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CHAPTER 1
Introduction: Water, sanitation and hygiene in humanitarian contexts
Richard C. Carter
Abstract
This introductory chapter explains the origins, scope and intended readership of Water, Sanitation and Hygiene in Humanitarian Contexts. It describes the human impacts of emergencies and disasters, briefly discusses some of the terms used in humanitarian work, and examines the diversity of types of emergency and disaster. The introduction then moves on to some of the specifics of water, sanitation and hygiene – WASH – in emergencies, referring extensively to the Sphere Handbook, Humanitarian Charter and Minimum Standards in Humanitarian Response. The final sections of the introduction touch on the challenges of transitioning from emergency to post-emergency, when resources and institutional capacity may be very different to the acute phase of the emergency. Lastly, the individual chapters of the book are summarized and suggestions are made as to how the book can most usefully be read.
In 2011, the world saw a massive earthquake, tsunami and nuclear meltdown in Japan; devastating drought in East Africa; extreme and costly floods in Thailand; and a damaging but under-reported typhoon in the Philippines. Since that time there has been a seemingly relentless unfolding of natural disasters – earthquakes, storms, floods and droughts – and still unresolved fighting in Central African Republic, South Sudan and Syria. At the time of writing, we are eight months into the world's worst Ebola outbreak in West Africa. All these examples, and many others, have implications for water and sanitation services.
The impact of emergencies and disasters is inevitably greater in what have come to be called 'fragile states' than in those which by virtue of effective government, strong institutions and wealthier economies have greater resilience to such events. In fragile states, periods of relative stability, in which development efforts make some progress, are often punctuated by crises which may have long-lasting impacts. Effective long-term development is the best form of disaster-risk reduction, and good governance and strong institutions represent the best form of disaster preparedness.
All of these crises, disasters or emergencies – choose your term – profoundly affect individual human beings, their families, their communities, the surrounding populations, and the nations in which these events take place. They all demand rapid and effective response to physical need – of which water and sanitation is one part – and longer-term recovery and reconstruction.
This book is not and cannot be a comprehensive treatise on disaster response (let alone disaster preparedness or post-disaster recovery). Rather it sets out a number of very down-to-earth issues and actions which have been addressed and undertaken by practitioner organizations in recent years. The individual contributions in the chapters which follow this scene-setting introduction fit within wider social, economic and political contexts. They address particular aspects of WASH – water, sanitation and hygiene – and taken together they give a useful flavour of the thinking, experimentation and reflection of those who are constantly striving for greater effectiveness in humanitarian emergency response.
Who the book is for
This book is for those whose work regularly involves them in providing WASH in emergencies, but it should also be of interest to those who are mainly involved in long-term development, from WASH and other sectors. It will be of value to those studying for technical and professional qualifications in WASH and in disaster management. It demonstrates the wide range of issues which WASH professionals have to address as they attempt to respond to emergencies.
Humanitarian disasters and emergencies
Neither the phrase 'humanitarian emergency', nor the more pithy reference to a 'disaster', do justice to the effects caused by such events. Imagine for some moments what happens when an emergency unfolds, when a sudden flood or earthquake hits, when a drought sets in, or when society falls apart during conflict.
The 'emergency' can happen either gradually (in the case of slow-onset droughts and famines) or suddenly (rapid-onset earthquakes and floods). Individuals and families lose their homes, their possessions, and, in some cases, their lives or those of loved ones. The number of deaths is what hits the news headlines and is the popular, if blunt, measure of the severity of the emergency. 'Thousands killed in disaster' shocks newspaper readers, but fails to reflect the reality for those who live on. For every death there are many times as many who survive, affected physically, mentally, and socially.
Those who survive may become 'displaced': no longer able to live in the places they once called home. If they cross national borders, they become refugees. They may reach the relative safety of family elsewhere, of towns or cities which they do not know, or of a hastily constructed 'camp'. Camps for internally displaced persons (IDPs) or refugees may take the form of tented cities or accommodation built in local styles and materials, but for their residents they represent more than a mere physical displacement. People are dislocated physically, socially and mentally. They are dislocated, along with all their pre-existing health needs and infirmities, and with all their individual and family frailties and strengths. Livings are disrupted, and those with least in reserve are naturally hardest hit. Social networks are upset as whole communities are displaced. People suffer loss, shock, stress and uncertainty.
