Learn @WELL

Emergency Water
Supply & Sanitation
Module
Unit 1 Introduction
UNIT 1 INTRODUCTION learn@WELL:INTRODUCTION TO EMERGENCY WATER
SUPPLY & SANITATION

Water, Engineering and Development Centre

Loughborough University
Leicestershire
LE11 3TU UK
WELL@lboro.ac.uk

London School of Hygiene & Tropical Medicine

Keppel Street
London
WC1E 7HT
WELL@lshtm.ac.uk

IRC International Water and Sanitation Centre

P.O. Box 2869
2601 CW
Delft
The Netherlands
WELL@irc.nl

www.lboro.ac.uk/WELL
© WEDC/LSHTM/IRC, 2006

Any part of this publication, including the illustrations (except items taken from other publications
where the authors do not hold copyright) may be copied, reproduced or adapted to meet local needs,
without permission from the authors or publisher, provided the parts reproduced are distributed free, or
at cost and not for commercial ends, and the source of WELL (WEDC, LSHTM and IRC) is fully
acknowledged. The publisher and authors would appreciate being sent copies of any materials in
which text or illustrations have been used.

WELL acknowledges the following for their contributions in developing and producing this module:
Jane Bevan, Sam Treglowan, Peter Harvey, Bob Reed

Published by WEDC on behalf of WELL

WELL is a network of resource centres:

WEDC at Loughborough University, UK TREND, Kumasi, Ghana
IRC at Delft, The Netherlands SEUF, Thiruvananthapuram, India
AMREF, Nairobi, Kenya ICDDR,B, Dhaka, Bangladesh
IWSD, Harare, Zimbabwe NETWAS, Nairobi, Kenya
LSHTM at University of London, UK NWRI, Kaduna, Nigeria

This module was funded by the UK Department for International Development (DFID).
The views expressed, however, are not necessarily those of DFID.

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UNIT 1
Introduction

What this unit is about

This unit introduces you to the theme of water supply and sanitation in emergency situations,
defines the terms involved, and explains the importance of water supply and sanitation services in
emergencies. It also forms an entry point to the further units of the module.

What you will learn

On completion of this unit you should:
• Understand the meaning of an emergency situation;
• Know the different stages of an emergency;
• Be aware of the key public health issues to consider in an emergency;
• Be familiar with rapid situation assessment techniques; and
• Know the minimum standards of provision.

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Contents
1. Introduction ............................................................................................................................ 5
1.1 What is meant by Emergency? ......................................................................................... 5
1.2 What is meant by Emergency Water Supply? .................................................................. 5
1.3 What is meant by Emergency Sanitation? ........................................................................ 5

2. Stages of an emergency ....................................................................................................... 6

2.1 Immediate Phase .............................................................................................................. 6
2.2 Short Term ........................................................................................................................ 6
2.3 Long term .......................................................................................................................... 6

3. Public health issues in emergencies ................................................................................... 7

3.1 Links between disease and water and sanitation ............................................................. 7
3.2 Assessing the severity of the emergency ......................................................................... 7

4. Situation Assessment ........................................................................................................... 9

4.1 Stages of assessment and programme design................................................................. 9
4.2 Community Participation and Socio-cultural issues ........................................................ 11
4.3 Environmental and technical issues................................................................................ 12
4.4 Tools of Assessment....................................................................................................... 12
4.5 Follow-up assessment and consultation ......................................................................... 17

5. Minimum Standards and Guidelines .................................................................................. 18

6. Bibliography and References ............................................................................................. 20

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1. Introduction
In this section we will begin with clear definitions of all our title terms.

1.1 What is meant by Emergency?

An emergency may arise due to either man-made or natural causes, resulting in communities
finding difficulty in coping with their situation. Catastrophes such as floods, earthquakes or
droughts, wars or political expulsions are typical causes of humanitarian emergencies. In such
situations, where people’s lives have been seriously disrupted and they find themselves in
overcrowded conditions, the rapid provision of basic necessities such as food, shelter, water and
sanitation is vital to minimise loss of life. A more detailed definition of the severity of an
emergency is defined by mortality rates, and is discussed later in this Unit.

1.2 What is meant by Emergency Water Supply?

For the purposes of this module, emergency water supply is defined as “The rapid delivery of safe
and wholesome drinking water to people affected by calamity or conflict in sufficient quantity to
sustain life and dignity”.
Although primarily a technical issue, emergency water supply requires an understanding of the
social and political environment in which the emergency is taking place. The definition of words
such as “sufficient” and “dignity” are not fixed but change with time and place. Practitioners must
be sympathetic to the needs and constraints of the community they serve if the technology they
deliver is to be appropriate to the needs.

1.3 What is meant by Emergency Sanitation?

It is possible to cause confusion here, as the term sanitation can range from including all waste
disposal as well as excreta and wastewater, to simply meaning ‘toilets’ to some. We prefer to use
the full definition of environmental sanitation.: “The means of collecting and disposing of excreta
and community liquid wastes in a hygienic way so as not to endanger the health of individuals
and the community as a whole”.(WHO, 1987).
However for the purposes of this module, we will use a narrower definition, and only cover
excreta disposal and hygiene promotion.
Water supply and sanitation are often lumped together in one ‘package’ as they are both
technical issues, to be dealt with by engineers. As we shall see, however, the broader definition
of sanitation includes a distinct health element, preventing the spread of disease. This
demonstrates that the emergency water & sanitation practitioner must have a good understanding
of public health issues, and be prepared to communicate important hygiene messages in order to
fully perform their function (see Unit 6 for a discussion on hygiene promotion).

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2. Stages of an emergency
Emergencies can last from a few days to several years. It is useful to distinguish three phases of
emergencies:

2.1 Immediate Phase

The immediate or acute period after an emergency has begun is often the most unstable, and
when the affected people are most vulnerable. Depending on the cause of the situation, there
may be a high level of illness, injury and mortality, and separated families and communities. The
priority is on the provision of basic necessities and the management of public health issues (see
section 3 below) to create a safer environment and minimise the spread of disease.

2.2 Short Term

This is a period of stabilisation or establishment, lasting up to six months. During this time, the
aim of the water & sanitation programme is to develop and maintain the provision of basic
services and to reduce morbidity and mortality, preventing the spread of disease.
During this phase community structures may start to reassemble and morbidity and mortality
rates should start to fall. However, the risk of epidemics may still be high. This typically lasts
several months, though in complex emergencies it may stretch to several years.

2.3 Long term

Lasting up to several years after an emergency situation, this period includes the resettlement
and recovery of the affected population. The emphasis will be on the promotion of self-sufficiency
and sustainability, whilst maintaining health and well-being.
The definition of these phases is not fixed and many situations do not follow a linear progression.
Some programmes may commence in the second or short term phase, or become more acute
and fall back to the first or immediate phase because the security situation deteriorates or an
epidemic occurs. Although this is necessarily an oversimplification, it is useful for the relief
worker to view emergency situations in these distinct phases as particular interventions are
required at different stages (Ferron, et. al. 2000). We will be referring to these stages throughout
this module.

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3. Public health issues in emergencies

Water and sanitation are a vital element of emergency provision, as fatal diseases such as
dysentery can spread quickly in precarious situations if the basic human needs of safe water
supply, effective sanitation and good hygiene practice are neglected.

3.1 Links between disease and water and sanitation

Not all causes of deaths in emergency situations are water and sanitation-related, but they can
often be made worse by diarrhoeal disease. For example, a very malnourished child who then
gets diarrhoea will be a much more serious and potentially fatal case than a healthy child. A body
already weak with pneumonia may not withstand persistent bouts of diarrhoeal infection. Thus,
the importance of effective sanitation, preventing the spread of life-threatening diseases, cannot
be over-emphasized.
Diseases transmitted via the faeco-oral route, such as diarrhoea, have been shown to account for
40% of all childhood deaths in an emergency (Davis and Lambert, 2002) and this figure may be
significantly higher in some cases. Epidemics of diseases are much more likely to occur when a
population is displaced or affected by a disaster. Studies (Esrey et al. 1991, Esrey & Habicht,
1986) have shown that whilst improvements in water quality alone can produce limited reductions
in childhood diarrhoea by 15-20%, greater reductions can be produced through safer excreta
disposal (36%) and hand washing, food protection and improvements in domestic hygiene (33%).
Children under five years of age are most at risk from communicable diseases since their immune
systems have not fully developed. Increased malnutrition, as is common in emergencies,
increases this risk further. Since young children are unaware of the health risks associated with
contact with faeces, it is essential that faeces are safely contained. Severely malnourished
children and adults are at increased risk from diarrhoeal disease, as are elderly people, especially
if exhausted after travelling considerable distances.
HIV/AIDS is also of particular relevance to water supply and excreta disposal in emergency
situations. Poor sanitation raises particular risks for people living with AIDS as their weakened
immune systems are less resistant to opportunistic infections. The HIV/AIDS epidemic is
therefore increasing the need to provide water supply, sanitation and improve hygiene practices
because diarrhoea and skin diseases are among the most common opportunistic infections.

Further reading. If you wish to find out more about the links between disease and water and
sanitation, the WEDC text ‘Controlling and Preventing Disease’ by Rottier and Ince (2003) is
recommended.
Annex 1 of the book lists all the common diseases, with details such as incubation periods,
symptoms, and preventative measures. Have a browse of this annex, and see how many more
diseases you can add to the categories in table 1.1.

3.2 Assessing the severity of the emergency

Before any intervention is made to prevent the spread of diseases, an assessment of the severity
of the situation is necessary.
The need for intervention should not be assumed by aid agencies, but is commonly assessed by
disease rates and/or death rates. The mortality (or death) rate is the most common measure of
the severity of an emergency. It is measured as the number of deaths per 10,000 people per
day, and is often expressed as the crude mortality rate or CMR. Measurement of the CMR is
shown in Box 1
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Box 1. Calculating Mortality Rates

Crude Mortality Rate = total number of deaths among population x 10,000
total population x number of days in record period

For example: In a population of approximately 45,000, there were 652 deaths from cholera in
one month (30 days).
Crude Mortality Rate (CMR) =(652 x 10,000) ÷ (45,000 x 30) = 4.8 per 10,000 per day.

Similarly, a disease rate, (or morbidity), is calculated as the number of cases, (e.g. of cholera),
diagnosed during a certain period, and is calculated in the same way. A crude rate should not be
viewed in isolation, but needs to be considered against the background rates, or the normal
number of deaths or cases that might be expected, and should take other factors into
consideration such as seasonal and overall trends. Table 1 suggests threshold mortality rates.

Table 1. Crude Mortality rates in Emergencies

Crude mortality rate Severity of Emergency

Deaths/10,000/day

Up to 0.5 ‘Normal’ or non-emergency rate

<1 Stable and under control

1-2 Very serious situation

2-5 Emergency / Out of control

>5 Catastrophic

Source Davis and Lambert, 2002

Essentially, a CMR greater than 1 constitutes an emergency situation where immediate

intervention is recommended to reduce the number of deaths, and to prevent the rate rising. The
target is at all times to reduce the CMR to below the 0.5 threshold. Continual monitoring of the
death and disease rates is necessary to assess the impact of the interventions, and to catch any
further outbreaks of disease at an early stage.
3.2.1 Should you get involved?
The majority of emergencies do not require external assistance, and are dealt with solely by the
affected population and their local institutions. External agencies should not interfere unless
specifically invited to do so, and then only if it is safe to intervene. Having established that the
environment is safe, the next step is to interpret the health data to assess the need for
intervention.

Further reading The Background Chapter in Ferron et al., (2000), Hygiene Promotion, Pages
4 to 11. This gives a good overview of emergency contexts and discusses further issues such
as neutrality and participation.

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4. Situation Assessment
If it has been established that there is an emergency situation in which intervention is required,
the next step is to perform an assessment to identify the key water and sanitation issues or areas
of intervention needed.
In consultation with the qualified medical staff in the area, morbidity and mortality data of the
affected population should be gathered and interpreted.
In a rapid assessment, the following health data will be useful:
• What are the major sanitation-related diseases among the affected population?
• What were the major diseases among the affected population before the emergency?
• What is the crude mortality rate?
• What was the crude mortality rate before the emergency?
• What are the major diseases amongst the local population?
By assessing the incidence of various diseases during the initial stages, it can be determined if
intervention is appropriate and any improvement or worsening in public health can then be
assessed and monitored. Take care in assessing health data, as changes in health may not be
directly due to the emergency or any particular water supply or sanitation intervention.
Diseases prevalent amongst the local population must also be considered. If there is a high
incidence of cases of a particular disease, reasons for this should be sought within the local
environment.
One of the dilemmas of emergency intervention is whether to treat incoming affected populations
to a different standard to the host population. Inequalities in levels of service provision are
frequent causes of strife.

4.1 Stages of assessment and programme design

The approach recommended when faced with an emergency situation is illustrated in Figure 1. It
outlines the five basic stages in programme design which are useful to follow.
The key to good decision making is a proper assessment. There is often a tendency in
emergencies for fieldworkers to rush straight into implementation without conducting a detailed
assessment. This assessment need not be lengthy, but it is essential that all relevant information
is collected and recorded. This minimizes the likelihood of inappropriate actions and wasted time
and resources.

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Figure 1 Stages in Emergency Programme Design

Source: Harvey et. al. 2002

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4.1.1 Rapid assessment and priority setting

This stage is designed to gather key relevant information rapidly and analyse it quickly in order to
decide the level and type of intervention necessary. It may not always be possible to gather the
most reliable information, so employ methods of triangulation or corroboration, that is, make sure
you have received similar information from more than one source. The basic health information
will be along the lines of the questions outlined previously, as well as rapid reconnaissance
information on existing water supplies, sanitation and other infrastructure (for example roads,
buildings and so on). You and your team will then be in a position to set the main priorities and
scale of the response to the emergency.
4.1.2 Outline programme design
In this stage an outline design for intervention is produced. Each sector of the emergency
response should produce a programme design, indicating specifications, equipment required and
a time scale. This is intended for submission to senior staff or donors for initial approval and
release of funds.
4.1.3 Immediate action
Should there be an immediate danger to health then actions may have to be taken before
programme approval is given. These actions should be aimed at dealing with the short term
problem and minimizing the spread of excreta-related disease without interfering with the longer
term plan. It is important that the key longer-term actions have already been identified in the
outline design to ensure that immediate actions do not have any negative effect on future
interventions.
4.1.4 Detailed programme design
Once the outline design has been approved, a stage of more detailed data collection, analysis
and consultation should occur. This should adopt a more consultative and participatory approach
involving all affected groups in the decision making process. This process is very similar to that
promoted for normal development based programmes. The approach is likely to be staged, with
immediate actions on priorities, and programme adjusting and upgrading as the situation
becomes clearer.
4.1.5 Implementation
Following the detailed design, the implementation of the longer term emergency sanitation
programme can now be conducted. This should include management and implementation of
construction, hygiene promotion, operation and maintenance activities, contingency planning, and
monitoring and evaluation.

4.2 Community Participation and Socio-cultural issues

In the first hours or days of an emergency, the affected population may be too traumatised to
participate. After this however, those that are able-bodied will rapidly come to terms with their
situation, and involving them in the decision making and the construction of facilities is a positive
move that will empower them, and encourage self-reliance. Involving the community can
contribute to the restoration of dignity and hope, and will reduce the dependency syndrome.
Consultation about preferences will also result in a greater take-up and use of facilities and
hygiene messages, helping to reduce the spread of water supply and sanitation-related diseases.

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4.2.1 Socio-cultural issues

Sanitation provision is essentially people-centred and the importance of socio-cultural issues is
paramount if programmes are to be successful. Water supply should also be people centred but
its technical nature makes it more difficult to involve people to the same extent. Relevant issues
to consider in assessments include:
• Population and demography – numbers of men, women and children, breakdown by age,
ethnic and religious groups, population density;
• Vulnerability and disability – numbers of people with physical and mental disabilities or
sickness, most vulnerable groups;
• Cultural beliefs, practices and preferences relating to excreta disposal and hygiene (e.g.
menstruation);
• Existing knowledge relating to health and hygiene;
• Anatomical considerations (e.g. how people squat);
• Anal cleansing materials;
• Hygiene and bathing preferences;
• Normal water collecting and storage vessels; and
• Typical timings of daily activities such as cooking, bathing laundry etc.
Such information is essential to set up a baseline for an effective excreta disposal programme.

4.3 Environmental and technical issues

The human and physical environment in which the emergency occurs also need to be considered
as part of the assessment. These will affect the range of technical options that can be applied in
any particular situation. Particular environmental and technical issues to consider include:
• Ground conditions – soil types and infiltration rates, groundwater levels, bearing capacity of
soil, ease of excavation;
• Location and risk of contamination of water sources;
• Topography and drainage patterns;
• Climate and rainfall patterns;
• Natural, physical and human resources (and skills) available locally or that can be procured
rapidly; and
• Possible environmental constraints or impacts.

Further reading: Chapter 4 on Background Information in Harvey, et. al. (2002), Emergency
Sanitation, Pages 21 to 29. This covers the general information that is likely to be needed as
part of an emergency assessment.

4.4 Tools of Assessment

In an assessment, it is necessary to first identify the key problems or issues related to water and
sanitation, and then identify the needs arising from those problems. Once identified, these needs
can be prioritized. This process is summarized in Figure 2.

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Figure 2. Assessment Steps

(source: Harvey, Baghri and Reed, 2002)

In the early stages of an emergency, assessment will be rapid, and based on consultation with
key informants. As more data is collected, the assessment will be refined and the analysis
improved. This should be seen as an ongoing and iterative process.
4.4.1 Data Collection
Time is valuable at this stage, and so only vital data should be collected – that which is necessary
to produce an effective response to the emergency. As information may often be imprecise, it is
worth collecting data from a variety of sources (if possible) to cross-check its validity. It is also
important to be aware of local politics and social structures, to evaluate any potential bias or
conflicting interests that may come with the data. Good records of information gathered should
be kept, so that others can access them, and updates can be performed as the emergency
progresses.
As discussed previously, health data - disease and mortality rates - are amongst the most
important information to collect. Morbidity rates for excreta-related disease can also be useful
indicators. Although it is not possible to provide ‘acceptable’ incidence rates for different diseases
(Rottier & Ince, 2003), figures should be lower than those presented in Table 2.
The transmission of water supply and excreta-related disease is exacerbated by lack of
appropriate hygiene practices, such as hand-washing after defecation, disposal of children’s
faeces, and regular cleaning of latrines. A brief baseline study on hygiene behaviour can prevent
project failure if subsequent messages are well-targeted. While it is difficult to assess whether all
sections of the population are aware of priority hygiene practices, it is always useful to conduct a
small study on issues such as hand-washing and disposal of children’s faeces.

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Table 2. Indicative acceptable incidence rates in camps for

displaced persons or refugees (after de Veer, 1998)

Disease Incidence rate

(in cases/10,000/week)

Diarrhoea total 60

Acute watery diarrhoea 50

Bloody diarrhoea 20

Cholera Every suspected case must be acted

upon

Key questions to be applied to collect baseline data in initial assessments are presented in Box 2.
These are generic and may not all be relevant in all emergency situations. Davis & Lambert
(2002) suggest that the question ‘so what?’ is a useful test of relevance and should be asked
frequently.

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Box 2 Questions for Rapid Assessment

1. What is the estimated population and what is the population density?
2. What is the crude mortality rate (number of deaths per 10,000 people per
day) and what are the main causes of mortality and morbidity?
3. What are the current beliefs and traditions concerning excreta disposal
especially regarding women and children’s excreta? (Do men and women or
all family members share latrines, can women be seen walking to a latrine,
do children use potties, is children’s excreta thought to be safe?)
4. What material/water is used for anal cleansing? Is it available?
5. Is soap available?
6. Are there any existing facilities? If so are they used, are they sufficient and
are they operating successfully? Can they be extended or adapted? Do all
groups have equal access to these facilities?
7. Are the current defecation practices a threat to health? If so, how?
8. What is the current level of awareness of public health risks?
9. Are there any public health promotion activities taking place? Who is
involved in these activities?
10. What health promotion media are available/accessible to the affected
population?
11. What is the topography and drainage pattern of the area?
12. What is the depth and permeability of the soil, and can it be dug easily by
hand?
13. What is the level of the groundwater table?
14. What local materials are available for constructing latrines?
15. How do women deal with menstruation? Are there materials or facilities they
need for this?
16. When does the seasonal rainfall occur?
17. Whose role is it normally to construct, pay for, maintain and clean a latrine
(men, women or both)?
18. Do people have access to sufficient water? Is the situation likely to change?
If so in what way?
19. Are the water sources adequate for the demand and are they sustainable?
20. Do people have sufficient water for all their needs?
21. Is the water supply accessible and do people have appropriate vessels for
collecting and storing it?
22. Is the water source contaminated? If so what treatment would be required?
23. Are there alternative water sources?
24. If the water supply is poor, could water be brought in by tanker or should
moving the people be considered?

Source: Adapted from Harvey, 2006 & Davis & Lambert 2002

4.4.2 Tools for data collection

4.4.2.1 Observation
Perhaps the simplest way of gathering information is through observation. This method allows the
assessor to record non-verbal behaviour among the affected population, the physical condition of
the affected area and the characteristics of the surrounding landscape. It can also explore
interactions among the affected population and local residents or other stakeholders.
On arrival in the field the first step in assessment is to conduct a rapid reconnaissance of the
affected area. This is best done on foot and may be a useful starting point in producing a simple
sketch map. Transect walks can be made through the site to take notes on any existing excreta
disposal facilities and practices and associated indicators. A huge amount of information can be

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gathered in this way but care should be taken not to make sweeping assumptions based on
limited observation.
4.4.2.2 Measurement and testing
Measurements can be used to determine quantities such as:
• available area;
• geographical position;
• elevation and slopes;
• latrine superstructure dimensions (or materials) for existing facilities;
• quantity of water available for hand washing / anal cleansing;
• ease of excavation for pits; and
• soil infiltration rates.
Measurements are likely to require the data collector to have some skill and experience in using
appropriate instruments. Assessment teams can be trained reasonably quickly for most
measurements, but should be carefully supervised throughout data collection.
4.4.2.3 Surveys
Surveys can be used to examine opinions or behaviour made by asking people set questions.
Surveys can be used to collect both quantitative and qualitative information. This may be
quantitative statistical data concerning demography, health and geography, or qualitative social
data such as community opinions and behaviour. There is a broad range of survey techniques
which can be used for emergency sanitation programmes, including random and selective
methods. The use of surveys should be balanced against available time, human resources,
logistical support, and the need for statistical analysis and interpretation of results. In most rapid
assessments this is not necessary but surveys may be appropriate for more detailed follow-up
assessments.
4.4.2.4 Interviews
Even in the initial rapid assessment it will be necessary to interview some groups and individuals.
There are various interview techniques ranging from open-ended discussion with randomly
selected members of the affected population to more directed interviews with key informants or
personnel from NGOs. Care should be taken in conducting interviews; the assessor should avoid
asking leading questions (where the desired answer is obvious) or restrictive questions (with yes
or no answers only). Interviewees can include:
• key informants (engineers, teachers, health staff etc.);
• men, women and children from the affected population;
• formal leaders; and
• representatives of minority or vulnerable groups.
Refugee women and children, as well as men, should be questioned. Female translators should
be used where possible in interviewing women, especially in cultures where women’s contact with
men is restricted.

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4.4.2.5 Participatory techniques

There are many participatory techniques that can be used in assessment. The most common at
the rapid assessment stage are group discussion and community mapping. In focus group
discussions the assessor guides conversation among a small group of the community with
common interests. These groups may be of mixed sex and age, although single sex focus groups
may promote greater freedom of expression by participants who may not want to express their
opinion in a mixed group.
Mapping is a useful exercise which can be used to gain an overview of the situation and to
identify problems which are causing a risk to people’s health. A mapping exercise should also
allow people themselves to appreciate possible risks and can often be a catalyst for community
planned action. This can build on the observation process during the initial reconnaissance by
sketching site plans or schematic maps.
Mapping can be carried out relatively quickly by community members in conjunction with local
staff. This is another way of stimulating discussion and obtaining information on a wide range of
issues from those present. Maps (no matter how rough) can be very useful in co-ordination and
planning meetings with other individuals, organisations and agencies.
Whatever technique is adopted, care must be taken during the initial rapid assessment that the
expectations of the affected community are not raised unduly prior to programme approval.

4.5 Follow-up assessment and consultation

Assessment is not a one-stage process. The initial rapid assessment is designed to collect key
information quickly in order to prioritize intervention activities and produce an outline programme
design. The assessment tools and techniques described above can be applied at any stage of an
excreta disposal programme, and techniques used in the initial assessment can be revisited and
repeated in the follow-up assessment.
Once the outline programme design has been produced and immediate actions are implemented
to stabilize the initial situation, a follow-up assessment and consultation process should begin in
order to gather more comprehensive information and produce a detailed programme design. This
more in-depth consultation phase takes time but is essential to ensure that interventions and
facilities are socio-culturally acceptable, and that they will be operated and maintained effectively.

Further reading: The Chapter on Assessment in Ferron et al., (2000), Hygiene Promotion,
Pages 21 to 36. This gives a good overview and plenty of examples of assessment for hygiene
promotion in particular, although much is applicable for general baseline data collection.

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5. Minimum Standards and Guidelines

Universal minimum standards for relief assistance have been proposed by the Sphere Project,
which was formed in 1997 through a multi-agency alliance, the Steering Committee for
Humanitarian Response (SCHR). The aim of the project has been to maintain consistency
wherever humanitarian support is given in emergencies, based on the core principles of meeting
essential human needs and restoring life with dignity (Davis and Lambert, 2002). The Sphere
Handbook (2004) has been published by Oxfam, and can also be accessed from the internet at
www.sphereproject.org . Further guidelines specifically for the water and sanitation sector have
been proposed by WHO (2006), which also contain useful checklists of questions to ask
regarding minimum standards.
The aim of these guidelines in emergencies is to provide indicative service levels (e.g. one toilet
per 20 users), and should not be taken as a rule that has to be stuck to rigidly. The standards
describe what people should have as a minimum for their health and dignity whilst providing a
level of accountability for those supporting them. Emergency situations vary greatly and these
objectives should always be viewed in the broader context of local conditions and adapted
accordingly.
Simply because objectives are set does not mean that agencies should strive to achieve these at
all costs. A consultative approach should always be taken in programme design and this may
identify times at which some objectives may be inappropriate or irrelevant. Conversely, agencies
should strive to do better than the minimum standards wherever possible.
However, in practice, the Sphere Guidelines are usually interpreted as aspirational, rather than
minimum standards. This means that in the early stages of an emergency lower levels of service
are common, with organisations gradually raising the level towards the minimum standards as
time progresses. Never the less, the standards set out in Sphere are very important and should
form the basis of any intervention Table 3 summarizes the key standards for water supply and
sanitation.

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Table 3. Key standards for satisfactory emergency hygiene promotion, water

supply and excreta disposal interventions

Hygiene promotion

All facilities and resources provided reflect the vulnerabilities, needs and preferences of the affected
population. User are involved in the management and maintenance of hygiene facilities where
appropriate.

Water supply

1 All people have safe and equitable access to a sufficient quantity of water for drinking, cooking and
personal and domestic hygiene. Public water points are sufficiently close to households to enable
use of the minimum water requirement.

2 Water is palatable and of sufficient quality to be drunk and used for personal and domestic hygiene
without causing significant risk to health.

3 People have adequate facilities and supplies to collect, store and use sufficient quantities of water
for drinking, cooking and personal hygiene, and to ensure that drinking water remains safe until it is
consumed.

Excreta disposal

1 People have adequate numbers of toilets, sufficiently close to their dwellings, to allow them rapid,
safe and acceptable access at all times of the day and night.

2 Toilets are sited, designed, constructed and maintained in such a way as to be comfortable,
hygienic and safe to use.

Source: The Sphere Project 2004

Further reading: The Sphere Project: Humanitarian Charter and Minimum Standards in
Disaster Relief (Sphere, 2004).

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6. Bibliography and References

Davis, J., and Lambert, R., (2002), Engineering in Emergencies, a practical guide for relief
workers. Second Edition, ITDG Publishing.
Delmas, G. and Courvallet, M., (1994) Public Health Engineering in Emergency Situation, MSF.
Esrey, S., & Habicht, J. (1986) Epidemiological Evidence for Health Benefits from Improved
Water and Sanitation in Developing Countries, Epidemiological Reviews, 1, 117-128.
Esrey, S.A., Potash, J.B., Roberts, L. and Shiff, C., (1991) Effects of Improved Water Supply on
Ascariasis, Diarrhoea, Dracunculiasis, Hookworm Infection, Schistosomiasis and Trachoma,
Bulletin of the World Health Organisation 69 (5): 609-621.
Ferron, S., Morgan, J., and O’Reilly, M., (2000), Hygiene Promotion, a practical manual for relief
and development. ITDG Publishing.
Harvey, P., Editor, (2006), Excreta disposal in emergencies, a field manual. WEDC.
Harvey, P., Baghri, S. and Reed, R., (2002), Emergency Sanitation, assessment and programme
design, WEDC.
Rottier, E. and Ince, M. (2003), Controlling and Preventing Disease, WEDC.
The Sphere Project: Humanitarian Charter and Minimum Standards in Disaster Relief (2004), on-
line version: http://www.sphereproject.org/content/view/27/84/lang,English/.
World Health Organization (1987), Technology for water supply and sanitation in developing
countries: A report of a WHO study group. (WHO technical report series, No 749) WHO Geneva

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