WASH in Emergencies

UNHCR has key WASH indicators which are systematically tracked by UNHCR and partner staff through the UNHCR WASH Monitoring System (WMS). The indicators recorded in the WASH Monthly Report Card should be collected every week during emergencies while those verified by Knowledge Attitude and Practice surveys should be collected at least once during the first phase of the emergency.

The main WASH standards and indicators are summarized below. While for the emergency response they are aligned with Sphere, beyond this they take into consideration the often-protracted nature of forcible displacement which may last for decades. Emergency standards need also to be adapted, taking into consideration the cultural habits and preferences of forcibly displaced, specific climatic conditions, public health considerations, and the national standards of the hosting country – these are agreed collectively within the sector. 

It is important that all WASH responders (UNHCR, other UN agencies, partners, local authorities, etc.) report through the UNHCR WMS, in order to generate comparable data and allow for consequent aligned response.

Note: where no basic standard is provided, the emergency standard is used.

a) Water Supply

The main water supply standards below, and their means of verification are applied by UNHCR.

1. Access and water quantity. People have equitable and affordable access to sufficient quantity of safe water to meet their drinking, domestic and hygiene needs.
2. Water quality. Water is palatable and of sufficient quality for drinking and cooking, and for personal and domestic hygiene without causing a risk to health.

Key considerations

Water supply systems design.

• Water supply systems should be designed to deliver at least 20 l/p/day.
• Calculations of water needs should also consider the needs of health centres, feeding centres, schools, and religious centres.
• The needs of livestock or agriculture activities should also be factored in. Thus, coordination with livelihood actors is crucial to define overall water requirements. 
• When groundwater is extracted, continuous groundwater monitoring should be undertaken to ensure extraction and recharge is done within the capacity of the aquifer to recharge (safe yield).

Water quality. Water quality standards apply to all water collection locations, including those at health care facilities and schools.

Water safety

• All settings (with the exception of locations where provision is guaranteed through public provision such as in urban and in some cases rural areas) receiving forcibly displaced populations should possess on-site water quality testing equipment, such as: turbidity tubes or electronic turbidity meter to measure turbidity; simple or electronic pool-testers to measure free residual chlorine; and kits for microbial tests.
• The most acute threats to human health associated with consumption of water are due to contamination by human or animal faecal matter. Test for residual chlorine and microbiological indicators of faecal contamination is thus paramount. The emergency operation should also ensure sufficient availability of test consumables to ensure tests can be conducted as frequent as necessary in line with a risk-based approach.
• Assess water safety using a risk assessment approach, including sanitary inspections. The Green Companion highlights potential sources of contamination and good practices to protect ground and surface water sources.  

Participation. Participation of forcibly displaced persons in water supply services should be developed through capacity-building, community-led hygiene promotion activities and the establishment of active gender-balanced and representative water users' committees. Water committees should participate in the design and location of water points and the operation and maintenance of facilities and services.

Climate and environmental related considerations

• Climate change poses serious risk to the delivery of water services to forcibly displaced and host communities. It impacts water resources and water requirements and drought and heatwaves, storms and flooding make the delivery of services more complex.
• Renewable energy sources should be prioritized over carbon-based fuel generators to eliminate as much as possible fossil fuel consumption in the operation and maintenance of water pumping, treatment and distribution, as early as possible in the emergency response.
• Leakage at extraction points, in water distribution systems and at communal collection points wastes water causes localized erosion, increases the risks of stagnant water, source contamination and can create water hazards, especially for young children. Leak mitigation measures should be included in the operations and maintenance of water systems.
• For further information on how to reduce the environmental impact of WASH responses please refer to the Green Companion, as well as the Climate and Environmental Considerations in Emergencies entry.

b) Sanitation, excreta and wastewater management

Safe excreta disposal and wastewater management is an essential element of any WASH programme because it helps to reduce direct and indirect water-borne disease transmission, water contamination and further pollution.

1. Environment free from human excreta: All excreta is safely contained on-site to avoid contamination of the natural, living, learning, working and communal environments. 
2. Access to and use of toilets: People have adequate, appropriate and acceptable toilets to allow for rapid, safe and secure access at all times. 
3. Management and maintenance of excreta collection, transport, disposal and treatment: Excreta management facilities, infrastructure and systems are safely managed and maintained to ensure service provision and minimum impact on the surrounding environment. 

Wastewater consists of blackwater from toilets, which is faecally contaminated, and greywater from bathing areas, laundries, kitchens and other use points, which is not generally faecally contaminated.

Key sanitation indicators, standards for emergency, transition and basic WASH services, and their means of verification are shown in the table below.

Key considerations.
To improve safe access to sanitation it is necessary to meet standards of privacy and safety using sanitation structures that are locally or culturally acceptable. Access to sanitation can be scaled up through the distribution of sanitation construction materials or cash-for-toilet programming and proper monitoring. 

