Emergency Sanitation: Assessment and Programme Design
!""#""$#%&'!%(')*+,*!$$#'(#"-,%
!"#"$%&'$(")*%+,-$'.%/'0-$1%'23%/,.%4""3
!"#$%&'()*+)$$%+)*'"),'-$.$/012$)#'3$)#%$
405*670%05*6'8)+.$%9+#:''8;
iii
Water, Engineering and Development Centre
Loughborough University
Leicestershire
LE11 3TU UK
© WEDC, Loughborough University, 2002
Any part of this publication, including the illustrations (except items taken
from other publications where the authors do not hold copyright) may be copied,
reproduced or adapted to meet local needs, without permission from the author/s
or publisher, provided the parts reproduced are distributed free, or at cost and
not for commercial ends, and the source is fully acknowledged as given below.
Please send copies of any materials in which text or illustrations have been used to
WEDC Publications at the address given above.
A reference copy of this publication is also available online at:
http://www.lboro.ac.uk/wedc/publications/es.htm
Harvey, P.A., Baghri, S. and Reed, R.A. (2002)
Emergency Sanitation: Assessment and programme design
WEDC, Loughborough University, UK.
ISBN Paperback 1 84380 005 5
This document is an output from a project funded by the UK
Department for International Development (DFID)
for the benefit of low-income countries.
The views expressed are not necessarily those of DFID.
Designed and produced at WEDC
iv
!"#$%&%'(&)$%'#*+
Peter Harvey is a Research Associate at the Water, Engineering and Development Centre (WEDC). He has worked as a public health engineer on emergency
water supply and sanitation (watsan) programmes in Africa, Asia and Eastern
Europe. He also has experience of rural water supply and sanitation projects in
low-income countries. His major interests include groundwater development and
the sustainability of water and sanitation projects.
Sohrab Baghri is a civil engineer with over fifteen years experience of water
supply and sanitation projects in Africa, Asia and the Middle East. He has worked
on both emergency and long-term development programmes with a wide range of
international aid agencies. His interests include water treatment, environmental
sanitation and watsan facilities for children and disabled people. He is now Water
and Sanitation Adviser at Plan International’s headquarters.
Bob Reed is a Senior Programme Manager at WEDC. He specialises in water
supply and sanitation for rural areas, low-income urban communities and refugees. He has considerable experience of training, design and project implementation in the Pacific, the Caribbean, Asia and Africa. In recent years he has focused
on the provision of improved and sustainable water supply and sanitation systems
for displaced populations.
The authors would like to hear from anyone who uses this book in the field with
comments on its usefulness and areas which require improvement. Please forward comments or suggestions to Bob Reed at the address overleaf.
Peter Harvey
Sohrab Baghri
v
Bob Reed
!"#$%&,-./
The Water, Engineering and Development Centre (WEDC) is concerned with
education, training, research and consultancy for improved planning provision
and management of physical infrastructure and services for development in lowand middle-income countries, focusing on the needs and demands of the poor.
WEDC is devoted to activities that improve the health and well-being of people
living in both rural areas and urban communities. We encourage the integration of
technological, environmental, social, economic and management inputs for effective and sustainable development.
Water, Engineering and Development Centre
Loughborough University
Leicestershire
LE11 3TU UK
Phone: +44 1509 222885
Fax: +44 1509 211079
Email: WEDC@lboro.ac.uk
http://www.lboro.ac.uk/wedc/
vi
/#00)"#*)%#*+
The ‘Assessment and Programme Design for Emergency Sanitation’ project
(R6873) has been funded by the Department for International Development
(DFID) of the British Government.
The following organisations have acted as peer reviewers for this research contract. They have reviewed draft documents, provided access to staff for interview,
given advice on project design and implementation, provided information, and
have been involved in and provided support for field trials. This project would not
have been possible without their support and encouragement.
Opinions noted within these documents do not necessarily represent those of
DFID or the collaborators, but are solely those of the authors.
