24. Water, Sanitation and Hygiene
Water and sanitation are basic human needs and rights. During and after emergencies, people are at great risk of contracting infectious diseases. Inadequate sanitation, poor hygiene practice and lack of access to safe water can lead to outbreak of disease. Even when there is no emergency, lack of access to safe water and sanitation is the world’s single largest cause of illness (UNICEF web, 2006, http://www.unicef.org/wash/index_31600.html). During protracted conflict, simple diarrhoeal diseases can kill more people than the fighting itself (WASH Cluster Hygiene Promotion Briefing Paper, 2007).
Provision of WASH is also fundamental to maintaining the dignity of displaced people, particularly women, through providing secure bathing spaces, hygiene supplies and private sanitation facilities.
This makes WASH is a critical intervention in any emergency. CARE’s Emergency Strategy aims for CARE to be a recognised leader in water, sanitation and hygiene response. CARE is an active participant in the Global WASH cluster led by UNICEF, and adopts approaches and standards set by the cluster (see section 3.1). CARE—like other WASH cluster agencies—is guided by the Sphere standards in all WASH programmes and makes every effort to achieve them (see Annex 8.1.1, Sphere handbook, 2011).
WASH in emergencies normally includes a range of interventions, from providing safe water through water trucking, on-site water treatment and distribution, or household water treatment and storage; to construction of latrines and bathing spaces, as well as hygiene promotion through trained volunteers and distribution of essential hygiene supplies. Provision of water and sanitation facilities, or hygiene kits, alone is not enough—if people lack knowledge or understanding of how to prevent water- and sanitation-related disease, then disease outbreak is likely to occur. Wherever possible, emergency interventions should aim to build longer-term sustainable solutions together with the community.
1.1 What is WASH in emergencies?
Conflicts and natural disasters affect women, girls, boys and men differently; they face different risks and are victimized in different ways. Humanitarian actors should understand these differences and ensure that services and aid delivered assist all segments of the population and do not put some at risk. Beyond the obvious importance of meeting basic needs and preventing disease, access to adequate and appropriate WASH facilities plays an important role in the protection and dignity of displaced individuals, particularly girls, women and other vulnerable groups. Providing water and sanitation facilities alone will not guarantee their optimal use, nor will it necessarily improve public health. Only a gender-sensitive, participatory approach at all stages of a project can help ensure that an adequate and efficient service is provided.
In many cultures, the responsibility of collecting water and maintaining hygiene standards falls to
women and girls and yet despite increasing gender awareness, all too often the perspectives and roles of women and other groups in WASH are ignored or undervalued due to perceived cultural sensitivities, whereas, in practice, cultural boundaries are flexible and appropriate interventions can take advantage of this. We must recognize this central role of women in managing water, sanitation and hygiene and ensure they have an equal voice in the emergency response.
To promote dignity, water points and sanitary facilities must be designed to cater to the special
needs of different vulnerable groups including women and children. Properly located water and sanitation facilities will help to promote equal access while reducing the risk of violence.
By ensuring we position women, girls and other vulnerable groups at the center of our emergency WASH response, we can help ensure facilities are used properly, and reduce the risk of disease, while also promoting dignity and reducing the risk of violence against women and girls. The involvement of vulnerable groups during an emergency is empowering and can help affected communities appreciate that everyone has a right, as equal human beings to participate in issues that affect their lives and those of their families and that women and other groups can and do make a significant contribution to water and sanitation services.
In an emergency program these are considered to be the key areas to focus on to ensure
gender issues are appropriately addressed.
- Assessments analyze and respond to gender roles and responsibilities and their differences between men and women, boys and girls
- Targeted actions are based on gender analysis
- Equitable access to water and sanitation facilities is ensured through inclusive participation and decision making
- Dignity, privacy and safety for affected populations using water, sanitation and bathing facilities is achieved.
- Monitoring and learning is based on sex-and age-disaggregated data and data is reported on and used to adapt programs.
See also Annex: WASH and Gender Marker Tipsheet.
3.1 The assessment process and tools for WASH
3.2 WASH checklist (adapted from Sphere)
The Emergency WASH Team is currently preparing sample proposal formats detailing response options in different emergency contexts (earthquake, floods etc). These will be posted here when finalized.
There are many different factors that will inform the response options to be selected. These can include:
- location of population (in original home location, displaced—in the community, or in large camps, dispersed)
- technologies or methods for WASH normally used by the community
- cultural practices
- resources available (e.g. surface water or groundwater)
- space available and site dimensions
- long-term operation and management considerations.