The following should be considered:

• Protection of water sources from fecal contamination. No excreta containment systems (pits, tanks, seepage, sewerage or spillage) should contaminate surface water or shallow groundwater sources. Toilets should be located at least 30 metres from groundwater sources. Additional measures should be taken in locations that have a high watertable or are prone to flooding. The bottom of pits and soak-aways should be at least 1.5 metres above the groundwater table. 
• Toilet access. Ensure that communal or family-shared toilets are evenly dispersed throughout a settlement; no dwelling should be more than 50 meters from the nearest toilet.
• Universal access. Make sure that all toilets can be used safely by all persons, including children, the elderly, pregnant women, persons with reduced mobility and other with specific needs. Collect data on users who have disabilities and construct dedicated toilet facilities as near to them as possible, considering the results from community consultations.
• Handwashing. Ensure that all toilets (public, communal, shared, and household ones) have hand-washing facilities, with soap (or a clean rubbing agent), and that arrangements are in place to ensure they remain functional. Target one handwash device per toilet block in the emergency response, and one per household when targeting basic WASH services.
• Toilet cleaning and maintenance. Ensure that toilets are kept clean and maintained, in a manner that does not deter use. Put in place a budget adequate to cover operational and maintenance activities. Particularly in the first phase of an emergency, incentives for toilet cleaning can be considered. In the case of family-shared or household level toilets, the family will be responsible for their cleaning and maintenance.
• Gender disaggregated distribution. As a rule of thumb, provide three female toilets to every male toilet, based on disaggregated population numbers. Toilet blocks should be segregated by sex and marked with culturally appropriate signage. 
• Participation and gender-balanced representation. Ensure that programmes are developed and run in cooperation with the refugee population. Women, adolescents and marginalized groups should be consulted on the design and siting of toilet facilities. All programmes should have active gender-balanced and representative sanitation or hygiene committees. Committees should participate in the operation and maintenance of facilities and services, and eventually through contributions of labor or finances.

Protection considerations. Ensure that the location and design of all toilet facilities eliminate threats to the security of users, especially women and girls, day and night. Locks and lighting (in discussion with users) should be installed during the initial emergency response.

• Household toilets. Ensure as soon as possible that refugees have the means, tools, materials and appropriate technical guidance to construct, maintain and clean household toilets. It is recommended to support families if they have no means to achieve self-construction.
• Bathing facilities. Ensure that refugees have access to facilities for bathing. These facilities should provide privacy and dignity. If this cannot be achieved at household level or if it is not culturally appropriate, design and locate communal facilities in consultation with users, notably women, adolescent girls, and persons with disabilities. Bathing/showering facilities should be available at household level as soon as possible.
• Laundry facilities. For laundry facilities, aim to meet the needs of small communal groups of up to 16 households; avoid large public wash blocks to improve privacy and dignity and which may be easier to maintain hygiene standards. 
• Wastewater management. Ensure that wastewater (from tapstands, bathing, laundry, handwashing points) is disposed in soakpits or drainage systems to minimize bodies of stagnant water, which act as breeding sites for disease vectors. Coordinate with settlement planning officers, and if relevant, local authorities, to develop an overall drainage plan, transitioning out of emergency drainage systems as quickly as possible. Beyond the emergency response, services should be upgraded to include safe treatment and disposal of wastewater. In arid zones and where culturally appropriate, runoff water may be reused in sub-surface irrigation systems, e.g. for household gardening purposes. 
• Monitoring. Ensure that sanitation facilities are monitored regularly (toilet distribution, use, access, cleanliness, conditions, etc.).

c) Solid waste management

Uncontrolled accumulation of garbage is unhealthy and promotes rodent and insect borne disease. Solid waste management is a joint responsibility of field coordination, as well as the WASH and health sectors. In urban and dispersed settings, national/municipal systems should be employed and, where necessary, strengthened. The main solid waste management standards below, and their means of verification are applied by UNHCR.

1. Environment free from solid waste. Solid waste is safely contained to avoid pollution of the natural, living, learning, working and communal environments.
2. Household and personal actions to safely manage solid waste. People can safely collect and potentially treat solid waste in their households.
3. Solid waste management systems at community level. Designated public collection points do not overflow with waste, and final treatment or disposal of waste is safe and secure.

Key solid waste management indicators, standards for emergency, transition and basic WASH services, and their means of verification are shown in the table below.

Key considerations.

• Collection: While in the emergency phase centralised solid waste management solutions may be appropriate, as the situation moves towards the provision of basic services, decentralised household level solid waste management solutions, as well as recycling and reuse, should be implemented where possible.
• Treatment and disposal: Safe treatment and disposal should be prioritized as quickly as possible.
• Disposal: Ensure solid waste disposal is properly managed, to avoid health hazards (injuries to children, mosquito breeding sites, etc.).
• Waste minimization: Waste minimization, including reducing, reuse and recycling, should be prioritized as quickly as possible. This should include strong community engagement activities and the development of final treatment and disposal systems.
• Hazardous substances and e-waste: Batteries (especially lead-acid), used oils, and broken electrical equipment can pose serious risks to public health and the environment, even in small quantities. Arrangements to collect such waste separately should be made. Prioritize interventions that prevent hazardous substances from entering the domestic waste stream over management of relatively inert domestic waste.
• Medical waste: Waste generated by health centres is a hazard. Access to medical sanitary services should be well controlled, and waste (used syringes and needles, contaminated bandages, laboratory specimens, etc.) should be treated separately without delay, in line with protocols of the local Ministry of Health. 

d) Hygiene

The main hygiene standards focus on knowledge and behaviour.

1. Hygiene promotion: People are aware of key public health risks related to water, sanitation, and hygiene, and can adapt individual, household and community measures to reduce them. This is done in close collaboration with health teams.
2. Identification, access to, and use of hygiene items: Appropriate items to support hygiene, health, dignity and well-being are available and used by the affected people.
3. Menstrual hygiene management and incontinence: Women and girls of menstruating age, males and females with incontinence, have access to hygiene products and WASH facilities that support their dignity and well-being.
4. WASH in healthcare facilities: All healthcare facilities should maintain minimum WASH-related infection prevention and control standards (IPC), including in disease outbreaks. While this is the responsibility of health workers, WASH actors can play an important support role in meeting this standard.  

Key considerations:

Monitoring:

• In protracted or post-emergency situations, a KAP survey is recommended at least once a year. (Ideally, conduct one KAP in the dry and another in the rainy season). See the entry on WASH needs assessment). 
• The standardized expanded nutrition survey (SENS) which happens in many operations includes a short WASH module and covers the core WASH household indicators. To use resources efficiently and avoid survey fatigue, liaise with a public health/nutrition officer on whether a SENS is already planned.

Access to soap:

• 250 grams/person/month should be supplied for personal hygiene only;
• Additional soap 250 grams/person/month for women and girls menstrual hygiene;
• For laundry, provide 200 grams/person/month.

These standards can be also achieved by including access to soap in CBI. 

Enable a hygiene-promoting environment. Hygiene promotion does not only address knowledge and skills but also ALL other determinants of health and hygiene such as environmental and socio-economic barriers and enablers. Ensuring access to water, sanitation and hygiene facilities is as much part of hygiene promotion as influencing attitudes and mind-sets. 

Key hygiene messages strategy

• Ensure hygiene promotion activities and messages are closely coordinated with the health sector: avoid duplication of efforts, especially when health promotion can already cover hygiene related messages
• Jointly with the health sector, develop hygiene messages and IEC materials within the first three months of an emergency. Review those every six months based on monitoring feedback.
• Too much focus on disseminating one-way messages and too much focus on designing promotional materials without listening properly to the views of the population is considered a common pitfall in hygiene promotion.
• Once the most important messages have been identified, these should be in local languages (or pictorials if literacy rates are low) and should target practices that are responsible for the most critical hygiene risks (e.g. non-use of chlorinated water, open defecation, etc.). Focus on priority groups at risk, risky practices, key interventions, and key indicators that can further inform any adjustment to the WASH response
• Do not attempt to communicate too many messages. Concentrate on practices that are most responsible for transmitting diseases and on interventions to prevent them. 

Empowerment. Develop and run hygiene promotion programmes in full cooperation with forcibly displaced people and the host population. 

During outbreaks of waterborne diseases (cholera, Hepatits E, Dengue, etc.), it may be necessary to:

• establish a task force composed of the WASH and health sectors that meets on very regular basis to make sure messages are consistent and harmonized and there is complementarity (rather than duplication) of efforts 
• ensure soap is distributed regularly and used
• ensure knowledge about handwashing is increased, and household-water treatment and safe storage is demonstrated and promoted.
• work closely with health sector to tackle any gaps (in hardware or soft skills)

Monitor disease trends and outbreaks (diarrhoea, Hepatits E, cholera etc) in settlements and health centres. The information gathered can guide efforts to prioritize WASH interventions. In close collaboration with the health sector correlate WASH trends (WASH monitoring) and water-related disease trends (public health monitoring) to inform targeted interventions.

High risk vectors: Elimination of high-risk disease vectors should be given the same priority as water supply, excreta management and hygiene promotion.

• Ensure that the environment is free of high-risk disease vectors.
• Take steps to drain bodies of stagnant water, and clean up any dumps of organic solid waste, faeces, or other potential breeding sites for disease vectors.