Study Session 14 Emergency Sanitation and Waste Management

Introduction

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.

Learning Outcomes for Study Session 14

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)

14.1 Emergencies and their impacts

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.

Figure 14.1 Newly arrived refugees from South Sudan registering at Kule camp, Gambella region, 2014.

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.

14.2 Phases of an emergency and initial response

Emergencies can happen at any time and, without rapid intervention, can spiral into an uncontrolled situation. Emergencies can be described as having three phases:

1. Immediate emergency — typically this lasts from several weeks up to three months. This is the most important phase for any emergency response and will require instant action. This will include deployment of staff and resources to the emergency area.
2. Stabilisation — this may last several months or several years depending on the type and severity of the emergency.
3. Recovery — this phase it may take several years or even a decade for a community to recover from an emergency, which can impact on long-term development issues.

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.

14.3  Rapid field assessment in an emergency

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).

14.4 Standards for emergency response

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.

Maximise

Figure 14.2 The Sphere Handbook: contents of the section ‘Minimum standards in water supply, sanitation and hygiene promotion’. (Sphere Project, 2011)

14.4.1 Water supply

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.

14.4.2 Latrine provision and excreta disposal

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:

• a maximum of 20 people use each toilet
• toilets are no more than 50 m from dwellings
• they can be used safely by all sections of the population including children, older people, pregnant women and persons with disabilities
• they are sited in such a way as to minimise security threats to users, especially women and girls, throughout the day and the night
• they are sufficiently easy to use and keep clean and do not present a health hazard to the environment
• they allow for the disposal of women’s menstrual hygiene materials and provide women with the necessary privacy for washing and drying menstrual hygiene materials
• separate, internally lockable latrines/toilets for women and men.

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).

Figure 14.3 Shallow trench latrine, appropriate for the first phase of an emergency.

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.

14.4.3 Handwashing and hygiene

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).

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.

14.4.4 Solid waste management in emergencies

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.

Figure 14.4 Solid waste burial pit. (Davis and Lambert, 2002)

14.5 Disposal of human bodies

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:

• Bodies should be collected as quickly as possible, but without interrupting other activities aimed at helping survivors. Bodies should be placed in body bags and labelled with a unique reference number. If body bags are not available, plastic sheets, shrouds or other locally available materials should be used.
• Although collection of bodies should be done quickly, it is not necessary or advisable to hurry their disposal. It is important for bodies to be identified and relatives to be informed and allowed to make their own decisions about the next steps.
• If possible, bodies should be stored under refrigeration but if this is not available, then temporary burial is the next best option.
• The recovery teams who are collecting bodies may be made up of members of the surviving community, volunteers and specialist search and rescue teams. Recovery teams should wear protective equipment such as gloves and boots. They should also be encouraged to wash their hands with soap after handling dead bodies.

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.

Summary of Study Session 14

In Study Session 14, you have learned that:

1. An emergency is a sudden and unforeseen event that calls for immediate measures to minimise its adverse consequences. As a consequence of emergencies there are often mass migrations of people who need to use temporary settlements.
2. It is essential, in the early stages of an emergency, to ensure affected people have access to safe water and sanitation. Planning and managing sanitation provision is therefore among the first priorities in any emergency. The provision of safe water and appropriate facilities for defecation are essential for people’s dignity, safety, health and well-being.
3. The first two phases of an emergency are critical and a rapid site assessment will need to be carried out to evaluate the scale of the emergency and the resources needed.
4. There are set standards for emergency provision and these can be used as targets for achievement. Two commonly used standards are from the Sphere Project and UNHCR, although others also exist.
5. The Sphere standards specify minimum requirements for water supply, excreta disposal, hygiene, and solid waste management among other critical aspects of emergency response.
6. The handling and disposal of the dead can be an important aspect of emergency sanitation. This carries a risk of physical and psychological harm to those concerned and must be done in a sensitive way.

Self-Assessment Questions (SAQs) for Study Session 14

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions.