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created_at: 2025-03-26 07:38:06
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created_at: 2025-03-26 07:38:06
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The United Nations Sustainable Development Goal 3 (SDG 3) aims to ensure healthy lives and promote well-being for all at all ages. This ambitious goal encompasses a wide array of direct and indirect health challenges, ranging from reducing maternal and child mortality and combating communicable and non-communicable diseases to addressing the detrimental impacts of poverty, inequality, lack of access to clean water and sanitation, and environmental degradation on health outcomes. This report provides a comprehensive overview of SDG 3, detailing its specific targets and outlining evidence-based solutions derived from extensive research for tackling these multifaceted health problems. Achieving SDG 3 is not only crucial for improving individual well-being but also forms a fundamental pillar for broader sustainable development, economic prosperity, and social equity, highlighting its interconnectedness with other Sustainable Development Goals.


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The 2030 Agenda for Sustainable Development, adopted by the United Nations in 2015, provides a global framework for addressing the most pressing challenges facing humanity. At the heart of this agenda are the 17 Sustainable Development Goals (SDGs), which offer a blueprint for achieving peace and prosperity for people and the planet, now and into the future 1. Among these goals, SDG 3 stands as a cornerstone, recognizing that health is a fundamental human right and a prerequisite for sustainable development 1. The well-being of individuals directly influences their capacity to participate in education, engage in productive work, and contribute to their communities 6. Indeed, healthy populations form the bedrock of thriving economies 2. Conversely, poor health can perpetuate cycles of poverty, limit economic opportunities, and hinder overall societal progress 6. This report aims to provide a detailed exposition of the guidelines and specific goals outlined within UN SDG 3. Furthermore,


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limit economic opportunities, and hinder overall societal progress 6. This report aims to provide a detailed exposition of the guidelines and specific goals outlined within UN SDG 3. Furthermore, it will delve into the intricate web of direct and indirect problems that SDG 3 seeks to address, offering comprehensive, evidence-based solutions derived from extensive research to facilitate the achievement of its ambitious targets. The scope of this analysis encompasses the thirteen specific targets articulated under SDG 3, alongside a thorough examination of the interconnected indirect factors that exert a significant influence on global health outcomes.


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The overarching guideline of SDG 3 is encapsulated in its central goal: "Ensure healthy lives and promote well-being for all at all ages" 1. This broad aspiration is further delineated into thirteen specific targets, each with a defined focus and timeline, primarily set for 2030, with one target aimed for 2020 2. These targets collectively represent a comprehensive strategy to tackle the diverse health challenges facing the global population. The targets range from addressing specific health outcomes like reducing maternal and child mortality to combating major epidemics and promoting mental health. They also encompass crucial aspects of healthcare access, including universal health coverage and access to essential medicines and vaccines. Furthermore, SDG 3 recognizes the importance of addressing environmental and behavioral risk factors that impact health. The targets also explicitly call for strengthening health systems, particularly in developing countries, and enhancing global


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addressing environmental and behavioral risk factors that impact health. The targets also explicitly call for strengthening health systems, particularly in developing countries, and enhancing global capacity for early warning and risk management of health threats 2. This multifaceted approach underscores the understanding that achieving good health and well-being requires interventions at various levels, from individual care to public health systems and global cooperation. The specific metrics associated with many of these targets, such as the reduction of maternal mortality to less than 70 per 100,000 live births, demonstrate a commitment to measurable progress and accountability 2. The breadth of these targets, addressing mortality, disease, prevention, access, and system strengthening, reflects a holistic vision for global health transformation. Recognizing that setting health goals alone is insufficient, SDG 3 explicitly addresses the necessary resources and infrastructure. The


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reflects a holistic vision for global health transformation. Recognizing that setting health goals alone is insufficient, SDG 3 explicitly addresses the necessary resources and infrastructure. The inclusion of targets related to research and development of vaccines and medicines for diseases primarily affecting developing countries (3.B), and the substantial increase in health financing and the health workforce in developing countries (3.C), underscores the critical role of enabling factors in achieving desired health outcomes.


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<table><tr><td>Target</td><td>Key Aim and Timeline</td><td>Key Indicators (Examples)</td></tr><tr><td>3.1</td><td>Reduce global maternal mortality ratio to less than 70 per 100,000 live births by 2030</td><td>Maternal mortality ratio (deaths per 100,000 live births) 8</td></tr><tr><td>3.2</td><td>End preventable deaths of newborns and children under 5 years of age by 2030</td><td>Under-5 mortality rate (deaths per 1,000 live births), Neonatal mortality rate (deaths per 1,000 live births) 8</td></tr><tr><td>3.3</td><td>End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases; combat hepatitis, water-borne diseases, and other communicable diseases by 2030</td><td>Number of new HIV infections per 1,000 uninfected population, Tuberculosis incidence per 100,000 population, Malaria incidence per 1,000 population at risk 8</td></tr><tr><td>3.4</td><td>Reduce by one-third premature mortality from non-communicable diseases through prevention and treatment; promote mental health and well-being by 2030</td><td>Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease, Suicide mortality rate 8</td></tr><tr><td>3.5</td><td>Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol</td><td>Coverage of treatment interventions for substance use disorders, Alcohol per capita consumption (aged 15+ years) 8</td></tr><tr><td>3.6</td><td>Halve the number of global deaths and injuries from road traffic accidents by 2020</td><td>Death rate due to road traffic injuries 8</td></tr><tr><td>3.7</td><td>Ensure universal access to sexual and reproductive health-care services, including family planning, information, and education by 2030</td><td>Proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods 8</td></tr><tr><td>3.8</td><td>Achieve universal health coverage (UHC), including financial risk protection and access to quality essential health-care services and affordable medicines and vaccines for all by 2030</td><td>Coverage of essential health services, Proportion of population with large household expenditures on health as a share of total household expenditure or income 8</td></tr><tr><td>3.9</td><td>Substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination by 2030</td><td>Mortality rate attributed to household and ambient air pollution, Mortality rate attributed to unsafe water, unsafe sanitation, and lack of hygiene 8</td></tr><tr><td>3.A</td><td>Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate</td><td>Age-standardized prevalence of current tobacco use among persons aged 15 years and older 8</td></tr><tr><td>3.B</td><td>Support research and development of vaccines and medicines for communicable and non-communicable diseases primarily affecting developing countries; provide access to affordable essential medicines and vaccines</td><td>Proportion of the target population covered by all vaccines included in their national program, Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis 8</td></tr><tr><td>3.C</td><td>Substantially increase health financing and the recruitment, development, training, and retention of the health workforce in developing countries, especially in least developed countries and small island developing States</td><td>Health worker density and distribution 8</td></tr><tr><td>3.D</td><td>Strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks</td><td>(Specific indicators not readily available in provided snippets)</td></tr></table>


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Target Key Aim and Timeline Key Indicators (Examples) 3.1 Reduce global maternal mortality ratio to less than 70 per 100,000 live births by 2030 Maternal mortality ratio (deaths per 100,000 live births) 8 3.2 End preventable deaths of newborns and children under 5 years of age by 2030 Under-5 mortality rate (deaths per 1,000 live births), Neonatal mortality rate (deaths per 1,000 live births) 8 3.3 End the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases; combat hepatitis, water-borne diseases, and other communicable diseases by 2030 Number of new HIV infections per 1,000 uninfected population, Tuberculosis incidence per 100,000 population, Malaria incidence per 1,000 population at risk 8 3.4 Reduce by one-third premature mortality from non-communicable diseases through prevention and treatment; promote mental health and well-being by 2030 Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease, Suicide mortality


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through prevention and treatment; promote mental health and well-being by 2030 Mortality rate attributed to cardiovascular disease, cancer, diabetes, or chronic respiratory disease, Suicide mortality rate 8 3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol Coverage of treatment interventions for substance use disorders, Alcohol per capita consumption (aged 15+ years) 8 3.6 Halve the number of global deaths and injuries from road traffic accidents by 2020 Death rate due to road traffic injuries 8 3.7 Ensure universal access to sexual and reproductive health-care services, including family planning, information, and education by 2030 Proportion of women of reproductive age (15-49 years) who have their need for family planning satisfied with modern methods 8 3.8 Achieve universal health coverage (UHC), including financial risk protection and access to quality essential health-care services and affordable medicines and


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satisfied with modern methods 8 3.8 Achieve universal health coverage (UHC), including financial risk protection and access to quality essential health-care services and affordable medicines and vaccines for all by 2030 Coverage of essential health services, Proportion of population with large household expenditures on health as a share of total household expenditure or income 8 3.9 Substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination by 2030 Mortality rate attributed to household and ambient air pollution, Mortality rate attributed to unsafe water, unsafe sanitation, and lack of hygiene 8 3.A Strengthen the implementation of the WHO Framework Convention on Tobacco Control in all countries, as appropriate Age-standardized prevalence of current tobacco use among persons aged 15 years and older 8 3.B Support research and development of vaccines and medicines for communicable and non-communicable diseases


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prevalence of current tobacco use among persons aged 15 years and older 8 3.B Support research and development of vaccines and medicines for communicable and non-communicable diseases primarily affecting developing countries; provide access to affordable essential medicines and vaccines Proportion of the target population covered by all vaccines included in their national program, Proportion of health facilities that have a core set of relevant essential medicines available and affordable on a sustainable basis 8 3.C Substantially increase health financing and the recruitment, development, training, and retention of the health workforce in developing countries, especially in least developed countries and small island developing States Health worker density and distribution 8 3.D Strengthen the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks (Specific indicators not readily available in


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the capacity of all countries, particularly developing countries, for early warning, risk reduction, and management of national and global health risks (Specific indicators not readily available in provided snippets)


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The aim of reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030 is a critical component of SDG 3 2. A significant proportion of maternal deaths occur in low-resource settings and are often preventable through access to appropriate sexual and reproductive health services 4. Ensuring that all births are attended by skilled health professionals, including doctors, nurses, and midwives, is paramount. Timely management and treatment of complications during pregnancy, childbirth, and the postpartum period can be life-saving for both mothers and newborns 9. Key interventions include the administration of oxytocics immediately after childbirth to reduce the risk of severe bleeding, practicing good hygiene to prevent infections, and detecting and appropriately managing conditions like pre-eclampsia with drugs such as magnesium sulfate to prevent eclampsia 9. Furthermore, preventing unintended pregnancies through universal access to contraception, safe


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managing conditions like pre-eclampsia with drugs such as magnesium sulfate to prevent eclampsia 9. Furthermore, preventing unintended pregnancies through universal access to contraception, safe abortion services to the full extent of the law, and quality post-abortion care is vital in reducing maternal deaths 9. Strengthening health systems, particularly the availability, accessibility, use, and quality of essential obstetric care, is crucial for creating an environment where these life-saving interventions can be consistently delivered 11. This includes ensuring the availability of parenteral antibiotics, oxytocics, and anticonvulsants, as well as facilities for manual removal of the placenta, removal of retained products of conception, assisted vaginal delivery, and blood transfusion 11. Sustainable impact on maternal mortality requires sector-wide approaches that allow for comprehensive improvements in health systems 11. The consistent emphasis on skilled birth attendance and


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11. Sustainable impact on maternal mortality requires sector-wide approaches that allow for comprehensive improvements in health systems 11. The consistent emphasis on skilled birth attendance and emergency obstetric care highlights their foundational role in preventing maternal deaths. Moreover, the clear link between preventing unintended pregnancies and reducing maternal mortality underscores the importance of comprehensive sexual and reproductive health services. Addressing maternal mortality necessitates systemic changes beyond individual interventions, requiring robust health systems capable of consistently delivering quality care.


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A core objective of SDG 3 is to end preventable deaths of newborns and children under 5 years of age by 2030, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births 2. A significant number of the estimated 5.9 million deaths in children under age 5 in 2015 were preventable 4. The leading causes of death in this age group include preterm birth complications, birth asphyxia/trauma, pneumonia, diarrhoea, and malaria, all of which can be prevented or treated with access to affordable interventions in health and sanitation 12. Access to basic life-saving interventions such as skilled delivery at birth, postnatal care, breastfeeding and adequate nutrition, vaccinations, and treatment for common childhood diseases can save many young lives 12. Malnourished children, particularly those with severe acute malnutrition, face a higher risk of death from common childhood illnesses 12.


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for common childhood diseases can save many young lives 12. Malnourished children, particularly those with severe acute malnutrition, face a higher risk of death from common childhood illnesses 12. Immunization programs and oral rehydration therapy (ORT) ORS have played a crucial role in reducing child mortality 13. Achieving this target requires targeted investments in available, accessible, quality healthcare, including skilled health personnel at birth, antenatal and postnatal care, care for small and sick newborns, preventive services such as vaccination, and diagnostic, preventive, and curative medicines 14. Addressing underlying social and environmental determinants of child health, such as nutrition and sanitation, is also paramount 12. The consistent emphasis on key interventions like vaccination, skilled birth attendance, and breastfeeding underscores their proven effectiveness. Furthermore, addressing nutrition and sanitation highlights the importance of broader social and


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like vaccination, skilled birth attendance, and breastfeeding underscores their proven effectiveness. Furthermore, addressing nutrition and sanitation highlights the importance of broader social and environmental factors. Achieving this target necessitates not only the availability of basic interventions but also ensuring they are of high quality and reach all children, especially in underserved communities.


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SDG 3 sets an ambitious goal to end the epidemics of AIDS, tuberculosis, malaria, and neglected tropical diseases by 2030, and to combat hepatitis, water-borne diseases, and other communicable diseases 2.


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HIV/AIDS: While progress has been made in reducing HIV incidence, with a decline observed between 2000 and 2015 4, the epidemic is far from over. UNAIDS has set ambitious 90-90-90 targets: by 2020, 90% of people living with HIV should know their status, 90% of those diagnosed should be on antiretroviral treatment, and 90% of those on treatment should have viral suppression 15. Achieving these targets requires scaling up HIV testing services, reducing the cost of antiretroviral therapy, and ensuring access to viral load testing 15. Efforts also focus on eliminating childhood AIDS through initiatives like Start Free, Stay Free, AIDS Free, aiming to provide treatment to 1.6 million children by 2018 and eliminate new infections among children by 2020 15. Ensuring access to a range of prevention options, including pre-exposure prophylaxis (PrEP), voluntary medical male circumcision, harm reduction, and condoms, is also crucial 15. Addressing the intersection of gender-based violence and HIV


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options, including pre-exposure prophylaxis (PrEP), voluntary medical male circumcision, harm reduction, and condoms, is also crucial 15. Addressing the intersection of gender-based violence and HIV risk is vital, as violence against women and girls increases their risk of HIV infection 16. Prioritizing the rights, health, and agency of women and girls, and ensuring their access to affordable and controllable HIV prevention methods, alongside accessible care and psychosocial support, is essential 16. Despite progress, a significant number of people living with HIV still lack access to life-saving treatment, and new infections remain alarmingly high, highlighting the need to address gender inequalities and funding shortfalls 17. The 90-90-90 targets provide a clear framework for treatment efforts, but persistent gaps indicate the need for continued action. The link between gender inequality and HIV risk underscores the importance of addressing social determinants. The ongoing


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efforts, but persistent gaps indicate the need for continued action. The link between gender inequality and HIV risk underscores the importance of addressing social determinants. The ongoing challenges in treatment access and new infections highlight the need to overcome barriers like stigma, discrimination, and inadequate funding.


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Tuberculosis: Similar to HIV/AIDS, tuberculosis incidence declined between 2000 and 2015, but ending the epidemic by 2030 requires intensified efforts 4. The 2023 UN High-Level Meeting on TB set new targets for 2023-2027, aiming to reach 90% of people with TB treatment and preventive treatment, ensure 100% of diagnosed individuals receive WHO-recommended rapid diagnostic tests, provide social benefit packages to all eligible people with TB, license at least one new TB vaccine, and reach US$22 billion annually for TB services and US$5 billion for research by 2027 18. Establishing high-level multisectoral mechanisms that report directly to heads of state is crucial for coordinating efforts across various sectors 18. The WHO's End TB Strategy also aims for a 95% reduction in TB deaths and a 90% reduction in TB incidence rate by 2035, along with ensuring no families face catastrophic costs due to TB 19. A multisectoral response at global, regional, and country levels is needed, with


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a 90% reduction in TB incidence rate by 2035, along with ensuring no families face catastrophic costs due to TB 19. A multisectoral response at global, regional, and country levels is needed, with increased political attention and effective tools for prevention, diagnosis, treatment, and care 19. Progress towards previous targets set in 2018 has been hampered by the COVID-19 pandemic and ongoing conflicts, resulting in shortfalls in treatment and preventive therapy coverage, as well as funding gaps for services and research 20. The launch of the TB Vaccine Accelerator Council aims to facilitate the development, licensing, and use of new TB vaccines 20. The repeated emphasis on multisectoral approaches highlights the need to address social determinants like poverty and malnutrition. The focus on developing a new TB vaccine acknowledges the limitations of current tools. The reported funding gaps and the impact of the pandemic underscore the need for sustained investment and resilient


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focus on developing a new TB vaccine acknowledges the limitations of current tools. The reported funding gaps and the impact of the pandemic underscore the need for sustained investment and resilient health systems.


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Malaria: Nearly half of the world's population remains at risk of malaria 4. Prevention strategies include avoiding mosquito bites through the use of insecticide-treated nets (ITNs), mosquito repellents, coils, vaporizers, and protective clothing 21. Vector control through ITNs and indoor residual spraying (IRS) is a vital component of malaria control and elimination strategies 21. Preventive chemotherapy, using antimalarial medicines for vulnerable populations, is also effective 21. Early diagnosis and treatment of malaria are crucial for reducing disease, preventing deaths, and limiting transmission 21. The Global Fund plays a significant role in financing malaria programs, supporting the distribution of millions of mosquito nets and indoor residual spraying 22. Innovations in malaria prevention and treatment include rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACT) 23. Intermittent preventive treatment for pregnant women (IPTp) and seasonal malaria


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prevention and treatment include rapid diagnostic tests (RDTs) and artemisinin-based combination therapies (ACT) 23. Intermittent preventive treatment for pregnant women (IPTp) and seasonal malaria chemoprevention (SMC) for children in high-risk areas are also key interventions 23. The WHO recommends the broad use of the RTS,S/AS01 and R21/Matrix-M malaria vaccines among children in regions with moderate to high transmission 21. Addressing antimalarial drug resistance through regular monitoring and the development of new drugs is essential 21. A comprehensive strategy involving vector control, preventive measures, early diagnosis and treatment, and vaccines is crucial. Sustained investment and equitable access to these interventions are paramount. The development and availability of malaria vaccines represent a significant advancement. The ongoing challenge of antimalarial drug resistance necessitates continuous research and monitoring.


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Neglected Tropical Diseases (NTDs): Ending the epidemics of neglected tropical diseases requires a multifaceted approach. The WHO recommends five core strategic interventions: innovative and intensified disease management, preventive chemotherapy (large-scale delivery of medicines), vector control, veterinary public health, and the provision of safe water, sanitation, and hygiene (WASH) 24. Combining these interventions often yields a more effective impact on both morbidity and transmission 24. Many NTDs are preventable through clean water, sanitary food handling, and good hygiene 25. Vector control measures, such as mass spraying of insecticides, can also be effective 25. Strengthening national capabilities to implement effective preventive, therapeutic, and control programs is crucial, including developing infrastructure for clinical and laboratory field operations, epidemiological analysis, surveillance systems, vector biology, and operational research 26. Integrated approaches that


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developing infrastructure for clinical and laboratory field operations, epidemiological analysis, surveillance systems, vector biology, and operational research 26. Integrated approaches that address multiple NTDs simultaneously can increase cost-effectiveness and expand coverage 24. The emphasis on preventive chemotherapy highlights the feasibility of reaching large populations. The strong link between NTDs and WASH underscores the importance of environmental health. Sustainable progress requires building local capacity and coordinating efforts across different programs and sectors.


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Hepatitis and Water-borne Diseases: Combating hepatitis and water-borne diseases necessitates a focus on prevention and treatment. For water-borne diseases, drinking clean and purified water, maintaining personal hygiene (especially handwashing), environmental management (proper sanitation), vaccination (for typhoid and hepatitis A), and ensuring food safety are key preventive measures 27. Treatment typically involves hydration therapy, antibiotics for bacterial infections, and antiparasitic medications for parasitic infections 27. For viral hepatitis, prevention strategies vary by type. Hepatitis B can be prevented through vaccination, including a birth dose within the first 24 hours 28. There is currently no vaccine for hepatitis C, so prevention focuses on avoiding behaviors that can spread the virus, such as sharing needles or practicing poor sanitation in healthcare settings 29. Safe practices for tattoos, piercings, and medical procedures are also important 29. Effective


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can spread the virus, such as sharing needles or practicing poor sanitation in healthcare settings 29. Safe practices for tattoos, piercings, and medical procedures are also important 29. Effective treatments, involving 8-12 weeks of oral therapy, are available for hepatitis C and can cure most people 29. Combating these diseases requires prioritizing vaccination, ensuring access to safe water and sanitation, promoting hygiene, and providing access to testing and treatment. While vaccines exist for hepatitis A and B, the lack of a vaccine for hepatitis C necessitates a focus on preventing transmission. Solutions for water-borne diseases are closely linked to improving water and sanitation infrastructure.


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Reducing premature mortality from non-communicable diseases (NCDs) by one-third by 2030 through prevention and treatment, and promoting mental health and well-being, is a significant challenge 2. NCDs, including cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases, were responsible for a large proportion of global deaths 4. Many NCDs share five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets, and air pollution 30. Prevention efforts should focus on controlling these risk factors through public health interventions and policies 30. Actions include reducing tobacco use, promoting physical activity, reducing harmful alcohol consumption, encouraging healthy diets, and improving air quality 30. Universal health coverage plays a critical role in the management of NCDs by ensuring access to detection, screening, treatment, and palliative care 30. Addressing modifiable risk factors through integrated prevention strategies


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a critical role in the management of NCDs by ensuring access to detection, screening, treatment, and palliative care 30. Addressing modifiable risk factors through integrated prevention strategies is key. Universal health coverage is crucial for ensuring equitable access to care. Promoting mental health and well-being alongside addressing physical NCDs is essential for overall health.


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Strengthening the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol, is crucial for public health 2. Evidence-based drug prevention programs can safeguard individuals and communities and weaken illicit economies 32. Drug use disorders are complex health conditions with psychosocial, environmental, and biological determinants, requiring multidisciplinary, comprehensive, and public health-oriented responses 33. Managing these disorders within the public health system, similar to other chronic medical conditions, is considered best practice 33. Prevention efforts should be evidence-based and aim to reduce the demand for illicit substances 33. Treatment services should be accessible, integrated, and well-coordinated 33. SAMHSA's initiatives in the US, such as the "Talk. They Hear You." campaign and the provision of funding through block grants, illustrate efforts to prevent underage drinking and substance misuse and support treatment and


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the US, such as the "Talk. They Hear You." campaign and the provision of funding through block grants, illustrate efforts to prevent underage drinking and substance misuse and support treatment and recovery 34. Evidence-based prevention programs are essential for preventing substance use. Multidisciplinary and comprehensive treatment services are needed for effective management. A public health approach that emphasizes treatment and harm reduction is crucial.


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The target of halving the number of global deaths and injuries from road traffic accidents by 2020, while the timeline has passed, remains a critical objective for improving global health 2. Road traffic accidents result in a significant number of fatalities and injuries each year, with vulnerable road users like children, pedestrians, cyclists, and older people being disproportionately affected 4. The UN Road Safety Strategy, built on five pillars – road safety management, safer vehicles, safer road users, post-crash response, and safer driving environments – provides a comprehensive framework for action 35. The Second Decade of Action for Road Safety (2021-2030) reiterates the goal of a 50% reduction in road deaths and serious injuries 35. Accelerating safety measures, particularly in low- and middle-income countries where vulnerable road users are at higher risk, is essential 36. Strengthening trauma and emergency care systems is also crucial for improving outcomes after accidents


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and middle-income countries where vulnerable road users are at higher risk, is essential 36. Strengthening trauma and emergency care systems is also crucial for improving outcomes after accidents 36. A holistic approach requires collaboration with local governments, urban planners, traffic police, and law enforcement 36. The five pillars of the UN Road Safety Strategy offer a comprehensive framework. Tailored interventions are needed to protect vulnerable road users in LMICs. Strengthening trauma and emergency care systems is crucial for improving outcomes.


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Ensuring universal access to sexual and reproductive health-care services by 2030, including for family planning, information, and education, and the integration of reproductive health into national strategies and programs, is a fundamental aspect of SDG 3 2. Women's rights to reproductive and sexual health are recognized as key to their overall health and are supported by international human rights documents 37. These rights encompass the right to life, liberty, security, health care, information, non-discrimination, autonomy, privacy, informed consent, and confidentiality 37. WHO's reproductive health strategy covers improving antenatal, perinatal, postpartum, and newborn care; providing family planning services; eliminating unsafe abortion; combating sexually transmitted infections (STIs); and promoting sexual health 38. While progress has been made in areas like HPV vaccination and contraceptive use, geopolitical tensions and global crises have caused setbacks 38. Addressing gender


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and promoting sexual health 38. While progress has been made in areas like HPV vaccination and contraceptive use, geopolitical tensions and global crises have caused setbacks 38. Addressing gender discrimination and violence, which undermine women's access to healthcare, is crucial 39. A rights-based approach is fundamental to ensuring universal access. A comprehensive range of services is needed, including family planning and maternal health. Addressing gender discrimination and violence is crucial for equitable access.


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Achieving universal health coverage (UHC) by 2030, including financial risk protection, access to quality essential health-care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all, is a core aim of SDG 3 2. UHC means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship 40. WHO recommends reorienting health systems using a primary health care (PHC) approach as the foundation for UHC 40. Achieving UHC requires strengthening health systems, ensuring financial risk protection, addressing health inequities, and fostering collaboration between governments, communities, and the private sector 40. Community-based organizations and civil society play a vital role in reaching local communities, particularly in low-income countries 42. A primary health care approach is a cornerstone for achieving UHC. Financial risk protection is a key element, ensuring


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role in reaching local communities, particularly in low-income countries 42. A primary health care approach is a cornerstone for achieving UHC. Financial risk protection is a key element, ensuring affordability. The involvement of community organizations is crucial for effective implementation.


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Substantially reducing the number of deaths and illnesses from hazardous chemicals and air, water, and soil pollution and contamination by 2030 is a critical environmental health target within SDG 3 2. Air and water pollution, along with poor management of hazardous chemicals, undermine health 43. Clean air, stable climate, adequate WASH, safe use of chemicals, and healthy workplaces are prerequisites for good health 44. Addressing this requires a stronger link between science and policy, international collaboration, and robust legislation 45. Policies and investments supporting cleaner transport, energy-efficient housing, and better waste management are essential 46. Individuals can also contribute by adopting sustainable practices in their daily lives 46. Addressing pollution requires strong regulations and enforcement. Investments in cleaner technologies and infrastructure are essential. A multi-sectoral approach, including the One Health framework, is necessary.


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Poverty has a profound and multifaceted negative impact on health 6. It exacerbates health risks, leads to higher mortality rates and undernourishment, and severely limits access to essential healthcare services 7. This creates a vicious cycle where poor health further entrenches poverty by limiting economic opportunities and increasing healthcare costs 6. Regions with the highest rates of extreme poverty, such as South Asia and sub-Saharan Africa, often experience the most significant health challenges, including high rates of hunger and malnutrition, which act as major barriers to overall development 48. SDG 1, which aims to end poverty in all its forms, is therefore intrinsically linked to achieving SDG 3 1. Solutions to mitigate the impact of poverty on health require a multipronged approach. Implementing nationally appropriate social protection systems and measures for all, including floors, can provide a safety net for the most vulnerable, ensuring access to basic services and


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approach. Implementing nationally appropriate social protection systems and measures for all, including floors, can provide a safety net for the most vulnerable, ensuring access to basic services and reducing their exposure to economic shocks that can worsen health outcomes 48. Ensuring that all individuals, particularly the poor and vulnerable, have equal rights to economic resources, as well as access to basic services like healthcare, education, and clean water and sanitation, is crucial 48. Building the resilience of the poor to climate-related extreme events and other economic and social shocks can also prevent further deterioration of their health status 48. Furthermore, addressing hunger and malnutrition through sustainable agricultural practices, supporting small-scale farmers, and ensuring equitable access to land, technology, and markets are essential for improving the nutritional status of impoverished populations and bolstering their overall health 48. Comprehensive social


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ensuring equitable access to land, technology, and markets are essential for improving the nutritional status of impoverished populations and bolstering their overall health 48. Comprehensive social protection programs are needed to provide a safety net. Economic empowerment initiatives can enable individuals to escape poverty. Addressing hunger and malnutrition is essential for improving nutritional status and overall health.


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Inequalities in income, social status, gender, and access to resources are significant drivers of health inequities 2. Countries with higher levels of income inequality often exhibit higher infant mortality rates, lower life expectancy, and a greater prevalence of non-communicable diseases, including mental illness and obesity 49. Health outcomes and access to health-promoting life conditions often follow a social gradient, with poorer health rates corresponding to lower socioeconomic positions 49. Gender discrimination systematically undermines women's access to healthcare due to factors such as fewer financial resources and constraints on mobility, further exacerbating health disparities 39. Progress towards achieving health-related SDGs has been uneven, both between and within countries, with significant gaps in life expectancy observed globally 48. Addressing these health inequalities requires policies that promote health equity across all segments of society. This includes


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with significant gaps in life expectancy observed globally 48. Addressing these health inequalities requires policies that promote health equity across all segments of society. This includes reducing inequalities in access to healthcare services, ensuring that quality care is available to all regardless of their socioeconomic status or geographic location 48. Multisectoral, rights-based, and gender-sensitive approaches are essential for tackling the underlying social and economic conditions that drive health inequities 48. Strengthening health systems to be more inclusive and equitable, and working with governments to improve health services for women and girls, including survivors of violence, are crucial steps 39. Policies promoting health equity need to address social determinants of health. Ensuring universal access to quality healthcare is essential for mitigating the impact of inequality. Adopting rights-based and gender-sensitive approaches is crucial for addressing the


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of health. Ensuring universal access to quality healthcare is essential for mitigating the impact of inequality. Adopting rights-based and gender-sensitive approaches is crucial for addressing the specific needs of marginalized populations.


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Access to clean water and sanitation is fundamental for preventing a wide range of diseases and promoting overall health and well-being 6. Lack of access to safe water sources is a leading cause of infectious diseases like diarrhoea, cholera, dysentery, hepatitis A, typhoid, and polio, and is a primary cause of illness and death among children under 5 in low- and middle-income countries 53. Waterborne diseases also place a heavy burden on healthcare systems 52. SDG 6 focuses specifically on ensuring availability and sustainable management of water and sanitation for all, and its achievement is critical for realizing the health targets of SDG 3 55. Improving access requires substantial investments in water and sanitation infrastructure, including the construction and maintenance of wells, pipelines, and sewage treatment plants 56. Promoting hygiene education, such as handwashing, is also crucial for reducing the spread of waterborne diseases 55. Community-led development approaches can


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and sewage treatment plants 56. Promoting hygiene education, such as handwashing, is also crucial for reducing the spread of waterborne diseases 55. Community-led development approaches can ensure that solutions are tailored to local contexts and are sustainable in the long term 57. Integrated water resource management is also essential for ensuring the sustainable and equitable use of water resources 55. Significant investment in infrastructure is crucial for expanding access. Promoting hygiene education is essential for maximizing health benefits. Integrated water resource management is necessary for sustainability.


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Environmental factors, including air and water pollution, poor management of hazardous chemicals, and the impacts of climate change, have significant direct and indirect effects on human health 6. Pollution and environmental factors are responsible for a substantial proportion of global deaths 59. Air pollution, in particular, is a major risk factor for non-communicable diseases, ranking just below high blood pressure and tobacco use 58. Climate change contributes to health problems through extreme weather events, food and water insecurity, and changes in the distribution of vector-borne diseases 58. Addressing these environmental threats requires a multifaceted approach. Implementing policies and making investments that support cleaner transport, energy-efficient housing, power generation, industry, and better municipal waste management are crucial 46. Strengthening the link between science and policy, fostering international collaboration, and enacting robust legislation are also


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industry, and better municipal waste management are crucial 46. Strengthening the link between science and policy, fostering international collaboration, and enacting robust legislation are also necessary 45. The health sector, through the One Health approach, plays a vital role in reducing pollution by recognizing the interconnectedness of human, animal, and environmental health 45. Individual actions, such as saving energy, using sustainable transport, reducing waste, and eating more vegetables, can also contribute to a healthier environment 47. Implementing policies to reduce air and water pollution is critical. Taking action to mitigate climate change is essential for preventing adverse health impacts. Strengthening environmental public health programs and promoting intersectoral collaboration are necessary for effective action.


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Achieving the ambitious targets of SDG 3 requires a concerted global effort employing integrated and multi-sectoral approaches. The solutions outlined in this report underscore the interconnectedness of health with various other aspects of sustainable development. Reducing poverty (SDG 1) and inequality (SDG 10) are fundamental for improving health outcomes, as are ensuring access to clean water and sanitation (SDG 6) and mitigating the negative impacts of environmental factors (SDGs 13, 14, 15). Furthermore, achieving gender equality (SDG 5) is crucial for ensuring women's access to essential health services. Sustained political will, adequate financial investment, robust monitoring and evaluation mechanisms, and effective global collaboration are indispensable for realizing the goals of SDG 3 by the 2030 deadline. Success in this endeavor holds the potential to transform global health, enhance well-being, and pave the way for a more sustainable and equitable future for all.


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All rights reserved for all countries. No reproduction, translation and adaptation may be done without the prior permission of the Copyright owner.


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Manual intended for the setting up of public health programmes in disadvantaged areas, particularly in refugee and displaced persons camps, and in health structures.


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Francisco Diaz, Jean-Francois Fesselet, Jan Heeger, Patrick Laurent, Charlie Mcqueen, Saskia Nijhof, Cecile Renaudin, Jordi Sacristan, Antoine Saintrain, Rutger Verkerk.


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Emmanuel Baron, Jean Bourgeois, Marc Coosemans, Eric de Miniac, Claire Dorion, Marie-Claire Durand, François Entin, Yannick Garbuzinski, Pierre Guillet, Henri Meyer, Peter Thomson, David Weatherill.


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Yves Chartier, Michel Courvallet, Gilles Delmas, Pierre de Rancourt, Guy Jacquier, Eric Laurent, Gérald Massis, Stéphane Quinton & Brigitte Renchon.


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This handbook is a collective accomplishment of the different sections of Médecins Sans Frontières (MSF), and has been written to consolidate the broad experience of MSF in the field of public health engineering. The first edition of this book was written in 1994 and is presently updated with a second edition.


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Public health engineering, long considered a specialist field by medical organizations, is not an end in itself. It has a direct influence on several major diseases related to poor water supply, hygiene and/or sanitation, like Chagas, Dengue, Diarrhoea, Guinea Worm, Malaria, Plague, Trachoma, Trypanosomiasis, Typhus, Viral Haemorrhagic Fevers or Yellow Fever. It is important to consider water supply, sanitation and hygiene not simply in terms of technical activities, but as an integral part of medical programs, in the same way as other preventive health work like vaccination, mother and child care and home visiting.


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The techniques described in this guide were chosen for their simplicity of implementation and maintenance, and because they are financially affordable. It is a handbook supporting the implementation of health programmes in deprived environments, in particular in closed settings like refugees and displaced persons camps, and in health structures. The purpose of the book is to increase the effectiveness with which relief workers can provide sound water, hygiene and sanitation assistance in precarious situations. To achieve this, the book provides pragmatic information to the field worker with a minimum of theoretical background.


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Nevertheless, it should always be borne in mind that, however good the techniques are in theory, it is only when they are correctly applied that they can have any health impact. However important it is to produce appropriate technical solutions, they have to be socially acceptable. The necessity for complementary activities such as health promotion and training of local technicians can never be too highly emphasized.


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The infrastructures described in this manual aim to improve the living conditions of populations in need and to reduce mortality and morbidity of affected populations. Paradoxically, fatal accidents can occur during the construction and/or the use of these infrastructures. Diggers can suffocate by natural gasses during excavation of dire needed wells. People can be crushed during collapse of inappropriate deep latrines. As such, the users of this manual are urged to take the provided security recommendations at heart to avoid human dramas.


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In addition to technical knowledge, the work of the "sanitarian" demands a good knowledge of the population being worked with, and of local hygiene practices. Some teaching skills and a sense of humour are also of great help.


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The guide starts with an introductory chapter (Chapter 1, "Management of Water, Hygiene and Sanitation Activities") covering the fundamentals of assessments and situation analysis, strategy definition and planning, implementation, monitoring and evaluation of projects.


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Chapter 2, "Water Supply", covers several aspects of water supply in precarious situations: water related diseases, required quantities based on basic human water needs, quality related to the characteristics of water, accessibility, different types of water resources with their protection and operation, water treatment methods, and distribution including transport and storage.


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Chapters 3 to 8 cover the different aspects of sanitation in precarious situations: "Safe Excreta Disposal" (Chapter 3), "Disposal of Runoff Water and Wastewater" (Chapter 4), "Collection and Disposal of Refuse" (Chapter 5), "Medical Waste Management" (Chapter 6), "Vector Control" (Chapter 7) and "Disposing of Dead Bodies" (Chapter 8).


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All the chapters of the guide are presented in a similar way. They start with a narrative section answering several questions according to the following sequence: Why, What, Where, When and by Who, and finally How. Each narrative section ends with a list of information sources (Further reading) that can be consulted if more information is required. Following each narrative section, practical Technical Briefs (T.B.) are presented, describing different techniques commonly used in the field.


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At the end, there is a glossary giving an as clear as possible definition of the technical terms used in this guide, or of those that are used every day in this domain. A conversion table, allowing to pass from the US / Imperial units system to the metric units system (and vice-versa), and formulas are also included.


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This guide was designed as an user’s manual. The authors strongly advise the user first to read it completely to have a good overview of what can be the water, hygiene and sanitation problematic in deprived environments, and then to utilize the needed issues, under the form of the Technical Briefs.


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Criticism and comments from users of this guide are welcomed. They are important to ensure that the guide is answering as appropriate as possible to the realities and needs of the field. Please send your comments to your technical Water, Hygiene and Sanitation referents.


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Chapter 4 : Disposal of Runoff Water and Wastewater Chapter 5 : Collection and Disposal of Refuse Chapter 6 : Medical Waste Management


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Humanitarian aid organisations are confronted daily with the deadly consequences of war, violence, natural catastrophes, poverty and illness. The typical contexts where the humanitarian aid has to intervene favour the spread of infectious diseases. In emergency situations, people are even more at risk of infection, linked to a weaker health condition and to exposure to new pathogens (lack of immunity to a disease or a particular strain of the disease in the settlement area). People are also more exposed to contextual risk factors including poor housing and extreme weather conditions, poor water, hygiene and/or sanitation conditions, population density, deterioration of health services and lack of access to effective treatment, physical (injuries) as well as socio-economical insecurity. Furthermore, people’s immunity can be weakened due to multiple infections and malnutrition.


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Diarrhoeal disorders kill millions of people each year, almost all of them in low-income countries, the vast majority children under five. Malaria is a major cause of morbidity and mortality in many parts of the world. Other diseases related to poor water supply, hygiene and/or sanitation (e.g. Chagas, Guinea Worm, Lassa Fever, Plague, Trachoma, Trypanosomiasis, Typhus, Yellow Fever) remain a major threat to millions in low income countries, particularly for those who are displaced or otherwise affected by conflicts and disasters.


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Providing in these precarious situations the basic supply of water, hygiene and sanitation (WHS) has a direct and documented impact on infectious diseases and should be included in the framework of the medical strategies. Their objective is to contribute to the reduction of morbidity and mortality. It is therefore important to consider water, hygiene and sanitation activities not simply in terms of technical programmes, but as an integral part of medical programmes, in the same way as other preventive work like vaccination, mother and child care and home visiting. Having access in these precarious situations to decent sanitation facilities also adds to the protection of human dignity.


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Water, hygiene or sanitation activities aim to reduce the environmental disease reservoirs and interrupt the transmission routes. Depending on the context, it means improving environmental hygiene and health by increased access to an adequate drinking water supply, a proper excreta disposal, runoff and waste water disposal, collection and disposal of refuse and medical waste, effective vector control interventions and proper disposal of dead bodies.


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WHS interventions, integrated within a more global medical project should be set up following the different stages of the project cycle. For a maximum health impact, attention should be given to the “technical aspect” as well as to the “human behavioural and cultural related aspect”. However good the techniques are, it is only when they are correctly used and maintained that they can have any prolonged impact on health. At the opposite, good health promotion programs cannot function without good quality infrastructures. WHS interventions have to answer to health problems but also to the beneficiaries needs.


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Water, hygiene and sanitation activities must be implemented in Health structures: this is to enable curative interventions and to prevent patients from being infected with another disease while in the health structure, as well as preventing health workers, visitors and neighbours from getting injured or infected. These WHS measures taken in the health structure consist of the Essential Requirements (T.B. 1.08) with regards to the provision of sufficient potable water, the provision of adequate excreta disposal, waste water, medical waste management and vector control. Furthermore, infection control measures must be respected and applied by all staff according to the universal / standard precautions.


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Water, hygiene and sanitation activities must also be implemented in case of humanitarian crises to prevent an increase of morbidity and mortality in the affected population. In acute humanitarian crises,


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the implementation of preventative water, hygiene and sanitation activities is mandatory. In chronic humanitarian crises (e.g. repetitive outbreaks of cholera, malaria and other infectious diseases) appropriate water, hygiene and sanitation activities must complement the other medical strategies to reduce and ultimately stop the spread of the disease by blocking the routes of transmission.


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The most appropriate water, hygiene and sanitation (WHS) implementation strategy will vary from place to place and over time, and has to be established in close co-operation with the whole coordination team and in close collaboration with the respective authorities. The involvement and close collaboration of both medical and non-medical staff are essential for the successful implementation of any WHS strategy. In case responsibilities are clear, this multidisciplinary approach increases largely the quality and impact of the projects.


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The project cycle allows prioritizing interventions, understanding how to establish them and to follow up their evolution. It is important to analyse and define the real problems first and then to fix and define the global objective, the specific objective(s) and the results that have to be reached during the life of the project, the activities to implement and the means needed. Tools that help this process are the problems and objectives trees, and the logic framework (section 1.5 Further Reading).


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According to the level of emergency, perform a rapid assessment (1 or 2 days) for an acute emergency, or a rapid and then a more in-depth assessment (from a few days to a few weeks) in case of chronic emergencies and stabilized situations.


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health data, in collaboration with medical teams (e.g. mortality and morbidity figures, weekly cholera incidence rates).


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There are a variety of methods and associated tools to collect water, hygiene and sanitation related data to complement the medical information. Data collections tools for assessments are described in


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The environment must be studied and described. A map, even basic must be established to visualize the global situation as well as the existing water, hygiene and sanitation facilities (T.B. 1.02). An area sampling (T.B. 1.03) can also be organized to evaluate the global size of the population of concern as well as the high and low population density areas within a camp.


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The checklists presented in this chapter help to target the required information and to prepare data collection methods that will be used during assessments:


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Even if these checklists help to target the information needed, they must however not be considered as a limit in the type of information and in the way to collect them. One must be aware that bias can exist in the information collected, specially if only interviews are used. A double crosscheck of the information should thus be undertaken.


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Once collected, those data must be analysed, notably by comparison with indicators like the Essential Requirements (T.B. 1.08, 1.09), and be used in all the remaining steps of the project cycle.


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On the basis of the assessment and analysis, the strategy planning can be initiated. A global objective must first be established. From there, specific objectives and results that have to be reached must be defined. Activities to obtain each of these results must be determined. During this phase, human and logistic needs allowing to put the activities in place must also be defined.


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Finally, a detailed budget must be joined to all proposals of intervention. This budget must be designed on the basis of the human and logistic needs and of a chronogram of intervention.


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From a general point of view and during all the duration of the project, it is extremely important to maintain and/or to reinforce the links with the population and other actors, like institutions, traditional social groups and/or other aid-agencies.


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The essence of the intervention lies in the tangible realisations and not in never-ending assessments and planning. The period between the initial assessment (exploratory phase) and the first actions in an acute emergency can be very short. The extreme seriousness of some situations (e.g. starvation, conflicts, population displacement) requires a quick start-up with tangible realisations. It is not compulsory to obtain all the means desired before starting up an intervention. Every action aiming to rapidly improve the living conditions of an at-risk population is welcome.


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For chronic emergencies and stabilized situations, the period covering the initial assessment to the implementation phase can be longer because of the in-depth assessment and the longer strategy planning phase.


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Training modules for the staff should come with the start-up of the activities to be able to guarantee their quality and their success. Every member of the team should know his responsibilities and must have access to the information and the tools needed to achieve the tasks he is responsible for.


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The objective of monitoring is to guarantee the permanent appropriateness between the objectives, the means implemented, the expected results and the results reached in the frame of the chronogram of the intervention. Monitoring is the regular observation and recording of activities taking place in a project. It is a process of routinely gathering information on all aspects of the project. Here again, activity reports, financial updates and permanent communication between the medical and logistical teams allowing to present epidemiological data and related improvements are of utmost importance. It is a very dynamic phase generating several questions, but also proposing alternative solutions allowing an increase in the performances. It requires a lot of flexibility to accept to modify point of views or decisions no longer considered as pertinent, and also a lot of energy to be able to locate the elements blocking the project.


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In the context of these guidelines dedicated to water, hygiene and sanitation, data collection methods (T.B. 1.01) can also be used as a monitoring tool. The different checklists presented in this chapter (T.B. 1.04 to 1.07) can also be used to prepare the monitoring tools; by comparison between the data collected based on the checklists during the assessment phase and during the implementation, improvements in the water, hygiene and sanitation situation can be detected.


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Evaluating a project is to look at its real impact (e.g. morbidity and mortality reduction) and at the results of the activities. It is also to evaluate if the global and specific objectives and their specific activities (e.g. WHS activities) are reached. The evaluation allows to highlight the strengths and the weaknesses of the project and to correct the situation if needed. An evaluation can be done at any time during the life of the project and is essential to allow improvements to occur and (potentially) a redefinition of the specific objectives that have to be reached during an extension of the project.


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Familiarise yourself and the data collection team with the methods, prior to use. Use the methods that the data collection team and the participants feel most comfortable with.


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Be unobtrusive and considerate in your approach. Practitioners should be sensitive to the cultural and social context and not raise unrealistic expectations from the beneficiaries.


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Respect informant confidentiality and security; data collection should have the consent of the community.


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Stimulate the data collection activity, but without “leading” the participants into a particular response or direction.


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<table><tr><td>Name</td><td>Description</td><td>Purpose</td><td>Material / Tools</td></tr><tr><td>Desk based literature review</td><td>Reading of relevant information that is already available in: -documents (e.g. medical, water, hygiene and sanitation). -medical data sheets. -books / guidelines / manuals</td><td>-To gain an insight of the situation before the assessment on the field is started (this review can already start in the headquarters or on the way to the study site).</td><td>-Reports (e.g. minutes of meetings, sitreps) -Medical data sheets -Books / guidelines -Media (e.g. newspapers)</td></tr><tr><td>Key- informant interview</td><td>Interviewing informally anyone who can provide detailed information, on the basis of his special expertise or knowledge of a particular issue: e.g. village leader, local health worker, hospital director, head nurse, entomologist. NB: Women (and children) can often be key-informants in water, hygiene and sanitation matters.</td><td>-To gain a good overview of the relevant (water and sanitation) issues. -To feed the potential in-depth assessment. -To identify issues to cover / validate in (structured) observations.</td><td>-List of topics to cover (based on checklists) -Basic survey form -Notebook and pencil</td></tr><tr><td>Mapping and area sampling (T.B. 1.02 and 1.03)</td><td>Drawing of a map of the study site, showing places or features that are important for the project: e.g. water sources, defecation areas, roads / buildings. Area sampling permits a good estimation of the population number, the household size and the average available space per person.</td><td>-Different maps can be made of the area and used for orientation and planning purposes. -The estimation of the population living in a closed setting helps to determine important data such as Crude Mortality Rate, the quantity needed for water and latrines. -To feed the potential in-depth assessment.</td><td>-Compass / GPS -Long tape measure -Hand clicker -Note book and pencil -Graph paper -Ruler -Calculator -Rope</td></tr><tr><td>Health walk</td><td>A walk through the study site(s) in a meandering fashion, to gather information through (unstructured) observations and informal talks with the population. NB: Most effective when carried out at dawn or dusk, when most hygiene practices and water collection occur.</td><td>-To familiarise yourself with the physical context in which hygiene practices occur. -To investigate how people behave in their daily routines -To feed the potential in-depth assessment.</td><td>-List of topics to cover (based on checklists) -Map if available -Basic survey form -Note book and pencil</td></tr><tr><td>Spot-check observation</td><td>Record information (defined on a clear but short list of topics) during the first moment of observation (e.g. quick observation of the issues on the spot-check list when entering a dwelling / hospital service or ward). NB: A rapid method particularly useful when time is a major constraint.</td><td>-To investigate the presence or absence of some clearly defined hygiene / health behaviour and practices -To feed the potential in-depth assessment.</td><td>-Spot-check list (based on previous data collection / checklists) -Basic survey form Note book and pencil</td></tr></table>


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Name Description Purpose Material / Tools Desk based literature review Reading of relevant information that is already available in: -documents (e.g. medical, water, hygiene and sanitation). -medical data sheets. -books / guidelines / manuals -To gain an insight of the situation before the assessment on the field is started (this review can already start in the headquarters or on the way to the study site). -Reports (e.g. minutes of meetings, sitreps) -Medical data sheets -Books / guidelines -Media (e.g. newspapers) Key- informant interview Interviewing informally anyone who can provide detailed information, on the basis of his special expertise or knowledge of a particular issue: e.g. village leader, local health worker, hospital director, head nurse, entomologist. NB: Women (and children) can often be key-informants in water, hygiene and sanitation matters. -To gain a good overview of the relevant (water and sanitation) issues. -To feed the potential in-depth assessment. -To identify


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can often be key-informants in water, hygiene and sanitation matters. -To gain a good overview of the relevant (water and sanitation) issues. -To feed the potential in-depth assessment. -To identify issues to cover / validate in (structured) observations. -List of topics to cover (based on checklists) -Basic survey form -Notebook and pencil Mapping and area sampling (T.B. 1.02 and 1.03) Drawing of a map of the study site, showing places or features that are important for the project: e.g. water sources, defecation areas, roads / buildings. Area sampling permits a good estimation of the population number, the household size and the average available space per person. -Different maps can be made of the area and used for orientation and planning purposes. -The estimation of the population living in a closed setting helps to determine important data such as Crude Mortality Rate, the quantity needed for water and latrines. -To feed the potential in-depth assessment. -Compass / GPS -Long


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living in a closed setting helps to determine important data such as Crude Mortality Rate, the quantity needed for water and latrines. -To feed the potential in-depth assessment. -Compass / GPS -Long tape measure -Hand clicker -Note book and pencil -Graph paper -Ruler -Calculator -Rope Health walk A walk through the study site(s) in a meandering fashion, to gather information through (unstructured) observations and informal talks with the population. NB: Most effective when carried out at dawn or dusk, when most hygiene practices and water collection occur. -To familiarise yourself with the physical context in which hygiene practices occur. -To investigate how people behave in their daily routines -To feed the potential in-depth assessment. -List of topics to cover (based on checklists) -Map if available -Basic survey form -Note book and pencil Spot-check observation Record information (defined on a clear but short list of topics) during the first moment of observation (e.g. quick


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-Map if available -Basic survey form -Note book and pencil Spot-check observation Record information (defined on a clear but short list of topics) during the first moment of observation (e.g. quick observation of the issues on the spot-check list when entering a dwelling / hospital service or ward). NB: A rapid method particularly useful when time is a major constraint. -To investigate the presence or absence of some clearly defined hygiene / health behaviour and practices -To feed the potential in-depth assessment. -Spot-check list (based on previous data collection / checklists) -Basic survey form Note book and pencil


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<table><tr><td>Name</td><td>Description</td><td>Purpose</td><td>Material / Tools</td></tr><tr><td>Desk based literature review</td><td>Reading of relevant information that is already available in: -documents (e.g. medical, water, hygiene and sanitation). -medical data sheets. -books / guidelines / manuals.</td><td>-To gain an insight of the situation before the assessment is taken back to the field again (this review can already be done at the office).</td><td>-Reports (e.g. minutes of meetings) -Medical data sheets -Books / guidelines -Information collected during the initial assessment</td></tr><tr><td>Structured observation</td><td>(Continuous) observation to collect information defined on a clear but short list of topics: e.g. Continuous structured observation (e.g. each time an action listed on the observation sheet is done, it is marked on the sheet). Ticketing (e.g. each time a person collects water, a mark is put on the ticketing sheet).</td><td>-To see where water and sanitation-related facilities are located. -To obtain information on water, hygiene and sanitation issues and practices in and around these facilities, at people’s homes or in their working environment, in health structures.</td><td>-Observation checklist (based on previous data collection / checklists) -Ticketing schedule -Pencil</td></tr><tr><td>Structured interview</td><td>Interviewing people based on a questionnaire with closed ended questions on predetermined topics (e.g. the answer can only be yes or no, or an option within a multiple choice question).</td><td>-To collect mainly factual and quantitative data (data is relatively easy to collect and to interpret as it is a preconceived questionnaire, which on the other hand is difficult to prepare).</td><td>-Written interview with closed questions on predetermined topics (based on previous data collection / checklists) -Pencil</td></tr><tr><td>Semi- structured interview</td><td>Interviewing people based on a questionnaire with open ended questions on predetermined topics (e.g. person being interviewed can answer with his own words). NB: it is useful to have an assistant to take notes.</td><td>-To investigate general as well as specific issues by asking questions, informally but systematically. -To investigate which hygiene / health practices are ideal / acceptable, and why. -Collection of qualitative data.</td><td>-Written interview with open ended questions on predetermined topics (based on previous data collection / checklists) -Notebook and pencil</td></tr><tr><td>Focus group discussion</td><td>Discuss a specific topic of interest to the investigator with a small group of people having similar backgrounds or experiences. NB: it is necessary to be at least two for the focus group discussion: 1 moderator and 1 person taking notes.</td><td>To investigate: -A range of opinions / points of views on the topic of interest. -The wide variety of local terms and expressions linked to the topic of interest. -The meanings of survey findings that cannot be explained (statistically).</td><td>-Written open ended questions and/or pictures to introduce the topic of interest -Notebook and pencil (and/or tape recorder)</td></tr></table>


