Ethiopia is affected by many different emergency situations and also the occasional disaster. In this study session you will learn about emergencies and an outline approach for rapid assessment of emergency situations. Management of emergency sanitation and waste can have a huge impact on ensuring the health of communities who are trying to cope with very difficult circumstances. You will also learn about the importance of effective sanitation, excreta disposal and solid waste management during emergencies and the recommended standards required for emergency responses according to international agreements.
When you have studied this session, you should be able to:
14.1 Define and use correctly each of the terms printed in bold. (SAQ 14.1)
14.2 Explain the purpose of rapid field assessment of emergencies. (SAQ 14.2)
14.3 Identify appropriate options for sanitation, excreta disposal and hygiene interventions needed during emergencies. (SAQ 14.3)
14.4 Identify minimum interventions for proper management of solid waste in emergency situations. (SAQ 14.4)
An emergency is a sudden and unforeseen event that calls for immediate measures to minimise its adverse consequences. Emergencies may force the population to move away from their homes to avoid the impacts. Emergency situations are often caused by disasters such as droughts, floods, earthquakes, disease outbreaks, wars and other conflicts.
A disaster is a serious disruption of the functioning of society, causing widespread human, material or environmental losses which exceed the ability of the affected population to cope using only its own resources. A rapid-onset disaster could be defined as resulting from a unique, distinct and unforeseeable event such as a flood. A slow-onset disaster unfolds gradually over time and is often the result of a combination of events such as drought which leads to population movements and to widespread famine.
Displacement of people as a result of emergencies is not uncommon in Ethiopia. The European Community Humanitarian Office (ECHO, 2015) states that in 2015 there were around 440,000 internally displaced persons (IDPs) in Ethiopia mainly as a result of flooding and clashes over scarce resources. Additionally there were 720,000 refugees who had moved across national borders into Ethiopia. Displaced people may need temporary settlements, like the one shown in Figure 14.1. When they are first established, these settlements will probably lack the infrastructure to deal with the sanitation requirements for a large number of people.
It is important to understand that management of water, sanitation and hygiene arrangements are often critical for survival, particularly in the early stages of any emergency. People in emergency situations are generally much more susceptible to illness and death from diseases that are related to inadequate sanitation, waste management, water supplies and poor hygiene conditions. Vulnerable groups such as young children, the elderly and pregnant women are most at risk.
The most significant diseases in emergencies are the infectious diseases transmitted by the faecal-oral route. The main objective of any sanitation, waste management and hygiene promotion intervention in an emergency situation is to reduce the transmission of faecal-oral diseases and the exposure to disease-bearing vectors. This is achieved through management, control and promotion of good hygiene practices along with the provision of safe drinking water. Emergency management aims to reduce environmental health risks by establishing the conditions that allow people to live with good health, dignity, comfort and security.
Emergencies require an immediate response to minimise impacts and bring order to the situation.
In Ethiopia, the Disaster Prevention and Preparedness Agency (DPPA) has the responsibility of responding and making interventions in emergencies. However, many other agencies are involved in an emergency response including the national government, international organisations such as the United Nations, as well as international and local NGOs.
Emergencies can happen at any time and, without rapid intervention, can spiral into an uncontrolled situation. Emergencies can be described as having three phases:
The first phase requires rapid intervention and response by the provision of basic facilities for sanitation and excreta disposal. Once these issues are under control, longer-term solutions to the problems can be developed and implemented.
Any intervention should address excreta disposal as a priority and minimise high-risk practices (such as open defecation) with the aim of reducing faecal disease transmission rates.
Why is excreta disposal so important? (It may help if you look back to Study Session 2.)
Excreta disposal is very important because human faeces carry many pathogens that cause a number of serious diseases such as cholera, typhoid, other diarrhoeal diseases and parasitic infections.
Think back to the F diagram of pathways for faecal-oral transmission of disease. What are the steps that can be taken to prevent the contamination links from faeces to people?
