simple latrine components (slabs, group, such as an individual family or a group
superstructures etc), on a modular basis, of families around a shared latrine.
rather than very large and specific or compre-
hensive kits. Tools and equipment
Use good quality tools and equipment and use a
Recommendations system for their management on site.
1 More research should be done on developing Latrine slabs are of four different types:
kits. imported eg Monarflex plastic slab
2 The possibility of using conventional package traditional log/mud
wastewater systems in emergencies should be sawn timber
investigated. concrete (domed or reinforced)
The choice is dependent on the site, availability of
materials, budget, etc.
Recommendations
3.3 Objectives, techniques, A comprehensive list of latrine digging and
building tools should be drawn up and those
tools, and equipment for tools stocked by agencies in case they are not
second-phase and longer- available in the country where the emergency is
taking place.
term excreta disposal
Objectives
Time: for as long as the community may be on
the site. This could be for as much as 10 to 15 3.4 Off-site and on-site
years.
Coverage: aim should be one latrine per family, excreta disposal
depending on availability of land, resources,
budget (roughly $20-30 per latrine), but if not, The group discussed a number of technologies
then a minimum of one latrine per 20 people. for excreta disposal (listed below), but concluded
that it was not possible to have a general debate
Techniques about the merits of either on-site or off-site
Identify one agency on site as having excreta disposal, as all conditions are specific.
34
Working group discussions
35
Sanitation in emergency situations
36
Working group discussions
37
Sanitation in emergency situations
How: safe collection and disposal of babies' b. Family hygiene starter kit
excreta; promotion of baby washing; dental care; 2 kg laundry soap
protection of babies from insect bites; promotion 1 kg antibacterial body soap
of safe feeding practices. 1 litre medicated shampoo
1 nail brush
Family hygiene kit 1 set hair combs (medium and fine tooth)
Objective: Provide items of critical need in pre- 5 toothbrushes
packaged kits which would facilitate the main- 2 large toothpaste
tenance of personal, household and family 1 laundry washboard
hygiene in emergency situations where there is 100 chlorine tablets for water purification
limited access to water, sanitation and health 1 drinking water storage bucket with lid and tap
services. 1 pack sanitary napkins/reusable cloths for
feminine hygiene
Uses: promote personal hygiene; promote safe 1 jerrican, 20 litres, rigid
storage of food & water; promote safe cooking 1 wash basin, 12 litres
practices and food handling; facilitate washing of 1 litre liquid bleach/disinfectant
clothes and bedding; promote safe collection and 1 portable bucket toilet with lid (plastic)
disposal of nightsoil. 2 sets bath towel/wash cloth
50 sachets oral rehydration salts
All kits should be: country/region/culture 1 large plastic food container with recloseable lid
appropriate; environmentally friendly regard- 2 mosquito bed nets, chemically treated (for
ing packaging, disposal (eg the container can be malaria zones)
used for food or water storage with a re-useable
lid); provided with simple hygiene messages with
illustrations or instructions where needed;
provided once to each family/child, with
consumable items replenished through local 3.9 Vector control in
markets or distribution system.
emergencies (2 groups)
Advantages: pre-prepared kits save time on (The work of two different working groups on
purchase, transport and distribution. vector control has been combined, as they came
up with very similar ideas and there was a general
Proposed lists (UNICEF) consensus on most points.)
a. Infant hygiene kit (for 0-5 yrs)
20 cotton re-useable diapers and safety pins Institutional issues
2 pairs of plastic pants to go around diapers
1 rubber bed sheet Whilst generalists can and should implement
2 baby towels environmental control programmes where
1 wash cloth or sponge disease vectors are a problem, chemical control
1 25-litre baby bath programmes generally need more specialist
1 baby potty (chamber pot) knowledge. Existing expertise within agencies is
1 rubber hot water bottle (for cold climates) generally inadequate, particularly concerning
1 feeding cup with cover, bowl and spoon for malaria control. This is often not recognised, so
baby ineffective or inappropriate vector control are
1 pair baby nail clippers often implemented.