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Name Description Purpose Material / Tools Desk based literature review Reading of relevant information that is already available in: -documents (e.g. medical, water, hygiene and sanitation). -medical data sheets. -books / guidelines / manuals. -To gain an insight of the situation before the assessment is taken back to the field again (this review can already be done at the office). -Reports (e.g. minutes of meetings) -Medical data sheets -Books / guidelines -Information collected during the initial assessment Structured observation (Continuous) observation to collect information defined on a clear but short list of topics: e.g. Continuous structured observation (e.g. each time an action listed on the observation sheet is done, it is marked on the sheet). Ticketing (e.g. each time a person collects water, a mark is put on the ticketing sheet). -To see where water and sanitation-related facilities are located. -To obtain information on water, hygiene and sanitation issues and practices


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collects water, a mark is put on the ticketing sheet). -To see where water and sanitation-related facilities are located. -To obtain information on water, hygiene and sanitation issues and practices in and around these facilities, at people’s homes or in their working environment, in health structures. -Observation checklist (based on previous data collection / checklists) -Ticketing schedule -Pencil Structured interview Interviewing people based on a questionnaire with closed ended questions on predetermined topics (e.g. the answer can only be yes or no, or an option within a multiple choice question). -To collect mainly factual and quantitative data (data is relatively easy to collect and to interpret as it is a preconceived questionnaire, which on the other hand is difficult to prepare). -Written interview with closed questions on predetermined topics (based on previous data collection / checklists) -Pencil Semi- structured interview Interviewing people based on a questionnaire


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-Written interview with closed questions on predetermined topics (based on previous data collection / checklists) -Pencil Semi- structured interview Interviewing people based on a questionnaire with open ended questions on predetermined topics (e.g. person being interviewed can answer with his own words). NB: it is useful to have an assistant to take notes. -To investigate general as well as specific issues by asking questions, informally but systematically. -To investigate which hygiene / health practices are ideal / acceptable, and why. -Collection of qualitative data. -Written interview with open ended questions on predetermined topics (based on previous data collection / checklists) -Notebook and pencil Focus group discussion Discuss a specific topic of interest to the investigator with a small group of people having similar backgrounds or experiences. NB: it is necessary to be at least two for the focus group discussion: 1 moderator and 1 person taking notes. To investigate: -A


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a small group of people having similar backgrounds or experiences. NB: it is necessary to be at least two for the focus group discussion: 1 moderator and 1 person taking notes. To investigate: -A range of opinions / points of views on the topic of interest. -The wide variety of local terms and expressions linked to the topic of interest. -The meanings of survey findings that cannot be explained (statistically). -Written open ended questions and/or pictures to introduce the topic of interest -Notebook and pencil (and/or tape recorder)


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<table><tr><td>Name</td><td>Description</td><td>Purpose</td><td>Material / Tools</td></tr><tr><td>Community / Health structure mapping</td><td>The participants are asked to make a map of their community / health structure, showing places that are important for them (e.g. market place) and to include features of interest to the investigator (e.g. water sources, latrines).</td><td>-To find out what facilities related to health and hygiene exist and to which the community has access. -To find out about hygiene and sanitation resources in people’s homes or health structures (e.g. latrines). -To find out how the community / health staff perceives its surrounding / working environment and what it prioritises within it.</td><td>-Blackboard and chalk or -Paper and markers</td></tr><tr><td>Three pile sorting</td><td>Participants have to discuss and decide if water, hygiene and sanitation related activities presented on the pictures are good, bad or in-between, and why. Once consensus is reached, the picture is placed in the appropriate good, in-between or bad pile. The discussions between the participants will provide essential information to the investigator.</td><td>-To break down social barriers and establish good communication. -To introduce potentially sensitive / personal topics (e.g. latrine use) that need to be investigated (knowledge / perception of the participants). -To choose improved hygiene behaviour, based on people’s perceptions and needs.</td><td>-Sets of pictures showing water and sanitation related activities -Good, bad and in-between signs -Notebook and pen</td></tr><tr><td>Pocket chart</td><td>The participants can indicate individually and secretly which water, hygiene and sanitation resources / methods, depicted on a matrix, they are using. The discussions between the participants afterwards will provide essential information to the investigator on the actual water, hygiene and sanitation practices. NB: each picture should be defined and its meaning agreed upon before a vote on a predefined aspect of the picture takes place.</td><td>-To investigate which resource / method is actually used, for what purpose, or by which population group (e.g. investigation on defecation methods used).</td><td>-Sets of pictures showing water, hygiene and sanitation activities. -Voting cards -Pocket chart -Notebook and pen</td></tr><tr><td>Gender / Staff role task analysis</td><td>An investigation of gender / staff issues, particularly in relation to task allocation and resource management. Pictures on various water, hygiene and sanitation activities are passed around and the participants are asked about who is performing the different tasks. Once consensus is reached, the picture is placed in the appropriate man, woman or both / medical, non-medical or both pile. The discussions between the participants will provide essential information to the investigator.</td><td>-To find out which activities or tasks are acceptable for / assigned to men, women or both / medical staff, non-medical staff or both, and why.</td><td>-Sets of pictures showing relevant activities / tasks -Picture of a man, woman and both together / of medical, non-medical staff and both together -Notebook and pen</td></tr></table>


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Name Description Purpose Material / Tools Community / Health structure mapping The participants are asked to make a map of their community / health structure, showing places that are important for them (e.g. market place) and to include features of interest to the investigator (e.g. water sources, latrines). -To find out what facilities related to health and hygiene exist and to which the community has access. -To find out about hygiene and sanitation resources in people’s homes or health structures (e.g. latrines). -To find out how the community / health staff perceives its surrounding / working environment and what it prioritises within it. -Blackboard and chalk or -Paper and markers Three pile sorting Participants have to discuss and decide if water, hygiene and sanitation related activities presented on the pictures are good, bad or in-between, and why. Once consensus is reached, the picture is placed in the appropriate good, in-between or bad pile. The discussions between  the


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presented on the pictures are good, bad or in-between, and why. Once consensus is reached, the picture is placed in the appropriate good, in-between or bad pile. The discussions between  the  participants  will  provide  essential information to the investigator. -To break down social barriers and establish good communication. -To introduce potentially sensitive / personal topics (e.g. latrine use) that need to be investigated (knowledge / perception of the participants). -To choose improved hygiene behaviour, based on people’s perceptions and needs. -Sets of pictures showing water and sanitation related activities -Good, bad and in-between signs -Notebook and pen Pocket chart The participants can indicate individually and secretly which water, hygiene and sanitation resources / methods, depicted on a matrix, they are using. The discussions between the participants afterwards will provide essential information to the investigator on the actual water, hygiene and sanitation practices.


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depicted on a matrix, they are using. The discussions between the participants afterwards will provide essential information to the investigator on the actual water, hygiene and sanitation practices. NB: each picture should be defined and its meaning agreed upon before a vote on a predefined aspect of the picture takes place. -To investigate which resource / method is actually used, for what purpose, or by which population group (e.g. investigation on defecation methods used). -Sets of pictures showing water, hygiene and sanitation activities. -Voting cards -Pocket chart -Notebook and pen Gender / Staff role task analysis An investigation of gender / staff issues, particularly in relation to task allocation and resource management. Pictures on various water, hygiene and sanitation activities are passed around and the participants are asked about who is performing the different tasks. Once consensus is reached, the picture is placed in the appropriate man, woman or both / medical,


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are passed around and the participants are asked about who is performing the different tasks. Once consensus is reached, the picture is placed in the appropriate man, woman or both / medical, non-medical or both pile. The discussions between the participants will provide essential information to the investigator. -To find out which activities or tasks are acceptable for / assigned to men, women or both / medical staff, non-medical staff or both, and why. -Sets of pictures showing relevant activities / tasks -Picture of a man, woman and both together / of medical, non-medical staff and both together -Notebook and pen


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Step in a normal pace along a preset length (e.g. 100 m) and count the number of footsteps needed to cover the distance. The average footstep can then be calculated by dividing the preset length by the number of footsteps: e.g. 100 m/119 steps = average footstep of 0.84 m.


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Point the direction arrow towards the next landmark and rotate the graduation ring until the graduation ring arrow is in position with the magnetic needle indicating the north (0°).


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Note the bearing (degrees of the angle in between the direction of the second landmark and the north). The bearing can be read on the graduation ring at the position of the direction arrow.


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Start walking in a normal pace towards the next landmark and count the number of footsteps needed to arrive there. In order not to make mistakes during the counting of the footsteps, it is strongly recommended to use a hand clicker.


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Keep on doing the same procedure from landmark to landmark until the starting point is reached again.


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Choose a place on a graph (millimetre) paper to plot the first landmark. This first mark should be chosen in order that all the other landmarks can be plotted on the same sheet, taking into account that the north should be on the top of the paper. It is also necessary to decide the scale of the map from the beginning.


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Rotate the graduation ring until the correct first bearing (measured during the landmark recording) is positioned exactly in front of the direction arrow.


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Put the preset compass with one of its long edges on top of the first designated landmark on the paper and turn it around this point until the graduation ring arrow points exactly towards the top of the paper, which is the north of the map (the parallel lines of the graduation ring should be exactly in position with the vertical lines of the graph paper).


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Draw a line on the graph paper starting from the first landmark following the direction arrow of the compass. Drawing the line in the opposite direction of the arrow will be an error that is dragged along in the remaining of the plotting, resulting in a faulty map.


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Convert the number of footsteps between the first and second landmark into the actual distance, which needs to be adapted for the map according to the chosen scale.


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Keep on doing the same procedure from landmark to landmark until the starting point on the map is reached again.


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Count and number the squares within the perimeter. Partial squares with at least half of their surface within the perimeter are calculated as whole ones, whereas those with less than half of their surface within the perimeter are ignored. It is estimated that the partial squares that have been included as whole ones compensate for the ignored partial squares. The total number of squares considered to be within the perimeter of the figure equals 71.


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Multiply the total numbers of squares (complete and accepted partial ones) with 625 m² (surface of a 25 m x 25 m square). This calculation will give an acceptable estimation of the total surface of the site. For the figure, the total surface is estimated at 71 x 625 m² = 44,375 m² or 4.4375 ha.


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<table><tr><td>C</td><td/><td/></tr><tr><td>Point</td><td>Degrees (°)</td><td>Meters</td></tr><tr><td>1</td><td>135</td><td>100</td></tr><tr><td>2</td><td>180</td><td>100</td></tr><tr><td>3</td><td>225</td><td>120</td></tr><tr><td>4</td><td>310</td><td>70</td></tr><tr><td>5</td><td>250</td><td>50</td></tr><tr><td>6</td><td>295</td><td>150</td></tr><tr><td>7</td><td>75</td><td>100</td></tr><tr><td>8</td><td>25</td><td>100</td></tr></table>


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C Point Degrees (°) Meters 1 135 100 2 180 100 3 225 120 4 310 70 5 250 50 6 295 150 7 75 100 8 25 100


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The study site will be mostly a refugee / displaced persons camp or a health structure, but it could also be a village or even a sector of a town (e.g. slum area).


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Walk as much as possible in a normal pace in order to stick to the average footstep length. However, footsteps will vary in length when climbing / descending a steep slope or when the access of the terrain is difficult.


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All the landmarks should be more or less located around the external limits of the site. However, don’t choose too many landmarks as this will increase the workload, not only to record them but also to draw the map. Obviously, the more landmarks are taken, the more the final map will resemble the reality of the field. But such precision is in most cases not necessary, and certainly not during acute emergencies.


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Be aware that the indication (precision) on the rotating graduation ring is often at 2 degrees interval.


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During the plotting of the landmarks of the map, the magnetic needle of the compass doesn’t play any role anymore.


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The scale of 1/10.000 is often chosen for a first map because 100 m on the field corresponds to 1 cm on the graph paper. This enables mostly to put the whole site on one A4 sheet, which is sufficient for the first usages of the map. It is important that the scale is indicated directly on the map.


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When the last line, plotted according the measured bearing and up to scale length, ends a long way from the first landmark on the drawn map, it indicates that something went wrong during the mapping. All marks should be verified according to their up-to-scale length and their bearing. A common mistake is that a line is drawn in the opposite direction of what it should be (180° off). Once this has happened, the map can’t be correct anymore. If after thorough verification and potential re-plotting of the whole map, the final mark still doesn’t correspond at all with the first mark, it’s probable that something went wrong during the recording of the landmarks on the field.


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Small discrepancies in between the final and the first mark are common and mostly due to small inaccuracies during the recording of the landmarks and the plotting of the map. These aren’t worrying because the mapping technique can only provide a sketch of the actual situation on the field anyway.


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The simple map of a camp will often be used as a basis for area sampling (T.B. 1.03). The initial map or a more precise version with more landmarks in a later stage can also be used to indicate specific places (e.g. river, wells) and facilities (e.g. latrines, health centre) that are important for the overall program. These indications can be directly drawn on the map, but a legend should be added on the paper to explain the symbols used.


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Instead of using a compass, the mapping can also be done by means of a GPS (Global Positioning System). Each time a landmark is passed, a simple click on the GPS will mark its coordinates (latitude and longitude). It will have to be verified beforehand however if it is set in decimal degrees (e.g. 39.4567° with a 4 decimal place position). As it won’t be necessary anymore to count the steps, nor to measure the angles in between sequential landmarks, the circumference of the site can be covered a lot quicker. The plotting of the landmarks on paper can be done by introducing manually all the coordinates of the landmarks into a computer or (even more rapidly) by connecting the GPS directly to the computer to download them, using an appropriate software program. Be also aware that the imprecision of a GPS can be as high as 10 m, which might be a problem for small study sites, but not for big ones.


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A car could also be used to do the mapping, certainly for very big sites. The distances could be measured with the odometer of the car, but be aware that the precision is only 100 m. The use of a GPS is certainly recommended in this case.


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Count on the map that was obtained by the mapping method (T.B. 1.02.) from left to right and from top to bottom all the complete 25 m x 25 m squares. Do not include the partial squares, even if they have more than half of their surface inside the perimeter. The number of complete squares on the figure equals 50.


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Select on the map through systematic sampling at least 15 complete squares (of 25 m x 25 m) that need to be visited to collect data (area sampling).


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➞ Divide the total amount of complete squares by 15, and round off this result to a non-decimal number. The rounded off number is the systematic sampling step (figure: 50/15 = 3,33 rounded off


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➞ Start from the first complete square on top of the grid and add towards the right-hand side the systematic sampling step to obtain the second complete square for area sampling. The systematic sampling step can only be counted on complete squares, partial squares within the perimeter should be ignored.


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➞ Keep on adding the systematic sampling step from left to right and top to bottom until 15 complete squares are selected. When the systematic sampling arrives at the bottom of the grid and there


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Measure on the map the bearing from the outer landmark towards the lower left corner of the first selected square. This is done by placing the compass with its long edge on the existing map along the line formed from the chosen outer landmark until the lower left corner of the selected square, making sure that the direction arrow is pointing towards the selected square. The rotating graduation ring is then rotated until its arrow is pointing to the north (top) of the map (parallel lines of the rotating graduation ring are exactly in line with the vertical lines of the graph paper). The bearing can be read on the graduated ring at the position of the direction arrow (T.B. 1.02.).


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Measure on the map the scale length in between the outer landmark and the lower left corner of the selected square, adapt it to the real distance according the scale of the map and convert it in number of footsteps (average length of footsteps should be known; T.B. 1.02).


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Go to the selected square on the site by means of the measured bearing and distance (number of footsteps), starting from the chosen outer landmark. By turning the rotating graduation ring until the bearing is in position with the direction arrow and having the graduated ring arrow in position with the magnetic needle indicating north, the direction to go in is determined.


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Form a square of 25 m x 25 m (4 ropes with marking at 25 meters can be of help to determine the square), starting from the left bottom corner as indicated on the map. Shelters on the edge that don’t fall completely within the 25 m x 25 m square should only be included in the sample if they have at least their south and east limits within the 25 m x 25 m square.


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Visit dwelling per dwelling within the 25 m x 25 m square and note the number of persons who have spent the previous night at each dwelling to determine the size of the household. Additional information on the age and sex of the household members can also be collected.


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Calculate the population of each square by adding up all household members per square. Note the figures down.


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Calculate the average size of a household by adding up all the figures of the population of each square, divided by the total number of households visited. Note the figure down.


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Calculate the average population per square by adding up all the figures of the population of each square, divided by 15. Note the figure down.


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Extrapolate the total population of the site by multiplying the average population per square with the total number of squares within the perimeter (complete squares and partial ones which have more than half of their surface included).


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Calculate the average available area (number of m² per person) by dividing the total surface of the site (T.B. 1.02) by the total population of the site. This figure should be compared with the site planning indicator (T.B. 1.10.).


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What is the field of intervention: e.g. assistance to victims of conflict or natural disaster, assistance to vulnerable groups in post-emergencies, epidemics or endemics, access to healthcare for excluded groups?


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Is it an acute or chronic emergency, or a stabilized situation? What is the foreseen project duration?


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What is the location of the health structure: camp, rural, urban? Is it located on private or public terrain?


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What kind of health structure: e.g. out-patient (OPD), in-patient (IPD), hospital, therapeutic feeding centre (TFC), cholera treatment centre (CTC) or unit (CTU)?


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What are the activities of the health structure: e.g. surgery, enlarged program of immunization (EPI), maternity?


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What is the (local) management organisation of the health structure? What is the involvement of aid-agencies in the health structure: e.g. owner, technical support, continuous presence, training? What is the role of MOH, others?


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Is there space available for a potential extension of the health structure, or to install temporary emergency facilities: e.g. during an outbreak?


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Is the health structure easy accessible for patients? What is the distance / time the patients have to travel to arrive at the health structure?


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Is access possible at all times of the year for heavy transport vehicles: e.g. medical material and equipment, building material, water supply?


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Is there a national legislation concerning water supply, medical waste, insecticides use (try to get a copy if existing)? Is it applied in the health structure?


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Is the layout of the existing buildings and facilities appropriate? Does a map exist? (if not, make one; T.B. 1.02).


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Are there sufficient and appropriate latrines, showers, washing facilities, a waste zone, a kitchen?


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Is there a responsible for the correct implementation and follow up of the essential water and sanitation requirements in the health structure (T.B. 1.08)? Is health promotion ongoing or planned?


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What is the total number of staff present: e.g. doctors, nurses, lab technicians, cleaners, technicians?


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Is all the staff aware about correct hygienic behaviour within the health structure (standard / universal precautions)? Did they receive any training / information concerning this topic? Are there hygiene / health promotion activities ongoing or planned for the staff?


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Are needle stick injuries reported? How often does it happen? Is there a protocol for Post Exposure Prophylaxis (PEP) available after the injury?


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Has the national staff been vaccinated against Hepatitis B / tetanus (medical and non-medical staff)?


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Are there cleaning products, disinfectants and equipment available, and if so, which kinds? Are the protocols of correct cleaning (e.g. latrines, wards) / disinfection / sterilisation available and practiced?


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Are there security considerations for the staff, the patients, the visitors or the surrounding population:


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Are there safety considerations for either the staff, the patients, the visitors or the surrounding population: e.g. presence of open pits, waste exposed on the ground, location of the latrines / showers?


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What is the period and duration of the rainy season / cold period (winter)? Does it have an influence on the material and equipment supply? Does it have an impact on the drainage?


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Are water resources available within or around the health structure compound? The further the water resource is away, the more complex and expensive the water supply will become.


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What kinds of resources are available: surface water, groundwater, rainwater catchments? Are the existing water resources available all year around?


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Do the available resources provide all year around sufficient quantities for all activities within the health structure (e.g. sterilisation, general hygiene, drinking, cooking, personal hygiene and sanitation)? What is the quality of the water? Is water easy accessible for staff, patients and visitors?


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What is the soil type of the health structure’s compound (important for its infiltration capacity, ease and safety of digging)? What is the depth of the highest water table (at the end of the rainy season)?


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Is the health structure located in a flood prone area, nearby a swamp, on land with a high water table or at risk of land slides? Is or will the groundwater be used for the health structure or by the surrounding population?


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Are there any vector borne diseases endemic to the area and if so, is the health structure sited in a high or low risk area?


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Are there any visible signs of vectors (organisms, faeces, eggs; T.B. 7.0.1 to 7.0.9), or nuisances related to them?


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Are there any socio-cultural problems linked with the health structure (e.g. latrines, dead bodies)? Is the population surrounding the health structure complaining about certain activities within the compound (e.g. incineration of waste that is generating smoke)?


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Do the wastes generated within the health structure have any commercial value for the population? Do you find them back on the local market (e.g. needles and syringes, expired drugs)?


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What is the field of intervention: e.g. assistance to vulnerable groups in post-emergencies, epidemics or endemics, access to healthcare for excluded groups, assistance to victims of conflict or natural disaster?


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Is there an integration or not within the resident population? What is the distance to residents dwellings?


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What is the involvement of aid agencies in the camp: e.g. medical infrastructure (in-patient / out-patient departments), nutrition, technical support, water, hygiene and sanitation, training?


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Is there the possibility of self-sufficiency for the population (e.g. the right to use the land for agricultural purposes)? Is it easy to supply food and materials to the camp?


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Are there security considerations for either refugees, displaced persons or relief workers? It is recommended that refugees will be settled at a reasonable distance from international borders and other potentially sensitive areas.


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Are there safety considerations for either refugees, displaced persons or relief workers: e.g. presence of open pits, waste exposed on the ground, location of the latrines / showers?


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Are there water resources available onsite or nearby, all year around? The further the water resource is away, the more complex and expensive the water supply will become.


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What kinds of resources are available; surface water, groundwater (including spring water), rainwater catchments? Are the existing water resources available all year around?


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Is there sufficient water quantity provided for drinking, cooking, personal hygiene and sanitation for the projected population? How is the water quality? Is water easily accessible, also for vulnerable people?


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Is the soil type suitable for digging and water infiltration? The soil type determines which sanitation and construction techniques may be used. Avoid rocks or areas with a high water table, as it will make latrine construction difficult.


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Is the camp located in a flood prone area, nearby a swamp, on land with a high water table (what is the depth of the highest water table) or at risk of landslides?


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Are there any vector born diseases endemic to the camp area? Is the camp located in an area with risks such as malaria, bilharzias (schistosomiasis), sleeping sickness (trypanosomiasis)? Is it a high or a low risk area?


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Are there visible signs of vectors (organism, faeces, eggs; T.B. 7.01 to 7.09), or nuisances related to them?


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Is there stagnant water, or other potential (and avoidable) vector breeding sites on site or in the close vicinity?


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Does the camp create a negative (environmental) impact on its surroundings: e.g. deforestation, soil erosion, poaching, sharing of scarce water resources? The possible impact this may have on local communities is important and has to be taken into consideration.


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Are there skilled people (e.g. nurse, water and sanitation technician, hygiene promoter) amongst the camp population or the local communities?


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Are there other aid-agencies present (national and international)? What is their field of activities? Is there a collaboration / coordination in between the different agencies?


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Who is in charge of the local water, hygiene and sanitation systems, and who is responsible for their maintenance and repairs?


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Which organisations are already involved, are realistically available and have the capacity to work in water, hygiene and sanitation programs (e.g. NGO’s / Red Cross / UN / Ministry of Works)?


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Are there hygiene-related diseases present including faecal-oral diseases, trachoma, scabies? Cross check morbidity statistics with the medical staff.


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Is soap available and used for hand washing, body washing and laundry? Are there alternatives available / used to replace soap, like ashes?


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Is there a sufficient quantity of water for personal hygiene and health structure / domestic cleaning?


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Are hand-washing facilities available in sufficient quantity? Are they accepted by the beneficiaries? If not, why? Are there some hand washing facilities located inside the health structure services / wards and / or near the defecation facilities?


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Are showers available in sufficient quantity? Are they accepted by the beneficiaries? If not, why? Are they located in a safe and accessible place?


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Are laundry facilities available in sufficient quantity? Are they accepted by the beneficiaries? If not, why? Are they located in a safe and accessible place?


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For all those facilities, is there a presence of an appropriate drainage system: e.g. grease trap, soak away pit, infiltration trenches?


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What goods are women normally using during menstruation? What supplies are available? Are there special facilities foreseen where the (fabric used as) sanitary towels can be collected / washed?


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What is the general level of hygiene practised by the health structure staff, patients and accompanies


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What is the frequency and type of general cleaning (in health structures, communal centres): e.g. cleaning of floors and surfaces with detergents, airing and cleaning of mattresses? Who is responsible?


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How is the cleaning organized? Who is responsible? What procedures are used? Is cleaning material available (e.g. brooms, soap, chlorine)? What is the maintenance frequency?


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How is the food hygiene: preparation, storage and cleaning of utensils / crockery? Who is responsible?


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Are hygiene / health promotion activities ongoing or planned? By who is it done and who is targeted?


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Verify the quantity, quality and accessibility of the various water related facilities because the combination of these factors determine their final usage, and therefore have an influence on the related health risks.


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What is the amount of available water, in litre per patient / person a day? Is this amount available every day or is the supply irregular?


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Are there water-related diseases present, including faecal-oral diseases, guinea worm, bilharzias? Cross check with the morbidity statistics of the medical staff.


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Determine the available water resource(s), the available water quantity and reliability of each resource:


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What are the estimated width and depth? Is the water moving fast or slow? These are all indicators of the capacity of the resource; even a small and shallow river with a good flow has already a decent water capacity.


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Is it a big or a small lake? Be aware that when large amounts of water are taken for a prolonged time, a small lake can dry up.


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What is the estimated discharge of the spring? Measure the time needed to fill up a bucket of known volume.


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Is the discharge of the spring stable during the whole year? Does the spring dry up during the year?


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What is the rainfall pattern over the year? These figures might be available in meteorological stations, universities or on the internet.


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Is there a risk of micro-biological or chemical contamination: e.g. open defecation, latrines, laundry, intensive agriculture (e.g. animals, pesticides, fertilisers), industry (e.g. mining)? What is the distance of the resource to latrines, waste disposal sites, farms, workshops, industry?


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How is the resource protected: e.g. intake system protection, zone fenced off, drainage ditch, overflow, drainage channels?


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How is the colour, smell, taste, turbidity (turbidity tube; T.B. 2.13), pH (pool tester; T.B. 2.22)?


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Does the water contain a lot of minerals / salts? If the adapted equipment is available, check the conductivity of the water.


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Is chlorine locally available? Is the water chlorinated? Measure the Free Residual Chlorine (FRC) concentration (with a pool tester; T.B. 2.22) at different locations (e.g. water reservoirs, piped systems).


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Are there filtration systems installed and used? What type of filters is available? What is the frequency of the backwashing?


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Are the resources foreseen with the necessary equipment to facilitate the accessibility (e.g. hand pump on a well, submersible pump on a high-yield borehole, motor pump at a river)?


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Is there enough capacity to fulfil the water needs (e.g. number and condition of the available trucks, condition of the roads, rotation time per fill up)?


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How is the water trucking organized (e.g. private or authorities trucks, conditions of the contract related to duration, human resources, running and maintenance costs)?


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What is the capacity of the reservoirs? How many hours per day are the reservoirs full of water? How often are they refilled?


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Where are the reservoirs located (e.g. nearby the health structure, spread within the camp)? Are they easily accessible for water trucks?


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What is the number of water containers per household, their capacities and the average number of refills (to estimate the total amount of water collected per day)?


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What type of containers (e.g. plastic jerry cans, clay pots, tins) are the beneficiaries using? Are these the kind of containers they would normally use?


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Is there safe and perennial access to water for all groups; especially the most vulnerable? Are certain groups denied access? If so, why?


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How long do the users have to wait for water? Is queuing observed (e.g. empty jerry cans left behind), is there crowding / fighting at water points?


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How often are the water quality treatment systems checked and maintained? What is the protocol / procedure of the assisted sedimentation, filtration and chlorination processes (if applied) and their frequency?


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Verify the quantity, quality (including the maintenance) and accessibility of the various excreta disposal facilities because the combination of these factors determine their final usage, and thus have an influence on the related health risks.


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Is there a lot of excreta laying around? Is wild defecation a normal practice? Are people defecating in surface water (e.g. river, lake)?


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Are there excreta-related diseases present, including faecal-oral diseases, bilharzias? Cross check with the morbidity statistics of the medical staff.


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What types of excreta disposal facilities are to be found: defecation areas / trench latrines / improved trench latrines / simple pit latrines / VIP latrines / twin pit latrines / pour-flush latrines / flush toilets / septic tanks / sewage system / others?


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What is the average number of persons per defecation facility? Are the defecation facilities provided per family (or group of families) or are they communal facilities?


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What is the capacity of the defecation facilities? Are there extension plans if the number of people increases?


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Are the defecation facilities adapted to the users’ preferences and limitations: e.g. physically impaired people, staff – patient / gender – family separation, are people washers or wipers, squatters or sitters?


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Is there a proximity of excreta disposal facilities to water resources and water distribution points? What is the highest static ground water level in the area?


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Is the latrine construction safe (e.g. pit not too deep, lined pit, lining and slab material that can’t rot or being infested with termites)?


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Do the defecation facilities prevent vectors from breeding / feeding in excreta (e.g. is the lid put back on the defecation hole of a simple latrine, is the net on the ventilation pipe of the VIP latrines intact)?


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Is local material used / available for the construction of excreta disposal facilities? Can the use of local materials have a negative impact on the environment (e.g. deforestation)?


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What is the minimum and maximum distance in between the defecation facilities and shelters / buildings? Are there defecation facilities foreseen at public areas (e.g. market, food distribution points, health facilities)?


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Is there safe and perennial access to the facilities for women, children, disabled or handicapped people, as well as for vulnerable groups? Are the defecation facilities situated in a safe location to avoid sexual violence? Is lighting provided for use at night?


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Are (hand) washing facilities (with water and soap) and waste bins available in the direct proximity?


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Are the defecation facilities clean / maintained inside but also outside? Is there any visible open defecation (look behind old buildings and outskirts)?


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Is there a significant presence of flies? Are there any visible signs of (other) vectors (organisms, faeces, eggs; T.B. 7.01 to 7.09) in the latrines?


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Are there any areas of stagnant water: e.g. puddles, blocked gutters, open (domestic) water containers indoors and outdoors, plant pots, open water storage tanks?


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Are there specific diseases present related to vector breeding in / living around stagnant water including malaria, dengue, yellow fever? Crosscheck with morbidity statistics.


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Are there any open drainage channels and if so, are they maintained regularly to avoid blockages and formation of standing water?


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How is runoff water controlled? Presence of drainage ditches, sewer system (open or closed), others?


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How is the wastewater controlled? Is there a presence of drainage ditches or pipes, a sewer system (open or closed), others? Are there soak away pits / infiltration trenches / evapo-transpiration areas


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Are the runoff and wastewater evacuation facilities correctly maintained? Is the grease layer of the grease trap removed and at what frequency? Where is this grease layer disposed of? Who is responsible for the maintenance of all the runoff / wastewater facilities? What are the procedures used? Is maintenance material available?


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Are waste collection containers available and what types if present? Do they have holes to evacuate the leachates? Do they prevent vectors from breeding / feeding in the waste (e.g. garbage bins with lids)? What is the quantity and location of the waste collection containers?


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What kind of waste collection and treatment / disposal system is available: a household or collective system? What means are available for the collective waste collection? How is the waste treated / disposed of (e.g. household refuse pits, open fire, incinerator, dumpsite, controlled landfill)? Do these facilities prevent vectors from breeding / feeding in the waste (e.g. waste pits covered daily with an compacted layer of soil)?


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Do the people put their waste in the household refuse pits or collective waste bins? If not, why? In case of household refuse pits, do the people cover it with a lid / compacted soil each time new garbage is introduced?


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What is the frequency for the collective waste collection and the treatment / final disposal? Who is responsible?


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Is maintenance material for the collective waste bins, the transport means and treatment / final disposal facilities available, and what kind? Is the maintenance done of these facilities and their surroundings?


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Is the medical waste segregated in different categories? What are the different categories? How much waste of each category is generated per day (kg/day)? What is done with hazardous waste (e.g. lab waste, pharmaceutical waste)?


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Is there a national legislation concerning medical waste (try to get a copy if existing)? Is it applied in the health structure?


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What materials are locally available for collection of waste: e.g. plastic 20 l buckets with tight fitting lid of different colours? Are there specific containers for sharps? Are those safe?


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Check if the treatment and/or final disposal of medical waste is done within or outside the health structure compound:


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How is the treatment and / or final disposal done for the different kinds of waste? Is there a presence of a volume reducer or incinerator, safety box reducer and/or glass crusher? Are there sharps, soft and/or organics waste pits available? If not, are materials locally available for the construction of the different facilities: e.g. concrete rings for a sharps pit, refractory cement and bricks for an incinerator?


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Is a waste zone, grouping all the facilities, present on the compound? Where is it situated within the compound (distance to buildings, dwellings, dominating wind, good access)? Is the waste zone protected to avoid non-authorized persons to enter?


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Where is the waste treated / disposed of? Is it done under safe and controlled conditions? Are there appropriate vehicles to do the waste transport towards the treatment / disposal area? Who is responsible for the transport and treatment / final disposal of the medical waste? Are waybills made?


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Is the medical waste being segregated by the medical staff in the treatment rooms / wards according to the correct categories?


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How often are the (different categories of) wastes being removed from the treatment rooms / wards? Who is responsible? Is the person adequately trained and equipped for this job?


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What is the treatment and/or final disposal frequency? Is it done in an acceptable way? Is there a waste manager? If not, who is responsible? Is the person adequately trained and equipped for this job?


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Assess the risk of vector-borne diseases and verify the clinical evidence of the disease among the affected population. Advice should be sought from local authorities on local disease problems and the available vector-control resources. The assessment should focus on the following:


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What is the immune status of the population? What is the distribution of vulnerable groups (e.g. children under five, pregnant women, movements of population from low to high transmission zones or vice versa)?


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What is the vector species’ behaviour (e.g. mosquito species that feed and rest indoors at night), and habitat (e.g. stagnant water, open defecation areas, wet latrines, garbage)?


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Are there existing individual protection and avoidance measures (e.g. are the general water and sanitation facilities in place and maintained)?


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What are the knowledge, attitude and practice factors in the affected population (e.g. how do people think the disease is transmitted, who is considered vulnerable, what do people know about prevention activities, what are the perceptions about pesticides and Insecticide Residual Spraying, are mosquito nets being used, how many mosquito nets are required per household considering the normal sleeping pattern)?


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Has the affected population the means to protect themselves from vectors that are considered to be a significant risk to health:


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Is control of the human body lice being carried out to an agreed standard where louse-borne typhus or relapsing fever are a threat?


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What is the number of households with Long Lasting Insecticidal Nets? Are they using them (correctly)?


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What is the number of households that is timely sprayed with appropriate, effective and safe insecticide?


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Is the personnel protected by providing training, protective clothing, supervision, and a restriction on the number of hours handling pesticides?


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Are the purchase, transport, storage, disposal of pesticides and application equipment following international norms? Can they be accounted for at all times?


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Are the people informed about the potential risks of pesticides and about the schedule for application? Are they appropriately protected during and after the application of pesticides?


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Are the choice of pesticide and application method conform to national and international protocols (e.g. timing of application / re-application is respected)?


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What are the cultural practices regarding funeral procedures (e.g. specific funeral rites, type of cremation, burial)?


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Is there a morgue with the needed facilities (e.g. water supply, working tables, safe storage for the deceased belongings, electricity, refrigerator)?


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What is the distance in between the cemetery / cremation area and dwellings / public buildings / water resources, others? Is there a risk of water resource contamination?


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Who prepares the funeral procedures and who is performing them: relatives, local population, military, aid-agencies?


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Surveyor:........................................................................Date:  .............................................................


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Country:..........................................................................Location:  .......................................................


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Area surveyed (e.g. type of health structure, camp): ...........................................................................


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Population size / patients: ..............................................Main ethnic group: ........................................


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Main actors / programs at location: ......................................................................................................


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Climate (e.g. precipitation details, temperature extremes):..................................................................


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Geography (e.g. altitude, type of terrain): ............................................................................................ Remarks:..............................................................................................................................................


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Resources:...........................................................................................................................................


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Condition of the water resources:........................................................................................................


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Yield/resource:.....................................................................................................................................


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Number of actual users/resource:........................................................................................................


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Users other than direct beneficiaries: ..................................................................................................


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Water quality: ................................Turbidity (NTU):.............................................................................


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pH:................................................................................................. Free Residual Chlorine (mg/l): ......................................................


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Thermo-tolerant coliforms / E. coli per 100 ml: ............................. Type of water treatment:......................................................................................................................


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Centralized water storage (e.g. bladders) :..........................................................................................


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Distance of source / distribution points from users:.............................................................................


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Condition of water distribution points:..................................................................................................


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Method of water collection: ..................................................................................................................


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Method of household water storage: ...................................................................................................


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Remarks ( e.g. implementing organization / opinions and attitudes of beneficiaries / cultural considerations): ...................................................................................................................................


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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Type of latrines: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Type of slabs: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Lining of pits: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Remaining depth of pits: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Number of latrines in use: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Number of actual users/latrine: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Condition and usage of latrines: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Location of latrines: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Hand washing facilities: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Availability of soap / ashes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Remarks ( e.g. implementing organization / opinions and attitudes of beneficiaries / cultural considerations): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Number of showers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Number of actual users/shower: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Condition and usage of showers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Location of showers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Number of washing / laundry places: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Number of actual users/washing or laundry place: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Condition and usage of washing / laundry places: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Location of washing / laundry places: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Slope of area (%): . . . . . . . . . . . . . . . . . . . . . . . .Drainage pattern: . . . . . . . . . . . . . . . . . . . . . . . . . .


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Stagnant water sites: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Presence and quality of grease traps: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Presence and quality of infiltration systems (e.g. soak away pit at water points, at showers):  . . . . .


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Remarks (e.g. implementing organization / opinions and attitudes of beneficiaries / cultural considerations): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Solid waste disposal system (household or collective) and general cleanliness: ................................


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.............................................................................................................................................................


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Number, quality and condition of public / household waste bins:......................................................... Number and condition of refuse pits / landfill: ......................................................................................


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Remarks (describe their situation / usage): .........................................................................................


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Segregation of medical waste (categories):.........................................................................................


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Disposal system (onsite or offsite) and general cleanliness: ...............................................................


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Type, number, condition and usage of waste bins and sharps containers:..........................................


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............................................................................................................................................................. Number, condition and usage of sharps pits:.......................................................................................


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Number, condition and usage of organic waste pits: ........................................................................... Type, number, condition and usage of incinerator / volume reducer: .................................................. Number, condition and usage of ash pits:............................................................................................


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Remarks (e.g. implementing organization / opinions and attitudes of beneficiaries / cultural considerations):....................................................................................................................................


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Identify species (if possible) and map sites where most of them are found. (: absent; : present; : problematic)


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Mosquitoes: // ....................................................Remarks: .......................................................


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Flies: // ...............................................................Remarks: .......................................................


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Sand flies: //.......................................................Remarks: .......................................................


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Fleas: //..............................................................Remarks: .......................................................


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Lice: // ................................................................Remarks: .......................................................


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Rodents: // .........................................................Remarks: .......................................................


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Mites (Scabies): //................................................Remarks: .......................................................


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Other vectors: // .................................................Remarks: .......................................................


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Current control measures: ...................................................................................................................


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Remarks ( e.g. implementing organization / opinions and attitudes of affected population):...............


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Availability and affordability of soap:....................................................................................................


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Individual hygiene practices (e.g. hand washing, use of laundry):.................................................


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....................................................................................................................................................... Hygiene / health promotion activities: ............................................................................................


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.......................................................................................................................................................


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Staff:...............................................................................................................................................


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Training: .........................................................................................................................................


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....................................................................................................................................................... Hygiene committees in health structures: ......................................................................................


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Remarks:..............................................................................................................................................


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Graveyards: ...................................................................................................................................


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Schools: .........................................................................................................................................


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Markets: .........................................................................................................................................


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Human-related activities required for assessment, planning, training, and promotion The essential requirements list mainly technical criteria, but it is clear that no intervention can be considered successful if facilities are inappropriate for local conditions, if they are incorrectly used, or if they are not maintained (correctly). The human-related activities must go hand in hand with any technical intervention.


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<table><tr><td>Acute emergency Initial assessment and analysis Technical training to the staff Information to the patients</td><td>Chronic emergencies and stabilised situations Initial assessment and analysis Set up or strengthen the Hygiene Committee In-depth assessment and analysis with the staff General and technical training to the staff (Health) promotion towards the patients / visitors</td></tr></table>


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Acute emergency Initial assessment and analysis Technical training to the staff Information to the patients Chronic emergencies and stabilised situations Initial assessment and analysis Set up or strengthen the Hygiene Committee In-depth assessment and analysis with the staff General and technical training to the staff (Health) promotion towards the patients / visitors


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<table><tr><td>“No” pathogens</td><td>Free residual chlorine concentration at distribution points 0.2 - 0.5 mg/l (if pH &lt; 8) minimum 30 minutes contact time 0.4 - 1.0 mg/l (if pH &gt; 8) minimum 60 minutes contact time or max 10 E.Coli/100 ml at discharge points if chlorination is really not possible (=&gt; water filters highly recommended)</td></tr><tr><td>Low turbidity</td><td>&lt; 5 NTU &lt; 20 NTU is permissible in an acute emergency</td></tr><tr><td>Low concentration of compounds that are acutely toxic or that have serious long-term effects</td><td>Context specific; in case of doubt, contact your technical referent</td></tr><tr><td>Acceptable to the users</td><td>Water is not rejected due to colour, taste, odour or salinity</td></tr></table>


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“No” pathogens Free residual chlorine concentration at distribution points 0.2 - 0.5 mg/l (if pH < 8) minimum 30 minutes contact time 0.4 - 1.0 mg/l (if pH > 8) minimum 60 minutes contact time or max 10 E.Coli/100 ml at discharge points if chlorination is really not possible (=> water filters highly recommended) Low turbidity < 5 NTU < 20 NTU is permissible in an acute emergency Low concentration of compounds that are acutely toxic or that have serious long-term effects Context specific; in case of doubt, contact your technical referent Acceptable to the users Water is not rejected due to colour, taste, odour or salinity


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<table><tr><td>Health structure / activity</td><td>Quantity/patient day</td><td>Max distance to water source</td><td>Min. storage capacity in closable reservoir</td></tr><tr><td>Mobile clinic: infrequent visits</td><td>2 l</td><td>100 m</td><td>1 day</td></tr><tr><td>Mobile clinic: frequent visits (in fixed tents / existing buildings)</td><td>5 l</td><td>100 m</td><td>2 days</td></tr><tr><td>Out-Patient Department (OPD)</td><td>5 l</td><td>100 m</td><td>2 days</td></tr><tr><td>In-Patient Department (IPD) / hospital</td><td>40 – 60 l*</td><td>100 m</td><td>2 days</td></tr><tr><td>Operating theatre / delivery room (sterilisation not included)</td><td>100 l/intervention</td><td>100 m</td><td>2 days</td></tr><tr><td>Blanket feeding</td><td>0.5 l (5 l if long waiting time)</td><td>100 m</td><td>2 days</td></tr><tr><td>Supplementary Feeding Centre (SFC)</td><td>5 l</td><td>100 m</td><td>2 days</td></tr><tr><td>Ambulatory Therapeutic Feeding Centre (ATFC)</td><td>5 l</td><td>100 m</td><td>2 days</td></tr><tr><td>In-patient Therapeutic Feeding Centre (ITFC)</td><td>30 – 50 l*</td><td>100 m</td><td>2 days</td></tr><tr><td>Cholera Treatment Centre (CTC)</td><td>60 l</td><td>100 m</td><td>3 days</td></tr><tr><td>SARS isolation</td><td>100 l</td><td>100 m</td><td>3 days</td></tr><tr><td>Viral Hemorrhagic Fever (VHF) Isolation</td><td>300 – 400 l*</td><td>100 m</td><td>3 days</td></tr></table>


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Health structure / activity Quantity/patient day Max distance to water source Min. storage capacity in closable reservoir Mobile clinic: infrequent visits 2 l 100 m 1 day Mobile clinic: frequent visits (in fixed tents / existing buildings) 5 l 2 days Out-Patient Department (OPD) 5 l In-Patient Department (IPD) / hospital 40 – 60 l* Operating theatre / delivery room (sterilisation not included) 100 l/intervention Blanket feeding 0.5 l (5 l if long waiting time) Supplementary Feeding Centre (SFC) 5 l Ambulatory Therapeutic Feeding Centre (ATFC) 5 l In-patient Therapeutic Feeding Centre (ITFC) 30 – 50 l* Cholera Treatment Centre (CTC) 60 l 3 days SARS isolation 100 l Viral Hemorrhagic Fever (VHF) Isolation 300 – 400 l*


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Context dependent: e.g. climate, number of patients (for small number of patients, high quantity range)


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For chronic emergencies and stabilised situations, all quantities should preferably be higher. Keep also in mind that up to 20% of the water can get lost through leaks and spillage.


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Reliable water points should be available within the health structure, certainly at the critical points:


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➞ OPD: consultation room, dressing room, waste zone, nearby latrines, sterilization, Ante Natal Care and immunization, pharmacy.


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➞ IPD / hospital: operating theatre, maternity, sterilization, laboratory, waste zone, nearby latrines / toilets, kitchen, morgue, all wards, laundry, pharmacy, emergency.


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<table><tr><td>In sufficient quantity</td><td>In-Patient health structures (e.g. IPD, ITFC) 1 latrine/20 users ➞ assume each patient has 1 visitor / attendant ➞ (1 + 1 for staff) + (N° of beds x 2)/20 OPD 1 for staff + 1 male + 1 female + 1 children’s latrine (or potties)</td></tr><tr><td>Technically appropriate (depending on local constraints)</td><td>Acute emergency Improved trench latrine Chronic emergencies and stabilised situations Pit latrine / children latrine VIP latrine / Double pit VIP latrine (Pour) flush latrine (potentially with septic tank and infiltration system or closed sewer)</td></tr><tr><td>Appropriate for the users</td><td>Facilities must be culturally and socially appropriate Separate facilities for staff and patients Preferably a separation between male and female (certainly if culturally necessary) In-patient health structures (e.g. IPD, ITFC): some latrines provided with seats and handlebars for physically impaired persons Children’s latrines provided near to paediatric ward and feeding centres (or potties) Bed pans / urine flasks (or similar local material) for bedridden patients</td></tr><tr><td>Easily accessible</td><td>Distance of improved trench / pit latrines: &gt; 5 m and &lt; 30 m from buildings</td></tr><tr><td>At safe location</td><td>To avoid risk of sexual violence Night lights provided and operating (if feasible)</td></tr><tr><td>Convenient hand washing facilities</td><td>Soap, hand washing and wastewater facilities provided at exit of latrines</td></tr><tr><td>Prevent contamination of water resources</td><td>Latrines &gt; 30 m away from water resources</td></tr></table>


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In sufficient quantity In-Patient health structures (e.g. IPD, ITFC) 1 latrine/20 users ➞ assume each patient has 1 visitor / attendant ➞ (1 + 1 for staff) + (N° of beds x 2)/20 OPD 1 for staff + 1 male + 1 female + 1 children’s latrine (or potties) Technically appropriate (depending on local constraints) Acute emergency Improved trench latrine Chronic emergencies and stabilised situations Pit latrine / children latrine VIP latrine / Double pit VIP latrine (Pour) flush latrine (potentially with septic tank and infiltration system or closed sewer) Appropriate for the users Facilities must be culturally and socially appropriate Separate facilities for staff and patients Preferably a separation between male and female (certainly if culturally necessary) In-patient health structures (e.g. IPD, ITFC): some latrines provided with seats and handlebars for physically impaired persons Children’s latrines provided near to paediatric ward and feeding centres (or potties) Bed pans / urine flasks


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ITFC): some latrines provided with seats and handlebars for physically impaired persons Children’s latrines provided near to paediatric ward and feeding centres (or potties) Bed pans / urine flasks (or similar local material) for bedridden patients Easily accessible Distance of improved trench / pit latrines: > 5 m and < 30 m from buildings At safe location To avoid risk of sexual violence Night lights provided and operating (if feasible) Convenient hand washing facilities Soap, hand washing and wastewater facilities provided at exit of latrines Prevent contamination of water resources Latrines > 30 m away from water resources


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<table><tr><td>In sufficient quantity</td><td>In-Patient health structures (e.g. IPD, ITFC) 1 (bucket) shower/40 users ➞ assume each patient has 1 visitor / attendant ➞ (1 + 1 for the staff) + (N° of beds x 2)/40 OPD (bucket) shower (in case of scabies or sexual violence)</td></tr><tr><td>Appropriate for the users</td><td>The facilities must be culturally and socially appropriate Separate facilities for the staff and patients Separation between male and female (small children can go to the women’s showers) In-Patient structures: some showers provided with seats and handlebars for physically impaired persons</td></tr><tr><td>At safe location</td><td>To avoid risk of sexual violence Night lights provided and operating (if feasible)</td></tr><tr><td>Related facilities</td><td>Water supply close by (maximum 5 to 20 m walking distance) Showers connected to wastewater facilities</td></tr></table>


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In sufficient quantity In-Patient health structures (e.g. IPD, ITFC) 1 (bucket) shower/40 users ➞ assume each patient has 1 visitor / attendant ➞ (1 + 1 for the staff) + (N° of beds x 2)/40 OPD (bucket) shower (in case of scabies or sexual violence) Appropriate for the users The facilities must be culturally and socially appropriate Separate facilities for the staff and patients Separation between male and female (small children can go to the women’s showers) In-Patient structures: some showers provided with seats and handlebars for physically impaired persons At safe location To avoid risk of sexual violence Night lights provided and operating (if feasible) Related facilities Water supply close by (maximum 5 to 20 m walking distance) Showers connected to wastewater facilities


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<table><tr><td>Separate washing areas for</td><td>The dishes, if a kitchen is present The structure’s laundry (e.g. bed sheets) with sufficient drying lines The patients’ laundry (if required)</td></tr><tr><td>Appropriate for the users</td><td>The facilities must be culturally and socially appropriate</td></tr><tr><td>Related facilities</td><td>Water supply close by (maximum 5 to 20 m walking distance) Washing areas connected to wastewater facilities</td></tr></table>


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Separate washing areas for The dishes, if a kitchen is present The structure’s laundry (e.g. bed sheets) with sufficient drying lines The patients’ laundry (if required) Appropriate for the users The facilities must be culturally and socially appropriate Related facilities Water supply close by (maximum 5 to 20 m walking distance) Washing areas connected to wastewater facilities


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<table><tr><td>Type of wastewater</td><td>Pre- treatment</td><td>Disposal</td><td>Distance between disposal and water resource</td></tr><tr><td>&quot;Clean&quot; wastewater e.g. from tap stand, hand pump (without soap, oil, grease)</td><td>No</td><td>Soak away pits (emergency) Infiltration trenches Evapo-transpiration area (arid zones)</td><td>&gt; 30 m</td></tr><tr><td>&quot;Clean&quot; wastewater e.g. from tap stand, hand pump (without soap, oil, grease)</td><td>No</td><td>Properly sealed sewer system.</td><td/></tr><tr><td>&quot;Dirty&quot; wastewater (grey water with soap, oil, grease)</td><td>Grease trap</td><td>Soak away pits (emergency) Infiltration trenches Evapo-transpiration area (arid zones)</td><td>&gt; 30 m</td></tr><tr><td>&quot;Dirty&quot; wastewater (grey water with soap, oil, grease)</td><td>Grease trap</td><td>Properly sealed sewer system</td><td/></tr><tr><td>Black water (overflow of a septic tank)</td><td>Septic tank</td><td>Soak away pits (emergency) Infiltration trenches Evapo-transpiration area (arid zones)</td><td>&gt; 30 m</td></tr><tr><td>Black water (overflow of a septic tank)</td><td>Septic tank</td><td>Properly sealed sewer system</td><td/></tr><tr><td>Rain and runoff water</td><td>No</td><td>Natural drainage</td><td/></tr></table>


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Type of wastewater Pre- treatment Disposal Distance between disposal and water resource "Clean" wastewater e.g. from tap stand, hand pump (without soap, oil, grease) No Soak away pits (emergency) Infiltration trenches Evapo-transpiration area (arid zones) > 30 m Properly sealed sewer system. "Dirty" wastewater (grey water with soap, oil, grease) Grease trap Soak away pits (emergency) Infiltration trenches Evapo-transpiration area (arid zones) > 30 m Properly sealed sewer system Black water (overflow of a septic tank) Septic tank Soak away pits (emergency) Infiltration trenches Evapo-transpiration area (arid zones) > 30 m Properly sealed sewer system Rain and runoff water No Natural drainage


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Provide a safe and secure segregation, collection and temporary storage, potential treatment and final disposal of all types of waste.


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Install the waste containers for patients / visitors at maximum 5 to 20 m walking distance from where the waste is generated.


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Provide 3 (single use) sharps, 3 soft and 3 organic waste containers per ward (with maximum 20 beds) / treatment room, one for use, one for rotation (kept in the waste zone after cleaning and disinfection), one for spare (kept in the ward).


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1 big soft waste container of 60 l (in case the sterilised material is kept in Kraft paper, which will help to light the volume reducer / incinerator, if kept dry).


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Provide appropriate sharps containers in convenient locations (next to the examination table, on a tray or trolley for mobile use in the wards):


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➞ Modified drugs pot / commercial sharps container (or reusable sharps container if available; in adapted quantities); if lots of empty ampoules and vials are generated, a separate glass container


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➞ Safety box: in case of immunization or for specific waste (e.g. very long needles), possibly also in the early stages of an acute emergency (latter to be avoided).


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➞ Concrete lined (sealed) pit or adapted drum / plastic container in case of acute emergency, small health post, starting up phase of bigger structures, slum where there isn’t space to construct a concrete sharps pit.


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Provide appropriate soft waste containers (plastic buckets of 20 - 60 l capacity with lid, all of the same colour) in convenient locations (next to the examination table, on a trolley for mobile use in the wards).


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Ensure at least daily collection of the soft waste, with safe temporary storage before (potential) treatment.


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Covered pit (without former treatment), but only if a (very) small quantity of waste is generated and/or a lot of space is available.


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Exceptionally, offsite disposal with appropriate transport facilities (e.g. containers, vehicles, waybills)


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Provide appropriate organic waste containers (plastic buckets with lid, all of the same colour, but different than for soft waste) in a convenient location (next to the delivery chair, the operating table).


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Exceptionally offsite treatment / disposal with appropriate transport facilities (e.g. containers, vehicles, waybills) or incineration with fuel feeded high temperature incineration if urban zone / dense population


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Ensure that all hazardous waste is disposed of legally, and disposal practices and methods comply with, or exceed the country legislation.


