Category Archives: Emergency Sanitation

Menstrual hygiene management in humanitarian situations

NEWS ARTICLES

Nepal Fact Sheet: Safaa Paani (WASH Recovery) Program. USAID, December 2017. Some of the key outcomes are to: Map water sources using GIS technology across the two project districts; Renovate or construct 200 community water supply systems in earthquake-affected communities; and Promote sanitation, hygiene and menstrual hygiene management at temporary learning centers and schools

Menstrual Cups and Reusable Pads Are Literally Changing Lives Uganda’s Refugee Camps. Global Citizen, December 2017. The main goal of WoMena’s pilot program was to assess whether menstrual cups and reusable pads are feasible options for displaced women and girls.

For refugee women, periods a dangerous, shameful time. Reuters, March 2017. For refugee women, fleeing their homes for safety, the challenges of a period can be even greater. “There’s no dignity in having your period when you’re a refugee,” Terri Harris, of the Muslim women-led development charity Global One told the Thomson Reuters Foundation.

REPORTS/JOURNAL ARTICLES

A Toolkit for Integrating MHM into Humanitarian Response: The Full Guide. Columbia University and International Rescue Committee, 2017. The toolkit was designed to support a range of humanitarian actors involved in the planning and delivery of emergency responses.

Transitions into puberty and access to sexual and reproductive health information in two humanitarian settings: a cross sectional survey of very young adolescents from Somalia and Myanmar. Conflict and Health, 2017. Very young adolescents (VYA) in humanitarian settings are largely neglected in terms of sexual and reproductive health (SRH). This study describes the characteristics of VYA aged 10-14 years in two humanitarian settings, focusing on transitions into puberty and access to SRH information.

Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and Lebanon. Confl Health. 2017 Oct 16. Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women.

Menstrual Health in RHINO Camp Refugee Settlement, West Nile Uganda. WoMena Uganda, 2017. With support from WoMena Uganda, ZOA implemented a MHM pilot intervention in Rhino Camp Refugee Settlement to assess the acceptability of introducing menstrual cups and reusable pads as part of their Teach Me More school-based programme. The pilot also aimed to assess the feasibility of following guidelines for safe use and care of the reusable products.

Menstrual Hygiene Management (MHM) for Education in Emergencies (EIE): A Study for Plan International Tanzania. PLAN International, September 2017. The study’s four objectives were to: • Identify the meaning of menstruation in the daily lives of adolescent girls in Nduta Camp; • Assess the impact of MHM on adolescent girls’ school attendance in Nduta Camp; • Assess the support resources (parents, teachers, community) align with MHM promotes the adolescent girls’ school attendance in Nduta Camp.

Mitigating Threats to Girls’ Education in Conflict Affected Contexts: Evidence Review. UNGEI, October 2017. Though there is scarce literature about this issue from conflict-affected contexts, we also include in this section a brief discussion of WASH and MHM facilities in schools, as these are very important for adolescent girls to feel safe, secure, and respected at school.

How can Humanitarian Organisations Encourage More Women in Surge? ActionAid, April 2017. Personal hygiene: The most critical thing that this study can advise in relation to menstrual hygiene is to encourage all humanitarian organisations to create safe spaces for women and men to talk about periods and toilet access.

Menstrual Health and Hygiene Management in Nepal. PSI Nepal, 2017. This scoping review and preliminary mapping of Menstrual Health and Hygiene Management (MHM) in Nepal is one of the first of its kind in Nepal. Through this review, we studied in-depth the MHM situation in Nepal, bottlenecks and opportunities for the way forward.

The Last Taboo: Research on menstrual hygiene management in the Pacific: Solomon Islands, Fiji, and Papua New Guinea. Australian Government, Department of Foreign Affairs and Trade (DFAT), September 2017. The study was undertaken in 2016-17 and focuses on menstruation and how it is managed by women and adolescent girls in Solomon Islands (SI), Fiji and Papua New Guinea (PNG). The purpose of the study was to explore the challenges experienced by women and girls in managing their menstruation.

What is the scope for addressing menstrual hygiene management in complex humanitarian emergencies? A global review. Waterlines, July 2016. This global review assessed the landscape of MHM practice, policy, and research within the field of humanitarian response.

