Sanitation in Emergencies Overview

Adapted from RUBERTO & JOHANNESSEN (2009) and JOHANNESSEN & BIKABA (2009)

Natural disasters (floods, earthquakes, storms, droughts) and conflicts in combination with adverse physical (environment) and social factors (e.g. poverty, vulnerability) can cause a wide range of emergencies that require interventions in terms of sanitation.

Interventions always aim at preventing the transmission of faecal-oral diseases, the contamination of water sources, and the (further) development of breeding sites for vectors, dignity and general wellbeing of the affected people (see also water sanitation and health). In a second stage, emergency situations can also be an opportunity for long-term development (see also water sanitation and development) as well as for emergency preparedness and resilience.

The best emergency toilet and excreta disposal system in emergencies does not exist. The choice for a certain system depends on the specific conditions, and each system has advantages and disadvantages. The choice can be influenced by:

• The event: e.g. people affected by an emergency situation can live “in-situ” (people remain at or close to their homes) or can be displaced (ex-situ) to a dense or a scattered context (cities, schools, mosques, camps etc).
• The environmental context: simple pit latrines are often the minimum and the most common toilets promoted in an emergency response. Challenging conditions such as difficult ground composition (rocky, sandy etc.), high water table or flooding, lack of water, or space constraints can make other options such as urine diverting toilets, elevated latrines, (shallow) trench latrines or peepoo bags more suitable though.
• The available capacities in the field: e.g. locally available skills to construct, operate and maintain the facilities.
• The choice can also be influenced by some conflicts of interests (e.g. long-term versus short-term thinking).

Gender issues as well as vulnerable groups such as children or disabled persons always need special attention especially when designing toilet systems (see also OXFAM 2007).

In-situ Emergency Response

In-situ emergencies response is addressed to people staying in or close to their homes after an emergency situation. Earthquakes or an urban flooding event could for instance induce an emergency response for an in-situ target population where people stay in or close to their homes.

Ex-situ Emergency Response

Ex-situ emergency response is addressed to people that have (temporarily) left their homes. The level and type of displacement vary. Settlements generally fall into one of the three categories: highly dispersed (dispersed settlement or host families); mass shelters (e.g. in schools, warehouses or mosques, mostly in urban areas) or self-settlements (spontaneous camps) or previously planned camps (UNHCR 2007). People living ex-situ after an emergency event have the status of internally displaced persons, IDPs, or that of refugees if they cross international borders.

Planned Emergency Camps

Adapted from UNHCR (2007) and HARVEY (2007)

The layout, the infrastructure and the shelter of a camp influence safety and wellbeing of people living in camps. The site selection is thus crucial. Authorities and refugees/IDPs should be involved as soon as possible. Apart from water (good quality, quantity and ease of access) being the single most important criteria, also access, land rights, security and protection are important. Camp planning and management relate to shelter, sanitation and hygiene, administration (warehouses), security, distribution of food (and non-food items), health services, education, community services (e.g. religious sites, sport or other distraction areas), and income-generating opportunities. A minimum surface area of 45m² should ideally be calculated for each person in a camp, but not less than 30m² (also including space for infrastructure and facilities).

The choice of the most suitable and efficient emergency toilet and excreta disposal system also depends on the emergency phase. Emergency phases roughly describe the steps that affected people go through after an emergency. The exact duration and the moment a phase sets in depend on the event and the context of the emergency and are defined differently by different authors. The phases are not time-bound but rather depend on the achievement of set targets to be achieved in that phase (DAVIS & LAMBERT 2002; CLASEN & SMITH 2005; HARVEY 2007):

• Immediate or acute emergency phase, about 1 week up to 3 months after the event
• Stabilisation phase, typically starting after 2-4 weeks and lasting until 2-6 months after the event
• Recovery phase with long-term action, taking several months and up to 1 or more years
• Settlement or long-term phase, lasting perhaps for years after the disaster

The international community of emergency response organisations has defined minimum standards that people who are affected by an emergency can expect from organisations providing humanitarian assistance. The most commonly mentioned are the Sphere Standards, which include for excreta disposal in emergencies (see also THE SPHERE PROJECT 2011):

• A living environment free from human faecal contamination;
• Access to adequate, appropriate and acceptable toilet facilities.

Some organisations and authors have translated these standards into objectives, which help to guide practitioners in achieving adequate and appropriate service levels for each of the sanitation sectors (excreta disposal, solid waste management, waste management at medical centres, disposal of dead bodies, wastewater management, hygiene promotion) (HARVEY et al. 2002; see also UNICEF 2005).