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Ensure that all hazardous waste is disposed of safely (according to the WHO recommendations). If required, ask advice from your technical referent.


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Provide a defined waste zone with soft waste storage and all appropriate treatment and disposal facilities located inside.


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Dead bodies related to war / famine / natural disasters DO NOT represent a major public health risk. A good management is needed however to avoid proximity to the dead (psychological effects), odours and scavengers / vectors. Dead bodies related to epidemics (e.g. cholera, Ebola, Marburg, typhus, plague) DO represent a public health risk and strict rules have to be followed in order to avoid further disease transmission (refer to specific guidelines!).


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➞ Provide an appropriately sized and located morgue for In-patients structures, with a separate morgue for the isolation units.


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Ensure that dead bodies are handled safely, and that appropriate hygiene and disinfection measures are taken when handling and preparing the bodies.


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All persons handling, preparing and burying bodies wear appropriate protective equipment (disease specific).


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All persons handling, preparing and burying bodies wash themselves within the isolation centre according to the appropriate rules (disease specific).


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Safe leak-proof containment of bodies; e.g. body bags for cholera, body bags and coffin for Viral Hemorrhagic Fevers (disease specific).


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Trained team perform and/or supervise burial (with burial practices to be evaluated in every context).


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➞ Cremation should only by done on specific demand of relatives and or if specific facilities are available.


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➞ Ensure that handling, preparation, and burial / cremation of the bodies is done in a culturally sensitive manner.


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Provide appropriate vector control facilities, equipment and services in addition to the other water and sanitation requirements (see table next page):


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<table><tr><td>Common Vectors</td><td>Common Diseases</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td></tr><tr><td>Common Vectors</td><td>Common Diseases</td><td>Proper site selection</td><td>Vegetation control around health structure</td><td>Impregnated screens in doors and windows</td><td>2 x IRS* of health structure/year</td><td>2 x IRS of latrines/year</td><td>1 LN*/inpatient</td><td>Patient under LN whole day</td><td>1 LN/other people sleeping in health structure</td><td>2 LN**/prenatal consultation process</td><td>Limit vector breeding sites in and around health structure</td><td>Fly traps and/or screens</td><td>General food hygiene (e.g. proper storage)</td><td>General hygiene management (e.g. proper waste disposal)</td><td>2 x per day face and hand hygiene for all patients</td><td>Insecticidal dusting of incoming patients</td><td>Airing bedding in sun</td><td>Floor washing with 0.2% chlorine solution</td><td>Poison and/or trap and disposal of rats</td><td>Insecticidal dusting of rat runs 1 x per week</td><td>Prevent entry of rats to buildings</td><td>Larviciding***</td><td>Space spraying in between and around health structure***</td><td>Insecticidal dusting of incoming patients &amp; spare clothes</td><td>1 x insecticidal dusting per week - all patients</td><td>1 x insecticidal dusting per week - all mats and bed frames</td><td>Insecticidal dusting of corpses and deceased clothes</td><td>1 x per week laundry &gt;60 °C of all linen and patients’ clothes</td><td>Laundry &gt;60°C of incoming patients’ clothing</td><td>Floor washing with 0.2% chlorine solution</td><td>No animals in health structure</td></tr><tr><td>Anopheles mosquitoes</td><td>Malaria</td><td>X</td><td/><td>X</td><td>X</td><td/><td>X</td><td/><td>X</td><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Aedes mosquitoes</td><td>Dengue, Yellow Fever</td><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td>X</td><td/><td/><td>X</td><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Culex mosquitoes</td><td>Filariasis, Encephalitis</td><td/><td/><td>X</td><td>X</td><td>X</td><td/><td/><td/><td/><td>X</td><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Flies</td><td>Enteric infections</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td/><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Flies</td><td>Eye infections</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td/><td>X</td><td>X</td><td/><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Sand flies</td><td>Leishmaniasis</td><td>X</td><td/><td>X</td><td>X</td><td/><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Lice</td><td>Typhus, Relapsing Fever, Trench Fever</td><td/><td/><td/><td/><td/><td>X</td><td/><td>X</td><td/><td/><td/><td/><td>X</td><td/><td>X</td><td/><td>X</td><td/><td/><td>X</td><td/><td/><td/><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/></tr><tr><td>Fleas</td><td>Plague, Typhus</td><td/><td/><td/><td>X</td><td/><td>X</td><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td>X</td><td>X</td><td/><td/><td/><td/><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Rodents</td><td>Lassa fever, Salmonellosis, Leptospirosis, Plague, Hanta Fever</td><td>X</td><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td>X</td><td/><td/><td/><td/><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td>X</td></tr><tr><td>Mites</td><td>Scrub typhus, Scabies</td><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr></table>


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Common Vectors Common Diseases Measures to take for endemic zones and/or high presence of the vector Extra measures to take during outbreaks Proper site selection Vegetation control around health structure Impregnated screens in doors and windows 2 x IRS* of health structure/year 2 x IRS of latrines/year 1 LN*/inpatient Patient under LN whole day 1 LN/other people sleeping in health structure 2 LN**/prenatal consultation process Limit vector breeding sites in and around health structure Fly traps and/or screens General food hygiene (e.g. proper storage) General hygiene management (e.g. proper waste disposal) 2 x per day face and hand hygiene for all patients Insecticidal dusting of incoming patients Airing bedding in sun Floor washing with 0.2% chlorine solution Poison and/or trap and disposal of rats Insecticidal dusting of rat runs 1 x per week Prevent entry of rats to buildings Larviciding*** Space spraying in between and around health structure*** Insecticidal dusting of incoming


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of rats Insecticidal dusting of rat runs 1 x per week Prevent entry of rats to buildings Larviciding*** Space spraying in between and around health structure*** Insecticidal dusting of incoming patients & spare clothes 1 x insecticidal dusting per week - all patients 1 x insecticidal dusting per week - all mats and bed frames Insecticidal dusting of corpses and deceased clothes 1 x per week laundry >60 °C of all linen and patients’ clothes Laundry >60°C of incoming patients’ clothing Floor washing with 0.2% chlorine solution No animals in health structure Anopheles mosquitoes Malaria X X X X X X X X Aedes mosquitoes Dengue, Yellow Fever X X X X X X X X X Culex mosquitoes Filariasis, Encephalitis X X X X X X X Flies Enteric infections X X X X X X X X X X X X Flies Eye infections X X X X X X X X X X Sand flies Leishmaniasis X X X X X X X Lice Typhus, Relapsing Fever, Trench Fever X X X X X X X X X X X Fleas Plague, Typhus X X X X X X X X X X X X X X Rodents Lassa fever, Salmonellosis,


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X X X X X Sand flies Leishmaniasis X X X X X X X Lice Typhus, Relapsing Fever, Trench Fever X X X X X X X X X X X Fleas Plague, Typhus X X X X X X X X X X X X X X Rodents Lassa fever, Salmonellosis, Leptospirosis, Plague, Hanta Fever X X X X X X X X Mites Scrub typhus, Scabies X X


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Human-related activities required for assessment, planning, training, and promotion The essential requirements list mainly technical criteria, but it is clear that no intervention can be considered successful if the facilities are inappropriate for local conditions, if they are incorrectly used, or if they are not maintained (correctly). The human-related activities must go hand in hand with any technical intervention.


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<table><tr><td>Acute emergency Initial assessment and analysis Technical training to the staff Health education to the beneficiaries</td><td>Chronic emergencies and stabilised situations Initial assessment and analysis In-depth assessment and analysis with the beneficiaries General and technical training to the staff Health promotion to the beneficiaries</td></tr></table>


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Acute emergency Initial assessment and analysis Technical training to the staff Health education to the beneficiaries Chronic emergencies and stabilised situations Initial assessment and analysis In-depth assessment and analysis with the beneficiaries General and technical training to the staff Health promotion to the beneficiaries


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➞ Appropriate protective clothing when they are involved in hazardous Water, Hygiene and Sanitation (WHS) activities.


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Water Provide adequate and appropriate water supply facilities The main issues for water supply facilities are their:


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<table><tr><td>No pathogens</td><td>Free residual chlorine concentration at distribution points 0.2 - 0.5 mg/l (if pH &lt; 8) minimum 30 minutes contact time 0.4 - 1.0 mg/l (if pH &gt; 8) minimum 60 minutes contact time or max 10 E.Coli/100 ml at discharge points if chlorination is really not possible</td></tr><tr><td>Low turbidity</td><td>&lt; 5NTU &lt; 20NTU is permissible in an acute emergency</td></tr><tr><td>Low concentration of compounds that are acutely toxic or that have serious long-term effects</td><td>Context specific; in case of doubt, contact your technical referent</td></tr><tr><td>Acceptable to the users</td><td>Water not rejected due to colour, taste, odour or salinity</td></tr></table>


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No pathogens Free residual chlorine concentration at distribution points 0.2 - 0.5 mg/l (if pH < 8) minimum 30 minutes contact time 0.4 - 1.0 mg/l (if pH > 8) minimum 60 minutes contact time or max 10 E.Coli/100 ml at discharge points if chlorination is really not possible Low turbidity < 5NTU < 20NTU is permissible in an acute emergency Low concentration of compounds that are acutely toxic or that have serious long-term effects Context specific; in case of doubt, contact your technical referent Acceptable to the users Water not rejected due to colour, taste, odour or salinity


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<table><tr><td>Scenario</td><td>Quantity/ person/day</td><td>Max. distance to source</td><td>Min. storage capacity and distribution</td></tr><tr><td>Acute emergency: first days</td><td>3 – 5 l</td><td>No max. distance</td><td>Min. collective storage capacity: 5 l/person (so for 1000 persons, a bladder of 5 m³ is needed) Min. household transport / storage capacity: 40 l/household Distribution: ➞ 1 tap/200 - 250 persons ➞ 1 hand pump/500 (- 750) persons</td></tr><tr><td>Acute emergency: as soon as possible</td><td>15 – 20 l</td><td>Max. 250 m</td><td>Min. collective storage capacity: 5 l/person (so for 1000 persons, a bladder of 5 m³ is needed) Min. household transport / storage capacity: 40 l/household Distribution: ➞ 1 tap/200 - 250 persons ➞ 1 hand pump/500 (- 750) persons</td></tr><tr><td>Chronic emergency and stabilised situation</td><td>15 – 20 l, but no restriction on quantity</td><td>Max. 250 m</td><td>Min. collective storage capacity: 5 l/person (so for 1000 persons, a bladder of 5 m³ is needed) Min. household transport / storage capacity: 40 l/household Distribution: ➞ 1 tap/200 - 250 persons ➞ 1 hand pump/500 (- 750) persons</td></tr></table>


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Scenario Quantity/ person/day Max. distance to source Min. storage capacity and distribution Acute emergency: first days 3 – 5 l No max. distance Min. collective storage capacity: 5 l/person (so for 1000 persons, a bladder of 5 m³ is needed) Min. household transport / storage capacity: 40 l/household Distribution: ➞ 1 tap/200 - 250 persons ➞ 1 hand pump/500 (- 750) persons Acute emergency: as soon as possible 15 – 20 l Max. 250 m Chronic emergency and stabilised situation 15 – 20 l, but no restriction on quantity


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<table><tr><td>In sufficient quantity</td><td>Acute emergency First days: ➞ Defecation field: 0.5 m²/user day (pathways not included) ➞ Trench latrines: 3.5 m/100 users As soon as possible: ➞ 1 improved trench latrine/100 users ➞ 1 latrine/100 users =&gt; 1 latrine/50 users =&gt; 1 latrine/20 users Chronic emergency and stabilized situation ➞ 1 latrine/20 users or 1 latrine/4 households (cluster) ➞ Family latrines (preferable for hygiene reasons)</td></tr><tr><td>Technically appropriate (depending on local constraints)</td><td>Acute emergency First days: ➞ Defecation fields (arid zones) ➞ Trench latrines As soon as possible: ➞ Improved trench latrines / pit latrines Chronic Emergency and stabilised situation ➞ Pit latrines ➞ VIP latrines (if people have already experience with these facilities) ➞ (Pour) flush latrines: only if there is: Cultural acceptance / demand Enough water and recipients availability (for anal cleansing)</td></tr><tr><td>Appropriate for the users</td><td>The facilities must be culturally and socially appropriate Preferably separation between male and female (certainly if it’s culturally necessary) Some latrines provided with seats and handlebars for physically impaired persons Some children’s latrines (often 1/5 of the population is &lt; 5 years old)</td></tr><tr><td>Easily accessible</td><td>Distance of trench latrines: &gt; 30m and &lt; 50m from dwellings Distance of improved trench latrines / pit latrines: &gt; 5m and &lt; 50m from dwellings</td></tr><tr><td>At safe location</td><td>To avoid risk of sexual violence Night lights provided and operating (if feasible) Guards at defecation fields and trench latrines ( also to explain correct use)</td></tr><tr><td>Convenient hand washing facilities</td><td>Soap / ash, hand washing and waste water facilities provided at the exit of defecation facilities</td></tr><tr><td>Prevent contamination of water resources</td><td>Latrines &gt; 30 m away from water sources (&gt; 50 m in case of defecation fields)</td></tr></table>


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In sufficient quantity Acute emergency First days: ➞ Defecation field: 0.5 m²/user day (pathways not included) ➞ Trench latrines: 3.5 m/100 users As soon as possible: ➞ 1 improved trench latrine/100 users ➞ 1 latrine/100 users => 1 latrine/50 users => 1 latrine/20 users Chronic emergency and stabilized situation ➞ 1 latrine/20 users or 1 latrine/4 households (cluster) ➞ Family latrines (preferable for hygiene reasons) Technically appropriate (depending on local constraints) Acute emergency First days: ➞ Defecation fields (arid zones) ➞ Trench latrines As soon as possible: ➞ Improved trench latrines / pit latrines Chronic Emergency and stabilised situation ➞ Pit latrines ➞ VIP latrines (if people have already experience with these facilities) ➞ (Pour) flush latrines: only if there is: Cultural acceptance / demand Enough water and recipients availability (for anal cleansing) Appropriate for the users The facilities must be culturally and socially appropriate Preferably separation between


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acceptance / demand Enough water and recipients availability (for anal cleansing) Appropriate for the users The facilities must be culturally and socially appropriate Preferably separation between male and female (certainly if it’s culturally necessary) Some latrines provided with seats and handlebars for physically impaired persons Some children’s latrines (often 1/5 of the population is < 5 years old) Easily accessible Distance of trench latrines: > 30m and < 50m from dwellings Distance of improved trench latrines / pit latrines: > 5m and < 50m from dwellings At safe location To avoid risk of sexual violence Night lights provided and operating (if feasible) Guards at defecation fields and trench latrines ( also to explain correct use) Convenient hand washing facilities Soap / ash, hand washing and waste water facilities provided at the exit of defecation facilities Prevent contamination of water resources Latrines > 30 m away from water sources (> 50 m in case of defecation fields)


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<table><tr><td>In sufficient quantity</td><td>2 (bucket) showers or washing facilities/community (about 80 persons)</td></tr><tr><td>Appropriate for the users</td><td>The facilities must be culturally and socially appropriate Separation between male and female (small children can go to the women’s showers)</td></tr><tr><td>At safe location</td><td>To avoid risk of sexual violence Night lights provided and operating (if feasible)</td></tr><tr><td>Related facilities</td><td>Water supply close by (maximum 5 to 20 m walking distance) Showers connected to wastewater facilities</td></tr></table>


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In sufficient quantity 2 (bucket) showers or washing facilities/community (about 80 persons) Appropriate for the users The facilities must be culturally and socially appropriate Separation between male and female (small children can go to the women’s showers) At safe location To avoid risk of sexual violence Night lights provided and operating (if feasible) Related facilities Water supply close by (maximum 5 to 20 m walking distance) Showers connected to wastewater facilities


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<table><tr><td>Separate washing areas for</td><td>The dishes if kitchens are present: 1 area/community (about 80 persons) The laundry with drying lines (if required): 1 area/community</td></tr><tr><td>Appropriate for the users</td><td>The facilities must be culturally and socially appropriate</td></tr><tr><td>Related facilities</td><td>Water supply close by (maximum 5 to 20 m walking distance) Washing areas connected to wastewater facilities</td></tr></table>


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Separate washing areas for The dishes if kitchens are present: 1 area/community (about 80 persons) The laundry with drying lines (if required): 1 area/community Appropriate for the users The facilities must be culturally and socially appropriate Related facilities Water supply close by (maximum 5 to 20 m walking distance) Washing areas connected to wastewater facilities


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The use of soap reduces the transmission of all kinds of diseases, so foresee soap distribution: 250 g per person a month.


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<table><tr><td>Type of wastewater</td><td>Grease trap</td><td>Disposal</td><td>Distance between disposal and water resource</td></tr><tr><td>Clean&quot; wastewater of water collection points e.g. tap stands, hand pumps (without soap, oil, grease)</td><td>No</td><td>Little vegetable garden Animal drinking trough Soak away pit Infiltration trenches</td><td>&gt; 10 m</td></tr><tr><td>Clean&quot; wastewater of water collection points e.g. tap stands, hand pumps (without soap, oil, grease)</td><td>No</td><td>Properly sealed sewer system.</td><td/></tr><tr><td>&quot;Dirty&quot; wastewater (grey water with soap, oil, grease)</td><td>Yes</td><td>Soak away pit Infiltration trenches Evapo-transpiration area (arid zone)</td><td>&gt; 30 m</td></tr><tr><td>&quot;Dirty&quot; wastewater (grey water with soap, oil, grease)</td><td>Yes</td><td>Properly sealed sewer system</td><td/></tr><tr><td>Rain and runoff water</td><td>No</td><td>Natural drainage (to be planned from the start)</td><td/></tr></table>


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Type of wastewater Grease trap Disposal Distance between disposal and water resource Clean" wastewater of water collection points e.g. tap stands, hand pumps (without soap, oil, grease) No Little vegetable garden Animal drinking trough Soak away pit Infiltration trenches > 10 m Properly sealed sewer system. "Dirty" wastewater (grey water with soap, oil, grease) Yes Soak away pit Infiltration trenches Evapo-transpiration area (arid zone) > 30 m Properly sealed sewer system Rain and runoff water No Natural drainage (to be planned from the start)


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<table><tr><td/><td>Collective (emergency)</td><td>Household (stabilized situation)</td></tr><tr><td>Temporary storage</td><td>100 - 125 litre drums</td><td>Waste bin (e.g. bucket)</td></tr><tr><td>Collection</td><td>Teams</td><td>Household member</td></tr><tr><td>Transport</td><td>Cart / vehicle</td><td>By hand</td></tr><tr><td>Treatment</td><td>Not recommended</td><td>Not recommended</td></tr><tr><td>Final disposal</td><td>Controlled tip</td><td>Domestic refuse pit</td></tr></table>


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Collective (emergency) Household (stabilized situation) Temporary storage 100 - 125 litre drums Waste bin (e.g. bucket) Collection Teams Household member Transport Cart / vehicle By hand Treatment Not recommended Not recommended Final disposal Controlled tip Domestic refuse pit


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In emergencies, it’s often easier for the aid-agency to install a collective system, because the household system demands a good training and collaboration of the beneficiaries, which might be difficult to obtain, especially in the initial phase. However in the long run, a household system is cheaper and more “sustainable”.


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<table><tr><td>Temporary storage</td><td>Collection and transport</td><td>Final disposal</td></tr><tr><td>2 bins/community (about 80 persons) Lid on the drums (to avoid dispersion by wind and animals)</td><td>Establishment of circuits Constitution of teams (2.5 persons/1000 inhabitants) Allocation of circuit to each team Daily collection</td><td>Controlled tip &gt; 800 m from dwellings Fenced Evacuation of runoff water</td></tr></table>


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Temporary storage Collection and transport Final disposal 2 bins/community (about 80 persons) Lid on the drums (to avoid dispersion by wind and animals) Establishment of circuits Constitution of teams (2.5 persons/1000 inhabitants) Allocation of circuit to each team Daily collection Controlled tip > 800 m from dwellings Fenced Evacuation of runoff water


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<table><tr><td>Temporary storage</td><td>Collection and transport</td><td>Final disposal</td></tr><tr><td>20 litre bucket with lid per household</td><td>Good practice of population required, thus need for: ➞ Training ➞ Discipline</td><td>1 pit/household or several households Need for a fence Waste covered (soil or lid) after each disposal Need for the population to re-dig a hole when the old one is full</td></tr></table>


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Temporary storage Collection and transport Final disposal 20 litre bucket with lid per household Good practice of population required, thus need for: ➞ Training ➞ Discipline 1 pit/household or several households Need for a fence Waste covered (soil or lid) after each disposal Need for the population to re-dig a hole when the old one is full


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<table><tr><td/><td>War / Famine / Natural disaster</td><td>Epidemics (cholera, haemorrhagic fevers)</td></tr><tr><td>Body preparation and dressing</td><td>No disinfection of body needed Body dressing depending on local customs and/or availability: coffin / shroud (cloth) / blanket / sleeping mat / body bag</td><td>Disinfection of the body (disease specific; according to the specific guidelines) and Sealed body bags + (coffins; disease specific)</td></tr><tr><td>Burial / cremation procedures by:</td><td>Relatives Aid-agencies potentially in case of mass burial</td><td>Trained and protected personnel of the aid-agency due to the very high contamination risk: ➞ Disinfecting the body, living environment, health structure ➞ Burial team (at least supervision)</td></tr><tr><td>Personal protection</td><td>Hand washing with soap</td><td>According to the specific guidelines related to the diseases Complete spraying of the staff with a chlorine solution Complete protective gear for staff</td></tr><tr><td>Other help from aid-agencies</td><td>Providing / involved in (if needed): Morgue in health structure Selection of the burial / cremation site Body dressing material Potential transport of the bodies</td><td>Providing / involved in: Morgue in the isolation centre Selection of the burial site Sealed body bags / impervious wrappings Transport of the bodies</td></tr></table>


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War / Famine / Natural disaster Epidemics (cholera, haemorrhagic fevers) Body preparation and dressing No disinfection of body needed Body dressing depending on local customs and/or availability: coffin / shroud (cloth) / blanket / sleeping mat / body bag Disinfection of the body (disease specific; according to the specific guidelines) and Sealed body bags + (coffins; disease specific) Burial / cremation procedures by: Relatives Aid-agencies potentially in case of mass burial Trained and protected personnel of the aid-agency due to the very high contamination risk: ➞ Disinfecting the body, living environment, health structure ➞ Burial team (at least supervision) Personal protection Hand washing with soap According to the specific guidelines related to the diseases Complete spraying of the staff with a chlorine solution Complete protective gear for staff Other help from aid-agencies Providing / involved in (if needed): Morgue in health structure Selection of the burial / cremation site


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staff with a chlorine solution Complete protective gear for staff Other help from aid-agencies Providing / involved in (if needed): Morgue in health structure Selection of the burial / cremation site Body dressing material Potential transport of the bodies Providing / involved in: Morgue in the isolation centre Selection of the burial site Sealed body bags / impervious wrappings Transport of the bodies


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Ensure that the handling, preparation, and burial / cremation of the bodies is done in a culturally sensitive manner.


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BurialCremationPreferred option in all situationsOnly when strictly demanded by the populationfor religious / cultural reasonsBurial site:> 50 m away from potable water resources> 500 m away from the dwellings1500 m²/10.000 inhabitantsGraves:➞ Preferably individual graves➞ Mass graves if really necessary (but trenches for people to be buried head to toe)Respect local customs:➞ Orientation of the graves➞ Position of the body in the grave➞ Separate burial areas for different religionsCremation site:> 500 m away from the dwellingsDownwind of the dwellingsBurial depth:> 1.5 m under the surface> 1.5 m above the highest possible water table (rainy season)Needs:At least 300 kg of firewood per bodyExperienced people for the cremation


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Provide appropriate vector control facilities, equipment and services in addition to the other water and sanitation requirements (see Table hereunder).


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<table><tr><td>Common vectors</td><td>Common diseases</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Measures to take for endemic zones and/or high presence of the vector</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td><td>Extra measures to take during outbreaks</td></tr><tr><td>Common vectors</td><td>Common diseases</td><td>Proper site selection</td><td>2 X IRS* of all dwellings/year</td><td>2 X IRS of all latrines/year</td><td>1 LN*/sleeping place</td><td>Limit vector breeding sites in and around camp</td><td>Fly traps and/or screens</td><td>General food hygiene</td><td>Airing bedding in sun</td><td>Promote 2 X per day face and hand hygiene for entire camp</td><td>Poison and/or trap and dispose of rats</td><td>Insecticidal dusting of incoming persons</td><td>Larviciding** and/or promote emptying stagnant water every week</td><td>Space spraying 300 m around dwelling of confirmed case</td><td>Follow-up insecticidal dusting on request</td><td>1 X insecticidal dusting mats, bed frames, clothes in dwellings</td><td>Insecticidal dusting of corpses and deceased clothes</td><td>Promote absence of animals in dwellings</td></tr><tr><td>Anopheles mosquitoes</td><td>Malaria</td><td>X</td><td>X</td><td/><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Aedes mosquitoes</td><td>Dengue, Yellow Fever</td><td>X</td><td>X</td><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td>X</td><td>X</td><td/><td/><td/><td>X</td></tr><tr><td>Flies</td><td>Enteric infections</td><td>X</td><td>X</td><td>X</td><td/><td>X</td><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Flies</td><td>Eye infections</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Sand flies</td><td>Leishmaniasis</td><td>X</td><td>X</td><td/><td>X</td><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Lice</td><td>Typhus, Relapsing Fever, Trench Fever</td><td/><td>X</td><td/><td>X</td><td/><td/><td/><td/><td/><td/><td>X</td><td/><td/><td>X</td><td>X</td><td>X</td><td/></tr><tr><td>Fleas</td><td>Plague, Typhus</td><td/><td>X</td><td/><td>X</td><td/><td/><td/><td>X</td><td/><td>X</td><td>X</td><td/><td/><td>X</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Rodents</td><td>Lassa fever, Salmonellosis, Leptospirosis, Plague, Hanta Fever</td><td>X</td><td/><td/><td/><td/><td/><td>X</td><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/></tr><tr><td>Mites</td><td>Scabies</td><td/><td/><td/><td>X</td><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/><td/></tr></table>


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Common vectors Common diseases Measures to take for endemic zones and/or high presence of the vector Extra measures to take during outbreaks Proper site selection 2 X IRS* of all dwellings/year 2 X IRS of all latrines/year 1 LN*/sleeping place Limit vector breeding sites in and around camp Fly traps and/or screens General food hygiene Airing bedding in sun Promote 2 X per day face and hand hygiene for entire camp Poison and/or trap and dispose of rats Insecticidal dusting of incoming persons Larviciding** and/or promote emptying stagnant water every week Space spraying 300 m around dwelling of confirmed case Follow-up insecticidal dusting on request 1 X insecticidal dusting mats, bed frames, clothes in dwellings Insecticidal dusting of corpses and deceased clothes Promote absence of animals in dwellings Anopheles mosquitoes Malaria X X X X Aedes mosquitoes Dengue, Yellow Fever X X X X X X Flies Enteric infections X X X X X X Flies Eye infections X X X X X X X Sand flies Leishmaniasis X


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in dwellings Anopheles mosquitoes Malaria X X X X Aedes mosquitoes Dengue, Yellow Fever X X X X X X Flies Enteric infections X X X X X X Flies Eye infections X X X X X X X Sand flies Leishmaniasis X X X X Lice Typhus, Relapsing Fever, Trench Fever X X X X X X Fleas Plague, Typhus X X X X X X X X X Rodents Lassa fever, Salmonellosis, Leptospirosis, Plague, Hanta Fever X X X Mites Scabies X


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Having chosen the site according to key criteria (T.B. 1.05), there are a series of decisions and specific activities that need to take place:


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Prepare a map of the site including amongst others the water resources, the existing defecation areas, the surface drainage patterns, the available space for a cemetery and potentially a controlled tip.