These are some of the realities for those who have survived death and been displaced from their homes by the emergency. There are other emergencies, however, which do not cause displacement – sometimes it can be precisely the opposite. As I write this, the Ebola outbreak in Guinea, Sierra Leone and Liberia is continuing. For those affected, 'lock-down' – prevention of movement and interaction – is the pattern, rather than escape. Yet the effects for those surviving are similar – livings are disrupted, and uncertainty, suspicion, and fear abound.
Every emergency is different in its details, despite some common features across certain categories. It may be that the apparently increasing diversity of emergencies reflects our increasing understanding of their nuances, and it is certainly true that large-scale demographic changes and the evolving nature of armed conflict are resulting in more people being affected by a wider range of types of emergency than ever before. The world is becoming more complex and unpredictable.
Disasters and emergencies not only affect those they kill and those who are left behind, but the communities, societies and nations where displaced people end up. They affect national economies, sometimes retarding investment and development for many years. In the case of war or other large-scale armed conflict, it is uncommon for visible progress to be seen in the processes of healing, renewal and restoration of confidence and security until a decade or more has passed.
Those affected by a disaster may need immediate fundamentals: shelter, food, water and sanitation, clothing and household goods; they may need health services and education – the children affected by the civil war in Syria have missed out on much schooling, and the closure of schools in Sierra Leone in response to Ebola has robbed children of a full year of education. This book addresses some aspects of WASH, but it is important to set these in the wider context of need.
Definitions and diversity
As with all fields of endeavour, there is a body of jargon which we need to deal with in the interests of clear communication. First, the word 'humanitarian' itself, which, according to the dictionary, means 'concerned with or seeking to improve human welfare'. In the present context, however, the word is used to refer to extraordinary events which have affected human beings, and which require urgent action – disasters or emergencies. This is in contrast to the concern for improving human welfare which is embodied in long-term sustainable development work.
According to ReliefWeb (2008) a disaster is 'a serious disruption of the functioning of a community or a society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources'. An emergency is 'a sudden and usually unforeseen event that calls for immediate measures to minimize its adverse consequences'. The two terms are often used interchangeably, although some argue that a disaster is larger in scale than many emergencies; a local emergency may or may not develop into a full-blown disaster. Some put emergencies, disasters and catastrophes on a sliding scale of increasing severity. A crisis – 'a time of extreme difficulty or danger' – or an emergency may develop into a disaster.
Emergencies and disasters have many root causes and triggers. Various categorizations exist, with the primary categories being natural disasters (e.g. earthquake, storm, flood, drought, epidemic), technological disasters (various kinds of accidents) and 'complex humanitarian emergencies' – those having multiple causes and in which violence, insecurity and breakdown of law and order often compound the difficulties faced by those who are affected. Table 1.1 summarises these categories, according to the International Federation of Red Cross and Red Crescent Societies. As well as the categories of disaster listed, a number of aggravating factors are highlighted – interestingly with no reference to general population growth, which surely accounts for much of the growth in disasters over recent years.
Disasters result when people live in hazardous situations (e.g. in floodplains or seismically active zones), an event occurs (flood or earthquake in the examples given), the population is vulnerable (e.g. as a result of its physical location or its poverty) and its capacity to cope is limited (e.g. because of limited resources or weak institutions).
Wherever and however a natural or man-made disaster affects people, basic services, including those of water and sanitation, may be disrupted. Prolonged droughts may reduce stocks of water; flooding and geophysical disasters (such as earthquakes and volcanic eruptions) may damage water supply and sanitation infrastructure; industrial accidents may pollute water resources; any form of human displacement may reduce people's access to services.
Disruption of water and sanitation services creates problems for those affected. But WASH actions also form part of the solution – when done well, they can help to safeguard health – especially by controlling outbreaks of water-related diseases such as cholera – and preserve dignity and well-being at a time when all of these are in short supply.