Timing and how to best stage different interventions over time must also be considered, especially to ensure immediate needs are met while preparing for transition and more sustainable solutions. For example, when people are immediately displaced into camps, a temporary sanitation design may be selected that can be implemented within days, which would be used by populations while semi-permanent toilets are being planned and constructed (materials being sourced, design of camp being developed, etc.).
The tables below outline common response options according to scenarios. This list is not exhaustive. The technical manuals in the annexes include more options. See Annex 24.1.3. Engineering in Emergencies, Annex 24.1.4 Excreta Disposal in Emergencies and Annex 24.1.5 Safe Disinfection Solutions.
4.1 First phase response options for water and sanitation
4.2 Second phase response options for water and sanitation
4.3 Response options for hygiene promotion
4.4 The importance of coordination and advocacy
4.5 Monitoring results
4.5.1 Sample WASH indicators
4.7 Case study: Haiti earthquake, January 2010—CARE’s WASH response
|Common bad practice||Potential result|
Assessment and planning
|Project is planned with a focus on construction of water provision and sanitation facilities only.||People lack understanding and/or skills to maintain or use facilities, as no hygiene promotion is conducted. There is no assumed responsibility. Lack of maintenance leads to problems that arise after construction not being resolved.
Facilities fall into disuse and disease spreads.
|There is lack of community involvement into design.||People do not use facilities because they are inappropriate and do not take cultural considerations into account.|
|Particular interests of women are not incorporated into design.||Women do not feel safe using facilities (due to location or type of construction) and do not use facilities. Lack of adequate lighting and poor siting of sanitation facilities can lead to safety problems and sexual violence.|
|The assessment is hastily designed and not enough guidance is given to survey collectors.
Staff and partners have not been trained on assessment and do not understand how to carry out assessment.
|Programme is designed poorly due to insufficient information being collected. This is a poor foundation for implementation.|
|Hygiene promotion plan is based on a model used in another context, and a local assessment is not properly undertaken.||Hygiene promotion programme is ineffective because priority hygiene risk and behaviours of local population have not been identified.|
|Assessment is not coordinated with other NGOs and WASH cluster, resulting in several assessments being done in the same place.||Results are duplicated, which wastes time and resources. Beneficiaries are overburdened by too many requests.|
|Drinking water supply and toilets are planned in isolation. No site plan is developed. WASH is not considered holistically in the site planning.||WASH needs of affected communities are unmet, and could lead to water supply contamination, and shelters with no water and sanitation. People need to use drinking water supply for bathing and washing dishes, etc., which can lead to poor drainage issues and contamination at source.|
|No solid waste management is planned.||Waste accumulates, causing vector control issues and other public health risks. People use toilets for waste disposal, thereby clogging the toilets and rendering them unusable.|
|Water trucking is planned without consideration of phase-out options or longer-term sustainability.||Financial resources are depleted quickly. People continue to need access to water, and more sustainable options are needed.|
Response options and implementation
|Engineers decide on design without community consultation and construct without any community involvement.||Community is not included in construction and do not feel ownership of facilities. Facilities are not appropriate for context. Facilities are not maintained and fall into disuse.|
|Water and sanitation facilities are constructed, but there is no access to essential hygiene items (or regular distribution) such as soap, Oral Rehydration Salts (ORS) and buckets.||Disease risk remains high.|
|Water is not provided close to toilets for flushing or cleaning.||People are not able to wash hands after using toilets or use water for flushing (depending on toilet design), and the risk of spread of disease is high.|
|Hygiene promotion programme is based on giving messages and information only—instead of participatory approaches—and does not take into account local factors and beneficiaries’ perceptions.||Hygiene promotion programme is ineffective because of a top-down approach, leading to unsanitary conditions in the camp.|
|Water supply focuses on delivery of water, and no chlorine residual testing is done.||Water can be contaminated, with risk of disease outbreak.|
|Chlorine residual testing is done at water source, not at household level.||Programme fails to identify contamination taking place during water handing (i.e. contamination occurs during handing, storage in buckets) and there is risk of outbreak.|
|Failure to plan for phasing of interventions (i.e. short- and long-term). Plan is based on funding, without realistic longer-term vision.||Emergency facilities are implemented, which are not suitable in the medium term (typically after 1–3 months). WASH facilities need upgrading.|
