Rethinking Faecal Sludge Management in Emergency Settings

Decision Support Tools and Smart Technology Applications for Emergency Sanitation

Fiona Zakaria

• Publisher: CRC Press
• Year: 2019
• eBook ISBN: 9781000692044
• Topic: Biological Sciences
• Subtopic: Environmental Science
• Index: Biological Sciences

The development of technology in the emergency sanitation sector has not been emphasised sufficiently considering that the management of human excreta is a basic requirement for every person. The lack of technology tailored to emergency situations complicates efforts to cater for sanitation needs in challenging humanitarian crisis. Concerns persists on the lack of faecal sludge management that considers the whole sanitation chain from containment until treatment. This study focused on the development of a smart emergency toilet termed the eSOS (emergency sanitation operation system) smart toilet to address the limitation in technical options. This toilet is based on the eSOS concept that takes into account the entire sanitation chain. This study also addresses the limited time for planning in emergencies by developing a decision support system (DSS) to help quick selection of optimal sanitation options. The aim was to enable users of the DSS to plan their emergency sanitation response within the shortest time possible. The study aims to contribute toward a better emergency sanitation response by application of technology advances.

1

General introduction

1.1 Emergencies following natural and anthropological disasters and displaced populations

1.2 State of public health in displacements

1.3 Emergency sanitation and urban sanitation

1.4 The Bill & Melinda Gates Foundation Pro-Poor Sanitation Project framework

1.5 Research gaps in emergency sanitation

1.6 Scope of the study

1.7 Research objectives

1.8 Outline of the thesis

References

1.1 Emergencies following natural and anthropological disasters and displaced populations

The world has seen an escalating number of disasters over recent decades, from natural as well as anthropological origins. There have been disasters in South Asia (Tsunami, 2004) and in Haiti (Earthquake, 2010) that each caused hundreds of thousands of deaths, whilst floods and droughts have occurred more frequently. Anthropological disasters, for instance armed conflicts are affecting millions of people globally. Moreover, with the threat of unpredictable weather changes, global warming, continuing earth crust movement and political uncertainties, the number of disasters will likely increase. Figure 1-1 illustrates the number of natural disasters from 1980 to 2014, showing an increasing trend. The escalation of anthropological disasters via the trend of global displacements also indicates an increase (see Figure 1-3).

Figure 1-1: Number of loss events globally (1980-2014); Source: NatCatSERVICE (2015) – As at January 2015

The scale of a disaster may be measured by the death toll, economic loss and numbers of affected people. Analysing natural disasters in the last decade, World Disaster Report 2010 (IFRC 2010) established the following.

• Earthquakes killed the most people from 2000 to 2008 – an average of around 50,000 people a year.

• Floods, meanwhile, have affected the most significant number of people – an average of 99 million people a year.

• The costliest urban disaster of the last decade was the Bam earthquake in Iran, in 2003, which left damages totalling US$500 M.

• The deadliest disaster was the South Asian tsunami in 2004, which affected seven countries and killed 226,408 people.

Figure 1-2 Trend of global displacement and proportion displaced 1996 – 2015 (UNHCR 2016)

Disasters cause people to flee from their homes to seek refuge in a safer place in or outside their country of origin. Displaced people within the boundary of their original country are referred to as internally displaced persons (IDP), while those displaced to another country are termed ‘refugees.’ Unlike for death toll, the number of displaced people has been more problematic to document as they change over time. By the end of 2014, the United Nations High Commissioner for Refugees (UNHCR) reported that the number of displacements worldwide was at all time high with 59.5 million, and was likely to deteriorate further (UNHCR 2015). The major contribution was from war events in Syria and several surrounding countries in the Middle East. The trend forecast was proven to be correct through their later report in 2016 (UNHCR 2016), as observed in Figure 1-2.

Complicated disasters, known as “complex emergencies” among humanitarian organisations, (Burkholder & Toole 1995) are attended by responses referred to as ‘emergency responses’. Complex emergencies are defined as “relatively acute situations affecting large civilian populations, usually involving a combination of war or civil strife, food shortages and population displacement, resulting in significant excess mortality” (Toole 1995). Emergency responses following a disaster are primarily concerned with the surviving population rather than those killed in the disaster. Therefore, immediate action, seconds after a disaster has struck, should focus on life-saving activities. For example, in the event of an earthquake, rescuing people surviving under rubble and collapsed buildings should be prioritised rather than the evacuation of dead people. Post-disaster, the responses should address the need of the population directly affected by the disaster, i.e. injured and displaced people. The need for emergency responses to continue after an occurring disaster is assessed based on certain indicators, such as excess mortality, an indicator that is constantly monitored in emergencies.