1 bar baby soap Vector control specialists are needed:
1 litre baby shampoo in the expertise core of NGOs, along with
1 250 g jar zinc ointment for nappy rash engineers and health workers
1 baby tooth brush, hair brush, comb for initial assessments of emergency situations
1 wash bottle, spout squeezy type, 1 litre to develop programmes with field-based,
1 pack 500 g cotton wool more generalist staff.
1 set assorted baby toys
1 nylon bag for storing baby items Increasing expertise within agencies may be
1 baby cot with mosquito netting achieved by bringing specialists onto the staff or
by training existing staff.
38
Working group discussions
39
Sanitation in emergency situations
40
Working group discussions
41
4 Recommendations and action points
The final afternoon of the workshop was spent in The direct relationship between sanitation and
plenary session, discussing how agencies could health should be used for promoting sanitation
respond more effectively to the next big in emergencies.
emergency involving sanitation; identifying
areas which require further work; and making Agencies should consider how to make sanitation
recommendations and agreeing action points a more interesting and attractive subject.
among the agencies represented at the work- Promoting sanitation requires good marketing
shop. One fundamental and general problem skills.
identified was the shortage of competent
agencies who could operate successful sanitation Sanitation in emergencies should be promoted as
interventions in emergencies. an important technical area, while also having a
Most of the recommendations relate to work strong community participation and health
necessary to overcome this problem. It was felt education component.
that with successful promotion of sanitation in
emergencies and better tools, training, and Issues for advocacy concerning sanitation in
funding, more agencies would be willing and emergencies should be recorded and a common
able to do good sanitation work in emergencies. set of messages developed.
The following summary condenses the
afternoon's discussion into areas of activity, with 2 Coordination of developments in
recommendations and, where possible, action emergency sanitation
points. Action points are marked thus ". In
general, the recommendations here were unani- Developing techniques and guidelines for
mously agreed upon by the participants present. improved practice in emergency sanitation
Where this is not the case, differing views are work should be given higher priority and
represented together. should be done in a collaborative way.
42
Recommendations and action points
A literature search should be made, as part of a " Improvement of existing kits and
process of assembling and making available development of new kits to be discussed at the
information already existing on the subject. next Inter-Agency Technical Coordination
Group meeting. UNICEF should be asked to
A directory of information should be established. liaise with governments on the suitability of
equipment for different countries.
An inter-agency newsletter dedicated to
sanitation in emergencies should be produced, to Directories of products for chemical vector
enhance information exchange. control should be made available for use when
selecting chemicals for specific vectors for specific
Existing networks and inter-agency fora should countries.
be used where appropriate.
6 Community participation in emergency
Lessons learned from experience (both good and sanitation programmes
bad) should be shared between agencies.
Community participation in emergency sani-
4 Initial assessment of emergency tation programmes should be encouraged
situations and practice improved.
43
Sanitation in emergency situations
Guidelines should be drawn up to help field staff More funding should be made available for
to choose and apply participatory techniques. training. A budget provision for training should
be included in budgets for emergency sanitation.
Agencies with established development practice
should feed lessons and techniques into Agencies should create proper staff development
emergency sanitation work. plans.
"RedR, with CRED, Oxfam and SCF(UK), to Selection criteria for sanitation workers should
draft a discussion paper on a consultative be reviewed and people in different professions,
framework for participatory tools and eg environmental health officers, should be
approaches to emergency sanitation. considered.
Project management tools should be developed Agencies should try to enable more on-the-job
to improve emergency sanitation interventions training by allowing less experienced staff to
throughout the project cycle, including assess- work alongside more experienced colleagues.
ment, implementation, monitoring, and evalua- This may mean employing additional staff at
tion. certain times.
9 Early warning systems and information
Tools for implementation should include mini- for project planning
mum standards for the quality of work done.
Early warning information, and baseline and
* Tom de Veer said he would produce a draft of
planning data, should be made more access-
his study on monitoring and evaluation by
ible for agencies working on emergency
mid-January 1996.
sanitation programmes.
