Access to water, hygiene, sanitation… Key priorities during an outbreak

Première Urgence Internationale has a long record of supporting people across the world, in crisis and conflicts situations. The ongoing global outbreak of COVID-19 replaces all countries on an equal basis, and imposes to respect everywhere the same guidelines and measures. Especially in terms of hygiene, access to water, and sanitation. Echoing on the World Water Day, this Sunday 22th of March, let’s remind the essential bases.

© Frédéric Noy.

During a health crisis, what is the emergency?

The most urgent part, during a health crisis, is obviously the medical care (identification, confinement and treatment of sick people) and supply of medical equipment to care sick people – in that case, those infected with the COVID-19 virus, but the same approach applies in case of bacteriological outbreaks. However, in parallel of the health response, and to ease and optimize the work of health workers, other issues are also crucial. As water, sanitation and hygiene (known under the acronym “WASH” in the humanitarian sector).

To be fully effective and to reach appropriate hygiene conditions, priorities must be ranked:

• First and foremost, to protect the humanitarian teams, and in particular the health workers: make sure they can wash their hands regularly and work in the highest hygiene standards. Maintenance and cleaning are essential for the prevention and the control of the disease.
• Then, to ensure the access to water in all the health structures but also in all settlements and slums where vulnerable people live. “Access to water is of course the key to ensure effective application of barrier gestures, says Timothée Le Guellec, technical expert for Première Urgence Internationale. The unhealthier is the environment, the more important is the supplying of water.
• Also, to guarantee the quality of water (different according to the use: drinking water, water for washing hands, water for washing the floor, water for washing clothes. Première Urgence Internationale supports the staff of health centers to adapt procedures in epidemic contexts (chlorination and monitoring of water quality for example). Quality monitoring is key to preventing the spread of the virus. This also prevents the spread of other bacteria or viruses that could worsen the situation, especially among populations who also suffer from severe malnutrition (Yemen, Nigeria, Democratic Republic of the Congo … among other examples)
• Finally, when the first three points are guaranteed, it is essential to ensure waste management. Collect and efficiently treat medical waste (needles, infusions, vials, paper, etc.) to prevent the spread of the virus and reduce the number of infections. And disinfect with additional precautions all sanitary facilities (toilets, showers, washing areas …). Here again, the challenge is to protect people, but also soils and ground and surface water resources.

Read also : “COVID-19: How to adapt the humanitarian response”

Which measures have to be taken concretely?

It is important to note that during the epidemic, minimum humanitarian standards change: the need for water drastically increases, due to the increase in the frequency of cleaning and disinfection of people and surfaces, but also because the sick, feverish, get dehydrated and need to drink more water to survive.

The actors of the health response coordinate to be able to effectively:

• ensure stocks of drinking water for 72 hours minimum (instead of 48 hours in normal times);
• adjust the amount and concentration of chlorine in drinking water, hand washing water, washing floors;
• adapt the facilities and acquire new equipment if necessary (vomit buckets, hand washing devices, footbaths);
• increase maintenance (emptying latrines, frequency of washing floors and surfaces, etc.);
• provide hygiene to the homes (distribution of hygiene kits so that the sick can continue the barrier gestures at home);
• increase staff protection during waste management procedures (personal protective equipment, trash carts, etc.);
• provide a minimum service on coordination to train staff, formalise procedures and adapt them on a daily basis if necessary.

“One of the important challenges is to establish procedures in the health centres where we intervene, to frame what we do during an epidemic,” explains Timothée Le Guellec. “For example: how do we guarantee the hygiene of caregivers when they give an injection? How to transport and incinerate waste contaminated by the virus?…. And above all, define who is responsible: by whom the waste must be removed (hygienist? Caretaker? State service? International treatment?) And with what protective equipment …?” Procedures which must, of course, be adapted to national standards and existing tools. But they do allow field teams to be able to deploy the response within hours.

What are the tools of Première Urgence Internationale?

Long before the spread of COVID-19, today in the status of a global pandemic, Première Urgence Internationale had launched an internal investigation and developed tools for emergency diagnosis and scaling up, adapted to the activities since.

Thanks to this preliminary work, in the current health emergency, the WASH and health technical teams are now able to carry out the key stages of an emergency health response: 1 – rapid assessment, 2 – preparation plan and response, 3 – monitoring, as recommended in the UNICEF note specific to the response on COVID-19. They also have essential tools at their disposal to collect information and map the situation on their land: for example, the location of water resources, waste treatment sites, etc. – which makes it possible to prioritize the water points to be filtered and treated.

Première Urgence Internationale also relies on new information and communication technologies, since rapid assessment tools are available to teams around the world via tablets or smartphones and can then be analysed via geographic information systems. This has the particular advantage of allowing real-time communication between headquarters in Paris and teams around the world.

The historical presence of teams in most intervention areas also allows Première Urgence Internationale to be integrated and recognized in the field, and to be able to raise awareness and convey crucial prevention messages. Reminder of barrier actions, procedures to follow in the event of contamination, remote psychological follow-up for people at risk and isolated… All these preventive communications are made in languages ​​and formats adapted to the targeted communities, so that the messages are well understood, shared, and applied.

And after the emergency?

Once the emergency is over, and until the epidemic is overcome and contained, Première Urgence Internationale, like other humanitarian structures, continues to update and establish new procedures and to work with local authorities. This is what has already been done in the Democratic Republic of the Congo, in the face of the epidemics of measles and Ebola virus disease, and it is also what is done regularly in Yemen, in the face of the epidemic outbreaks of cholera.

One of the medium-term objectives is, for example, to train government personnel in international procedures and standards for the prevention and management of health crises. “So that when the emergency response is stopped, the local teams are able to resume the response by themselves, so that the intervention can continue,” explains Timothée Le Guellec. And so, so that the health risks are reduced to the maximum, in the event of future epidemics on these grounds.

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