The links can be broken in several ways:
You may find yourself in a team providing support in an emergency situation. It is important for the team to understand the extent of the emergency and the priorities for their efforts. This is established through a rapid assessment, which is a key requirement of Phase 1 of the emergency. The assessment needs to address the main issues that can impact on health. It should quickly gather key relevant information which can be used to put the possible interventions in an order of priority. The assessment should also consider medium- and long-term interventions for Phases 2 and 3 of the emergency. The principles are very similar to the rapid assessment methods you read about in Study Session 3.
Harvey (2007) suggests 20 key questions to be applied when collecting baseline data for initial assessments. The questions are designed to find out what sanitation facilities are available, whether the current provision and practices represent a health threat, whether there is space for additional latrines, and whether there are facilities for dealing with menstruation. There are also questions about the environmental context such as the local ground and surface water situation (drainage patterns, soil types, height of the water table), etc.
From the rapid assessment, a programme of planning and implementation of the response needs to be drawn up. Harvey suggests the process has a number of stages. The first stage is to carry out any immediate actions necessary to deal with the initial problems. This would be followed by a more detailed assessment of the situation, consultation with the community and other stakeholders. This second phase would lead to the design and implementation of a programme to address the longer-term needs. For emergency WASH provision, the World Health Organization has published a set of brief technical guidance notes that provide practical recommendations for responses to immediate and medium-term water, sanitation and hygiene needs of populations affected by emergencies (WHO/WEDC, 2013a).
There are various standards produced by different agencies that specify the minimum requirements for water supply, sanitation, hygiene, food, shelter and health in emergency situations. Two important ones are the United Nations High Commissioner for Refugees Standards (UNHCR, 2007) and the Sphere Handbook (Sphere Project, 2011). You may also come across other standards produced by different agencies. One thing they have in common is the importance of providing facilities that prevent the spread of disease, do not contaminate water supplies and give the people sufficient dignity and privacy. These standards can be useful in planning and designing an emergency response and act as a goal for achievement.
The Sphere standards describe the humanitarian actions that should be taken in the event of an emergency in order for ‘disaster-affected populations to survive and recover in stable conditions and with dignity’ (Sphere Project, 2011). In the section on water supply, sanitation and hygiene promotion, there are several standards in different categories, as shown in Figure 14.2.
Water supply is not the focus of this module but is obviously essential in an emergency situation. As you can imagine, there may not be sufficient water available to meet basic needs and in this situation supplying a survival level of safe drinking water is of critical importance. The Sphere Handbook sets standards for the minimum quantity and quality of water that should be available to people in emergencies, shown in Table 14.1. The recommended absolute minimum is 7.5 litres per person per day although this can vary depending on a number of different factors.
|Water use||Volume per person per day||Comments|
|Survival needs: water intake (drinking and food)||2.5–3 litres||Depends on the climate and individual physiology|
|Basic hygiene practices||2–6 litres||Depends on social and cultural norms|
|Basic cooking needs||3–6 litres||Depends on food type and social as well as cultural norms|
|Total basic water needs||7.5–15 litres|
The Sphere standards for excreta disposal state that the environment should be free of faeces and that people should have adequate and appropriate toilet facilities. It then goes on to list more specific requirements which include:
The Sphere standards also lists the possible options for safe excreta disposal and when they would be used in an emergency situation (Table 14.2).
|Excreta disposal type||Phase of use/comments|
|Demarcated open defecation area (e.g. with sheeted-off segments)||First phase (2–3 days) when there may be a huge number of people needing immediate facilities|
|Trench latrines (Figure 14.3)||First phase for up to two months|
|Simple pit latrines||From the start through to long-term use|
|Ventilated improved pit (VIP) latrines||For medium- to long-term use|
|Ecological sanitation (ecosan) with urine diversion||In situations where there is a high water table or flooding. May be required from the start and suitable for medium to long term use|
|Septic tanks||Mid- to long-term phases|
It is important to remember that successful excreta disposal programmes are based on an understanding of people’s varied needs as well as on the continuing participation of the users. It may not be possible to make all latrines acceptable to all groups and special latrines may need to be constructed for the vulnerable sectors of a community. These may include children, older people and disabled people. They may require potties or latrines with lower seats or supporting hand rails.