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List the resources needed (budgetary, logistic, human) according to the respective responsibilities taken by the aid-agencies.


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In order to see how much land is available, it’s important to have a map of the available site. One way of obtaining this map is by the mapping method (T.B. 1.02.). In this stage, it might be interesting to have a map with a bigger scale than 1/10,000 to be able to indicate more details. Information on the slopes of the camp can be obtained by doing a topographic survey (T.B. 2.24). As such, the map will also be an interesting tool for the camp design.


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Community facilities (e.g. market, cultural centre, workshops, schools, religious structures, recreation grounds).


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The size of the camp will depend on the available space of the selected site. But it’s preferable not to make too big camps for management purposes, even if the availability of space would permit it. Ideally, a camp should host maximum 20,000 people in subdivisions of 5,000 persons. Be aware that the site should also offer space for firebreaks, a separated cemetery and landfill. Additional space should be preserved for a potential extension of the camp.


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<table><tr><td>Area available/person : 30 m² (including area for dwellings, firebreaks, storage, administration, market, dispensary, cemetery, landfill) : 45 m² (if small vegetable gardens are required additionally) Dwelling space/person : 3.5 m² (4.5 – 5.5 m² in cold climates) Firebreaks : 30 - 75 m strip every 300 m</td></tr></table>


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Area available/person	: 30 m² (including area for dwellings, firebreaks, storage, administration, market, dispensary, cemetery, landfill) : 45 m² (if small vegetable gardens are required additionally) Dwelling space/person	: 3.5 m² (4.5 – 5.5 m² in cold climates) Firebreaks	: 30 - 75 m strip every 300 m


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All the necessary structures / facilities should be added to the initial map and the way that shelters are to be grouped decided. This decision will eventually affect the correct use of latrines and water points. Security for the population and re-establishment of its social fabric should also be considered when deciding on the shelter layout.


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Water and sanitation facilities are a priority issue when designing the overall layout of a camp. In case the water resources are located inside or nearby the camp site, it is important to protect them from (further) contamination; correct locations of the water intakes and the evacuation places of runoff water.


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Latrines, showers and washing facilities should be located at places that won’t contaminate the water resources, but not too far and too isolated either in order to prevent sexual violence. These places should preferably be well lighted at night. A landfill and cemetery / cremation site will have to be located at appropriate places as well: away from water resources, and at a minimum distance and downwind from camp dwellings and potential population housing.


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Additional information on water and sanitation facilities within camps can be found in T.B.1.06 and 1.09.


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The road system within the camp should be organized according to the structures / facilities that should be easily reachable and according to the shelter layout. In order to preserve their condition, the roads should have a drainage system which should be connected to the general drainage system of the camp.


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Direction signs / logos are also important within the camp: they should enable the easy identification of zones with different activities and of each residential area, for visitors as well as for residents. Signs


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/ logos should be understandable for everybody, given that not everybody knows how to read or masters international as well as local languages. For large camps, a detailed plan placed at the entrance may be necessary.


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Several blueprints for shelter layout exist, but the cultural habits of the population concerned should be the guiding principle.


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Avoid layouts in lines and rows; they increase distances from dwellings to latrines and water points. On the other hand, this method can be implemented quickly and it is better than no planning at all. Give preference to a shelter layout per community unit, without separating families. The basic community unit is formed by grouping 16 shelters in a square or rectangle around a communal space. Latrines, water points and washing areas may be placed around the community unit. Spaces for community facilities and services are created by leaving out a number of basic units according to the space required.


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<table><tr><td>Distance between two tents / shelters : 2 m minimum, but preferably twice the size of the overall height of the shelters (to avoid damage when a neighbouring shelter collapses), or even 3 – 4 times the height if the shelters are made from highly inflammable material (straw, thatch) Distance between two rows : 10 m</td></tr></table>


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Distance between two tents / shelters	: 2 m minimum, but preferably twice the size of the overall height of the shelters (to avoid damage when a neighbouring shelter collapses), or even 3 – 4 times the height if the shelters are made from highly inflammable material (straw, thatch) Distance between two rows	: 10 m


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Tents are often used in the initial phase. Apart the fact that they do not last long, they are expensive to buy and to transport. It is often more feasible therefore, to use locally available construction materials (e.g. planks, corrugated iron sheets).While more durable dwellings are being built, plastic sheeting may be stretched over ropes and poles for temporary shelters.


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Energy is needed essentially for cooking food, but sometimes also for heating. Wood is often the most commonly used energy source, but it may be logistically difficult to supply it. And it involves politico-ecological problems because of deforestation.


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Lighting is desirable in the camp as a whole because it reduces insecurity and allows better access to sanitary facilities. Take into consideration however that the installation of an electricity supply system in the camp may cause safety problems (e.g. illegal connections), as well as troubles with the local population if they do not have access to electricity (which is often the case). Electricity is indispensable though in health centres open at night like an isolation ward, a Cholera Treatment Centre (CTC) and an In-patient Therapeutic Feeding Centre (ITFC).


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The selection and general planning is normally done by the official authorities (e.g. UNHCR, local authorities), but involvement of Non-Governmental Organisations (NGO) is recommended. The selection and planning of a site should preferably be done by a multi disciplinary team that consists of a medical person, a logistician and a water, hygiene and sanitation technician / engineer.


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Besides the general planning, it will have to be decided what will be the respective responsibilities of each aid-agency regarding the installation of the different services and infrastructures to respond to the different needs of the beneficiaries. The aid-agencies should be accountable for the engagements taken.


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According to the responsibilities / engagements taken, budgetary, logistic and human resources will be needed. These could be defined by means of the logic framework, which is an interesting tool in the strategy planning.


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Water is indispensable for human life, in adequate quantity and quality. Without water, human beings cannot live for more than a few days. It plays a vital role in nearly every function of the body. But besides being a vital element of (public) health and well-being, water is also related to most of human activities. Also, a health structure cannot function properly without a reliable source of clean water.


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Water is often also related to quite some health problems, so appropriate attention should be given to it.


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Water-borne diseases: caused by the ingestion of water containing pathogenic micro-organisms. Water can be a transmission route of certain diseases when it has been contaminated by faeces or urine of human beings or warm-blooded animals. But some of these diseases may also be transmitted by any of the other faecal-oral routes like dirty hands and contaminated food, which are grouped in water-washed diseases.


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Water-washed diseases: due to lack of proper domestic and personal hygiene. Insufficient water supply is one factor leading to improper hygiene. The diseases linked to lack of water for hygiene are:


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➞ Faecal-orally transmitted diseases: lack of hygiene, particularly of hands and food, allows the transmission


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of these diseases from infected individuals and animals (sick or healthy carriers) to uninfected individuals. This results in the so-called “dirty hands diseases”.


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➞ Dermatological and ophthalmic diseases: lack of personal hygiene can lead to skin and eye infections.


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➞ Diseases transmitted by lice: lack of personal hygiene and washing of clothes encourages the proliferation of lice which, in addition to the problems caused by their presence (itching and scratching, skin sores),


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Water-based diseases: their causal agent (pathogen) has to pass part of its life-cycle in an intermediate organism (host) that is living in the water.


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Water-related insect vector diseases: are related with an insect vector which develops in or lives near water.


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A safe water supply has the objective to ensure the access of the consumers to correct quantities of good


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In tropical climates, the daily minimum volume of water required for survival (drinking and cooking) would be around 3 to 5 litres per person a day, because the human body needs a minimum intake to sustain life before mild and then severe dehydration occurs. It is estimated that 2.6 litres of water per day is lost through respiratory loss, (insensible) perspiration, urination and defecation. In addition, a significant quantity of water is lost through sensible perspiration if hard work is performed.


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The need for domestic water supplies for basic health protection exceeds the minimum required for survival. Additional volumes should be foreseen for maintaining domestic and personal hygiene through food and hand washing, bathing and laundry. Therefore should the survival quantity be increased as soon as possible because insufficient water quantities will induce poor hygiene, which in turn will cause all kinds of water-washed diseases. Domestic water supply should thus be minimal 15 to 20 litres per person a day (T.B. 1.09). Where possible, it is better not to put any limit on consumption as the health status of the population is influenced by the quantity of water used. The quantities of water used worldwide depend on many variables and cultural practices.


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<table><tr><td>In the first phase of an emergency, it is preferable to have a lot of water of average quality than a little amount of water of very good quality. A soon as possible, high quantities of good quality water must be delivered however.</td></tr></table>


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In the first phase of an emergency, it is preferable to have a lot of water of average quality than a little amount of water of very good quality. A soon as possible, high quantities of good quality water must be delivered however.


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Besides the water needed by the population itself, additional water might be necessary for special needs like cattle (e.g. 30 l per animal a day) and certainly to cover the losses due to leaks and spillages (up to 20 %).


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Health structures including inpatients and outpatients departments, and specific health facilities such as cholera treatment and feeding centres will always require considerable amounts of water of good quality, even in acute emergencies (T.B. 1.08). When these essential water requirements can’t be reached, the correct functioning of the health structure will be jeopardized. In later phases of emergencies and in stabilized situations, the water quantities should be increased because the water demand will most probably rise (improved medical activities, but also more “domestic” activities by and for the patients and their visitors, such as showering and doing the laundry).


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According to the needs, it is important to evaluate the amount of water that can be supplied to cover those requirements. The objective should be to secure water sources that provide more water in 24 hours than the strict daily volume required for the targeted purpose. In health structures, it is strongly recommended to have a reserve storage capacity lasting for at least two days in order to cope with a water supply failure.


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One has also to keep in mind however that there is no direct relationship between the appearance of a water sample and its drinkability (a cloudy sample may be safe, whereas a clear sample may be both chemically and biologically dangerous).


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Water can be the cause of diseases, which can spread epidemically in a (concentrated) population. Five categories of pathogens can be found in water: bacteria, viruses, protozoa, helminths (eggs) and fungi. Water contaminated with (one of) these biological elements can cause a variety of communicable diseases through ingestion or physical contact. The potential consequences are such that microbial contamination control is always of paramount importance and can never be compromised (T.B 2.10).


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Chemical contaminants present in the water might have been introduced naturally, caused by the geological structure of the underground, or man-made due to (intensive) agricultural and industrial activities. Removing chemicals from water often proves to be an expensive and very difficult task. The choice of the water source will therefore be of utmost importance.


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The chemical quality of drinking water can have a direct health implication, due to the absence of necessary chemical constituents (although very rare) or by the excessive presence of certain chemical elements. This is a rapidly increasing problem in low-income countries. Most of the human intake of chemicals occurs through the food, not via the drinking water however.


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The health risk due to toxic chemicals in drinking water differs from that caused by microbiological contaminants. The problems associated with chemical constituents at a low concentration within drinking water arise primarily from their ability to cause adverse health effects after prolonged periods (years) of exposure. High concentrations of chemicals in the potable water supply, and certainly massive (accidental) contamination can cause serious (acute) health problems.


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The chemical contaminants (T.B 2.10) can be harmful organics like pesticides or harmful inorganic products such as:


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Arsenic: which is widely distributed throughout the Earth’s crust, and of great concern for instance in Pakistan and Bangladesh as it is carcinogenic.


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Fluoride: which is an element of importance in eastern Africa. A high concentration carries an increasing risk of dental fluorosis, and can lead to skeletal fluorosis.


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Mercury: which presence should be suspected in areas where gold extraction is carried out. It is a toxic heavy metal.


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Nitrates: which are introduced by over-fertilizing or due to high amounts of excreta (mainly urine) being disposed of in very dense population settings (e.g. a refugee camp). A relatively low concentration of nitrates can already cause methaemoglobinaemia in newborn babies (blue-babies disease).


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Nitrites: which is a reduced form of nitrates can be introduced by backfilling wells with termite hills and can lead to immediate death.


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<table><tr><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td><td>Control measures for water related infectious diseases</td></tr><tr><td>Diseases</td><td>Water-borne</td><td/><td>Water-washed</td><td>Water-washed</td><td>Water-washed</td><td/><td>Water-based</td><td>Water-related insect vectors</td></tr><tr><td>Control measures</td><td>Cholera Dysentery Giardiasis Hepatitis A Poliomyelitis Typhoid fever</td><td>Faeco-oral Cholera Diarrhoeas Dysenteries Hepatitis A (Para)typhoid fevers Poliomyelitis Various helminths diseases</td><td>Faeco-oral Cholera Diarrhoeas Dysenteries Hepatitis A (Para)typhoid fevers Poliomyelitis Various helminths diseases</td><td>Skin / eye infections Scabies Conjunctivitis Trachoma</td><td>Lice related Louse-borne typhus Recurrent fever</td><td>Bilharzias Dracunculosis (Guinea worm)</td><td>Bilharzias Dracunculosis (Guinea worm)</td><td>Malaria Dengue Yellow fever</td></tr><tr><td>Improve water qua- lity: source protec- tion, water treatment</td><td>X</td><td>-</td><td>-</td><td>-</td><td>-</td><td>X</td><td>X</td><td>-</td></tr><tr><td>Increase water quantity</td><td>-</td><td>X</td><td>X</td><td>X</td><td>X</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Improve water accessibility</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>-</td></tr><tr><td>Reduction of the contact with the in- fected water</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>X</td><td>X</td><td>-</td></tr><tr><td>Improve the environ- mental sanitation: latrines, drainage, waste (water) elimination</td><td>X</td><td>X</td><td>X</td><td>-</td><td>-</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Choice of settlement site</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td><td>X</td><td>X</td><td>X</td></tr><tr><td>Correct household water storage: quality / quantity</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>-</td><td>-</td><td>X</td></tr><tr><td>Improve personal hygiene</td><td>-</td><td>X</td><td>X</td><td>X</td><td>X</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Improve food hand- ling and preparation</td><td>-</td><td>X</td><td>X</td><td>-</td><td>-</td><td>-</td><td>-</td><td>-</td></tr><tr><td>Use of pesticides</td><td>-</td><td>-</td><td>-</td><td>-</td><td>X</td><td>X e.g. snail control</td><td>X e.g. snail control</td><td>X</td></tr><tr><td>Personal protection (e.g. bed nets)</td><td>-</td><td>-</td><td>-</td><td>-</td><td>X</td><td>-</td><td>-</td><td>X</td></tr><tr><td>Health promotion</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td><td>X</td></tr></table>


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Control measures for water related infectious diseases Diseases Water-borne Water-washed Water-based Water-related insect vectors Control measures Cholera Dysentery Giardiasis Hepatitis A Poliomyelitis Typhoid fever Faeco-oral Cholera Diarrhoeas Dysenteries Hepatitis A (Para)typhoid fevers Poliomyelitis Various helminths diseases Skin / eye infections Scabies Conjunctivitis Trachoma Lice related Louse-borne typhus Recurrent fever Bilharzias Dracunculosis (Guinea worm) Malaria Dengue Yellow fever Improve water qua- lity: source protec- tion, water treatment X - - - X - Increase water quantity - X X X - - Improve water accessibility X X X X X - Reduction of the contact with the in- fected water - - - - X - Improve the environ- mental sanitation: latrines, drainage, waste (water) elimination X X - - X X Choice of settlement site - - - - X X Correct household water storage: quality / quantity X X X X - X Improve personal hygiene - X X X - - Improve food hand- ling and preparation - X - - -


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X - - X X Choice of settlement site - - - - X X Correct household water storage: quality / quantity X X X X - X Improve personal hygiene - X X X - - Improve food hand- ling and preparation - X - - - - Use of pesticides - - - X X e.g. snail control X Personal protection (e.g. bed nets) - - - X - X Health promotion X X X X X X


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This characteristic is a measure of the amount of suspensible particles in the water (T.B. 2.13). The turbidity of water is mainly of importance because it inhibits the effectiveness of disinfection (T.B. 2.13 and 2.21) and hence the correct microbiological quality of the water. Turbidity will also directly affect the acceptance of the water by the consumers.


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Salinity is a measure of the amount of dissolved salts in the water which should be low for the acceptability of the consumers, and to avoid corrosion of the equipment. A high salinity concentration can also cause negative health effects such as diarrhoea, vomiting and renal failure.


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Colour, taste and smell are characteristics due to the presence of some micro-organisms and/or chemical substances in the water.


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Corrosion can also be caused by the high acidity (low pH) of the water, and encrustation is due to certain minerals (e.g. calcium carbonate). Both may affect the longevity of equipment (e.g. pipes, pumps). The pH also has a serious influence on water treatment procedures (e.g. coagulation / flocculation, chlorination). The chemical water quality and/or the above mentioned characteristics may affect a consumer’s acceptance to drink that particular water, therefore turning to more palatable but potentially biologically unsafe water from a contaminated source. As such, these factors can also become an indirect health hazard.


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Efforts to obtain sufficient water quantities of correct quality are ineffective if the beneficiaries don’t have a rather easy and nearby access to it. The further the distance in between the water discharge / distribution point and the beneficiaries living area, the less water they will collect. In case water has to be paid for, it will probably reduce the amount of water that is collected. To avoid problems of long queuing, which could result in aggression, enough water points should be foreseen. Besides the installed procedures and facilities to get the water unhampered in quantity and quality to the beneficiaries, correct transport and storage recipients at household level are essential as well.


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Whatever the context, water is essential for the functioning of a health structure. From the start, even in acute emergencies, it will be crucial for the aid-agency to provide the required quantities of high quality water (T.B. 1.08). In case good quality water sources aren’t available on the spot, water trucking and/or appropriate treatment procedures will have to be implemented. In stabilized situations, the preferred choice would be water sources requiring as little as possible external interventions such as treatment involving chemicals, with the possible exception of chlorine since its use is always recommended to disinfect water in health structures.


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Water is needed in all places where people are living, such as camps, urban and rural areas. The choice of the water sources and of the actors involved in managing the water system is very much context related. In practice, there is rarely a wide choice between different water sources, particularly in (the first phase of) emergency situations.


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In the acute phase of an emergency, the main concern will be to provide enough clean water to the beneficiaries. Therefore, if there is no available supply of good quality water (e.g. town water supply, spring, borehole), the fastest way to extract water is usually to take surface water, and then to treat it. Be sure however that the surface water is of sufficient quality in order to be treatable. In order not to diminish the quality of the surface water by human actions, the first step is to foresee a protected drinking water collection area upstream of dirty activities (e.g. laundry, personal hygiene), and a zone for animal watering downstream. Often in emergencies, aid-agencies might have to support or install and run the water chain.


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Once the situation starts to stabilize, the investigation for a better quality and/or a more reliable water source (like groundwater) should begin. The beneficiaries should be involved in this process as well. It might also be important to provide water not only to the people affected by the emergency, such as the refugees, but also to the host population.


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For all the scenarios described above, it is strongly recommended to verify always if there are potential local partners, such as national NGO’s, water companies, municipal water supplies or water committees. They can be of help for instance in indicating existing water resources, in providing water, in monitoring water quality, and be involved in operation and maintenance follow up.


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When a new water source is put into service and if the infrastructures are available, water sampling and analysis should be undertaken by the appropriate (national) authorities, according to the national standards. In this way, the local government will be involved in the process and the responsibility transferred to them. In acute emergencies however, this procedure might be more complicated.


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For correct planning and organisation of a water supply system, it is necessary to follow all the different steps described in chapter 1, even for acute emergencies.


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As water is essential for human survival and the good functioning of a health structure from the very first phase of an emergency already, only simple and rapid (often temporary) water supply solutions should be chosen in the beginning. An initial assessment to collect some basic data on the demography, the practices of the population (e.g. where and how do they collect water and where do they defecate, do they have a private water source), the physical nature of the site, the available water sources (and their capacity to respond to the needs) and the available material are sufficient to determine the acute emergency strategy. The first implementation priority will be to protect the source from (faecal) contamination, with amongst other basic means, the installation of simple defecation facilities (T.B. 3.01, 3.02 and 3.03) far enough from the water source. In case the water storage capacity of the users would be insufficient, recipients should be provided immediately as well.


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Within days, it should be possible to augment the water availability by setting up a basic supply system with increased protection of the water source (possibly more than one at this stage), potential treatment (at least chlorination), reservoirs and distribution points. As the situation changes daily, the monitoring will be essential to adapt the system rapidly to the actual needs. The first evaluation should have as an objective to look if the time has come to install less vulnerable systems.


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Chronic emergencies and stabilized situations often demand less vulnerable water supply systems. This means that a lot more information needs to be collected and analyzed (e.g. topographic survey, T.B. 2.24) during an in-depth assessment before the strategy can be completely developed. As there isn’t a real urgency (anymore), a lot more time and care can be spent on the implementation, monitoring and evaluation of the complete water supply system.


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Whatever the context, the chosen strategy will depend largely on the selected water source. Three potential drinking water sources can be distinguished: surface water, groundwater and rainwater.


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Water that does not infiltrate into the ground is called surface water. As the water flows at the surface, it is exposed to all kinds of microbiological, chemical and physical contaminants, which may be harmful to humans. All surface water is considered to be contaminated unless proven otherwise. Common types of surface water include runoff water, rivers, streams, lakes, and swamps. Because of its easiness to locate and to access, it is often the primary water source in acute emergencies. This doesn’t mean however that other water sources shouldn’t be considered from the start as well


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Water running in the top layers of the soil are also considered as surface water, because the filtration process through the soil has not been completed. An arbitrary limit of 3 meters is usually considered as the limit between surface and groundwater. Even if a river is dry, there may be an important quantity of surface water underneath the river bed.


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Groundwater is water that is stored in porous underground layers, called aquifers. Most groundwater originates from precipitation that soaks into the ground. Generally the groundwater will progress in the direction of the oceans, either by movement through the ground or by flowing out (becoming surface water) and joining rivers or streams.


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Groundwater is found in most parts of the world and can be a reliable source of drinking water. It is generally free from microbiological contamination, if it is protected correctly and no contamination sources are in the neighbourhood. However, groundwater can pick up minerals from the underground, which have a potential influence on the correct chemical and physical quality of the water. For deep groundwater, there is a lower seasonal flow variation than for surface water.


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A well is a hole that pierces an aquifer so that groundwater can be pumped or lifted out. Usually, the hole that pierces the aquifer is called a hand dug well (T.B. 2.01; 2.02) if it has been excavated manually, and a borehole or tube well if it is made with special equipment (e.g. drilling rig, jetting; T.B. 2.07). Capitalize as much as possible on local knowledge for the right localisation of a new well and/or ask advise to your technical referent. Protecting a well is of utmost importance to avoid its contamination (T.B. 2.04).


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Springs and seeps may be the resurgence of groundwater. These sources are interesting as they often combine good microbiological water quality with reasonably easy access. The protection of springs will be of prime importance to avoid its good quality water getting contaminated (T.B. 2.08). An inconvenience of springs might be their variable water yield over the different seasons, or they may even dry up completely.


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Rainwater in non-industrialized and non-urban areas presents good quality characteristics. It may represent an important source of water, although its variability in quantity over the seasons is important. Rainwater can be collected from any clean surface, with roof catchments being used most often. The contamination of harvested rainwater comes primarily from the first rains, rinsing away the accumulated dirt on the roof. Correct techniques of rainwater harvesting will remove this contamination first (T.B. 2.09) before the water is stored in reservoirs (e.g. T.B. 2.38) that potentially need to be (very) big.


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<table><tr><td/><td/><td>Advantages</td><td>Disadvantages</td><td/></tr><tr><td/><td>Surface water</td><td>Relatively big quantities Easier extraction Easy to discover</td><td>Usually contaminated, and to be considered as unsafe Always need for treatment</td><td/></tr><tr><td/><td>Groundwater*</td><td>Generally of good microbiological quality if correctly protected</td><td>May be subject to chemical contamination</td><td/></tr></table>


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Advantages Disadvantages Surface water Relatively big quantities Easier extraction Easy to discover Usually contaminated, and to be considered as unsafe Always need for treatment Groundwater* Generally of good microbiological quality if correctly protected May be subject to chemical contamination


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<table><tr><td>Precipitation</td><td>In rural areas, it is of drinking</td><td>Very important variability in quantity</td></tr><tr><td>(rainwater)</td><td>quality if correctly collected</td><td>Needs big storage capacity</td></tr><tr><td/><td>Easy to collect</td><td>to cover dry periods</td></tr></table>


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Precipitation In rural areas, it is of drinking Very important variability in quantity (rainwater) quality if correctly collected Needs big storage capacity Easy to collect to cover dry periods


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All water sources can potentially be taken into account for water supply, possibly even a combination of different ones. It is always better to use non-polluted water than to try to treat polluted water. But it is useless to focus on water quality alone if all other faecal-oral transmission routes are open: e.g. excreta is scattered everywhere and flies have unhindered access to food.


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Operation and maintenance procedures are often forgotten when a water supply system is installed. This should already be taken into consideration when the water source is chosen, certainly if the beneficiaries (water committee) will have to operate and maintain the system themselves. Surface water will always demand a treatment and a distribution system, thus intense operation and maintenance will be required. But also a protected well with a hand pump needs operation and maintenance, as well as a protected spring, certainly when it’s connected to a water distribution system. People responsible for the maintenance should be trained, and a system providing sufficient consumables / spare parts should be installed.


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The consumption of sufficiently clean and safe water can only be achieved by actions at all levels, with global activities on water supply, sanitation (e.g. safe excreta disposal) and health promotion. Pollution at the source and/or during the collective transport can be more dangerous than contamination of the water at home, because it affects the whole population at once and consequently encourages large scale epidemics.


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To ensure that the quality characteristics of drinking water are obtained and/or preserved from the source until it is consumed, several technical steps might need to be integrated within the water supply system. Where people take water immediately from a safe source, like for instance from a protected well with a hand pump, the number of technical steps is reduced. But for surface water that needs treatment and that is located away from the beneficiaries, different technical steps will be needed to get it safely to the consumers.


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Intakes are wells and boreholes, but also collection boxes and pipes through which water from springs, rivers or lakes enters a water supply system and goes either to treatment and/or storage, or in some of the cases, directly to the users. Infiltration galleries are an interesting alternative, except for acute emergencies given the time and expertise that are required for their construction (contact your technical referent). Water moves through the intake either by gravity, either it has to be lifted (T.B. 2.01). It is an important stage because it has to be well designed to avoid loss and (further) contamination of the water. Source protection (T.B. 2.04; 2.08) is nearly always the best and simplest method of ensuring safe drinking water and has to be preferred over treatment of contaminated water. It is important to avoid pollution of the water source by providing latrines, bathing areas and animals watering places at the correct location, thus downstream / downhill of the intake.


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water. It is important to avoid pollution of the water source by providing latrines, bathing areas and animals watering places at the correct location, thus downstream / downhill of the intake. Surface water can be made more accessible and treated to a certain extent by means of shallow wells, infiltration galleries and the diversion of rivers.


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The main objective of water treatment in precarious situations is the elimination of microbiological pathogens. Several principles exist: proper boiling, appropriate filtration methods, UV-radiation (solar or lamps) and chemical disinfection. For the pathogen elimination to be effective, certain of these principles will require the removal of the particles in suspension (turbid water) first. The main turbidity reduction principles used in emergencies are (assisted) sedimentation and/or filtration. All the above mentioned principles have their specific advantages and disadvantages (T.B. 2.12).


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For health structures and closed settings, the treatment will mainly be done on a centralized level. Be aware that treated water can potentially be dangerous in case there is a (hidden) failure in the treatment system. For open settings, household treatment would be ideal, but the (rapid) distribution of equipment and/or supplies to the population needs to be planned carefully. Another difficulty (certainly in emergencies) is the correct usage of the household treatment method, therefore needing an intense promotion campaign to provide the essential knowledge and skills, and to do a close follow up. For these reasons, semi-centralized systems like bucket chlorination (T.B. 2.23) are sometimes set up during (acute) emergencies in open settings.


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In case the water source isn’t nearby the beneficiaries, it will have to be transported where the people are based. In a first instance, water can be carried with tanker trucks (T.B. 2.34). This system can be set up rapidly and can be very effective. However, it is usually the most expensive way in delivering water, and should only be considered in the very first phase of an emergency (few days or weeks).


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Although it might take some time to install, a piping system to carry the water over reasonable distances (some km) should be considered. Water flows through pipes either by gravity, either by assistance of a pump. In the first phase of an emergency, the pipes, such as spiralled (Heliflex) pipes or flat hose, may be laid on the surface, but this results in the water getting hot, which renders the water less palatable and potentially reduces the remnant effect of the Free Residual Chlorine. In a later stage, the pipes will have to be buried at a depth of at least 0.5 m (deeper in cold climates), laying on a sand bed of a few centimetres thick. Although spiralled pipes could still be used for buried systems, it’s preferable to install PVC or polyethylene (PE) pipes. Well designed and installed systems (T.B. 2.30; 2.31; 2.32 and 2.33) can last for several years.


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Correct storage ensures that a sufficient quantity of drinking water is available when the consumers need it. Storage is required for:


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All kinds of pre-fabricated (emergency) reservoirs are available with their specific volume, use, advantages and inconveniences (T.B. 2.35; 2.36; 2.37). In case a reservoir would be constructed on the spot (e.g. T.B. 2.38), use plans that are approved by your technical referent in order to avoid accidents.


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The water delivery point is crucial in the water chain as it might be a point where a lot of water is lost and (re-)contamination occurs. Water may be delivered through individual connections or at public water points.


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Individual connection: Ideally, water should be provided inside or near each house. It will usually lead to a significant increase in water consumption, even if only a single tap is installed. Individual connections should be considered when managing long-term water supply in a grouped habitat area, and certainly for health structures in chronic emergencies and stabilized situations. However, keep in mind that for each water delivery point, an evacuation of the spilled water needs to be foreseen as well.


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Public water point: In many cases, it won’t be possible to construct individual connections. It is known however that once the distance from the water point to the dwelling exceeds 100 m, the quantities collected decrease drastically, to reach a point where only the survival minimum is taken. The waiting time at the delivery point is also of importance; the longer it is, the lower the potential amount of water that will be collected. It is recommended to allow at least one tap per 200 - 250 persons, certainly in closed settings such as camps. Sufficient taps should deliver enough water to the consumers within a reasonable time, in order to avoid pushing and shoving at the distribution point. This implies as well that the delivered flow should be high enough (minimum 10 l per minute a tap), especially during peak hours. In case wells are provided with a hand pump, there should be one pump per 500 persons (maximum 750 persons during acute emergencies). Queuing at water points should be


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especially during peak hours. In case wells are provided with a hand pump, there should be one pump per 500 persons (maximum 750 persons during acute emergencies). Queuing at water points should be organised and controlled by community members, certainly during acute emergencies. Special attention should be given to the access to water for vulnerable groups (children, physically impaired people and the elderly).


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To be able to collect the water that is provided to them, and to store and use it correctly at household level, the beneficiaries should have enough appropriate recipients with a sufficient capacity. If this isn’t the case, it is a top priority to distribute containers.


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A water storage capacity of 40 l per household should be considered as a strict minimum, with suitable recipients having a volume of 10 to 20 l. In order to avoid internal contamination, the containers should ideally have a small opening for the water to be poured out instead of dipping into them. The cap should always be replaced on its opening when the container isn’t in use to prevent contamination by dirty hands, dust and animals. Closable empty plastic cooking oil jerrycans and traditional clay containers may be suitable as long as they are covered. Regular cleaning and potential disinfection of household storage recipients is necessary.


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In case taps with a continuous water supply are available within the health structure / dwelling, the technical step of “household storage” seems less important. However, it is always wise to have a back up storage with some recipients when the water supply system needs maintenance, or in case it would fail.


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Rivers and streams usually have a wide seasonal variation, and this will affect the location of the intake. During the raining season, floods can occur that may destroy the intake, and during the dry season, the flow may disappear completely. In a fast flowing river, erosion may be a problem. The intake should be located away (preferably upstream) from contamination sites such as bathing and washing zones, animal watering places and latrines.


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A direct intake with motorised (surface) pumps is the most common method used during emergencies (T.B. 2.28). The intake should be placed at least 0.3 m below the water surface, to minimize floating debris, algae or aquatic plants to be pumped up. Water containing a lot of plant life and organic matter may have unacceptable taste and odour, and will drastically increase the chlorine demand for disinfection. The pump’s intake should not be placed too close to the bottom either (preferably a minimum distance of 0.5 m, and certainly not less than 0.3 m). It may disturb the sludge and/or the settled particles, which render the pumped water very turbid. In practice, the intake equipped with a strainer should be kept in place by means of a floater and some kind of an anchor or a rope. In case a (small) river would be less than 0.6 - 0.8 m deep, its depth can be increased by constructing some kind of dam, called a weir. In acute emergencies, simple materials such as sand bags (possibly mixed


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(small) river would be less than 0.6 - 0.8 m deep, its depth can be increased by constructing some kind of dam, called a weir. In acute emergencies, simple materials such as sand bags (possibly mixed with some cement) can be used for the construction of a weir.


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A division on a river can sometimes be sufficient as an intake. But open channels don’t provide any protection against (further) contamination of the surface water. Piped systems provide better protection if they are fitted with a screen and possibly with a structure that helps retaining the water (e.g. a dam), in order that the inlet always stays under the water level.


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In chronic emergencies and stabilised situations, time is a less critical factor. Thus it is recommended to invest in more sustainable solutions such as infiltration wells and galleries if surface water has to be taken from rivers. These alternatives provide several advantages:


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One can be sure that there is water available because they are located nearby (visible) water sources.


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A certain quantity of water is most of the time accessible, even in seasons when the river itself would dry up.


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They improve the water quality by filtering out debris and sediments, and in some cases also quite some pathogens (chlorination stays recommended however).


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In fine or compacted soil, the infiltration wells should be placed at least 2 m from the river. In coarser soil, the distance might have to be increased to 15 m. To increase the yield of the infiltration well, infiltration galleries can be added. These infiltration galleries are pierced water collecting ducts that are specifically designed for that purpose or locally made out of PE or PVC pipes with a diameter of at least 100 mm. They are buried in the river bed itself, or in a trench dug parallel to the river. The trench will have to be about 1 m below the water level in the dry season, and filled with a filtering layer of gravel and/or coarse sand around the pipe. Another possibility is to drive pierced galvanised iron pipes perpendicular to the river. This method is much more difficult to install, as solid pipes are not easily available and driving them may be problematic.


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Obviously, the water will have to be lifted out of the infiltration well. This can be done with the same means as for normal wells (as described below).


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Groundwater often has a better physical and microbiological quality than surface water. It is therefore very important that the quality of the groundwater stays guaranteed by means of correct intakes. Amongst the different groundwater sources, only springs can have a direct gravity flow system by means of one or several spring catchments (T.B. 2.08).


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To collect real groundwater (at least 3 m deep), hand dug wells can be constructed (T.B. 2.02; section 2.5 Further reading). Tube wells (boreholes) can be an interesting alternative because they can be made rapidly, at least if the required drilling equipment is available. Several methods, as well manual as motorised techniques exist to construct tube wells. With the exception of jetting (T.B. 2.07), constructing tube wells with motorised techniques is a specialised work that should be left to professionals. Advice should always be looked for from your technical referent before contracts are signed with local companies.


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Wells will require a mechanism to lift the groundwater to the surface, such as a pulley, a windlass or a shaduf. Alternatives to lift the water are hand or motorized pumps, being indispensable for small diameter boreholes. The common aim of all these lifting mechanisms is to ease the task, while avoiding that the water source gets contaminated.


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Hand pumps can be divided in suction pumps and deep-well pumps. Suction pumps have their piston above the water level, which makes them simple in design and maintenance, but have the inconvenience that they certainly can’t be used if the water table is more than 7 m deep. When they haven’t been used for some hours, it might be necessary to re-prime them to be functional. Unfortunately, the re-priming is often done with water that has been polluted (e.g. by a dirty recipient) and therefore contaminates the whole well.


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Deep-well hand pumps are preferred over suction pumps under all circumstances, and are the only possibility anyway if the water table is more than 7 m deep. Different kinds of deep-well pumps exist with all their own specifications. The choice on the most appropriate deep-well hand pump depends on physical factors such as the depth of the water level and the yield of the well, but also on the pump’s characteristics (yield), its price, its lifespan, and most importantly its existing presence in the region. The latter is an indicator if spare parts might be available within the region, and if some people know how to maintain and repair the pumps. In case several models would respond to the above specifications, choose the VLOM type (Village Level Operation and Maintenance), if available.


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The choice of a motorized pump type (T.B. 2.26) will depend on the required flow, but also on the kind of groundwater intake (hand dug or tube well) and the water table depth. Certain motorized surface pumps (T.B. 2 25) can be used to lift water from shallow wells (less than 7 m deep). For deeper hand dug wells, professional de-watering pumps (T.B. 2 25) can be used. Deep tube wells will demand mostly a real submersible pump (T.B. 2.25), if motorisation is required.


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Rainwater, collected far away from industrialized and urban areas, represents normally good quality characteristics, if it’s harvested correctly. It may represent an important source of water, although its variability along the seasons is generally important. Rainwater can be collected from any clean surface, roof catchments being one of the most used. The water is then transferred to tanks via gutters and pipes. The contamination of harvested rainwater comes primarily from the first rains, rinsing away the accumulated dirt on the roof. Correct catchment techniques will discard the contaminated rinsing water before the rainwater is stored in completely closed reservoirs (T.B. 2.09).


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Properly constructed wells give not only access to the groundwater, but they also prevent its contamination. Therefore should a correct well consist of an underground and an aboveground part.


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Intake: As it is the part that pierces the aquifer, the intake is the most important component of the well. To allow groundwater to get inside the well, the intake lining should be made of permeable or perforated (concrete) rings (T.B. 2.06) bolted and/or mortared together, or of open-jointed (honeycombed) masonry walls. The lining allows the groundwater to trickle through, while it avoids the well to collapse and soil (e.g. sand and/or gravel) to enter. It is important that the intake has enough wall surface for sufficient quantities of groundwater to enter the well. For a well with an intake diameter of around 1 m, it is recommended that it pierces the aquifer by about 2 m during the dry season, or even more in case of a low soil permeability. In addition, the quality of the intake lining has a direct influence on the well’s yield, and sometimes also on the quality of the collected groundwater. Permeable concrete rings will retain fine aquifer particles from intruding into the well.


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has a direct influence on the well’s yield, and sometimes also on the quality of the collected groundwater. Permeable concrete rings will retain fine aquifer particles from intruding into the well. These fine particles may also damage pumping systems.


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Graded aggregate filter: Water should enter mainly by the vertical walls of the intake and not too much via the bottom of the well. The graded aggregate filter, positioned on the bottom of the well, catches particles settling down which may otherwise get / stay in suspension while the groundwater is withdrawn. This graded aggregate filter is especially useful in fine sand aquifers as it won’t be swirled up from the bottom when water is retrieved from the well.


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Shaft: The underground part of the well above the water table is called the shaft. To avoid that the well collapses and that there would be a direct ingression of polluted water from the surface, the shaft should be reinforced with impermeable (concrete) rings or sealed masonry walls (called lining). If made of (concrete) rings, they should be bolted and/or mortared together.


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Wellhead: The extension of the shaft lining raised aboveground is called the wellhead. It should be about


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0.3 m above the apron for closed wells with a hand pump and at least 0.8 m for (open) wells without a hand pump (still preferably with a safe lifting mechanism and closable). Made out of impermeable concrete rings or sealed masonry walls, the wellhead should protect the well water from surface pollution. It is also a safety measure to avoid users falling into an open well.


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A lid on the wellhead protects the well from becoming contaminated by (dust) particles and bird droppings, and it can provide a support for the lifting mechanism. The lid can be completely removable, but for closed wells equipped with a (hand) pump, it is advised to foresee a manhole, permitting future maintenance and repairs.


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Apron: A concrete slab around the wellhead, called the apron, together with an anchorage should be made as an extra protection to avoid contaminated water (e.g. water used to rinse the users’ recipients) polluting the well water. The slope of the apron (at least 1%, preferably 2%), together with the protective kerb lead the wastewater away from the well, via a drainage channel (2% slope) towards an infiltration system (T.B. 4.06; 4.07; 4.08), a garden or a drinking trough for animals. Certainly in cold countries, it is advised to have some kind of foundation underneath the edge of the apron. This should avoid water getting underneath the apron, which could crack if the water starts to freeze.


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For the well water to be of drinking quality, it should have gone through the natural soil filtration process and be considered as “groundwater” as opposed to “surface water”. As an approximate value, if the water level is at 3 m or deeper, it can be assumed that it is groundwater.


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Correct siting of a new well requires (local) expertise because there are several parameters to take into consideration (e.g. presence of vegetation, other water sources, geological parameters, safe distances from pollution points). A geologist, geophysical equipment and hydrological maps can be helpful to find the right spot to construct a well (for more information, contact your technical referent).


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Under normal conditions, the time required for the complete construction of a proper hand dug well could be a matter of several weeks. However, it may take much longer if the aquifer is situated very deep and/or in adverse soil conditions, such as hard rock.


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Hand dug wells should normally be constructed during the dry season when the water table is at its lowest level. If constructed during the rainy season (when the water table is mostly higher), there is a considerable risk that the well will run dry during the dry season and that it will have to be deepened using the telescoping method.


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The intake can be constructed with its outer diameter smaller than the shaft’s inner diameter, which is called telescoping. This technique permits deepening the well when it would run dry, because additional intake rings can be installed which will “slide“ downwards in the shaft when further excavation takes place. If this kind of well would be constructed during the rainy season, it is recommended to foresee some additional porous or perforated intake rings in case the well would dry up in the dry season.


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It is important to install a correct water lifting mechanism on a hand dug well. A recipient (e.g. bucket) with rope is a simple and cheap lifting mechanism, but has several inconveniences:


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➞ When the recipient and rope are not in use, they will often be lying on the ground, thus picking up dirt and pathogens that will be introduced in the well and contaminate it.


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A windlass will avoid that the rope comes in contact with the ground and therefore reduces the risk of well contamination. It also permits to hoist bigger and heavier recipients in a safe manner.


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A shaduf is a lever permitting to lift water out of (very) shallow wells. The counterweight on the shaduf will make it easier to lift a heavy recipient out of the well. The counterweight will also avoid that the recipient touches the ground when it is not in use, which helps to keep it away from contamination.


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Installing a hand pump makes water collection easier for the users, but it also prevents potentially contaminated objects like buckets from being introduced into the well. On top of that, the well can be completely closed (with access via a manhole), avoiding dust and bird droppings falling in. Suction hand pumps can still be found on the field. They have their piston above the water level, which makes them simple in design and maintenance, but have the inconvenience that they certainly won’t work if the water table level is more than 7 m deep. When they haven’t been used for some hours, it might also be necessary to re-prime them in order to be functional. Unfortunately, the re-priming is often done with water that has been polluted (e.g. by a dirty recipient) and therefore contaminates the whole well.


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Motorized pumps offer the same advantages as hand pumps but have most often a higher capacity, which is interesting to cover bigger water demands. However, the pump capacity should not be too high and certainly not surpass the maximum pumping rate of the well (T.B. 2.27). Over-pumping will (drastically) increase the turbidity of the well water, and might even cause the surrounding soil to sink. The latter can cause serious damage to the well and certainly to the apron that starts to crack as there isn’t any supporting ground underneath anymore.


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Backfilling around a well can be done, but only with concrete or non-contaminated earth (e.g. the use of earth collected at termite hills is prohibited as it contains a lot of nitrates / nitrites, which is potentially harmful).


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The cleaning and disinfection procedure is done with the objective to eliminate pathogens (bacteria and viruses) that could be present in the well. This procedure is implemented after the well is built or after maintenance or rehabilitation works have been done inside the well or on the pump. It can also be done when there are some reasons to suspect that a contamination was (punctually) introduced in the well (e.g. floods), or if a sanitary inspection shows a risk of an existing pollution.


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If it is possible to empty the well completely, it’s the preferred method as it gives the best results.


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Empty the well by means of a pump. Be aware that the well depth can’t exceed 7 m (at sea level) if a surface pump (e.g. motor pump) is used. If the water table is deeper, a dewatering pump will be needed (T.B. 2.25). The sludge can potentially be removed by putting the “suction” pipe / dewatering pump very close to the bottom of the well and swirl the groundwater to put the mud in suspension.


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Remove all the potential debris that has entered the well (after an accidental event like a flood), using a strong metal bucket lifted by means of a winch and tripod. Make sure to follow all the safety prescriptions (see hereunder). Deepen the well in case of a massive influx of sludge.


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Prepare a 0.05% chlorine solution (T.B. 2.20). The amount of chlorine solution needed will depend on the total surface of the wellhead, shaft and intake.


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Scrub the complete lining with the chlorine solution, following the safety prescriptions (see hereunder).


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Pump the water carefully out of the well again, while measuring the turbidity (T.B. 2.13) and the Free Residual Chlorine (FRC) concentration (T.B. 2.22). The pump can be stopped when the turbidity is lower than 5 NTU and the FRC concentration lower than 0.5 mg/l.


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Try to remove as much sludge and debris as possible (after an accidental event like a flood) by means of a surface pump (if the water table < 7 m deep) or a dewatering pump (water table even > 7 m deep).


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Prepare a 0.05% chlorine solution (T.B. 2.20). The amount of chlorine solution needed will depend on the surface of the lining above the water table, including the wellhead.


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Scrub the lining above the water level with the 0.05% chlorine solution according to the safety prescriptions (see hereunder).


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with π = 3.14; d = inner diameter of the well; h = depth between the water table and the well bottom


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Prepare a 1% chlorine mother solution (T.B. 2.20). The amount of chlorine solution needed will depend on the water volume in the well.


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Add 10 l of the 1% solution per m3 of well water, mix and leave the well closed for at least 12 hours.


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Pump the water carefully out of the well after this period, while measuring the turbidity (T.B. 2.13) and the FRC concentration (T.B. 2.22). The pump can be stopped when the turbidity is lower than 5 NTU and the FRC concentration lower than 0.5 mg/l.


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If a lot of wells need to be cleaned and disinfected in a short period (e.g. after a big flood), this method is preferred because it’s the fastest, but it’s also the least effective.


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Try to remove as much sludge and debris as possible by means of a surface pump (only if the water table


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Add 100 l of 1% chlorine solution per m3 of well water, mix and leave the well closed for 30 minutes.


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Equip the delivery hose of the pump with a disinfection tube, which is a pierced sleeve (small holes of 4 - 6 mm diameter), closed at one extremity. The highly chlorinated well water being pumped through the small holes of the disinfection tube will result in strong jets, permitting the cleaning and disinfection of the well lining above the water table.


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Start the pump and move the disinfection tube up and down for at least 15 minutes, in order to spray thoroughly the shaft and the wellhead (T.B. 2.02) with a high flow of the highly chlorinated well water. When the well is completely cleaned, wait 30 minutes for the chlorine to act.


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Safety measures must seriously be considered before starting the cleaning of a well. This includes the safety of the workers and the equipment, but also the surroundings of the working area:


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The working area should be fenced all the time, with no access to people other than the authorised personnel.


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Supervised by a competent and trained team leader, there must be a minimum of three trained workers per well. Two workers should be at the surface, one operating the winch and the other watching the third person inside the well. All three workers should rotate, every 15 minutes ideally. A clear and simple system of communication must be used between the person inside the well and the workers remaining at the surface.


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All workers should wear a helmet, an overall, heavy duty gloves and boots. When manipulating chlorine products, goggles or a face shield, a respirator and rubber gloves should be added.


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The staff should be trained to use the material correctly, including the safety equipment present on site like the lifting apparatus with harness and the first aid kit.


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Chlorine is a dangerous product that must be stored and handled with great care (T.B. 2.19). The manual disinfection (scrubbing) of the lining should be done as much as possible with the staff being outside of the well, by means of long handled hard brushes.


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Electric dewatering pumps can be used to empty a well before cleaning. However, a dewatering pump should be stopped and disconnected from its electricity source before people enter the well, as faulty equipment could cause electrocution.


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Generators and motor pumps should be located as far as possible away from the well to avoid exhaust gases entering, potentially causing asphyxia of people working inside. For the same reason should motor pumps never be lowered inside a well.


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The cleaning techniques described above are meant for lined wells. The cleaning and disinfection of an unlined well is not very useful, except perhaps after being flooded. Unlined wells should not be entered, especially not after they have been flooded because they might collapse. In such a case, it can be tried to remove the sludge by pumping, although it will be impossible to take out the potential big debris. The dirt layer on the unlined walls can be removed by technique C, but care should be taken not to erode the walls (any further), as this could lead to (partial) collapse.


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In general, a properly protected well (T.B. 2.04) is considered as being non-polluted. Nevertheless, a biyearly maintenance before and after the rainy season, including cleaning and disinfection is strongly recommended.


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The described types of cleaning / disinfection do not have any permanent effect. These kinds of interventions are effective on punctual contamination linked to maintenance or construction works, or accidental pollution (e.g. floods), but not for unprotected wells. If the source of contamination is not removed, water taken out of the well will not be disinfected due to the very temporary impact of chlorine.


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In any case, possible contamination sources must be searched and corrective measures applied before the disinfection of the well can occur.


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Microbiological contamination of a well through the ground by latrines or cattle is quite rare, unless the contamination source is located at a short distance from the well (the minimum recommended distance for latrines is set at 30 m, and 10 m for cattle). If the contamination really occurs through the ground, it could be necessary to close the well or to eliminate the source of contamination (e.g. latrines), knowing that it will take a minimum of 60 days before the adverse microbiological effects have disappeared. If the well is the only water source, implementation of bucket chlorination (T.B. 2.23) can be considered to reduce the risks and to give time to seek and implement an alternative solution.


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Potential damages to the outside (TB. 2.04) and the inside lining of the well, discovered during or after the cleaning, should always be repaired. The repaired patches should be disinfected before the well is put back into function.


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When a well has to be emptied, the first (non-disinfected) water pumped out of the well should preferably be disposed of via a soak away pit (T.B. 4.06) or infiltration trenches (T.B. 4.07).


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In case a well has to be emptied during of a cholera outbreak, it is strongly recommended to hyper- chlorinate the well water before, because of the environmental contamination risk by the potentially polluted groundwater. Per m³ of well water, 100 l of 1% chlorine solution should be added.


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Since this chlorination method does not guarantee a continuous disinfection, it is strongly recommended to implement controlled bucket chlorination (T.B. 2.23) as long as the well is not properly protected or if there is a strong suspicion that the well is the origin of infection of several people.


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Debris and sand inside a tube well (borehole) can’t be removed manually, but can be blown out by means of a compressor. Other techniques exist but fall out of the scope of these guidelines. Contact your technical referent for more information when required.


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The disinfection of a tube well (borehole) can be done by pouring 10 l of 1% chlorine solution per m³ of water within the well (as described for technique B). For the whole casing to be disinfected, it is advised to pour the chlorine mother solution over the whole circumference of the tube well. Pump the water carefully out of the tube well after a minimum period of 12 h while measuring the FRC concentration (T.B. 2.22). The pump can be stopped when this concentration is lower than 0.5 mg/l. Do not forget to pour an abundant amount of potable water afterwards in the tube well to rinse stagnant chlorine solution on the couplings of the raising main.


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Prepare the site: remove all debris, install a fence and bring in the needed material and equipment.


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Line the existing well completely. Ideally, some kind of foundation (e.g. concrete 300 kg/m³; T.B.2.05) should be made first at the bottom, but emptying the unlined well completely could lead to its collapse. This means that the concrete foundation should be poured under water or be prefabricated and then lowered inside the well. Concrete rings that are bought or fabricated locally (T.B. 2.06) should be placed on top of the foundation. The rings underneath the water table should be perforated. All rings should be bolted and/or mortared together. The uppermost ring should extend well above ground level.


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Place a layer of gravel, the graded aggregate filter, on the bottom of the well. This layer of about 0.1 m thick will avoid the re-suspension of settled particles.


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Fill the gap between the (perforated) rings and the sides of the well with gravel. The height of this gravel pack should reach (just) above the water table level.


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Compact a thick clay layer above the gravel. In case of limited availability of clay or a difficult access within the gap, pour cement grouting (viscous liquid mortar) on top of the clay (a thin layer at least).


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Backfill the pit with compacted soil. If cement grouting has been used, the backfilling should only be done once it has hardened enough (at least 3 days).


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Excavate around the wellhead to a radius of at least 1.5 m, until all vegetal (black) earth is removed. This excavated area will be the basis of the apron. At the circumference of the future apron, a deeper trench can be made for a foundation. This foundation is mandatory for cold countries to avoid that water can get underneath the apron, which could crack if the water freezes.


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Continue to dig a triangular trench around the wellhead (as per figure C) with a depth of at least 0.3m, in order to prepare the construction of the obligatory anchorage.


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Prepare a horizontal grid of reinforcing bars for the apron, with meshes of 0.2 m x 0.2 m. The size of the grid depends on the excavated area.


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Interconnect the triangles in a circular pattern to the horizontal grid with metal wires. The diameter of the circular pattern should be slightly bigger that the outer diameter of the wellhead.


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Fit the assembly inside the excavated area around the wellhead. The reinforcing bars should be minimum 30 mm away from the concrete ring and the bottom of the excavation.


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Cast the anchorage and apron in homogeneous concrete layers (300 kg/m³) and vibrate the concrete. Once the concrete starts to settle, the apron’s cone should be created, sloping itself towards the foreseen drainage channel. Both the tilt of the cone, as the cone itself should have a slope of minimum 1%, preferably 2%.


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Build on the apron’s circumference a protective kerb with a minimum height of 0.1 m. The protective kerb helps to direct the spilled water via a cemented / concrete drainage channel (slope 2%) towards a soak away pit (T.B. 4.06), infiltration trenches (T.B. 4.07) or potentially an evapo-transpiration area (T.B. 4.08), which should be at least 10 m away from the well. When the well area isn’t used for activities needing soap such as laundry and personal hygiene, a grease trap isn’t necessary, and interesting alternatives for the evacuation of spilled water can be an irrigated garden or a cattle drinking trough.


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Extend the height of the wellhead if needed. This can be done with a concrete ring or masonry-work. A closed wellhead provided with a hand pump should rise about 0.3 m above the apron, whilst one without at least 0.8 m.


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Provide a (concrete) cover (either removable or fitted with an inspection hole), on which to mount a lifting mechanism.