Emergency WASH – recent studies and news

Environmental Impact Assessments in refugee crises. Institute of Development Studies, October 2017.

Although much of the literature found by this rapid review emphasizes the necessity of including environmental considerations into the planning of mass displacement camps, and the role of environmental impact assessments (EIAs), there is little available literature on the assessments carried out, and the quality of these. The literature specifically highlights the role of previous humanitarian interventions in the overexploitation of groundwater resources, but specific EIAs related to this were limited. The review highlights a selection of accessible examples of the where EIAs (or other environmental assessments) have been carried out in refugee situations, focusing on mentions of WASH and water supply considerations within these.

 Solid waste and faecal sludge management in situations of rapid, mass displacementInstitute of Development Studies, October 2017.

Solid waste and faecal sludge management in situations of rapid mass displacement are important to public health and providing for a better environment. Despite this, both have been neglected in WASH programmes, which tend to have a focus on water. However increasing efforts are being made to find solutions to challenges in solid waste and faecal sludge management in difficult circumstances in humanitarian emergencies.

Innovative WASH options in situations of severe overcrowdingInstitute of Development Studies, October 2017.

A rapid review of the literature has found a selection of innovative WASH options available for situations of severe population overcrowding and limited spaces. Key findings are as follows: In some cases, e.g. refugee camps, extending the lifespan of latrines is more important than the technology used. e-vouchers that can be spent on hygiene items are used in Syrian camps; The Urinal Project by Cewas Middle East provides a safe odourless unisex alternative to using camp toilet blocks. In conclusion, often the term ‘innovation’ is limited to technological innovation. However, as far as the WASH sector is concerned, much of the technology already exists for use in these situations. Innovative solutions should be found in the areas of service delivery, financing and even data collection.

 Making Lebanon’s water flow: delivering better basic urban servicesIIED, November 2017.

Lebanon’s urban spaces have been shaped by regional and national conflict. Basic services, including water provision, have long suffered from fractured urban planning and extensive informal urbanization. Reflecting on water-focused interventions in urban Lebanon over a six-year period, we identify approaches that could increase the efficacy, flexibility and sustainability of responses: inclusive integrated planning; recognizing the positive and disruptive power of data; partnership between state and non-state agencies to support autonomous utilities and local institutions; and engagement with the informal sector.

The importance of thinking beyond the water-supply in cholera epidemics: A historical urban case-studyPLoS Neglected Tropical Diseases, November 2017.

Spatially targeted cholera interventions, such as reactive vaccination or sanitation/hygiene campaigns in hotspot neighborhoods, would likely have been more effective in this epidemic than control measures aimed at interrupting long-cycle transmission, such as improving municipal water quality. We recommend public health planners consider programs aimed at interrupting short-cycle transmission as essential tools in the cholera control arsenal.

 In the News

 How Zero Mass is using solar panels to pull drinkable water directly from the airThe Verge, November 2017.  Because that’s what Zero Mass does: harvest drinking water out of thin air, using a combination of materials science, solar power, and predictive data. Source panels have, so far, been installed in wide range of places: in hurricane-stricken Puerto Rico, at schools and orphanages for refugees in Lebanon, and at high-end homes in California.

 UNICEF warns of contaminated drinking water in camps for Rohingya refugees. UN News Centre, November 2017. “The latest figures from the World Health Organization suggest that 62 per cent of water available to households is contaminated,” UNICEF spokesperson Christophe Boulierac told reporters Tuesday at the regular press briefing in Geneva.

 

Recent studies on Emergency WASH

Studies

Understanding the menstrual hygiene management challenges facing displaced girls and women: findings from qualitative assessments in Myanmar and LebanonConflict Health, October 2017. Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors.

Water, crises and conflict in MENA: how can water service providers improve their resilience? IIED, October 2017. The capacity of local water service providers (state-owned and private) to maintain adequate levels of services has decreased as conflicts and population movements across the region have continued, mainly towards urban areas. Other actors including United Nations agencies, international organisations, local NGOs and independent – often informal – water providers have played an important role in filling gaps in supply. This study analyses all these actors’ responses to continuing the supply of water during conflicts, focusing on factors of resilience building that particularly concern local service providers.