Keeping latrines clean is an important on-going task in an emergency situation. If latrines are not kept clean then people will prefer not to use them and find alternative uncontrolled areas to defecate in. Latrines will be more likely to be kept clean if users have a sense of ownership. This is encouraged by promotional activities, having latrines close to where people sleep and involving users in decisions about their design and construction and in the development of rules on proper operation, maintenance and use.
Inappropriate siting of latrines may also make women and girls more vulnerable to attack, especially during the night. Ways should be found to ensure that women feel, and are, safe using the latrines provided. Where possible, communal latrines should be provided with lighting or families provided with torches. The input of the community should be sought with regard to ways of enhancing the safety of all users.
The Sphere Handbook also specifies standards for handwashing facilities close to latrines. The standard states: ‘Users should have the means to wash their hands with soap or an alternative (such as ash) after using toilets, after cleaning the bottom of a child who has been defecating, and before eating and preparing food. There should be a constant source of water near the toilet for this purpose.’ (Sphere Project, 2011).
List at least five critical times for handwashing in an emergency?
The critical times for handwashing in an emergency are mostly the same as they would be normally and include:
There is an addition to this list which may arise in an emergency which is to always wash hands after touching dead bodies.
Sphere also sets a standard on the minimum hygiene items to be provided in an emergency (Table 14.3). Often, displaced people will have brought very little with them and only have what they can carry. Personal items such as hygiene materials may get left behind so people will be dependent on replacements being available.
|10–20 litre capacity container for transporting water||One per household|
|10–20 litre capacity container for storing water||One per household|
|250 g bathing soap||One per person per month|
|200 g laundry soap||One per person per month|
|Suitable materials for menstrual hygiene (e.g. washable cotton cloth)||One per woman|
Outline in a sentence or two how the approach to sanitation differs in an emergency to a normal sanitation situation.
Sanitation facilities will need to cope with a huge concentration of people in a small area with very limited or no resources. The people may not be used to community latrines. They will be stressed, possibly malnourished, and be more likely to be ill or injured than in normal conditions.
The safe disposal of solid waste is critical for public health, especially during an emergency. Not only will existing solid waste collection and disposal systems be disrupted but there will be extra waste caused by the emergency itself. Initially at temporary settlements for displaced people or refugees there will be no arrangements in place at all for solid waste management. If solid waste is not dealt with quickly, serious health risks will develop, which may further demoralise the displaced community already traumatised by the emergency.
If organic solid wastes (such as food waste) are not managed properly, there are major risks of fly and rodent infestation (particularly rats) and surface water pollution. Solid waste often blocks drainage channels and leads to environmental health problems associated with stagnant and polluted surface water that can lead to drinking water contamination. Uncollected and accumulating solid waste and the debris left after an emergency, natural disaster or conflict may also create a depressing and ugly environment, discouraging efforts to improve other aspects of environmental health.
The Sphere standard for solid waste management aims to ensure that ‘the affected population has an environment not littered by solid waste, including medical waste, and has the means to dispose of their domestic waste conveniently and effectively’ (Sphere Project, 2011).The key indicators in the Sphere standards include specific requirements such as ‘all households have access to refuse containers which are emptied twice a week at minimum and are no more than 100 m from a communal refuse pit’.
At a temporary settlement site, routines for the storage, collection and the disposal of solid waste or refuse need to be implemented and resourced. This is particularly important at high density sites. Engaging the community can be a vital aspect and any initial clean-up operation should be community based.