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Install preferably a complete pumping system, according to the pump manufacturer’s instructions. A pump makes the retrieval of the water easier for the users, and is also useful because it prevents contact between contaminated objects like buckets and the well water.


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Respect the minimum safety distances: no latrines closer than 30m from a well, no cemeteries or (medical) waste zones that include organic waste pits closer than 50 m. Latrines, cemeteries and (medical) waste zones should be downhill from the well.


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➞ before the works start, in order to avoid non-authorised people entering the site. This will reduce the risk of accidents.


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➞ after the works have finished to protect the improved well even more, certainly if there are animals (e.g. cattle) around.


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Lowering rings in the well should be done with a tripod, security equipment and by an experienced team.


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A skilled mason is required to make the apron with the correct cone and tilted slopes. A square apron is slightly easier to construct as it only needs to be tilted (no cone), but special attention should go to the slope at the corners. When the slopes aren’t correct, spilled water will be stagnating, which could become a breeding ground for several vectors.


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Before the first use, after maintenance or after accidental pollution, disinfect the well with a chlorine solution (T.B. 2.03).


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It is strongly recommended to avoid (domestic) activities like dish washing, laundry or personal hygiene directly around the well site, as this could potentially lead to the contamination of the well water. Separate services like showers (T.B. 4.01) or a washing area (T.B. 4.02) should be installed with their own waste water facilities; a grease trap (T.B. 4.04) and an infiltration system.


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The apron should be cleaned regularly, together with the drainage system. Possible cracks of the apron should be repaired. Regular check-ups, preventative maintenance and potential repair of the pump system should be done.


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Mortar and concrete are frequently used in construction. In complying with some preparation and implementation recommendations, these materials will have a lifespan exceeding 20 years, while keeping up their properties. They ensure a good bonding between the materials, a distribution of the loads whilst being resistant to them, and a low deformation. Mortar is a mix of cement, sand and water. Concrete has the same ingredients and includes additional gravel.T.B. 2.05 Mortar and concrete preparation


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It must be clean and washed, without silt or impurities (soluble, soft or carbon materials). Sand used for masonry-work can contain a little bit of clay, but none at all for cement plaster (river sand is therefore recommended). Avoid sea sand because salt impairs with the bonding of the cement.


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Originates naturally from river beds or from crushing rocks. It cannot contain earth or plants. The selected grain size of the above products varies according to the use:


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<table><tr><td>Grain size (mm)</td><td>Quality</td><td>Use</td></tr><tr><td>0.1 - 0.5</td><td>Fine sand</td><td>Smooth cement plaster</td></tr><tr><td>0.5 - 2</td><td>Medium sand</td><td>Cement plaster, mortar for masonry</td></tr><tr><td>2 - 5</td><td>Grainy sand</td><td>Mortar for masonry</td></tr><tr><td>5 - 20</td><td>Gravel</td><td>(Reinforced) concrete</td></tr><tr><td>Cement</td><td/><td/></tr></table>


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Grain size (mm) Quality Use 0.1 - 0.5 Fine sand Smooth cement plaster 0.5 - 2 Medium sand Cement plaster, mortar for masonry 2 - 5 Grainy sand Mortar for masonry 5 - 20 Gravel (Reinforced) concrete Cement


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It is a mixture of clay (5 to 25%) and limestone (75 to 95%), fired at 1400°C. Afterwards the mixture is finely pulverized.


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It must be clean, without impurities. Avoid sea water and water containing organic or chemical matters.


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The addition of water to cement creates a chemical reaction (hydration) and produces hydrates with a crystal formation. When water is added, a malleable mixture should be obtained and the appearance of crystals causes the setting phenomenon (from 1 to 4h), followed by the hardening. During the hardening process, the mortar / concrete will acquire its resistance. The time rate at which concrete hardens depends a lot on the ambient temperature.


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The respective proportions of the different constituents depend on the planned use of the mortar or concrete, as presented below. The quantity of cement is often mentioned to define the proportioning. Practically speaking, proportions are usually indicated in kg for the cement (generally provided per 50 kg bags) and in litre for sand and gravel. Masons often work with proportions of a number of wheelbarrows of sand (and gravel) per bag of cement (50 kg).


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<table><tr><td>Cement</td><td>Sand</td><td>Used for:</td></tr><tr><td>Mortar 20 kg</td><td>60 l</td><td>making cement blocks</td></tr><tr><td>2/5 of a 50 kg bag</td><td>1 wheelbarrow</td><td>masonry-work, joining: - fired bricks</td></tr><tr><td/><td/><td>- cement blocks</td></tr></table>


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Cement Sand Used for: Mortar	20 kg 60 l making cement blocks 2/5 of a 50 kg bag 1 wheelbarrow masonry-work, joining: - fired bricks - cement blocks


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The total quantity of water to be included in mortar or concrete depends of the natural humidity level of the sand. For 150 kg/m³ concrete, about 90 l of water will be needed for 1 m³ of concrete. For 300 kg/m³ concrete, the amount of water required will be about double.


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Amount of the different constituents needed to make 1 m³ of concrete with crushed rock or river gravel:


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<table><tr><td/><td>Cement</td><td>Sand</td><td>Gravel</td><td>Used for:</td></tr><tr><td>Lean concrete</td><td>150 kg</td><td>400 l</td><td>800 l</td><td>base of lined pits</td></tr><tr><td>150 kg/m³</td><td/><td/><td/><td>floor slabs like:</td></tr><tr><td/><td>3 x 50 kg bags</td><td>7 wheelbarrows</td><td>14 wheelbarrows</td><td>- washing areas</td></tr><tr><td/><td/><td/><td/><td>- showers</td></tr><tr><td/><td/><td/><td/><td>- tapstands</td></tr><tr><td>Concrete</td><td>300 kg</td><td>400 l</td><td>800 l</td><td>latrine slabs</td></tr><tr><td>300 kg/m³</td><td/><td/><td/><td>foundation</td></tr><tr><td/><td>6 x 50 kg bags</td><td>7 wheelbarrows</td><td>14 wheelbarrows</td><td>ring beams</td></tr><tr><td/><td/><td/><td/><td>concrete rings</td></tr></table>


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Cement Sand Gravel Used for: Lean concrete 150 kg 400 l 800 l base of lined pits 150 kg/m³ floor slabs like: 3 x 50 kg bags 7 wheelbarrows 14 wheelbarrows - washing areas - showers - tapstands Concrete 300 kg 400 l 800 l latrine slabs 300 kg/m³ foundation 6 x 50 kg bags 7 wheelbarrows 14 wheelbarrows ring beams concrete rings


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In case of doubt what proportions to use for concrete, keep it as simple as possible in all situations:


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Deposit the required amount of cement on top of the sand heap (and not the other way around). Some prefer to put only part of the cement in the beginning and to add the remaining quantity once there has been a first mixture.


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Move the complete heap of sand and cement by shovelling it to a second spot on the surface. This is to get a mixture of the sand and cement.


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Repeat this action several times until a homogeneous colour is obtained (preferably at least three times). When concrete is prepared, the second time the heap is moved, it should be shovelled on top of the required amount of gravel. The complete heap, gravel included, should be moved at least another two times until a homogeneous colour appears, in order to ensure a good mixture.


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Keep on mixing in a similar way, and add little by little water until a homogenous and malleable paste is obtained. Don’t add too much water because it can cause significant shrinking afterwards. This phenomenon occurs during the evaporation of the water. The particles will get closer to each other, causing thus a volume reduction of the mortar / concrete. Shrinking can be detected through the appearance of cracks. Other factors influencing shrinking are a too high cement dosage, the use of sand that is too fine and unclean, and working during the hot hours of the day.


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Use the mortar / concrete before it starts setting, meaning within half an hour following the introduction of the water to the mixture. During the setting (solidification period), the mortar / concrete will lose its plasticity (beginning of the setting), and finally won’t be deformed anymore under finger pressure (end of the setting, around 4 hours after the water has been introduced to the mixture).


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When big quantities of constituents have to be ordered, their weight and volume have to be taken in consideration for transport reasons. The following table gives the approximate weight of:


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<table><tr><td>Cement (loose)</td><td>Sand (dry)</td><td>Gravel (loose)</td></tr><tr><td>1200 – 1440 kg/m³</td><td>1875 – 2595 kg/m³</td><td>1745 kg/m³</td></tr></table>


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The way cement is stored is crucial for its properties because it easily absorbs ambient humidity. If the storage is too long or uncared-for, a lack of resistance of the cement will occur: e.g. a 40% reduction in resistance can be measured after 12 months.


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Cement is expensive. Contractors sometimes try to reduce its proportion when preparing mortar or concrete, thus rendering the construction weaker.


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Concrete is very resistant against pressure, but not against tension. Therefore should concrete be reinforced with iron reinforcing bars at the places where it will be under tension.


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Once concrete has been cast, it should be “vibrated” by tapping on the mould, by ramming its surface with a wooden rammer or by poking (compacting) it rigorously with a reinforcing rod. A vibrating rod improves the removal of oxygen within thick layers of cast concrete.


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Concrete should be kept coffered and shored up during a certain time, depending on the size of the element (contact your technical referent if needed). This is to allow the hardening of the concrete, during which the resistance of the mixture will increase.


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Too much water in the mortar / concrete mixture will decrease its resistance and is therefore harmful. A minimum quantity of water must thus be added to the mixture. Adding some more water 30 minutes after the mortar / concrete has been prepared is absolutely prohibited.


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Setting and shrinking processes need hydration water, thus a quick evaporation of the water should be avoided. Mortars and concretes must therefore be watered twice a day during one week to obtain a correct shrinking process and thus a better mechanical resistance. Additionally, slabs and ring beams must be protected from wind and draughts with plastic sheeting as this would increase the evaporation rate and thus the risk of cracks. Walls must just be moistened by watering.


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If cement blocks can’t be purchased locally, they can be made with a normal mortar composition. When a lot of cement blocks are needed, a fabrication team should be set up, consisting of one mason (supervisor) and six unskilled workers, divided in three posts:


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A well-trained and organized team can produce up to 400 cement blocks per day. For this quantity, 16 bags of cement, 40 wheelbarrows of sand and 2 m3 of water (including watering) are needed. Foresee that 5 to 10% of the blocks will be lost (being broken).


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➞ The mould set should be composed of two parts: the internal and external elements. Each of these elements is generally made of three or four sections which are bolted together. In order to be able to remove the inner mould once the cast concrete ring has hardened enough, a separate spacer element has to be available that will be removed first.


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➞ The inner diameter of a concrete ring (thus the outer diameter of the internal mould element) should be at least 1 m (strict minimum 0.8 m), so that a person can dig inside the ring. The external element should have an adapted inner diameter, permitting to make rings of 0.10 m thick.


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➞ Moulds are generally between 0.5 - 1 m high. A reduced height is compulsory for very big rings to keep their weight reasonable (e.g. a ring with a diameter of 1.60 m should maximal be 0.5 m high).


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➞ Tube-shaped templates for the moulds should be present, allowing to leave big openings in the concrete rings that will facilitate their lowering inside the well.


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➞ In case perforated concrete rings have to be made, the elements should have holes every 0.15 m and smooth metal pegs should be provided. Once inserted in the assembled moulds, the pegs should form an angle of 45° upwards from the outer to the inner side. This angle is important to limit sand entering into the well, once the perforated concrete rings are installed.


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➞ The mould set should be provided with two ground pedestals and a cover, all permitting to make positioning


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Make sure that all mould parts that will be in contact with the concrete are coated abundantly with an special oil for concrete casting (food graded) or an alternative (e.g. olive oil) to prevent concrete sticking to them.


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Bolt the internal mould sections and the spacer together, and install the assembly over the pedestal.


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Prepare a circular network of reinforcing bars around the inner mould, placed 0.1 m above the bottom and halfway between the internal and external mould elements.


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➞ Ordinary / perforated rings: the re-bars’ length equals the mould’s height minus 0.2 m, with a mesh size of


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Bold the outer mould sections together in a concentric way around the inner element, and introduce the tube-shaped templates. Insert also the oiled metal pegs if a perforated concrete ring is to be made.


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➞ Porous concrete rings should have the same cement and gravel composition, but the amount of sand should be halved. This concrete should not be too wet either.


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Cast the concrete in between the inner and outer mould elements in layers of 0.25 m high, and position the cover when the mould is almost full of concrete, to create the upper positioning groove.


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Remove the tube-shaped templates and potential metal pegs before the concrete sets completely (maximum 4 hours after the concrete has been prepared). Clean and oil all the templates and pegs.


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Remove all the mould sections about 24 hours after casting. The mould sections should be scraped and brushed to remove the concrete residues, and their contact surfaces oiled abundantly.


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Cure the concrete rings in the shade for at least 1 week, during which they should be kept damp (wetted twice a day and covered with jute sacking or plastic sheeting). Porous rings should cure longer than ordinary / perforated ones. They are more fragile and should be handled with care.


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Assemble the pre-jetting rod (½” GI pipe, 1 m long) and jetting rods assembly (self-boring strainer, rigid pipes, connections, valve, elbow and rapid coupling) as per figure A. Although jetting is possible without a self-boring strainer, it is a strongly recommended accessory. It concentrates the jet during the jetting operation and functions as a strainer when the flow will be reversed for developing and exploiting the tube well (if the water level is not deeper than 6 - 7 m at sea level). Kits, containing all these elements, are available.


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Make sure enough water will be available during the jetting procedure. In case the jetting takes place nearby a high yield river or a lake, the water can be taken directly from the source. When the yield or the available water quantities on the spot wouldn’t be sufficient, a big reservoir (e.g. 15 m³ bladder) will have to be filled (potentially from an external water source) to cover the jetting needs.


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Install a surface centrifugal pump (e.g. motor pump) and perform all its checks according to the manufacturer’s instructions.


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Connect with spiralled pipes the pump’s inlet to the water supply and its outlet to the pre-jetting rod.


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Introduce the pre-jetting rod vertically into the soil where the tube well will be installed and let it sink over its complete length (about 1 m), before removing it and stopping the pump.


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Replace the pre-jetting rod with the jetting rods assembly after having drained the spiralled pipes that are connected to the pump’s outlet (weight reduction).


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Insert the jetting rods assembly in the pre-jetted hole and start lifting it in the vertical position. When GI pipes are used, it will take several persons to perform the lifting, due to the weight.


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Start the pump and rev it up in order to create a good jet, whilst the others keep the rods assembly in a vertical position.


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Guide the jetting rods assembly as it is sinking. In soft soil, take care that the assembly doesn’t sink too fast as this could lead to the collapse of the jetted well. In case the jetting rods assembly doesn’t sink, it can be wiggled a bit to remove some harder objects (e.g. small stones) blocking the rods from sinking. Under all circumstances, keep the pump working to remove the “cuttings”.


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Stop and disconnect the pump when the desired depth is reached (at least 3 - 4 m under the ground surface). The jetted well should be deep enough for the self-boring strainer to be completely in a water baring layer with good permeability (e.g. sand).


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Stamp on the elbow of the jetting rods assembly if a self-boring strainer is used. As a result, the ball foot valve of the self-boring strainer should be closed.


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Connect the pump’s inlet to the sunken jetting rods assembly, and its outlet to a long pipe draining the water away from the jetted well.


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Start the pump and keep it at low speed for 15 minutes. The fine (sand) particles will rise to be discarded, while the heavier particles (e.g. coarse sand, gravel) will remain down. This phase allows the creation of a filtering medium around the self-boring strainer.


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Pulsate the speed of the pump and keep on monitoring the yield and the turbidity. After some time, the turbidity should normally decrease to levels under 5 (N)TU.


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The jetting technique doesn’t work for consolidated soils. It will be able to pass through thin layers of gravel and clay, but the latter will not provide a high yield, even when it contains plenty of water.


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The sites where jetting will be performed have to be carefully chosen: the alluvial ground of river banks and around lakes might be a good area. Also jetting in or around a dry wadi can give good results, but be aware that the jetted well might be lost or at least flooded when the wadi fills up again.


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The jetted well should be at least 30 m away from latrines, and 50 m away from waste zones (with organic waste pits), landfills and cemeteries.


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The area where the jetting takes place should be fenced off in order to avoid accidents to bystanders. Unauthorised personnel should not be allowed on the site.


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The jetting rods are often made of galvanised iron (GI) pipes because of their strength. They have the big inconvenience however to be very heavy, which is not only a burden during their transport. It is also difficult to lift and keep the GI pipes in the vertical position during the jetting procedure. It will take several persons to lift a 2” jetting rod assembly of 5-6 m length, and potentially even ropes. One person will initially be needed to keep the self-boring strainer in the pre-jetted hole, while the others push the assembly in the vertical position.


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A (4x4) car can be used to push a 2” galvanised iron (GI) jetting rods assembly (longer than 6 m) in the vertical position. Besides the driver, one person will still be needed in the beginning to keep the self-boring strainer in the pre-jetted hole and at least two others to hold the assembly in position with long ropes.


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An alternative for galvanised pipes are rigid PVC tubes that resist high pressures (at least PN 10; T.B. 2.30). PVC pipes will bend a lot when long lengths are lifted from a horizontal to a vertical position, especially with the spiralled hoses connected. Introduce therefore short lengths of PVC pipe (e.g. 2.5 m) with threaded connectors on both sides (female on one side, male on the other). This means as well that the spiralled hoses coming from the pump and the elbow / valve will have to be disconnected each time a new rod is installed. Connect a short piece of spiralled pipe (e.g. 1m) to the elbow to ease the installation of every new rod.


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Special attention should always go to the jetting rods assembly not falling sideways, potentially causing damages and/or injuries. This entails as well that protective gear such as a hardhat, heavy duty gloves and boots should be worn by all personnel present during the jetting procedure. An overall is strongly recommended as well.


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Once the development of the jetted well is completed, it should be disinfected. This can be done by adding 10 l of 1% chlorine solution per m³ of water inside the jetting rods assembly (for 2” rods, this would mean pouring in 20 ml of 1% solution per meter of tube well under the water table level). After 12 hours, the hyper-chlorinated water should be pumped out of the jetted well and wasted until the Free Residual Chlorine concentration (T.B. 2.22) has dropped to 0.5 mg/l.


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Shallow high yield jetted wells, located in the neighbourhood of a surface water source (e.g. river), will often improve the turbidity enormously in comparison with the raw surface water. As such, the need for assisted sedimentation and/or filtration might be avoided (e.g. in emergencies). But its micro-biological quality might still be inadequate. Hence, such water should always be disinfected before consumption, according to the drinking water standards (T.B. 2.21).


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One motor pump can be connected at the same time to several jetted wells to increase the yield. However, the jetted wells should be spread out by at least 5 meters.


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Jetting can also be used to probe the soil rapidly to decide on the construction of (shallow) hand dug wells. Not only will the depth of the water table be known, some simple pumping tests on the jetted well can give information on the potential well yield that can be obtained.


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Clean and excavate the area around the spring to catch all the resurgences, in order to obtain the maximum yield. From the start, it will have to be decided if a separate spring box will be constructed downhill, or if the people will collect the water directly from the spring.


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➞ For a separate spring box, excavate only around the spring eye until the impermeable layer is reached and


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➞ For direct collection (as presented in the figure), similar excavation works need to be done. But the excavation works will have to be deeper in order to install a slightly sloping platform, where the users will be able to fill their recipients.


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Calculate the quantities of materials that are needed (e.g. concrete, stones, bricks) according to the size of the spring and the local construction means. The amounts of materials also depend on the decision to build a spring box nearby the resurgences or not.


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Make a clay or concrete (150 kg/m³, T.B. 2.05) bowl-shaped slab just above the trench for the dam wall foundation, but below the spring eye.


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➞ The outlet pipe (galvanized iron) should be imbedded with clay or mortar in the bowl-shaped slab and slightly inclined along the slope of the hill. The bowl-shaped slab should be covered with a large stone or a concrete slab.


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➞ The inlet of the overflow should be just underneath the level of the spring eye and its pipe (with a bigger diameter then the outlet pipe) inclined along the slope of the hill.


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Make the dam wall watertight on the inside (side of the spring eye) with a clay coating or two layers of cement plaster (each 10 mm thick; T.B. 2.05). The second layer should only be applied once the first one has dried. Pay particular attention around the pipe passages. Put preferably also one layer (10 mm) on the outside of the dam wall.


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Backfill the remaining gap in between the dam wall and the excavation with small stones so as to avoid erosion and collapse.


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Place clean pebbles (gravel) between the bowl-shaped slab and the spring eye in order to allow the spring water


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Cover the pebbles with large stones (or concrete slabs) and a clay layer (at least 0.1 m thick) that continues until the dam wall. This clay layer prevents the spring being contaminated by surface or runoff water. It is recommended to pour a 1% chlorine solution on top of the bowl-shaped slab and the pebbles, before the protective clay layer is applied.


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Make a concrete floor just underneath the dam wall. This concrete floor will avoid erosion (e.g. caused by the spring overflow) and will provide a clean area in case the people will collect water directly at the outlet pipe.


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Make also drainage canals above the catchment area leading the runoff water around the spring. This prevents the runoff water damaging or contaminating the resurgences.


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Install a fence (e.g. bushes) around the site, with a radius of at least 10 m to avoid access to animals that can contaminate and/or damage the spring area.


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Plant short rooted vegetation (e.g. grass) on top of the spring catchment to stabilise the soil and to protect it against erosion.


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It is important, before any construction work starts, to do a sanitary survey to identify the pollution risks, and to determine the real water demand. Before the start-up of a big spring construction, specialised literature should also be consulted and a site-specific plan drawn.


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A real spring should have a constant water temperature. If this is not the case, it is probably surface water that went underground somewhere uphill and is re-emerging. The yield of such a re-emerging “spring“ will most often rise rapidly if it rains.


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Be careful not to divert the spring in another direction or into another fissure when digging around it. Terracing should start at the point where the water comes out of the earth. Dig by working upstream the water bearing layer, while ensuring that the spring water can flow freely away.


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The excavation should continue until the impermeable soil layer is reached. This is the level from where the spring water should be captured, thus it also indicates where the outlet pipe should be installed.


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In case the underground wouldn’t be (completely) impermeable (e.g. fissures), the bottom of the excavation should be made watertight by plastering it with a layer of clay or lean concrete.


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For larger springs with a yield higher than 30 l/min, several outlet pipes will be required. For small springs with a yield lower than 20 l/min, one 1½” outlet pipe is sufficient.


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Never let the water level inside the catchment rise above the spring eye as this could produce a back pressure which can make the flow emerge elsewhere. Therefore is the correct level of the overflow pipe crucial for the good functioning of a spring, meaning that it should never be positioned above the level of the spring eye.


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In case the water collection is done directly at the outlet pipe, there should be a sufficient height difference in between the outlet pipe and the platform for (large) water recipients to fit in between (0.5 m is often enough).


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When a spring box is added to an existing catchment where water is collected directly, the outlet pipe should preferably be covered with soil. Therefore will it be necessary to backfill the platform until the outlet pipe is covered and a new concrete floor should be constructed to drain the overflow water away without causing erosion.


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A (separate) spring box is recommended because it will permit heavy particles coming from the resurgences to settle down, which will protect the pipeline downhill from getting clogged and/or people having dirt in their water. It is recommended to have the spring box divided into two compartments by a ¾ high wall. The particles will settle in the first compartment and the water flowing over the wall into the second compartment should be exempt of dirt. The settled particles will have to be drained once in a while from the spring box, therefore a separate drainpipe with valve (besides the outlet and overflow pipes) will have to be foreseen.


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A spring box can also function as storage capacity (during the night). This is essential in case the spring has an insufficient yield to cover the actual water demand with daytime collection only. However, it might be difficult or even impossible to transport all building materials or a pre-fabricated reservoir (e.g. plastic) to the spring site. A storage reservoir can then be located nearby the consumption area (e.g. village, health structure). Another advantage of having the reservoir close to the consumption point is that it is easier to chlorinate the water (to protect it from post-contamination). Often a combination of a relatively small (separate) spring box at the catchment and a storage reservoir nearby the consumption point is the preferred option for long-term use.


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Once the construction is finished or maintenance works have been done, the spring box / reservoir should be disinfected. This can be done in a similar way as hand dug wells are disinfected (T.B. 2.03, technique A), at least once a year.


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A spring will require a minimum of maintenance; the collection area and drainage channels should be kept clean and vegetation should be kept under control not to damage the structure (e.g. plants with long roots starting to grow on the spring catchment should be eliminated).


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Determine the total daily demand (m3/day), based on the number of consultations and number of beds of a health structure for instance.


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Verify the total ground surface covered by the roof (including the eaves) that will be used for the rainwater collection; this “horizontal” collecting roof surface (R) equals the length (L) x breadth (B).


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Collect monthly rainfall data for the region. This data can be found at meteorological stations (e.g. at airports), or potentially in universities and on the internet (e.g. www.worldclimate.com)


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Calculate the average daily supply based on the annual rainfall and the collecting roof surface according to the formula:


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C = runoff coefficient (it considers mainly evaporation, wetting and leakages, and it depends on the roof material and its age; apply a coefficient of 0.8 – 0.9 for tiles, 0.7 - 0.9 for corrugated metal sheets and 0.7 - 0.8 for plastic sheeting)


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Compare the total daily demand to the average daily supply (ADS). If the supply is higher than the demand, rainwater harvesting can fully be used to provide sufficient water over the whole year, as long as there is enough storage capacity. If the supply is lower than the total demand, the collecting roof surface should be increased, augmenting the costs significantly, or the rainwater will only be used:


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➞ Occasionally: the very limited storage capacity only permits to cover the demand with rainwater when it’s


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raining; one or two days without rain means that another source has to be used. This system can be useful in areas with a uniform rainfall pattern, with a limited investment.


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➞ Intermittently: the storage capacity is such that the demand is covered during the whole rainy season, but during the dry season another source will have to be used. This system can be useful in areas with a long rainy


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➞ Partially: the storage capacity permits to cover the demands partially over the whole year (e.g. good quality water for drinking and cooking), while the other needs (e.g. laundry) have to be covered with another source of lesser quality (or the other way around). This system can be achieved for areas with a uniform rainfall pattern by a relatively small storage capacity, but needs a big reservoir if the pattern isn’t uniform.


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➞ Occasional: its storage capacity should be for 1 or 2 days, the latter certainly for health structures.


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➞ Intermittent: its capacity should be able to cover the total daily demand over all the days the rainy season lasts.


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➞ Partial: its storage capacity should cover the specific demand (e.g. drinking) over the whole year.


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➞ Full: the storage capacity should cover the total demand over the whole year, knowing there will be months with a supply surplus and others with a deficit. The calculation of the needed reservoir capacity falls outside


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Make a final choice to invest in rainwater harvesting systems or to exploit other sources, depending on:


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➞ The demand / supply analysis: high demands can significantly increase the investment costs for the collection and storage capacity, as do long dry seasons.


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➞ The comparison between the development and operation costs of alternative water sources and the costs of the rainwater harvesting system, including storage costs.


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Install a water reservoir with the correct size. The reservoir can be constructed in masonry-work, concrete, or ferrocement (T.B. 2.38), or it can be prefabricated (e.g. plastic, fibreglass). It should be a completely closed reservoir with a covered manhole. It should have an inlet at the top, a sludge drainpipe with a valve, an outlet with an individual tap or a connection to a distribution system via a valve, and an overflow that is covered with a mosquito screen. Its location should be as close as possible to the roof where the rainwater is harvested. A correct evacuation system should be foreseen for the overflow and the spilled water from the tap, with the aims to avoid stagnant water and erosion around the reservoir.


