13. Planning for excreta disposal in emergencies
Technical Notes on Drinking-water,
Sanitation and Hygiene in Emergencies
The pressure to help people immediately after a disaster often leads to actions starting before they have been properly planned. Experience shows that this results in a waste of resources and in poor service delivery; it seldom leaves long-term benefits for the affected community. Among other issues, this is the case for emergency disposal. This Technical Note is a guide to the planning process of excreta disposal during the first two phases of an emergency. Technical options are presented in Technical Note 14.
Phases in an emergency
There are three phases in an emergency:
- Immediate emergency
In this phase, mortality rates can be high and there may be a risk of a major epidemic. The phase usually lasts for the emergency period and a few weeks beyond. The main objective for an excreta disposal programme is to minimize contamination related to high-risk practices and reduce exposure and faecal-oral disease transmission. Interventions are usually rapid and designed for the short term.
During this period more sustainable interventions can be implemented for longer-term use. Typically, community structures are re- established and death rates start to fall. However, the risk of epidemics may still be high. This phase can last from several months to many years, depending on the complexity of the emergency.
Stages in planning
Figure 13.1 shows the main stages for planning emergency excreta disposal. A common complaint about planning processes is that they take too long, but this is not necessarily the case as Figure 13.1 suggests. The figure shows the approximate time required for each stage for an affected population of about 10,000.
Figure 13.1. Stages in emergency sanitation programme design
Interventions are only necessary if there is an expressed and measurable real need for them. This stage aims to rapidly collect and analyse key information to assess if an intervention is indeed necessary.
The data required to assess the problems and needs of the affected population must be collected quickly but in sufficient detail to provide enough information for analysis. In Box 13.1 a checklist of twenty key questions is presented, to be answered in order to complete the assessment procedure. Information thus collected will support informed decision-making on the further course of action.
Box 13.1. Twenty questions for rapid assessment
Source: Adapted from Harvey et al., (2006)
The usefulness of the information collected will depend as much on how it is collected as on the quality of the questions asked. Even under normal circumstances, the information presented cannot always be trusted. In the chaotic circumstances of an emergency there is even more reason to doubt the validity of information provided.
Follow the principles listed in Box 13.2 to ensure that the data you produce are as accurate as possible.
Box 13.2. Data collection principles
The main things to remember when collecting data about an emergency are:
Like any other people, those affected by an emergency have views and opinions. There is no reason to treat them any differently than other communities – except to make allowances for the trauma they have experienced.
Involving communities in the planning and design process is beneficial to their recovery as it promotes self-respect and continued self-reliance. The affected community should be involved as soon as the decision to intervene has been made.
Who should get involved?
External organizations should only get involved if the affected institutions and population are unable to deal with the situation themselves and if the health of the population is getting (or is likely to get) worse (Figure 13.2). Tables 13.1 and 13.2 present health data that will assist in deciding whether or not to intervene.
Figure 13.2. The worsening health of the population is a reason for external organizations to get involved
|Disease||Incidence rate (in cases/10,000/week)|
|Diarrhoeal diseases total
Acute watery diarrhoea
Every suspected case must be acted upon
Table 13.1. Suggested maximum infection rates for displaced people
[Source: After de Veer (1998)]
|Crude mortality rate (CMR) Deaths/10,000/week||Severity of emergency|
3.5 – 6
7 – 14
15 – 35
|'Normal' or non-emergency rate
Stable and under control
Emergency / Out of control
Table 13.2. Crude mortality rates in emergencies
[Source: After Davis & Lambert (2002)]
Once a decision has been made to intervene the next step is to decide what to do. In emergencies, the normal methods of making decisions about which facilities to provide do not apply. Instead, a set of internationally-recognised standards are used to ensure that the services provided to people in distress are broadly the same around the world. Table 13.3 sets out indicators for emergency excreta disposal. A comparison of existing facilities with those presented in Table 13.3 will indicate whether any additional work needs to be done and whether it is urgent.
|Indicator||Immediate emergency||Stabilization phase|
|Coverage||50 people per latrine cubicle||20 people per cubicle|
|The ratio of female to male cubicles should be 3:1|
|Location||Less than 50m one way walking distance
At least 6m from a dwelling
|Less than 25m one way walking distance
At least 6m from a dwelling
|Privacy and security||Doors should be lockable from the inside
Latrines to be illuminated at night where necessary
Provision made for the washing and drying of menstruation cloths where necessary
|Hygiene||Handwashing facilities with soap to be supplied near to all toilets
Appropriate materials for anal cleansing to be provided
|Vulnerable groups||Adequate latrines should be accessible to disabled people, the elderly, the chronically sick and children|
Table 13.3. Indicators for minimum service levels for excreta disposal
[Source: Based on Sphere (2004)]
This stage develops an outline plan for what should be done, when and how. The plan contains sufficient information for senior officials to decide whether action should be taken and to allocate resources. The design should include the following sections:
- Goal: The ultimate aim of all the interventions in the emergency (i.e. sustaining life and protecting health). This will usually be stated in an organization’s charter.
- Purpose: What will be achieved by the proposed intervention (e.g. access to and use of hygienic latrines by the whole population).
- Outputs: What the actions will actually produce, such as a number of latrines constructed, the maintenance system established, or the changes in hygiene practices brought about.
- Activities: The actions carried out to achieve the outputs, such as purchasing materials, training staff, discussions with the community etc., with a timetable.
- Inputs: The resources needed to complete the work, namely: money, tools, equipment, materials and labour.
At times, the health threat is so great that something must be done immediately to prevent widespread disease and death. Immediate actions will be targeted at providing a quick response to an urgent situation (Figure 13.3), while time is dedicated to consider, design and approve a more sustainable solution (the outline design).
Figure 13.3. A simple trench latrine: an immediate action to an urgent situation
Once the outline design has been approved, a detailed activity plan must be drawn up prior to implementation. This process is the same as for any other sanitation project except that it must remain flexible in case the emergency situation changes or worsens. Figure 13.4 shows an example of an action plan for waste management improvements at a medical centre.
Figure 13.4. Action plan for waste management improvements at a medical centre undertaken by Médecins Sans Frontières (MSF)
Following detailed design, the implementation of the longer-term programme can commence. This should include specifications, implementation and management for:
- hygiene promotion;
- operation and maintenance;
- contingency planning (what to do if a major change happens); and
- monitoring and evaluation.
- Harvey, P., Baghri, S. and Reed (2002) Emergency Sanitation: Assessment and programme design, WEDC, Loughborough University, UK.
- Sphere (2004) Humanitarian Charter and Minimum Standards in Disaster Response, The Sphere Project: Geneva, Switzerland (Distributed worldwide by Oxfam GB) http://www.sphereproject.org/
- Harvey, P. (2007) Excreta disposal in emergencies – a field manual, WEDC, Loughborough University, UK http://wedc.lboro.ac.uk/publications/
- Ferron, S., Morgan, J. and O'Reily, M. (2007) Hygiene Promotion: a practical guide for relief and development, Practical Action, Rugby, UK.
- Potable Water Hauler Guidelines http://www. hamilton.ca/NR/rdonlyres/3C2443DF- 80FA-4708-8486-5F6935246FD1/0/ Apr10PH06012WaterHaulerInspectionProgram.pdf
Prepared for WHO by WEDC. Authors: Bob Reed. Series Editor: Bob Reed.
Editorial contributions, design and illustrations by Rod Shaw
Line illustrations courtesy of WEDC / IFRC. Additional graphics by Ken Chatterton.