DR!P
Development through Resource
Organisation and Planning
International Federation
of Red Cross and Red Crescent Societies
INTERNATIONAL COMMITTEE OF THE RED CROSS
UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES
vii
!123#40(56(7(3%+
Thanks go to all individuals and organisations that have been involved in the
production of the manual, guidelines and training modules. It is hoped that the
wide range of organisations and individuals that have contributed to this project
will facilitate the usefulness of this work to an even wider range of personnel and
emergency situations.
All contributions are gratefully acknowledged. It should be noted, however, that
the opinions in this document are solely those of the authors. The following
individuals have contributed to the research either as peer reviewers, advisory
panel members, by testing the work in the field, or by providing information for
specific sections of the work.
Peer reviewers
DFID
John Adams
Ben Fawcett
Joy Morgan
Rutger Verkerk
Department for International Development, UK
Bioforce/Trinome, France
IIDS, Southampton, UK
Independent Consultant, UK
MSF, Amsterdem, Holland
Advisory panel members
Astier Almedom
ex-LSHTM, London, UK
Andy Bastable
OXFAM, Oxford, UK
Murray Biedler
MSF, Brussels, Belgium
Dixon Chanda
ex-MSF, Amsterdam, Holland
Riccardo Conti
ICRC, Geneva, Switzerland
Ulrich Jaspers
IFRC, Geneva, Switzerland
Ajeet Oak
DROP, Pune, India
Claude Rakotomalala
UNHCR, Geneva, Switzerland
Rutger Verkerk
MSF, Amsterdam, Holland
viii
Editorial contributions
Kimberley Clarke
Independent Consultant, UK
Other contributors
Raissa Azzalini
William Corkill
Jean-Michel Detre
Shemeles Gebeyehu
Julius Kibassa
Peter Maes
Radjabu Mavlidi
Qumrun Nahar
Joseph Ng’ambi
Deo Ntahonsigaye
Gorik Ooms
Samuel Phiri
Veronique Ridel
Hans Van Dillen
Alberto Villani
MSF, Burundi
IFRC, Nairobi, Kenya
MSF, Burundi
MSF, Kala, Zambia
TRCS, Lugufu, Tanzania
MSF, Brussels, Belgium
MSF, Burundi
UNICEF, Bangladesh
MSF, Kala, Zambia
MSF, Burundi
MSF, Burundi
MSF, Kala, Zambia
MSF, Burundi
MSF, Lusaka, Zambia
MSF, Burundi
ix
x
89(*9:(4
30)#$)#9
.%:.5990+
The approach to emergency sanitation programmes that this book promotes is illustrated in
Figure 1.1.
/
"#$%#&
EMERGENCY SANITATION
!
RAPID ASSESSMENT
AND PRIORITY SETTING
OUTLINE
PROGRAMME DESIGN
IMMEDIATE ACTION
DETAILED
PROGRAMME DESIGN
ASSESSMENT
IMPLEMENTATION
?*:&.0(!"!"(#>>.%5/)('%(090.:06/;(+56*'5'*%6(>.%:.5990+
The implementation stage includes monitoring and evaluation (M&E). In the long term this
process can evolve into the traditional development Project Cycle of assessment, planning
(programme design), implementation and M&E.
The Guidelines are designed to guide the reader through this process to facilitate effective
disaster response programmes. The Manual contains supporting information to assist the
Guidelines process as well as chapters on specific sanitation sectors.
0
"#$%#&
INTRODUCTION
!"@
A0%>B0
All humanitarian relief programmes should be designed to meet the needs of people who
require assistance and who find themselves in an extraordinary situation in which their lives
have been severely disrupted. For the purposes of this book these people are collectively
referred to as the ‘affected’ community or population. This may include displaced people,
settled people and people living in areas to which displaced people have moved.
!"@"! C%99&6*';(>5.'*/*>5'*%6
Community participation refers to members of the affected population being actively involved in analysing their own problems and needs and those of their community, making
decisions affecting their lives, and implementing appropriate intervention programmes.
Chapter 12 looks at community participation in more detail but it should be considered in all
sections of this book.
!"@"2 D0670.(567(E&B60.5$*B*';
It is essential that any emergency humanitarian programme aims to reach people of both
genders and the most vulnerable people within the affected population. In many emergency
situations in which people have been displaced unaccompanied women make up the vast
majority of the adult population; in other situations there may be large numbers of children or
disabled people. Specific attention is given to the differing needs of men, women and
children throughout this book, as well as to the needs of the sick, disabled and elderly.
F010.06/0+(567(1&.')0.(.057*6:
Adams, John (1999) Managing Water Supply and Sanitation in Emergencies. Oxfam:
Oxford.
Davis, Jan and Lambert, Robert (1996) Engineering in Emergencies: A practical guide for
relief workers. RedR / IT Publications: London.
Médecins Sans Frontières (1994) Public Health Engineering in Emergency Situation.
Médecins Sans Frontières: Paris.
WHO (1987) Technology for Water Supply and Sanitation in Developing Countries: A report
of a WHO Study Group. (WHO Technical Report Series, No.749) WHO, Geneva.
1
!
"#$%#&
EMERGENCY SANITATION
!
2
$%&'%(
IS INTERVENTION NECESSARY?
"
#
!"#$%&'()
)*+,&-./0.&-,1&+&.2.**%/34
The first questions that humanitarian agencies should ask themselves are ‘Under what
conditions is emergency sanitation intervention necessary?’ and ‘Should we intervene in this
particular situation?’.
!"#
$%&'(%&)*+,%*&-'(%.(-'&,-
There are several factors which are likely to influence where and when an agency decides to
intervene. These include the:
!
!
!
!
!
!
capacity of the affected population;
political situation;
security situation;
access to area;
current health of the affected population; and
potential health risks to the population.
The vast majority of emergencies worldwide receive no external assistance and are dealt with
by the affected population themselves. In general, where there is existing capacity to do this,
external agencies should not interfere. In some cases, however, there is limited capacity
among the population and a great need for external assistance.
Assuming external assistance is required, the political context will have a major influence on
where agencies are able work or decide to intervene. In general, it is impossible to operate in
an area in which the government does not welcome, or at least tolerate, the presence of aid
agencies.
Security and access are also important factors, as agencies are responsible for the safety and
well-being of their own staff as well as those they are trying to assist. Insecure conflictaffected areas may be too dangerous to work in, or access to these areas may be extremely
hazardous or even impossible.
Where these factors are not major constraints, the over-riding factor to be considered for an
emergency sanitation programme is health. The purpose of any emergency sanitation pro-
!
$%&'%(
#
EMERGENCY SANITATION
gramme should be to sustain or improve the overall health status and well-being of the
affected population. Many diseases that occur after disasters are linked to poor sanitation and
hygiene practice, so it is essential that sanitation is given as much priority as ‘traditional’
humanitarian interventions such as healthcare, food provision and water supply.
!"!
/,012)'&,-*)-3*4()2'4
!"!"# 5&-67*8('9((-*3&7()7(*)-3*7)-&')'&,Not all diseases that occur during emergencies are directly sanitation-related. Common
causes of death in young refugee children are malaria, diarrhoea, pneumonia and malnutrition. Whilst diarrhoea and malaria can be sanitation-related, generally pneumonia and
malnutrition are not. However, although malnutrition is not directly sanitation-related, it is
often related to persistent and repeated diarrhoeal infection. It should also be noted that the
affect of diarrhoea on severely malnourished children is normally more severe than on
healthy children, and may be fatal. The importance of sanitation and hygiene is therefore farreaching.
The diseases in Table 2.1 are considered to be directly sanitation-related. It should be noted
that this is not an exhaustive list of sanitation-related diseases and does not include illnesses
directly related to water supply.
:)82(*!"#"*;)-&')'&,-(,@("#/01#7"+/9(#@%&'(0&@&4#%+,/(#/0(=&@,'&(@,,0
$'&$#'#%+,/
F5+&7
;6&-*)-3*(A(*&-+(>'&,-7
!"#"$%&'$(")*%+,-$'.%/'0-$1%'23%/,.%4""3
!"#$%&'()*+)$$%+)*'"),'-$.$/012$)#'3$)#%$
405*670%05*6'8)+.$%9+#:''8;
iii
Water, Engineering and Development Centre
Loughborough University
Leicestershire
LE11 3TU UK
© WEDC, Loughborough University, 2002
Any part of this publication, including the illustrations (except items taken
from other publications where the authors do not hold copyright) may be copied,
reproduced or adapted to meet local needs, without permission from the author/s
or publisher, provided the parts reproduced are distributed free, or at cost and
not for commercial ends, and the source is fully acknowledged as given below.
Please send copies of any materials in which text or illustrations have been used to
WEDC Publications at the address given above.
A reference copy of this publication is also available online at:
http://www.lboro.ac.uk/wedc/publications/es.htm
Harvey, P.A., Baghri, S. and Reed, R.A. (2002)
Emergency Sanitation: Assessment and programme design
WEDC, Loughborough University, UK.
ISBN Paperback 1 84380 005 5
This document is an output from a project funded by the UK
Department for International Development (DFID)
for the benefit of low-income countries.
The views expressed are not necessarily those of DFID.
Designed and produced at WEDC
iv
!"#$%&%'(&)$%'#*+
Peter Harvey is a Research Associate at the Water, Engineering and Development Centre (WEDC). He has worked as a public health engineer on emergency
water supply and sanitation (watsan) programmes in Africa, Asia and Eastern
Europe. He also has experience of rural water supply and sanitation projects in
low-income countries. His major interests include groundwater development and
the sustainability of water and sanitation projects.
Sohrab Baghri is a civil engineer with over fifteen years experience of water
supply and sanitation projects in Africa, Asia and the Middle East. He has worked
on both emergency and long-term development programmes with a wide range of
international aid agencies. His interests include water treatment, environmental
sanitation and watsan facilities for children and disabled people. He is now Water
and Sanitation Adviser at Plan International’s headquarters.
Bob Reed is a Senior Programme Manager at WEDC. He specialises in water
supply and sanitation for rural areas, low-income urban communities and refugees. He has considerable experience of training, design and project implementation in the Pacific, the Caribbean, Asia and Africa. In recent years he has focused
on the provision of improved and sustainable water supply and sanitation systems
for displaced populations.
The authors would like to hear from anyone who uses this book in the field with
comments on its usefulness and areas which require improvement. Please forward comments or suggestions to Bob Reed at the address overleaf.
Peter Harvey
Sohrab Baghri
v
Bob Reed
!"#$%&,-./
The Water, Engineering and Development Centre (WEDC) is concerned with
education, training, research and consultancy for improved planning provision
and management of physical infrastructure and services for development in lowand middle-income countries, focusing on the needs and demands of the poor.
WEDC is devoted to activities that improve the health and well-being of people
living in both rural areas and urban communities. We encourage the integration of
technological, environmental, social, economic and management inputs for effective and sustainable development.
Water, Engineering and Development Centre
Loughborough University
Leicestershire
LE11 3TU UK
Phone: +44 1509 222885
Fax: +44 1509 211079
Email: WEDC@lboro.ac.uk
http://www.lboro.ac.uk/wedc/
vi
/#00)"#*)%#*+
The ‘Assessment and Programme Design for Emergency Sanitation’ project
(R6873) has been funded by the Department for International Development
(DFID) of the British Government.
The following organisations have acted as peer reviewers for this research contract. They have reviewed draft documents, provided access to staff for interview,
given advice on project design and implementation, provided information, and
have been involved in and provided support for field trials. This project would not
have been possible without their support and encouragement.
Opinions noted within these documents do not necessarily represent those of
DFID or the collaborators, but are solely those of the authors.
DR!P
Development through Resource
Organisation and Planning
International Federation
of Red Cross and Red Crescent Societies
INTERNATIONAL COMMITTEE OF THE RED CROSS
UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES
vii
!123#40(56(7(3%+
Thanks go to all individuals and organisations that have been involved in the
production of the manual, guidelines and training modules. It is hoped that the
wide range of organisations and individuals that have contributed to this project
will facilitate the usefulness of this work to an even wider range of personnel and
emergency situations.
All contributions are gratefully acknowledged. It should be noted, however, that
the opinions in this document are solely those of the authors. The following
individuals have contributed to the research either as peer reviewers, advisory
panel members, by testing the work in the field, or by providing information for
specific sections of the work.
Peer reviewers
DFID
John Adams
Ben Fawcett
Joy Morgan
Rutger Verkerk
Department for International Development, UK
Bioforce/Trinome, France
IIDS, Southampton, UK
Independent Consultant, UK
MSF, Amsterdem, Holland
Advisory panel members
Astier Almedom
ex-LSHTM, London, UK
Andy Bastable
OXFAM, Oxford, UK
Murray Biedler
MSF, Brussels, Belgium
Dixon Chanda
ex-MSF, Amsterdam, Holland
Riccardo Conti
ICRC, Geneva, Switzerland
Ulrich Jaspers
IFRC, Geneva, Switzerland
Ajeet Oak
DROP, Pune, India
Claude Rakotomalala
UNHCR, Geneva, Switzerland
Rutger Verkerk
MSF, Amsterdam, Holland
viii
Editorial contributions
Kimberley Clarke
Independent Consultant, UK
Other contributors
Raissa Azzalini
William Corkill
Jean-Michel Detre
Shemeles Gebeyehu
Julius Kibassa
Peter Maes
Radjabu Mavlidi
Qumrun Nahar
Joseph Ng’ambi
Deo Ntahonsigaye
Gorik Ooms
Samuel Phiri
Veronique Ridel
Hans Van Dillen
Alberto Villani
MSF, Burundi
IFRC, Nairobi, Kenya
MSF, Burundi
MSF, Kala, Zambia
TRCS, Lugufu, Tanzania
MSF, Brussels, Belgium
MSF, Burundi
UNICEF, Bangladesh
MSF, Kala, Zambia
MSF, Burundi
MSF, Burundi
MSF, Kala, Zambia
MSF, Burundi
MSF, Lusaka, Zambia
MSF, Burundi
ix
x
89(*9:(4
30)#$)#9
.%:.5990+
The approach to emergency sanitation programmes that this book promotes is illustrated in
Figure 1.1.
/
"#$%#&
EMERGENCY SANITATION
!
RAPID ASSESSMENT
AND PRIORITY SETTING
OUTLINE
PROGRAMME DESIGN
IMMEDIATE ACTION
DETAILED
PROGRAMME DESIGN
ASSESSMENT
IMPLEMENTATION
?*:&.0(!"!"(#>>.%5/)('%(090.:06/;(+56*'5'*%6(>.%:.5990+
The implementation stage includes monitoring and evaluation (M&E). In the long term this
process can evolve into the traditional development Project Cycle of assessment, planning
(programme design), implementation and M&E.
The Guidelines are designed to guide the reader through this process to facilitate effective
disaster response programmes. The Manual contains supporting information to assist the
Guidelines process as well as chapters on specific sanitation sectors.
0
"#$%#&
INTRODUCTION
!"@
A0%>B0
All humanitarian relief programmes should be designed to meet the needs of people who
require assistance and who find themselves in an extraordinary situation in which their lives
have been severely disrupted. For the purposes of this book these people are collectively
referred to as the ‘affected’ community or population. This may include displaced people,
settled people and people living in areas to which displaced people have moved.
!"@"! C%99&6*';(>5.'*/*>5'*%6
Community participation refers to members of the affected population being actively involved in analysing their own problems and needs and those of their community, making
decisions affecting their lives, and implementing appropriate intervention programmes.
Chapter 12 looks at community participation in more detail but it should be considered in all
sections of this book.
