Water and Sanitation

A human being on average can survive on 5 l of water per day. Basic needs, however, go beyond what we need to drink or ingest through our food for daily survival. It is estimated that one person requires 15 l per day to maintain a basic standard of personal and domestic hygiene sufficient to maintain health.

Clean water is a basic requirement for life and health. Sufficient and safe water is necessary to prevent death from dehydration, reduce the risk of water-related disease, and provide for consumption, cooking, and personal and domestic hygienic requirements. Sanitation has proven equally critical in preventing ill health and is also recognized as a basic human right.
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The need for safe water and sanitation becomes elevated in the initial stages of a disaster when people are more vulnerable as a result of injuries, malnourishment, and stress, and diseases are able to spread easily through overcrowding and contaminated water supplies. Preventable diseases such as diarrhea kill more people in chronic emergencies than any other factor, including conflict.

From 1993 to 2006, 6.5 million people received emergency water and sanitation (WATSAN) aid. The Sphere Handbook details the minimum requirements for this aid, which include standards and indicators regarding water quality, supply, use, and sanitation facilities. Simply providing sufficient water and sanitation facilities, however, will not ensure optimal use or impact on public health unless coupled with hygiene promotion. The affected population must possess the necessary information, knowledge, and understanding regarding waterand sanitation-related diseases. This relies on information exchange between the aid agency and affected community in order to identify the key hygiene problems, existing awareness, and required knowledge to ensure optimal use of water and sanitation facilities. This information enables the design, implementation, and monitoring of water and sanitation aid to have the greatest impact on public health.

The Sphere Standards recognize the importance of hygiene promotion and incorporate appropriate standards to ensure that hygiene-promotion messages and activities address key behaviors and any misconceptions. Water, sanitation, and hygiene promotion aid must be designed and implemented in consultation with the affected populations. This is necessary to ensure that the key hygiene risks of public health importance are identified. The involvement of both men and women is also needed to ensure equitable access to the resources provided. In most disaster situations, the responsibility for collecting water falls to women and children. When using communal water and sanitation facilities, women and adolescent girls can be vulnerable to sexual violence or exploitation. An equitable participation of men and women in planning, decision making, and local management will help minimize these risks and ensure that the affected population has safe and easy access to water and sanitation facilities. Initially the delivery of water and sanitation aid was dominated by the provision of clean water, whereas sanitation facilities were often inadequate if not totally absent. Politicians, decision makers, and donors did not consider sanitation to be of equal importance to water supply. They failed to recognize, for example, that while investments in water quality and quantity could reduce deaths from diarrhea by 17%, sanitation could reduce these by 36% and hygiene promotion by 33%. In recent years, however, research and an expanse of literature and information available have ensured that the importance of sanitation has become more internationally recognized: . In 2002 sanitation was recognized as a basic human right.

. The Millennium Development Goals (MDGs) (2000) include a target to halve by 2015 the proportion of people without sustainable access to safe drinking water and sanitation.
. The Water Supply and Sanitation Collaborative Council (WSSCC) (1990) was established, which has a special interest in sanitation and hygiene and emphasizes the need to view water, sanitation, and hygiene as inseparable. (WSSCC exists under a mandate from the United Nations and is governed by a multistakeholder steering committee. It focuses exclusively on people around the world who lack water and sanitation.)
. The internationally used Sphere Handbook (2004) has a specific chapter detailing standards for water supply, sanitation, and hygiene promotion.
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Sanitation is becoming recognized as an essential element of humanitarian assistance that is equally important as supplying clean water, food, and medical care in ensuring the health of populations. Furthermore, these international initiatives, together with an increase in research and publications, have highlighted that water and sanitation must come hand in hand with hygiene promotion to ensure the optimal use of humanitarian aid.