The outbreak of hepatitis E in refugee camps in the Greater Darfur Region and in eastern Chad and the risk of a cholera outbreak following an outbreak in the central and western part of the country highlighted the urgent need to speed up water and sanitation activities in internally displaced persons (IDP) camps. Improvements in access to clean water and sanitary latrines coupled with health and hygiene education and promotion has been set by the United Nations consolidated Appeal for the Sudan Assistance Programme (ASAP) as one of five life-saving strategic priorities for the remainder of 2004 along with food and agriculture, health, shelter and non-food items (NFI). Around US$ 33 million for 2004, of which US$ 18 million is for the Assistance in Darfur only, are needed.
While the number of deaths from the recent outbreak of waterborne disease is small compared to those from other conflict-related causes, hepatitis E is nevertheless adding to the death toll and morbidity in the Greater Darfur Region. The region plunged into conflict beginning in February 2003. To date, more than 1.2 million are estimated to be displaced people and probably more are affected. WHO's environmental engineers have inspected the three Greater Darfur IDP camps and describe here the cocktail of environmental hazards that are set to cause more casualties and human suffering,
particularly to women.
Unprotected or open wells
Water from unprotected or open wells as seen in the camps is susceptible to contamination in a variety of ways including from: 1) containers which are used for retrieving water; 2) water that is spilled back into the well during the retrieval process; 3) various types of debris including garbage, dust, animal droppings; and 4) rainwater runoff which could contain feacal matter where sanitation conditions are poor.
In Kerenek camp in West Darfur, the State Ministry of Health ordered that open wells be closed until proper well improvements can be made. WHO recommends the closure of open wells, provided an adequate quantity of water is available to the population from other water sources, until they can be properly protected.
Open containers
Some families use open jerry cans and other containers for water hauling and storage. Water that is transported and stored in open containers is at risk of becoming contaminated by unclean hands or objects. WHO recommends that containers be narrow-necked or closed because these types of containers limit opportunities for water to be contaminated.
Transportation of water
Water hauling by donkey is customary in all of Sudan and the Greater Darfur Region. Goatskin bags on donkeys are a traditional way of transporting water from one location to another. Water has the potential to become contaminated during the filling of the bag, during transport, and during the emptying processes. Health and hygiene community health workers must give directions as to the filling and storage of the water. If water is not from a chlorinated source, then chlorination is highly recommended. Also users must filter the water with a cloth to get rid of small and large objects. The water must be stored in cleaned and closed containers at the household level.
Personal hygiene
With limited quantities of water available, as is the case in the IDP camps in Greater Darfur, water is likely to be used very sparingly for personal hygiene purposes such as clothes and hand washing. Hygiene promotion campaigns are crucial for disseminating messages on the importance of improved hygienic behaviour such as hand washing with soap, safe handling and storage of water in the home, proper disposal of children's faeces, importance of latrine cleaning, and safe food handling practices.
Flood waters
It's the rainy season in Darfur and these seasonal rains often cause flooding in the camps. Stagnant floodwater in and around camps is undesirable for several reasons. First, floodwaters, which may contain disease-causing pathogens, can contaminate well water by entering the wells when wellheads become submerged. Second, stagnant water increases the risk of malaria.
Collection of wood
In the camps, wood is collected for cooking. In such densely populated areas as camps, the collection of firewood can take a tremendous toll on the nearby environment. In addition, a competition for natural resources can lead to friction between the displaced population and the host population. As natural resources near the camp become more depleted, displaced people, particularly women and girls, may need to venture further away from camp perimeters putting them at risk for abuse and assault.
Population density has dramatically changed in some locations in Darfur. For example, the village of Mornei in West Darfur, which was originally populated by 5,000 people, ballooned to over 70,000 people as a result of the recent conflict.
Defecation in the field
Traditionally, people may be accustomed to defecating in open areas and this practice is continuing in or near camps because of a lack of adequate sanitation facilities. Latrine facilities should be adequate in number and design and properly cleaned and maintained to facilitate their use. Hygiene education and promotion regarding latrine use and maintenance is crucial. If defecation fields are temporarily used, they must be carefully identified so that water supply sources are protected from contamination from the field.
Digging trench latrines
Community mobilization is vital if people are to take ownership, responsibility, and pride in their water supply and sanitation facilities. Including and empowering women is also vital because the primary responsibility of household environmental activities often fall upon women. Females within a household play a pivotal role in every aspect of environmental health, including the hauling and storage of water, food preparation, gathering fire wood, latrine construction, cleaning of the children, and upkeep of the household environment.
WHO in the field
WHO continues to host outbreak control meetings with representatives of the state government, UN agencies, and NGOs to curtail the current hepatitis E infection and to prepare in the event of cholera or other disease outbreaks. These meetings have been critical for linking disease outbreak and control efforts. In some locations in Darfur, water and sanitation sector coordination has involved designating specific NGO partners as camp focal points for leading disease control efforts. These measures include water supply improvements, particularly chlorination and hygiene promotion activities.
WHO has and will continue to support the efforts of State Ministries of Health and other partners with supplies and equipment for environmental health related activities including water bladders, chlorine, water quality monitoring equipment, and vector control supplies.
The task at hand is great indeed. Humanitarian efforts are faced with the tremendous challenge of raising money and mobilizing human resources to provide clean water supplies, basic sanitation services and crucial hygiene education messages to over one million internally displaced persons.
For more information contact:
Ms Fadéla Chaib
WHO
Telephone: +41 22 791 3228
Mobile phone: +41 79 475 5556
Email: chaibfwho.int
Yvette Bivigou - Communications officer
WHO/Sudan
Telephone: +249 912 167 501
Email: bivigouysud.emro.who.int
who.int