Integration of water, sanitation and hygiene intervention delivery at health facilities with a reactive ring vaccination programme to reduce cholera. International Journal of Epidemiology, February 2017. Globally there are estimated to be 2.8 million cholera cases annually, resulting in 95 000 deaths.1 Ali and colleagues recently reported results on the spatiotemporal risk for cholera and estimated overall and indirect cholera vaccine effectiveness of a ring vaccination programme, by analysing data from an oral cholera vaccine (OCV) trial in Kolkata, India.2 Cohorts in close proximity to a cholera case had a 5–11 times higher risk of cholera during the 1-month period after the onset of case illness when compared with cohorts not exposed to a case.

USAID/OFDA WASH Sector Update: FY2016OFDA. In Fiscal Year (FY) 2016, USAID/OFDA provided approximately $247 million to support WASH programs in more than 35 countries. WASH interventions in emergencies often include construction or repair of latrines, hygiene support, solid waste removal, and the provision of safe, treated water.

Surface water in temporary humanitarian settlementsWaterlines, January 2017. Reviewing core humanitarian engineering texts and global standards, this paper sets out the current state of the art and shows that there is a lack of clarity in the “ownership” of the problem and the established responses are disjointed and poorly articulated, especially at field staff level. Since the core texts have been written, there has been a change in the way surface water is being managed in urban areas. Sustainable urban drainage practices may have potential in resource poor but densely populated situations such as some refugee camps. The paper highlights the lack of adequate advice in both content and delivery mechanisms.

Learning from Oxfam’s Tiger Worm Toilets projectsWEDC Conference, July 2017. The world is witnessing the highest levels of forced human displacement on record, leading to people being housed in urban centres and camps. Generally the sanitation needs of these people are initially met by external agencies. The long-term costs of operating and maintaining traditional sanitation systems can be unviable when communities or local authorities take over their management. Therefore Oxfam has been trialling the Tiger Worm Toilet (TWT) in peri-urban and camp settings. The aim of this paper is to review Oxfam’s TWT projects and to share the learnings, together with the innovations that have occurred. The learnings are that TWTs are not the solution to all sanitation problems, but they have been proven to work well at household level. Monitoring and documenting the trials has been an ongoing problem due to a number of issues, which are linked to short term funding, and the use of project rather than program approaches.

Uncharted Waters: The New Economics of Water Scarcity and VariabilityWorld Bank, October 2017. Uncharted Waters shows that droughts in cities are costlier than floods. For firms in cities, the economic cost of droughts is four times greater than that of floods, with even more severe and longer-lasting effects. While the damage of floods is immediate, severe and grab the headlines, the effects of droughts are silent, slow and hard to detect.

Online Courses

Health in Complex Humanitarian Emergencies. Emory University, starts November 20, 2017. This course covers the technical and management principles that are the basis of planning, implementing, and evaluating health programs for acutely displaced populations in developing countries. The emphasis is on refugees in camp situations. The course includes modules on assessment, nutrition, epidemiology of major health problems, surveillance, and program management in the context of an international relief operation.

News Items

A Sleek Portable Toilet and Other Design Solutions for Disaster VictimsSmithsonian, November 2017. The toilet kit, from a Japanese design studio, is part of wave of interest in design fixes for the problems created by disasters

Improving Handwashing in Humanitarian Crises: Methods for Researching Handwashing Practices and Behavior

Improving Handwashing in Humanitarian Crises: Methods for Researching Handwashing Practices and Behavior. by Sian White, Research Fellow, Hygiene and Behaviour Change, The London School of Hygiene and Tropical Medicine. CAWST Blog, October 11, 2017.

This year CAWST has been working with Action Contre Faim (ACF)and The London School of Hygiene and Tropical Medicine (LSHTM) to better understand handwashing practices among internally displaced people.

Working together on this project, this partnership brings together our experience and networks in academic health research, humanitarian operational experience in WASH and Mental Health, and development of educational material.

Left: A participant draws two images of himself, making one intentionally messy to symbolise his life falling apart. Right: The research assistant plots milestones on the timeline as the participant narrates her story.

Left: A participant draws two images of himself, making one intentionally messy to symbolise his life falling apart. Right: The research assistant plots milestones on the timeline as the participant narrates her story.