The importance of WASH in emergencies and disasters
Emergencies and disasters affect WASH services and practices by damaging existing infrastructure or by separating displaced populations from the services which they had enjoyed. In the case of displacement, host populations are also affected, as greater demands are placed on their services. Those who reach the relative safety of IDP and refugee camps may be there for many years or even decades before repatriation.
The Humanitarian Charter and Minimum Standards in Disaster Response (known in short as the Sphere Handbook, 2011) sets out standards and guidance in relation to four fundamentals, of which WASH is the first. The others are Food Security and Nutrition, Shelter, Settlement and Non-Food Items, and Health Action.
The Handbook explains why WASH is so important in disasters: 'Water and sanitation are critical determinants for survival in the initial stages of a disaster. People affected by disasters are generally much more susceptible to illness and death from disease, which to a large extent are related to inadequate sanitation, inadequate water supplies and inability to maintain good hygiene. The most significant of these diseases are diarrhoeal and infectious diseases transmitted by the faeco-oral route. Other water- and sanitation-related diseases include those carried by vectors associated with solid waste and water.'
The maintenance of good health is justifiably one of the most important considerations for doing WASH in emergencies and disasters. However, just as in long-term development situations, there are several other reasons for doing WASH, and doing it well. Adequate water supply is a basic need for drinking and cooking, laundry, personal and home hygiene. Safe and private latrines or toilets are necessary because the opportunity to practice good hygiene is not just the means of preserving health, but a matter of human dignity.
The various components of WASH each have aspects which are common to emergencies and to non-emergency situations; and they each have aspects which are particular to emergencies.
Water supply
Standards of access, quantity and quality of water supply in emergencies have much in common with similar considerations in the absence of an emergency. An important difference, however, is that unlike the case of rural water supply more generally – in which protected, 'improved' water sources are used – emergency water supply is always treated. Water provided for potable uses is nearly always chlorinated, and consequently one of the tests used for water supplied in emergencies is the chlorine residual.
Water supplied in emergencies is usually provided free-of-charge to the consumers – a significant difference from normal practice in urban and rural water supply generally. This has important implications post-emergency.
High standard treatment of water, and non-payment for water, are generally true in the acute phase of an emergency, but many IDP and refugee camps last for years or even decades. Further reference is made below to the transition from emergency to post-emergency measures.
Sanitation
The term 'sanitation', throughout the Sphere Handbook, refers to excreta disposal, vector control, solid waste disposal and drainage. This broad definition is just as appropriate to non-emergency situations as to emergencies. Defining sanitation simply in terms of excreta disposal is too narrow a point of view, in general, and in emergencies.
The purpose of sanitation in the broad sense is to keep the environment in which people live free of hazardous wastes, and to reduce disease transmission by insect and animal vectors.
The Sphere Handbook explains the importance of disease vectors: 'A vector is a disease-carrying agent and vector-borne diseases are a major cause of sickness and death in many disaster situations. Mosquitoes are the vector responsible for malaria transmission, which is one of the leading causes of morbidity and mortality. Mosquitoes also transmit other diseases, such as yellow fever, dengue and haemorrhagic fever. Non-biting or synanthropic flies, such as the house fly, the blow fly and the flesh fly, play an important role in the transmission of diarrhoeal disease. Biting flies, bedbugs and fleas are a painful nuisance and in some cases transmit significant diseases such as murine typhus, scabies and plague. Ticks transmit relapsing fever, while human body lice transmit typhus and relapsing fever. Rats and mice can transmit diseases, such as leptospirosis and salmonellosis, and can be hosts for other vectors, e.g. fleas, which may transmit Lassa fever, plague and other infections.'
Control of disease vectors is especially important in densely populated IDP and refugee camps, as in urban areas generally. A number of different measures may need to be taken to control vectors; at the level of the individual, the dwelling and the wider environment. As is the case with hygiene, knowledge and understanding are good starting points, but these are not necessarily sufficient to bring about action or changed behaviours.
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