Emergency WASH biweekly update – October 15, 2019

Dear Colleagues:

This biweekly update includes an upcoming webinar and recent reports on water trucking and other topics. Also included is a brief bibliography on mobile technologies in humanitarian WASH settings. Please let us know if you have other studies and resources to add to the bibliography.


November 13, 2019 Period Posse Presents | Changing the Norm: Mainstreaming Female Friendly Toilets | Speakers: David Clatworthy, IRC: Developing a female-friendly toilet toolkit for emergencies; Lea Jimera Acallar, Danish Red Cross: Innovative toilet designs in Bangladesh; Annie Msosa, WaterAid: Female-friendly public and community toilets: A Guide wateraid


Briefing note on water trucking in refugee settings. UNHCR, 2018. This UNHCR technical guideline has been prepared for anyone involved in planning and implementing water trucking in refugee contexts including UNHCR staff, WASH organizations, water trucking contractors, governments and individuals.

Household Water Insecurity Experiences (HWISE) Scale. HWISE, 2019. The HWISE Scale has many uses: identify populations vulnerable to water insecurity; understand causes and consequences of water insecurity; track trends in household water insecurity over time; monitor and evaluate the impact of water policies and programs.

USAID OFDA DRC Ebola Fact Sheets – September 2019.

Humanitarian Investing – Mobilizing Capital to Overcome Fragility. World Economic Forum, 2019. This paper offers an articulation of the humanitarian investing landscape and its main actors and guiding principles, building upon ongoing work that promotes new models and multistakeholder dialog to complement, not replace, existing humanitarian response mechanisms.

Global humanitarian assistance report 2019. Development Initiatives, 2019. In 2018, an estimated 206.4 million people living in 81 countries were deemed in need of humanitarian assistance. A large portion of these people continued to be concentrated in a small number of countries: six countries accounted for 80.6 million people in need.

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Emergency WASH biweekly update – October 2, 2019

Dear Colleagues:

Please let us know if you have upcoming events or recent studies and reports to feature in the next biweekly update.


USAID Yemen Water, Sanitation and Hygiene Fact Sheet, September 2019. USAID is implementing programming that addresses the underlying issues of limited access to safe water and sanitation. USAID’s Comprehensive WASH Support (CWS) program aims to improve access to safe and adequate water supply and basic sanitation infrastructure for households, hospitals, and schools. wateraid

Denial, Delay, Diversion: Tackling Access Challenges in an Evolving Humanitarian Landscape. CSIS, September 2019. To ensure the ability of aid to reach those who need it most and to uphold the principles of international humanitarian law, the United States should elevate humanitarian access as a foreign policy priority and work to reconcile tensions between critical national security measures and the growing needs of vulnerable populations in fragile, conflict-affected states.

Jordan: WASH Knowledge, Attitude and Practices (KAP) survey in Za’atari camp. REACH, July 2019. This assessment found that the integration of the water network has been successful as the vast majority of households are fully connected to both the water and waste water networks. Households have an increased understanding of the importance of water conservation practices, and a significantly greater proportion reported to practice such methods.

“Like a Drop of Water on a Fire” INADEQUATE INVESTMENT IN DURABLE SOLUTIONS FOR DROUGHT IDPS IN ETHIOPIA. Refugees International, September 2019. In the Somali region of eastern Ethiopia, drought internally displaced persons (IDPs)—people who have been forced to relocate because of the effects of severe drought—are now a forgotten population.


WHO guidance for refugees in camps: systematic review. BMJ Open, August 2019. This is the first systematic analysis of how well WHO guidelines cover the specific clinical health needs of people in refugee camps.

Factors associated with practice of water, sanitation and hygiene (WASH) among the Rohingya refugees in Bangladesh. Journal of Water, Sanitation and Hygiene for Development, in press. This study was conducted to examine WASH practices and associated risk factors among the Rohingya refugees in Bangladesh. The present study comprised 350 participants with data collected via a semi structured questionnaire. Most respondents (84%) did not have a good knowledge concerning WASH.

Acute Water-Scarcity Monitoring for Africa. Water, September 2019. We developed a monthly monitoring system that computes annual water availability per capita based on hydrologic data from the Famine Early Warning System Network (FEWS NET) Land Data Assimilation System (FLDAS) and gridded population data fromWorldPop.


Averting a Cholera Epidemic in the Wake of Dual Natural Disasters. USAID Global Waters, September 2019. When Tropical Cyclone Idai made landfall March 15, 2019, it pummeled Mozambique’s fourth-largest city Beira and three neighboring provinces, leaving only 10 percent of the port city intact.

Faircap Open Water Filter. Elrha, September 2019. A low cost, small, portable antibacterial water filter that can be screwed into standard plastic bottles and can provide clean drinking water by filtering out sediment and bacteria to reduce gastrointestinal disease during emergency relief situations, refugee camps and poor urban and rural areas.

How handwashing behaviour change programmes can save lives in an emergency. By: Claudia Codsi, Private Sector Partnerships, Oxfam, August 2019. We created a program called ‘Mum’s Magic Hands’ drawing on emotional motivators, nudges and triggers to drive sustained behavior change. The results had a positive effect on mothers’ handwashing practice, increasing both awareness and practice of handwashing with soap.

150,000 refugee women and girls to receive transformative menstrual health management solution. Sanitation Updates, September 2019. The UN refugee Agency UNHCR and AFRIpads have just begun the largest rollout of reusable sanitary pad distribution and Menstrual Health Management (MHM) sensitization of refugees in Uganda.

Water Currents: WASH and Antimicrobial Resistance

Water Currents: WASH and Antimicrobial Resistance – October 1, 2019

Antimicrobial resistance (AMR) occurs when microorganisms such as bacteria or virus change to resist the action of antimicrobials (e.g., antibiotics). Currently, it is estimated that at least 700,000 people die each year due to drug-resistant diseases.

Each year, more and more common diseases are becoming untreatable and lifesaving medical procedures are becoming much riskier due to AMR. A recent UN report on AMR (“No Time to Wait,” listed below) states that drug-resistant diseases could cause 10 million deaths each year by 2050, and that by 2030, AMR could force up to 24 million people into extreme poverty. amr

This issue of Water Currents contains recent studies on the connection between AMR and water and sanitation, the One Health approach to tackling AMR, country situation reports, and other AMR–related topics.

USAID’s priorities under the U.S. Government Global Water Strategy—improving good governance, water access, and sanitation and hygiene—are considered essential to prevent and counteract the spread of global microbial resistance. In addition, USAID’s Bureau for Global Health works with international organizations and local governments, academia, and private sector partners across Asia and Africa to promote prudent use of antimicrobials in the livestock, aquaculture, and crop production sectors to minimize the likelihood of AMR development and spread.

We would like to thank staff from the Sanitation and Hygiene Applied Research for Equity (SHARE) project, Emory University’s Center for Global Safe Water, Sanitation, and Hygiene, and Global Water 2020 for suggesting AMR as a topic and for contributing content to this issue.


Antimicrobial Resistance: An Emerging Water, Sanitation and Hygiene IssueWorld Health Organization (WHO), 2015. This briefing note provides an overview on the role of water and waste in combating AMR and identifies key areas to explore related to risk assessment management, policy, and research.

No Time to Wait: Securing the Future from Drug-Resistant InfectionsWHO, April 2019. AMR is a global crisis that threatens a century of progress in health and achievement of the Sustainable Development Goals. Because the drivers of AMR lie in humans, animals, plants, food, and the environment, a sustained One Health response is essential to engage and unite all stakeholders around a shared vision and goals.

Differential Drivers of Antimicrobial Resistance Across the WorldAccounts of Chemical Research, March 2019. Researchers show that high population densities in cities that suffer from poor sanitation and solid-waste disposal can potentially impact the dissemination of resistance.

Global Antimicrobial Resistance: A Complex and Dire Threat with Few Definite AnswersTropical Medicine and International Health, March 2019. Global AMR data and projections are simply alarming. Despite widespread recognition of the issue’s magnitude and urgency, the key drivers of global AMR dissemination, and how best to contain it, remain poorly defined.

The Economics of Antimicrobial Resistance and the Role of Water and Sanitation ServicesWASHeconomics, January 2019. Water, wastewater, and feces play a key role in the carriage of microorganisms and their genetic material. For example, water can act as a reservoir of antimicrobial-resistant bacteria and exposure route to humans (and animals).

Read the complete issue.

150,000 Refugee women and girls to receive transformative menstrual health management solution

The UN refugee Agency UNHCR and AFRIpads have just begun the largest rollout of reusable sanitary pad distribution and Menstrual Health Management (MHM) sensitization of refugees in Uganda. The project aims at benefiting some 150,000 women and girls in south-western Uganda. With this, UNHCR Uganda is putting critical spotlight on the challenges refugee women and girls face during their periods. In addition to providing the AFRIpads kit to refugee women and girls, they have been providing MHM capacity building since late September to equip hundreds of NGO field staff with the appropriate knowledge and tools dedicated to breaking taboo and stigma around the topic of menstruation.

The project is in response to a 2018 UNHCR and AFRIpads pilot study in South West Uganda, which found that:

  • The number of girls that reported missing school during their period was cut in half when using AFRIpads reusable pads
  • 84% of refugee schools girls indicating they would prefer to use AFRIpads over disposable pads

Read the full press release and the announcement (with photos) on the AFRIpads website.