" Each agency represented at the workshop to
investigate their own project management
tools. Information giving early warning of eme-
rgencies, and information for planning emer-
8 Recruitment and training gency sanitation projects should be collected and
made available to interested agencies by a focal
Recruitment and training of emergency agency. (Possibly, but not necessarily, the
sanitation workers should be improved at all UNDHA.)
levels.
The sort of information needed for planning and
implementing emergency sanitation projects
"The Inter-Agency Technical Coordination should be more clearly defined.
Group to look at training needs for the sector
and report to other agencies. The existing Existing sources of information, such as satellite
group should possibly be expanded to include imagery, aerial photographs, geological, meteor-
other agencies with training needs in this field. ological, and soil data should be investigated.
"Agencies at the workshop to choose focal
points for training on sanitation in Local information systems should be reinforced
emergencies. and coordinated in the field.
44
Recommendations and action points
Agencies should share the information they have 11 Further work from the participating
which relates to emergencies they are involved agencies
in.
10 Funding This workshop should not be simply a one-off
event, but the start of a process to improve the
More and better-targeted funding should be status and practice of sanitation in emer-
made available, to enable high-quality gencies.
sanitation work to be done in emergencies.
45
Annexe 1 Programme and presentations
46
Annexe 2 List of participants
Mr John Adams
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7DZ Fax: +44 1865 312380
Mr Jonathan Andrews
East Africa Desk Tel: +44 1865 311311
OXFAM Tanzania Fax: +44 1865 312380
Mr Thomas B Barton
International Rescue Committee
122 East 42nd Street
New York, NY 10168-1289 Tel: (212) 573 7283
USA Fax: (212)5513185
Nega Bazezew
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7DZ Fax: +44 1865 312380
Mr David Bikeba
East Africa Desk Tel: +44 1865 311311
OXFAM Uganda Fax: +44 1865 312380
Mr Yves Chartier
MSF - France
8 Rue St Sabin
F-7544 Paris Tel: +33 1 40.21.29.29
France Fax: +33 1 48.06.68.68
Dr Desmond Chevasse
London School of Hygiene & Tropical Medicine
Keppel Street Tel: +44 171 636 8636
London WC1E 7HT Fax: +44 171 436 5389
Dr Carole Collins
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7DZ Fax: +44 1865 312380
Mr Riccardo Conti
Head of Watsan Department
International Committee of the Red Cross
19, Avenue de la Paix
CH-1202 Geneva Tel: +41 22 734 6001
Switzerland Fax: +41 22 733 2057
47
Ms Marie de Cool
MSF - Spain
Avenida Portal Del Angel No 1
E-08002 Barcelona Tel: +34 3 304.61.00
Spain Fax: +34 3 304.61.02
Ms Gloria de Sagarra
UNHCR/PTSS
Case Postale 2500 Tel: +41 22 739 8143
CH-1211 Geneva 2. Depot Fax: +41 22 739 7371
Switzerland Email: [email protected]
Mr Tom De Veer
Oude Vest 33A
2312 XR Leiden Tel: +3171514 2499
The Netherlands Fax:
Ms Pat Diskett
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7DZ Fax: +44 1865 312380
Mr Brendan A Doyle
Senior Project Officer
WES Cluster
UNICEF
3 United Nations Plaza, DH40B
New York, NY 10017 Tel: (212) 702 7269
USA Fax: (212) 702-7150
Mr David Ede
Register of Engineers for Disaster Relief
