Andy Bastable

Innovative designs and approaches in sanitation when responding to challenging and complex humanitarian contexts in urban areas

As recent emergencies have shown, there are still significant challenges in the timely provision of safe sanitation in natural disasters or conflict situations. In urban emergencies or areas where it is impossible to dig simple pit latrines because of high water tables, hard rock, or lack of permission, it takes agencies considerable time to construct elevated latrines or alternative designs such as urine diversion toilets. This paper describes the challenges often faced in the rapid construction of latrines in emergencies and then looks at a number of case studies, from the Haiti earthquake and the 2010 floods in the Philippines, of how these obstacles were overcome. It also documents some of the recent innovations and improvements suppliers have made in increasing the scope of their emergency sanitation equipment.

Excreta disposal in emergencies: Bag and Peepoo trials with internally displaced people in Port-au-Prince

After a series of earthquakes devastated Port-au-Prince, Haiti, on 12 January 2010, safe excreta disposal became an urgent priority. To mainstream innovative approaches to sanitation within the realities of urban humanitarian response, Oxfam GB undertook a trial from April to May 2010, of standard bag and Peepoo excreta disposal systems in two IDP settlements. Trial results demonstrate that with proper collection and removal, both bags and Peepoos are viable excreta disposal options in emergencies. A reduction was seen in ‘flying toilets’, open defecation and user reports on diarrhoea in both settlements. For in-home use, the Peepoo was preferred over bags, 84 per cent to 55 per cent (χ2 = 6.15, p=0.013) based on its ability to contain odour. Key programmatic recommendations include contingency planning for disaster-prone areas and further analysis of cost effectiveness and phase-out points for bag excreta disposal systems. Additionally, the Peepoo size should be adjusted to be more widely applicable in d...

Chlorination of drinking water in emergencies: a review of knowledge to develop recommendations for implementation and research needed

Clean water provision is a critical component of emergency response, and chlorination is widely used in emergencies to treat water. To provide responders with practical, evidence-based recommendations for implementing chlorination programmes and recommend areas for future research, we conducted a literature review of chlorination in emergencies, supplemented with a literature review on chlorination in general. We identified 106 total documents, including 7 with information on technical efficacy, 26 on chlorine dosage, 22 on technical challenges, 21 on product options, 8 on user acceptability, 33 on programmes for emergencies, and 8 on monitoring. We found that: 1) international chlorine dosage recommendations in emergencies are highly inconsistent; 2) high-quality information from the general chlorination literature on challenges of chlorination can be adapted for emergencies; 3) many chlorine products are available for use in point-of-delivery, point-of-source, and point-of-use emergency-response program...

Chlorination of hand-dug wells in Monrovia

In peri-urban Monrovia, contaminated hand-dug wells were contributing to cholera outbreaks. Various chlorination methods were evaluated to determine their appropriateness and efficacy, both for public health emergencies and sustainable community-managed systems.

Assessment of a membrane drinking water filter in an emergency setting

The performance and acceptability of the Nerox(TM) membrane drinking water filter were evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6-month period, 230 households were visited and filter performance and use were assessed. Only 6% of the visited households still had a functioning filter, and the removal performance ranged from 80 to 93%. High turbidity in source water (irrigation canals), together with high temperatures and large family size were likely to have contributed to poor performance and uptake of the filters.

Adherence to point-of-use water treatment over short-term implementation: parallel crossover trials of flocculation-disinfection sachets in Pakistan and Zambia

The health benefits of point-of-use (POU) water treatment can only be realized through high adherence: correct, consistent, and sustained use. We conducted parallel randomized, longitudinal crossover trials measuring short-term adherence to two single-use flocculant-disinfectant sachets in Pakistan and Zambia. In both trials, adherence declined sharply for both products over the eight week surveillance periods, with overall lower adherence to both products in Zambia. There was no significant difference in adherence between the two products. Estimated median daily production of treated water dropped over the crossover period from 2.5 to 1.4 L person-1 day-1 (46% decline) in Pakistan and from 1.4 to 1.1 L person-1 day-1 (21% decline) in Zambia. The percentage of surveillance points with detectable total chlorine in household drinking water declined from 70% to 49% in Pakistan and rose marginally from 28% to 30% in Zambia. The relatively low and decreasing adherence observed in this study suggests that these products would have provided little protection from waterborne disease risk in these settings. Our findings underscore the challenge of achieving high adherence to POU water treatment, even under conditions of short-term adoption with intensive follow-up.

Setting priorities for humanitarian water, sanitation and hygiene research: a meeting report

Recent systematic reviews have highlighted a paucity of rigorous evidence to guide water, sanitation and hygiene (WASH) interventions in humanitarian crises. In June 2017, the Research for Health in Humanitarian Crises (R2HC) programme of Elrha, convened a meeting of representatives from international response agencies, research institutions and donor organisations active in the field of humanitarian WASH to identify research priorities, discuss challenges conducting research and to establish next steps. Topics including cholera transmission, menstrual hygiene management, and acute undernutrition were identified as research priorities. Several international response agencies have existing research programmes; however, a more cohesive and coordinated effort in the WASH sector would likely advance this field of research. This report shares the conclusions of that meeting and proposes a research agenda with the aim of strengthening humanitarian WASH policy and practice.