One commonly used parameter linked to excess mortality is Crude Mortality Rate (CMR). CMR reflects the health status of the emergency-affected population (CDC 1992; Burkholder & Toole 1995) and furthermore, relates to the number of deaths in a specified population over a specified period (Thomas & Thomas 2004). CMR has been widely used as measurement tools in complex emergencies to define phases of emergency like ‘emergency phase’ (CMR > 1 per 10,000 persons per day) and ‘post-emergency phase’ (CMR<1per 10,000 persons per day) (Spiegel et al. 2001; Thomas & Thomas 2004).

There is evidence that excess mortality following a disaster may not be directly caused by the disaster itself, but rather happens as a result of contracting diseases while staying in the displacement area. A recent study on the cause of deaths in Darfur, Sudan – a complex emergency case from prolonged conflict – highlighted that the majority of deaths occurred not due to violence but due to diseases that were contracted as the result of overcrowding and unsanitary conditions in displacement camps (Degomme 2011). For natural disasters, it was concluded that they are not associated with diseases outbreak when they do not result in massive displacement (Watson et at 2007; Kouadio et at 2011). Thus, excess mortality, as well as morbidity following disasters is closely associated with the health status of displaced people during displacements.

1.2 State of public health in displacements

Displaced people are situated in displacement centres, emergency shelters, public utilities, or are hosted by other surviving households. These locations are not prepared to cope with a sudden influx of a large group of people. Hence, it results in displaced people living in temporary settlements or camps with over-crowding and rudimentary shelters, inadequate safe water and sanitation, and increased exposure to disease vectors.

Specific observations indicated that the highest excess morbidity and mortality regularly occurs during the acute phase of an emergency, when relief efforts are in the early stage (Toole & Waldman 1990; Connolly et at 2004). During this phase, deaths were up to 60 times the CMR when compared with non-refugee populations in the country of origin (Toole & Waldman 1990). In general, displacement increases these CMRs to at least double normal baseline rates in the population prior to any displacement activity (Thomas & Thomas 2004). Additionally, the high morbidity and mortality rate still occurs when the displacement continues. In protracted and post-conflict situations, populations may have high rates of illness and mortality due to the breakdown of health systems, flight of trained staff, failure of existing disease control programmes and destroyed infrastructure (Michelle Gayer 2007). These populations may be more vulnerable to infection and disease because of high levels of undernutrition or malnutrition, low vaccine coverage, or long-term stress (Michelle Gayer 2007).

The major reported causes of death of refugees and internally displaced populations have been those same diseases that cause high death rates in non-displaced populations in developing countries, i.e. malnutrition, diarrheal diseases, measles, acute respiratory infections (ARls), and malaria (Toole & Waldman 1988; Toole & Waldman 1990; CDC 1992). A longer list of displacement associated infectious diseases from more recent assessments includes diarrheal diseases, acute respiratory infections, malaria, leptospirosis, measles, dengue fever, viral hepatitis, typhoid fever, meningitis, in addition to tetanus and cutaneous mucormycosis (Kouadio et at 2011). Amongst those infectious diseases, diarrheal diseases are the major contributors to overall morbidity and mortality rates following a disaster (Connolly et at 2004; Waring & Brown 2005; Kouadio et at 2011).

The World Health Organisation (WHO) defined ‘diarrhea’ or ‘diarrhoea’ as the passage of 3 or more loose or liquid stools per day, or more frequently than is normal for the individual. It is usually a symptom of gastrointestinal infection, which can be caused by a variety of bacterial, viral and parasitic organisms. Rotavirus and Escherichia coli (E. coli) are the two most common causes of diarrhoea in developing countries. Norwalk-like viruses, Campylobacter jejuni, and cytotoxigenic Clostridium difficile are seen with increasing frequency in developed areas; and moreover, Shigella, Salmonella, Cryptosporidium species and Giardia lamblia are found throughout the world (Guerrant et at 1990). Following a disaster event, in a complex emergency situation, humanitarian agencies use WHO’s classification of clinical diarrhoea to distinguish the many types of diarrheal diseases. In this regard, there are three types of clinical diarrhoea:

• Acute watery diarrhoea – lasts for several hours or days, and includes cholera

• Acute bloody diarrhoea – also called dysentery; and

• Persistent diarrhoea – lasts for 14 days or longer.

Diarrheal diseases are caused by intestinal based pathogens which are micro-organisms such as those transmitted via the faecal-oral route, which ar...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Thesis summary
• Samenvatting
• 1 General introduction
• 2 eSOS™ - emergency Sanitation Operation System
• 3 eSOS™ Smart Toilet development history
• 4 Evaluation of eSOS™ Smart Toilet
• 5 Evaluation of water treatment and wastewater characterisation from eSOS Smart Toilet
• 6 Effectiveness of UV-C light irradiation on disinfection of an eSOS™ Smart Toilet
• 7 User acceptance of the experimental eSOS™ Smart Toilet
• 8 Decision support system for the provision of emergency sanitation
• 9 Development and validation of a financial flow simulator for the sanitation value chain
• 10 Reflections and outlook
• About the Author
• List of Publications
• Acknowledgement