!"@"2 D0670.(567(E&B60.5$*B*';
It is essential that any emergency humanitarian programme aims to reach people of both
genders and the most vulnerable people within the affected population. In many emergency
situations in which people have been displaced unaccompanied women make up the vast
majority of the adult population; in other situations there may be large numbers of children or
disabled people. Specific attention is given to the differing needs of men, women and
children throughout this book, as well as to the needs of the sick, disabled and elderly.
F010.06/0+(567(1&.')0.(.057*6:
Adams, John (1999) Managing Water Supply and Sanitation in Emergencies. Oxfam:
Oxford.
Davis, Jan and Lambert, Robert (1996) Engineering in Emergencies: A practical guide for
relief workers. RedR / IT Publications: London.
Médecins Sans Frontières (1994) Public Health Engineering in Emergency Situation.
Médecins Sans Frontières: Paris.
WHO (1987) Technology for Water Supply and Sanitation in Developing Countries: A report
of a WHO Study Group. (WHO Technical Report Series, No.749) WHO, Geneva.
1
!
"#$%#&
EMERGENCY SANITATION
!
2
$%&'%(
IS INTERVENTION NECESSARY?
"
#
!"#$%&'()
)*+,&-./0.&-,1&+&.2.**%/34
The first questions that humanitarian agencies should ask themselves are ‘Under what
conditions is emergency sanitation intervention necessary?’ and ‘Should we intervene in this
particular situation?’.
!"#
$%&'(%&)*+,%*&-'(%.(-'&,-
There are several factors which are likely to influence where and when an agency decides to
intervene. These include the:
!
!
!
!
!
!
capacity of the affected population;
political situation;
security situation;
access to area;
current health of the affected population; and
potential health risks to the population.
The vast majority of emergencies worldwide receive no external assistance and are dealt with
by the affected population themselves. In general, where there is existing capacity to do this,
external agencies should not interfere. In some cases, however, there is limited capacity
among the population and a great need for external assistance.
Assuming external assistance is required, the political context will have a major influence on
where agencies are able work or decide to intervene. In general, it is impossible to operate in
an area in which the government does not welcome, or at least tolerate, the presence of aid
agencies.
Security and access are also important factors, as agencies are responsible for the safety and
well-being of their own staff as well as those they are trying to assist. Insecure conflictaffected areas may be too dangerous to work in, or access to these areas may be extremely
hazardous or even impossible.
Where these factors are not major constraints, the over-riding factor to be considered for an
emergency sanitation programme is health. The purpose of any emergency sanitation pro-
!
$%&'%(
#
EMERGENCY SANITATION
gramme should be to sustain or improve the overall health status and well-being of the
affected population. Many diseases that occur after disasters are linked to poor sanitation and
hygiene practice, so it is essential that sanitation is given as much priority as ‘traditional’
humanitarian interventions such as healthcare, food provision and water supply.
!"!
/,012)'&,-*)-3*4()2'4
!"!"# 5&-67*8('9((-*3&7()7(*)-3*7)-&')'&,Not all diseases that occur during emergencies are directly sanitation-related. Common
causes of death in young refugee children are malaria, diarrhoea, pneumonia and malnutrition. Whilst diarrhoea and malaria can be sanitation-related, generally pneumonia and
malnutrition are not. However, although malnutrition is not directly sanitation-related, it is
often related to persistent and repeated diarrhoeal infection. It should also be noted that the
affect of diarrhoea on severely malnourished children is normally more severe than on
healthy children, and may be fatal. The importance of sanitation and hygiene is therefore farreaching.
The diseases in Table 2.1 are considered to be directly sanitation-related. It should be noted
that this is not an exhaustive list of sanitation-related diseases and does not include illnesses
directly related to water supply.
:)82(*!"#"*;)-&')'&,-(,@("#/01#7"+/9(#@%&'(0&@&4#%+,/(#/0(=&@,'&(@,,0
$'&$#'#%+,/
F5+&7
;6&-*)-3*(A(*&-+(>'&,-7