A Bibliography of WASH and Cholera Studies

A Bibliography of WASH and Cholera Studies, September 17, 2019

In response to an information request, we have compiled a bibliography of 29 studies and reports published in 2018 and 2019 that discuss WASH-related aspects of cholera epidemiology and prevention/control. Please add additional studies to this google document or contact us to add additional resources such as videos, webinars, etc.


Global Cholera Epidemiology: Opportunities to Reduce the Burden of Cholera by 2030. J Infect Dis. November 2018.  The roadmap consists of targeted multi-sectoral interventions, supported by a coordination mechanism, along 3 axes: (1) early detection and quick response to contain outbreaks; (2) a multisectoral approach to prevent cholera recurrence in hotspots; (3) an effective partnership mechanism of coordination for technical support, countries capacity building, research and M&E, advocacy and resource mobilization.

syriaBroad approaches to cholera control in Asia: Water, sanitation and handwashing. Vaccine, August 2019.  Increased research to develop and policy flexibility to implement a new generation of solutions that are designed specifically to address the physical, financial and political constraints of low-income communities offers the best prospect for reducing the burden of cholera across Asia.

Cholera Treatment Centers/Healthcare Facilities

Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health, 2019. This study presents a theory- and evidence-based approach that can be implemented for the development of future water, sanitation, and hygiene mHealth programs in low-resource settings.

Technical Note: Water, Sanitation and Hygiene and Infection Prevention and Control in Cholera Treatment Structures. Global Task Force on Cholera Control, January 2019. Cholera treatment facilities provide inpatient care for cholera patients during outbreaks. Proper case management and isolation of cholera patients is essential to prevent deaths and help control the spread of the disease.

Assessment of Recommendation for the Containment and Disinfection of Human Excreta in Cholera Treatment Centers. Water, January 2019. These findings suggest that the use of 30% hydrated lime suspensions or 2% chlorine solutions may offer a simple public health protection measure for the containment, safe handling, and disinfection of human excreta during humanitarian emergencies.

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Turning fecal sludge into a resource: New approaches required to achieve the rural sanitation SDGs

WorldBank_publication_FSM_Rural_Areas_Verhagen_ScottSafely managed sanitation is a focus of the Sustainable Development Goals (SDGs). It is central to stunting reduction and early childhood survival, both identified by the World Bank’s Human Capital Index as critical for humans to develop their full potential. It is widely known that 4.5 billion people lacked access to safely managed sanitation in 2015, according to the Joint Monitoring Programme. Less well understood is that hundreds of millions more people in densely populated rural areas are exposed to significant health risk due to unsafely managed sanitation.

In contrast to urban areas, fecal sludge management (FSM) is not yet recognized as a priority for the rural sanitation sector – it is assumed to be less of an issue because rural areas are more sparsely populated. However, some densely populated areas fall under rural administrations, notably in deltas and on the periphery of rapidly growing rural areas. In these areas there is also a need to safely manage fecal waste. Many sanitation systems that, for lack of scrutiny, are assumed to be improved and safe, but due to lack of scrutiny they fail to safely manage fecal sludge.

A new World Bank report-supported by the Global Water Security and Sanitation Program (GWSP) – and six case studies identified specific causes of health risks in locations in Bangladesh, Bolivia, Egypt, India, and Vietnam. They include compromised construction of on-site sanitation solutions, incorrect technology choices, poorly developed FSM markets, predominantly manual emptying practices and indiscriminate dumping of sludge in the immediate environment. They found that environmental regulations and building codes do not address FSM effectively, and enforcement is often weak. Rural administrations typically lack the mandate and institutional capacity to provide and manage FSM services.

Read the full blog by Joep Verhagen and Pippa Scott

“Verhagen, Joep; Scott, Pippa. 2019. Safely Managed Sanitation in High-Density Rural Areas : Turning Fecal Sludge into a Resource through Innovative Waste Management. World Bank, Washington, DC. © World Bank. https://openknowledge.worldbank.org/handle/10986/32385 License: CC BY 3.0 IGO.”


Tackling slippage – Frontiers of CLTS: Innovations and Insights

Tackling slippage – Frontiers of CLTS: Innovations and Insights, September 2019.

This issue of Frontiers of CLTS explores current thinking and practice on the topic of tackling slippage of open defecation free (ODF) status. clts

It looks at how slippage is defined and identified, and at different patterns of slippage that are seen after ODF is declared.

Although a considerable amount has been written on how to establish strong Community-Led Total sanitation (CLTS) programmes that prevent slippage from happening, this issue looks at how to reverse slippage that has already taken place.

From the literature, there is little documented evidence on how slippage can be reversed; evidence and guidance tend to focus on prevention. This review begins to address this gap.

Implementers are encouraged to use the proposed patterns of slippage
framework and slippage factors section to understand the type and extent of slippage experienced, then use the examples in the section on tackling slippage to identify potential slippage responses.