|NFI (e.g. hygiene kits) distributions and household water treatment is distributed once, with no clear plans for follow-up. No clear information is given to communities. No coordination is done with other agencies.||Consumables (e.g. soap, water purification tablets) are used up within a month. Poor planning can lead to inequality: over-distribution in some areas, while other areas do not receive anything.|
|Water and sanitation staff and hygiene promotion team do not coordinate well together, with little exchange of information.||WASH facilities are built without community input and fail to meet needs of the population. Programme lacks cohesion and effectiveness.|
|Hygiene promotion programme decides to pay hygiene mobilisers based on cash for work, and does not coordinate this decision with other NGOs.||Hygiene volunteers working for other NGOs become demotivated and demand payments, thus creating hostility. Entire system of community mobilisation is undermined, and people demand payments for all cleaning and maintenance, eventually leading to unsanitary conditions in camps.|
|NFIs are distributed according to donation, and what is available and sent from overseas.||NFIs are not used in local context and therefore are inappropriate. Beneficiaries sell NFIs.|
|Staff attend cluster meetings irregularly, and do not contribute to technical working groups or strategic meetings.||Could lead to missing funding opportunities (i.e. Flash Appeal). There are missed opportunities to share information and strategies, as well as joint advocacy in implementation challenges. This leads to poor-quality response.|
|Focus on own programme implementation, with no coordination with other clusters (i.e. shelter) or agencies, and therefore no adequate site planning process.||Water and sanitation facilities are constructed in inadequate areas, possibly on unapproved lands. Construction of toilets in area of poor drainage can lead to poor sanitation issues, or problems with vector control.|
|Lack of coordination with government or permission to build. No MOU developed for land use.||Facilities constructed on lands where there is no permission to build, and so must remove them.|
|Lack of permission from government or owner for use of water source for water trucking||Problems and local tension arise, including with government due to lack of permission.|
|Reliance on Sphere without adapting indicators to local conditions||Unrealistic goals are developed that cannot be achieved. There is a lack of realistic understanding of challenges in that particular setting.|
|Failure to engage qualified engineering staff at beginning of process.||Facilities not built according to standards.|
|Dependence on high-tech solutions that require materials to be brought in from abroad.||Programme implementation is delayed waiting for materials to arrive. There is missed opportunity to support local community.|
|Septic tank or similar toilets are constructed without planning for emptying of tanks or de-sludging, including method for de-sludging and final dumping of sludge.||Toilets are filled rapidly while solutions are sought, thus rendering them unusable.|
|No yield measurements or demand calculations are considered for water source.||Over-abstraction, or water source goes dry during dry season.|
|No planning is done for secondary sources of water on-site.||First source fails, with lack of an alternative option.|
|Lack of sanitary survey, and water source is not adequately protected.||Leads to contamination and continued risky practices being conducted around source.|
|Toilet pits are not sealed in areas of high groundwater table or flooding conditions.||Leads to contamination of water source and/or the environment in general.|
Many CARE COs have existing WASH capacity. There are many advantages to having and using locally available WASH expertise in CARE COs due to familiarity with local and national norms, customs and standards. Specialised technical advice should be called upon where local capacity is overwhelmed, or where the scope or nature of the emergency demands an alternative or creative approach. The WASH Team’s Offer of Service describes the range of support available.
The CARE Emergency WASH Team (1*Team Leader, 2*WASH Advisors and 1*WASH and Gender Advisor) is available to all COs and Members (refer to contact details above). The team will provide specialist advice and support in an emergency response, and helps to build WASH capacity across the CARE confederation.
CARE has identified WASH as one of the four priority sectors (along with food security, shelter and sexual and reproductive health & rights) in the CARE International Emergency Strategy. In line with this commitment, it is recommended that CARE would contribute to between 10% and 25% of the total WASH response to the needs of the severely affected population. CARE would expect to be at the higher end of this range in circumstances where:
- the CO has established WASH programmes
- the emergency impacts on or near an area where we are already working
- there are few other WASH actors present.
CARE is a committed member of the Global WASH cluster, and there is the expectation that at the country level, CARE would actively participate in the cluster. This includes being a member of the Strategic Advisory Group (SAG) in cases where this exists, and communicating CARE’s plans and areas of intervention to the WASH cluster promptly, so that other WASH actors know when and where we have accepted responsibility for WASH and do not duplicate interventions.
CARE’s programmes in WASH should follow approaches agreed with the WASH cluster and should meet international standards including:
- Sphere standards
- WHO standards for drinking water quality
- Technical guidance set out by WASH cluster and other technical institutions.