1-7 Great George Street Tel: +44 171233 3116
London SW1P 3AA Fax: +44 171 222 0564
Mr Gino Hendry
Register of Engineers for Disaster Relief
1-7 Great George Street Tel: +44 171233 3116
London SW1P3AA Fax: +44 171 222 0564
Mr Luc Henskens
CRED/ECHO
30-34 Clos Chapelle-Aux-Champs
1200 Brussels Tel: +32 2 764 3823
Belgium Fax: +32 2 764 3441
Mr Enamul Hoque
Asia Desk Tel: +44 1865 311311
OXFAM Bangladesh Fax: +44 1865 312380
48
Mr Jim Howard
245 South Avenue
Abingdon Tel: +44 1235 520672
Oxfordshire 0X14 1QT Fax:
Mr John Howard
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7DZ Fax: +44 1865 312380
Katakweba
East Africa Desk Tel: +44 1865 311311
OXFAM Tanzania Fax: +44 1865 312380
Mr Bobby Lambert
Register of Engineers for Disaster Relief
1-7 Great George Street Tel: +44 171233 3116
London SW1P3AA Fax: +44 171 222 0564
Ms Jean Long
Concern Worldwide
Camden Street
Dublin 2 Tel: +353 1 475 4162
Eire Fax: +353 1 475 4647
Ms Lynette Lowndes
IFRC
P.O. Box 372
CH-1211 Geneva 19 Tel: +41 22 733 0395
Switzerland Fax: +41 22 730 4222
Mr Richard Luff
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7D2 Fax: +44 1865 312380
Ms Shona McKenzie
Emergencies Department Tel: +441865 311311
OXFAM Goma Fax: +44 1865 312380
Mr Woldu Mahary
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford 0X2 7DZ Fax: +44 1865 312380
Ms Susanne Niedrum
Department of Civil Engineering
Leeds University Tel: +44 1532 332302
Leeds LS2 9JT Fax: +44 1532 332265
Mr Ajeet Oak
DROP
9 Amardeep Jyoti Society
Abhinav School Lane
Erewandawane Pune 411004 Tel: +91 212 368535
India Fax:
49
Mr Martin Oudman
Watsan Advisor
MSF-Holland
Max Euweplein 40
1001 EA Amsterdam Tel: +3120 520 8921
The Netherlands Fax: +3120 420 0149
Dr Sicko Pijpker
Bellamystraat 22
3514 EM Utrecht Tel: +3130 2715437
The Netherlands Fax: +3130 2715437
Mr Eddie Potts
Liverpool School of Tropical Medicine
Pembroke Place Tel- +44 151708 9393
Liverpool L3 5QA Fax: +44 151 708 8733
Mr Claude Rakotomalala
UNHCR/PTSS
Case postale 2500
CH-1211 Geneve 2. Depot Tel: +41 22 739 8843
Switzerland Fax: +41 22 739 7371
Mr Bob Reed
Water Engineering & Development Centre
Loughborough University of Technology
Loughborough Tel: +44 1509 222628
Leicestershire LEI 1 3TU Fax: +44 1509 211079
Ms Moniek Reinders
MSF- Holland
Max Euweplein 40
1001 EA Amsterdam Tel: +3120 520 8921
The Netherlands Fax: +3120 420 0149
Mr David Saunders
IRC
Prinses Margrietplantsoen 20
The Hague Tel: +31 70 33 141 35
The Netherlands Fax: +31 70 38 140 34
Mr Paul Sherlock
OXFAM Public Health Team UK/1
274 Banbury Road Tel: +44 1865 311311
Oxford OX2 7DZ Fax: +44 1865 312380
Ms Hermione Singer
SCF(UK)
17 Grove Lane Tel: +44 171 793 5400
London SE5 8RD Fax: +44 171 793 7610
50
Ms Karen Thompson
Silsoe College
Silsoe Tel: +44 1525 863000
Bedfordshire MK45 4DT Fax: +44 1525 863300
Dr Madeleine Thomson
Liverpool School of Tropical Medicine
Pembroke Place Tel: +44 151708 9393
Liverpool L3 5QA Fax: +44 151708 8733
Mr Sean Tyrrel
Silsoe College
Silsoe Tel: +44 1525 863000
Bedfordshire MK45 4DT Fax: +44 1525 863300
Dr Dennis B Warner
Chief Rural Environmental Health Office L150
World Health Organization
20, Avenue Appia
CH-1211 Geneva 27 Tel: +41 22 791 3546
Switzerland Fax: +41 22 791 4159
Mr Jost AWidmer
ICRC
19, Avenue de la Paix
CH-1202 Geneva Tel: +41 22 734 6001
Switzerland Fax: +41 22 734 2057
51