The general objective of the research is to develop deep understandings of the determinants of hand hygiene in emergency settings so as to contribute to the development of rapid and effective intervention tools; the ultimate goal of the research will be to equip emergency responders with the knowledge and tools to intervene rapidly and effectively on hygiene behaviour. The full findings of this research, including practitioner resources, will be available in 2018.

In this blog post, Sian White, the project’s lead researcher, shares four research methods she has been using and what these have revealed so far.

Read the complete blog post.

Emergency WASH – Water Currents

Emergency WASH – Water Currents, September 5, 2017.

The current cholera crisis in Yemen is just the latest example of the need for practical evidence-based recommendations and updated research on WASH in emergency settings.This issue focuses on case studies, recent research, and innovative approaches to implementing WASH services in emergencies, and includes links to recent publications about water treatment, menstrual hygiene management, container-based sanitation, among other topics. Also featured are links to relevant websites and select WASH news items, including several on the cholera epidemic in Yemen. watercurrentsissue

Publications and Videos 
WASH Interventions in Disease Outbreak ResponseOxfam, February 2017. This synthesis identifies, combines, and evaluates existing evidence from 47 studies on the impacts of 10 different WASH interventions during disease outbreaks in 51 humanitarian contexts in 19 low and middle-income countries.

Short-Term WASH Interventions in Emergency Responses in Low and Middle-Income CountriesInternational Initiative for Impact Evaluation, February 2017. WASH interventions are used in nearly all emergency contexts, but limited evidence is available to support best practices and effective use. This literature review synthesizes findings from 106 studies to assess the effectiveness of 13 specific interventions.

Read the complete issue.

A big-picture look at the world’s worst Ebola epidemic

A big-picture look at the world’s worst Ebola epidemic. Hutch News, April 12, 2017.

International team of scientists show how real-time sequencing and data-sharing can help stop the next outbreak

An international effort to analyze the entire database of Ebola virus genomes from the 2013–2016 West African epidemic reveals insights into factors that sped or slowed the rampage and calls for using real-time sequencing and data-sharing to contain future viral disease outbreaks.

Published online today in the journal Nature, the analysis found that the epidemic unfolded in small, overlapping outbreaks with surprisingly few infected travelers sparking new outbreaks elsewhere, each case representing a missed opportunity to break the transmission chain and end the epidemic sooner.

dudas

Dr. Gytis Dudas, a Mahan Postdoctoral Fellow at Fred Hutchinson Cancer Research Center, is the paper’s lead author. Photo by Bo Jungmayer / Fred Hutch News Service

“We calculated that 3.6 percent of cases traveled, basically meaning that if you were able to focus on those mobile cases and reduce their mobility, you might have had a disproportionate effect on the epidemic,” said computational biologist Dr. Gytis Dudas, a Mahan Postdoctoral Fellow at Fred Hutchinson Cancer Research Center and the paper’s lead author.

The West African Ebola epidemic dwarfed all previous central African outbreaks of the virus, sickening more than 28,000 people and killing more than 11,000 of them.

The 1,610 Ebola virus genomes analyzed by the researchers represented more than 5 percent of the known cases, the largest sample analyzed for a single human epidemic. The analysis is the first to look at how Ebola spread, proliferated and declined across all three countries most affected: Guinea, Sierra Leone and Liberia. Previous analyses focused primarily on either a single country, a limited time frame or used fewer sequences.

Read the complete article.

Guide to Community Engagement in WASH: A practitioner’s guide, based on lessons from Ebola

Guide to Community Engagement in WASH: A practitioner’s guide, based on lessons from Ebola, November 2016. Oxfam.

This guide is a compilation of best practices and key lessons learned through Oxfam’s experience of community engagement in the 2014–15 Ebola responses in Sierra Leone and Liberia.

It provides ideas for all stages of an intervention, including the importance of assessment; principles and methods for community engagement; the challenges of scaling-up responses and changing communities’ behaviours; and reflections on how to better advocate for communities.

Drawing on semi-structured interviews and input from practitioners in various agencies, as well as a literature review, this guide aims to inform public health practitioners and programme teams about the design and implementation of community-centred approaches during a disease outbreak.