With regards to sanitation, emergency responses may considerably vary with in-situ rural areas, urban areas or when dealing with displaced persons (ex-situ situations) (WISNER & ADAMS 2002; EAWAG 2008):

• The immediate response in an urban area may include establishing or reinforcing sewage tanker services to bypass blocked sewers or to carry out intensive septic tank or latrine emptying in peri-urban areas. Every effort should be made to allow people to use their existing toilets. Where necessary, public facilities may need to be provided by allowing access to schools or community centres, or by setting up temporary public toilets.
• In rural areas, a focus on the protection of water sources is usually the priority because of the lower concentration of people and lower risk of faecal contamination.
• When dealing with displaced persons, immediate sanitation measures and technologies are available that would not be recommended in non-emergency situations. Emergency toilet structures are chosen based on the urgency of the need and should be provided and improved gradually from clearly marked open defecation fields, to trench defecation fields, to communal trench latrines, communal pits or borehole latrines to household or family pit latrines (see immediate and short-term sanitation in emergencies).

An emergency sanitation system is not only a physical product (superstructure, interface, storage etc.). It also has to consider the context of the emergency (e.g. culture, user density, soils, water level, accessibility, or availability of skills and materials) and the process of getting that particular sanitation system implemented and fully operational (planning, installation, use, final disposal etc.) (HARVEY et al. 2002; JOHANNESSEN 2011). Therefore the assessment and planning of sanitation systems in emergencies require many aspects to be taken into account in a very limited amount of time (see HARVEY et al. 2002 for extensive assessment guidelines).

There is disagreement on whether sanitation solutions should be short-term only, or adaptable to mid- and long-term sanitation solutions from the outset. However, experience has shown that sanitation facilities are often used for a longer time than initially planned by aid agencies. Hence, the question of emptying pits or septic tanks should always be raised from the outset (JOHANNESSEN 2011)(for more information see also immediate and short-term sanitation in emergencies and medium and long-term sanitation in emergencies).

Especially in an in-situ emergency situation, response coordinators might have to choose between providing communal or family latrines with the affected population. The table shows the many factors to be considered. Often, the conditions on site facilitate the choice. Source: Adopted from HARVEY et al. (2002).

Especially for ex-situ situations, the choice for one of the many excreta disposal facilities depends on the emergency context and emergency phase, and usually follows a step-by-step upgrade approach. Source: THE SPHERE PROJECT (2011)

In emergencies, excreta disposal is often only one of many environmental factors that affect the health of the population. Sanitation is also concerned with the disposal of dead bodies which can be one of the most difficult aspects of a disaster response - not so much due to health-related risks, but to psychological and social impact of the trauma (WHO 2011; HARVEY et al. 2002).

Where large amounts of people live in a camp or a temporary settlement, the management of solid waste will likely have to be addressed. Similar to sanitation, repairing of existing solid waste collection infrastructure should be a priority (see small or large scale composting; anaerobic digestion for organic waste; and incineration, small or large scale). Stormwater management and drainage of surface runoff will also be of high importance in order to maintain hygienic conditions and prevent contamination of water bodies and the environment. Special attention should be paid to and treatment applied for clinical waste (see HARVEY et al. 2002).

The complementary planning and organisation of hygiene promotion is critical in emergency sanitation; all users of emergency sanitation should contribute with their hygiene behaviour to minimising the spread of faecal-oral diseases and to restoring a healthy environment (see also awareness raising (see PPT)).

Adapted from: JOHANNESSEN & BIKABA (2009); OXFAM (2009); RUBERTO & JOHANNESSEN (2009)

In an emergency situation, the choice of dry or ecological toilet systems, such as urine diversion toilets, composting toilets, or terra preta toilets is very often driven by factors other than the re-use of its by-products. Such toilets first of all do not require any water to function safely and treatment is much easier if no infrastructure for treatement is available (e.g. drying and composting). Unlike pit latrines, they can be used for longer time, making them a much more attractive option in terms of longevity. Moreover, the dry system such as ecosan toilets are very often better suited to rocky ground or areas with high water tables, making them more resistant to cyclic flooding for instance.

Moreover urine diverting toilets reduce odour and flies and if refugee camps are established long-term, urine can for instance be reused for gardening (see also reuse of urine. However, ecological toilets require more careful operation and maintenance, and handling of excreta poses higher health risks. A case study has shown that ecological technologies e.g. UDDTs can be successfully implemented in the long-term phase of an emergency response (MWASE 2006). The two most important criteria for ecological toilet applicability have been identified as the awareness and expertise in ecological toilets within the aid agencies, and the availability of standardised, lightweight toilet units that are quick to assemble and easy to transport (VON MUENCH et al. 2006).