A common way to produce storage containers is to use 200-litre drums that can be cut in half to give two 100-litre drums. Drainage holes should be drilled in the bottom. UNHCR suggest that these drums should be placed throughout the site so that no household is more than 15 m away from one (UNHCR, 2007).
Collection from site containers should be done regularly (daily if possible). Lorry or tractor and trailer-based collections can be expensive. It may be more appropriate to use hand carts, wheelbarrows or donkey-pulled carts if available.
The options for treatment and disposal of solid waste in emergency situations are similar to the standard methods that you learned about in Study Session 10. Open dumping should be avoided because of the health risks for people and animals. Burning of solid waste is possible although it creates the problem of smoke and will not achieve a sufficiently high temperature unless a purpose-built incinerator is used. The most likely disposal method is burial. If it is possible to do so, existing waste disposal sites should continue to be used. For temporary settlements, areas should be designated for burying waste and they should be well away from households and fenced off. If waste is to be buried on-site in either household or communal pits, it should be covered daily with a thin layer of earth to prevent it attracting vectors such as flies and rodents. Figure 14.4 shows the main features of a solid waste burial pit.
Briefly outline why standards are important in the management of emergencies.
They set a benchmark of targets to achieve and maintain. They are universally accepted as good practice and can help the planning of resources and preparation for emergencies.
It is an unpleasant fact that in some disaster situations people may lose their lives. In the worst cases, this may result in many bodies needing to be disposed of quickly, safely and respectfully. This is inevitably very distressing for everyone concerned. The WHO Technical Note (WHO/WEDC, 2013b) includes the following recommendations:
The people involved in body recovery and other aspects of dealing with the immediate problems of an emergency may need to be protected from other hazards. Depending on the type of emergency, there may be danger of physical injury, for example, from collapsing buildings. There are obvious health risks in the case of outbreaks of infectious disease which may need specialist protective clothing. There are also potential impacts on the mental health of survivors and recovery team members which may not become apparent until well after the event. Appropriate medical treatment and care should be available to all those affected by an emergency to ensure long-term recovery.
In Study Session 14, you have learned that:
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions.
Rewrite the paragraph below using terms from the list provided to fill the gaps:
disasters, emergency, IDPs, rapid-onset disasters, slow-onset disasters.
Floods, droughts, famines and earthquakes are examples of ……………… that can cause ……………… situations requiring immediate intervention to help the people affected. In these situations, many people leave their homes and become ……………… when they move to other places within their own country.
Floods and earthquakes happen unexpectedly and are examples of ……………… Drought and famine are ……………… because they develop gradually over time.
Floods, droughts, famines and earthquakes are examples of disasters that can cause emergency situations requiring immediate intervention to help the people affected. In these situations, many people leave their homes and become IDPs when they move to other places within their own country.
Floods and earthquakes happen unexpectedly and are examples of rapid-onset disasters. Drought and famine are slow-onset disasters because they develop gradually over time.
What are the most important questions you would need to address in a rapid assessment of an emergency?
Some of the important questions to include for rapid assessment of an emergency would be:
Imagine that in the area where you are working a flood emergency happened and nearly 5,000 people, the majority of them children, women and old people, were displaced from their area. Your office assigned you to be a member of the emergency response team. The team conducted a quick assessment on the existing situation and identified that there is an urgent need for more latrines. What latrine options would you suggest in the immediate and longer term to cope with this particular population?
The immediate response would be to allocate an area for open defecation and provide sheeting and materials necessary to build temporary walls for privacy. This should soon be followed by more organised facilities such as a trench latrine with the intention of starting work to provide pit latrines. Handwashing facilities should also be provided near the latrines as a matter of urgency.
The longer-term needs of the population to be taken into account include:
What are the possible interventions to manage the solid waste in an emergency situation? List at least three actions that could be taken.
Possible activities to manage solid waste in emergencies are: