1. Water and Sanitation In Humanitarian Crisis Presented By Roy Hunt, P.Eng. Komex International Ltd.

2. Outline Elements of a Humanitarian Crisis Elements of a Humanitarian Crisis Humanitarian Crisis Response Humanitarian Crisis Response Importance of Water and Sanitation Importance of Water and Sanitation WatSan Intervention WatSan Intervention Case Study Case Study How to get Involved How to get Involved

3. Elements of a Humanitarian Crisis Vulnerable Population Conflict Conflict Poor Governance Poor Governance Geographical Isolation Geographical Isolation Weak Infrastructure Weak Infrastructure Lack of Disaster Response Planning Lack of Disaster Response Planning Marginalized Groups Marginalized Groups Demographic Shift Demographic Shift IDPs in Sudan Source: CARE Burmese Refugees in Thailand Source: ECHO

4. Elements of a Humanitarian Crisis Catastrophic Event Conflict Conflict Pandemics Pandemics Famines Famines Natural Disasters Natural Disasters

5. 300,000 people are killed each year Majority of deaths are civilian 10 Million International Refugees (2004) 25 Million Internally Displaced (2004) 70 to 80% are Women and Children Extended conflicts often neglected by media Myanmar, Columbia, Cote D’Ivoire, DRC, Indonesia, Iraq, Nepal, Chechnya, Somalia, Sudan, Uganda Elements of a Humanitarian Crisis Conflict as a Catastrophic Event

6. Elements of a Humanitarian Crisis Setting Refugee Camp Refugee Camp Hosted in Local Community Hosted in Local Community Population in Disaster Area Population in Disaster Area Population on the Move Population on the Move Refugees Pakistan Border Source: MSF Refugees In Burundi Source: ECHO Flooding in Bangladesh Source: ECHO

7. Humanitarian Crisis Response Process Assessment Assessment Mobilization Mobilization Program Design Program Design Implementation Implementation Monitoring and Evaluation Monitoring and Evaluation Transition Transition Rwandan Refugee in DRC Source: MSF Water Provision in Tanzania Source: ECHO Loading Materials Source: OXFAM

8. Logistics Source: ICRC Food Distribution in Sudan Source: MSF Refugee Registration in Sudan Source: MSF Myanmar Source: MSF Humanitarian Crisis Response Important Aspects Population Assessment Population Assessment Site Planning Site Planning Logistics Logistics Health Services Health Services Commodity Distribution Commodity Distribution Food and Nutrition Food and Nutrition Communication Communication Transport Transport Hygiene Hygiene Water & Sanitation Water & Sanitation External Liaison External Liaison IDP in DRC Source: ECHO

9. Importance of Water & Sanitation Developing Countries - Causes of Death Communicable Disease Major Cause of Death in Disaster Directly Related to Poor Water and Sanitation Source: WHO 2001 CauseDeaths HIV / AIDS2,678,000 Respiratory Infections2,643,000 Heart Disease2,484,000 Diarrhoeal Disease1,793,000 Cerebrovascular Disease1,381,000 Childhood Diseases1,217,000 Malaria1,103,000 Tuberculosis1,021,000 Pulmonary Disease 748,000 Measles 674,000

10. Importance of Water & Sanitation Diarrhoeal Disease Intervention Effect ↑ Water Quality ↑ Water Quality ↑ Water Quantity ↑ Water Quantity Hand Washing Hand Washing Latrines Latrines All Measures All Measures EXCRETA WATERFLIESHANDS MOUTH FOOD BARRIER

11. WatSan Intervention Water Supply Objective To provide safe and equitable access to a sufficient quantity of water to meet communal needs through effective source selection, collection, treatment, storage, and distribution.

12. Give priority to quantity while respecting quality Give priority to quantity while respecting quality Directly involve beneficiaries Directly involve beneficiaries Avoid the need to treat water (surface water) Avoid the need to treat water (surface water) For high population concentrations, disinfection is absolutely necessary For high population concentrations, disinfection is absolutely necessary Secure a reserve supply and capacity to cover contingencies Secure a reserve supply and capacity to cover contingencies Rainwater Catchment Source: WSSC Water Supply in Iraq Source: ECHO WatSan Intervention Water Supply Principles Albania Water Storage Tank Source: ICRC

13. WatSan Intervention Water Supply Principles Account for variations in demand, quality, and supply Ensure equitable distribution When minimum survival needs can’t be safely met, population must be moved Minimum survival needs 7 liters / person / day Increase to 15-20 liters as soon as possible Sudan Water Distribution Source: ICRC Well Construction - Myanmar Source: ICRC Tap Stand - Sudan Source: ICRC

14. WatSan Intervention Sanitation Objective C ontrol and manage excreta, solid waste, medical waste, dead bodies, and wastewater Promote best hygiene practice in to create a safer environment and minimize the spread of disease in a disaster affected area

15. Pit Latrine Construction Source: MSF Casting Latrine Slabs Source: WSSC WatSan Intervention Sanitation Principles Take fast action to prevent water supply contamination Swift provision of a basic system is better than delayed, improved systems Account for sanitation in site selection and design Technology should be as simple as possible Include continuous maintenance of facilities VIP Latrine Source: WSSC

16. WatSan Intervention Sanitation Principles Latrines best allocated on a family basis Latrines best allocated on a family basis Refuse disposal arranged on a community basis Refuse disposal arranged on a community basis Safely dispose of medical waste Safely dispose of medical waste Burial arrangements are required from the start Burial arrangements are required from the start Provide vector control Provide vector control Preference for environmental measures over chemicals Preference for environmental measures over chemicals Mosquito Spraying Source: WHO Banda Aceh Body Removal Source: ECHO Tanzania Soap Distribution Source: OXFAM

17. WatSan Intervention Community Participation Establish consultative and participatory structures and work within local structures to support and enhance their long term capacity. Establish consultative and participatory structures and work within local structures to support and enhance their long term capacity. Essential when unfamiliar with customs and culture of those being assisted Essential when unfamiliar with customs and culture of those being assisted Make full use of resources Make full use of resources Local Residents Local Residents Skilled and Unskilled Labour Skilled and Unskilled Labour Public Health Experts Public Health Experts National Institutions National Institutions Materials & Technology Materials & Technology Traditional Practices Traditional Practices Sudan Source: ICRC

18. WatSan Intervention Indicators The crude mortality rate is the number of deaths in a population due to disease, injury and malnutrition The crude mortality rate is the number of deaths in a population due to disease, injury and malnutrition Specific causes of morbidity should be tracked for early detection of epidemics, and indications of inadequate water and sanitation Specific causes of morbidity should be tracked for early detection of epidemics, and indications of inadequate water and sanitation

19. Case Study – Sierra Leone Project Area

20. Civil war began with rebel incursions in in 1991 and escalated through decade Majority of the population was displaced Cease fire signed in 2001 Peace process included deployment of over 15,000 UN peacekeepers Most of the upland areas remained in rebel control with no security or services Case Study Sierra Leone Civil War Peacekeeper Source: BBC Refugees Source: www.sierraleone.org

21. Case Study - Sierra Leone But Not All Bad

25. Case Study Sierra Leone Joined Medecins Sans Frontieres in 2001 Completed Logistic and WatSan Training Posted to Magburaka, Sierra Leone After briefing, arrived at project Christmas Eve Nine month assignment High security risk

26. 60 International Staff 60 International Staff 500 National Staff 500 National Staff Restoring Healthcare Restoring Healthcare Mental Health Mental Health Therapeutic Therapeutic Feeding Centers Case Study - Sierra Leone MSF In Sierra Leone Amputee Source: BBC Child Soldier Source: BBC

27. Returnee population Returnee population Medical facilities destroyed, abandoned Medical facilities destroyed, abandoned High infant mortality High infant mortality High maternal mortality High maternal mortality Recent shigella outbreaks Recent shigella outbreaks High incidence of watsan related diseases High incidence of watsan related diseases Malaria Malaria Diarrhoea Diarrhoea Respiratory Infections Respiratory Infections Parasites Parasites Case Study - Sierra Leone Tonkolili Project - Local Situation

28. Support Large Hospital Pediatrics & Maternity Pediatrics & Maternity Emergency Surgery Emergency Surgery Lab Services Lab Services Out-Patient Services Out-Patient Services Health Care in District Remote Locations Remote Locations Mobile Clinics Mobile Clinics Outbreak Intervention Outbreak Intervention Mother-Child Healthcare Mother-Child Healthcare Psycho-Social Support Psycho-Social Support Population Monitoring Population Monitoring Case Study - Sierra Leone Providing Primary Health Care

29. Case Study - Sierra Leone Logistics and WatSan Human Resources Human Resources Communications Communications Power Supply Power Supply Rehabilitation Rehabilitation Construction Construction Supply Chain Supply Chain Purchasing Purchasing Fleet Management Fleet Management Financial Control Financial Control Water Base Medical Facilities Temporary Facilities Sanitation Latrines Vector Control Waste Disposal Wash facilities Training

30. Case Study - Sierra Leone Magburaka Hospital

32. Case Study - Sierra Leone Surgery

33. Case Study - Sierra Leone Hospital Rehabilitation

34. Case Study - Sierra Leone After Hospital Rehabilitation

35. Case Study – Sierra Leone Community Health and Hygiene Training

36. Case Study - Sierra Leone Reconstructed Health Outpost

37. Case Study - Sierra Leone Providing WatSan at Refugee Transit Station

38. Case Study - Sierra Leone Latrine Construction

39. How to get Involved International Organizations Many groups Many groups 1,000 in 1951 1,000 in 1951 16,000 in 1990 16,000 in 1990 Differences Differences Philosophy Philosophy Area of focus Area of focus Engagement Engagement Capacity Capacity Security Security International Confederation of the Red Cross/Crescent Medecins Sans Frontieres Registered Engineers for Disaster Relief Maintains a roster of emergency professionals for short term assignments with other agencies www.reliefweb.int Job posting site for INGO’s

40. Thank You for Your Time Questions and Discussion