On July 19, three days after the earthquake, the priority of relief efforts shifted from treatment of injuries to public health concerns. For example, numerous broken pipes completely disrupted water systems, limiting the availability of potable water, and refugees who camped in open areas had no adequate toilet facilities. Early efforts at providing potable water by giving refugees chlorine granules were unsuccessful. Most potable water was distributed from fire engines, and Department of Health (DOH) sanitarians chlorinated the water before it was distributed. Surveys of refugee areas showed few latrines; these had to be dug by the DOH.