A Case Study for the Setting of Water Supply

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A Case Study for the Setting ofWater Supply
Sanitation Priorities in the PAK Emergency
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Choices, choices. . . . .

• Much of life is about making choices. Even in
  if not especially in - the practice of public
  health, one is faced with choices, the outcomes
  of which are likely to show how correct those
  choices were. Standard texts will often portray
  situations where the choices are clear, but in
  real life, this clarity of choice is rarely on
  offer.

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The Kashmir Earthquake

• On Oct 8th, 2005, at approx 850am, an earthquake
  struck northern Pakistan. It measured 7.6 on the
  Richter Scale. Destruction was widespread and
  while the precise number of dead may never be
  known, some 100,000 are thought to have perished.
• This case study is of the Bagh District in PAK.
  Bagh lies south and slightly east of Muzaffarabad
  which itself was close to the epicentre of the
  quake.

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Background to Water Sanitation

• In Bagh District, the town of Bagh suffered
  extensive destruction, and immediate attention
  was focused on the urban area because of the fear
  of diarrhoeal epidemics. Later, attention was
  drawn to the choices of where next to concentrate
  relief efforts. What emphasis should be given to
  water supplies and where and what specific
  sanitation interventions should be undertaken,
  and where and, for all choices, why ?

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Priority 1

• Soon after the earthquake, spontaneous tented
  villages appeared in Bagh Town. These were
  considered most likely to be the focus of any
  epidemic because of crowded and unsanitary
  conditions.
• Those not having access to safe or chlorinated
  water supplies were given safe water and all
  tented villages were provided latrines (separate
  for women and men), with those for women being
  lit for security.
• Bathing cubicles were provided as well

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The Sphere Project

• The Sphere Project was the guide for minimum
  levels of service though, until the supply chain
  was properly established, the first guide was 1
  latrine per 50 dropping to 120 as soon as
  possible thereafter
• Separate facilities for men and women are a
  cultural imperative in Kashmir
• Latrines for women must be lit at night and
• Latrines and bathing cubicles for women must have
  a roof covering.

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The Sphere Project

• Water is abundant in Kashmir, particularly from
  springs. Few waters are turbid so that
  generally, simple chlorination is all that is
  required to ensure that water is safe
• In general, people take care about the quality of
  the water they drink
• The majority of Kashmiris exercise reasonable
  standards of personal hygiene so
• If soap is provided, nearly everyone will use it
  for clothes washing and washing themselves

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Priority 2

• Spontaneous tented villages tended to be created
  by those from a specific area. For formal
  camps to be created by UNHCR or the Army or the
  Government, it was felt that people who were
  going to be persuaded to settle in them, were
  likely to be those who were poor, or who had been
  driven down due to heavy snows. They were likely
  to be even more crowded than the spontaneous
  tented villages. Thus these had to be the next
  priority.

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Priority 3

• After tented villages and camps, urban areas
  represent the next most concentrated areas so
  they had to be the next priority
• Areas where groups of householders concentrate
  should be provided emergency latrines, separated
  by gender, with lighting for womens latrines and
  bathing cubicles
• Where variable voltage affects water supplies,
  standby power should be considered and
• Soap should be provided

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Priority 4

• Clinics without latrines must be the next
  priority. The majority of patients attending
  OPDs are ill by definition, so that containing
  excreta where patients are concentrated is
  essential but
• While latrines must be segregated by gender,
  lighting is probably not necessary since clinics
  do not operate at night. Also, bathing cubicles
  are not necessary here.

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Priority 5

• Hospitals normally are provided latrines,
  especially where emergency facilities are
  provided by international NGOs. However, where
  they do not have latrines, they must be provided
  together with systems for the disposal of medical
  wastes (including sharps)

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Priority 6

• Schools particularly those operating out of
  tents are the next priority
• Latrines must be segregated by gender BUT girls
  MUST have greater access to latrines than boys
  particularly during puberty, or drop-out rates
  will rise and
• The final aim of 1 latrine per 20 pupils is ideal
  but may depend on available funding in the early
  phases. Some latrines are better than none at
  all.

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Priority 7

• Sparsely populated areas probably do not carry
  immediate urgency after the event. Water quality
  is usually excellent and the risk from open
  defecation is very low, and besides, people
  nearly always select defecation sites away from
  their water source. Soap availability can have
  an impact on personal hygiene and should be
  considered. Only when other priorities have been
  satisfied should latrines be considered for these
  areas.

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Commentary 1

• Communities which had a working water supply
  before the earthquake and have had parts of their
  long water pipeline swept away by a slide
  should carry a higher priority than those for
  whom a short walk to a nearby spring is an
  inconvenience
• Areas which suffered minimal damage should wait
  in favour of those more seriously affected and
• Spurious requests should be eliminated

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Commentary 2

• Perhaps the most serious risk in Kashmir is still
  to come. Present temperatures are quite low and
  epidemic risks are proportionately low. In
  spring with the snow melt (March, April or May
  depending on altitude), temperatures will rise as
  will the risk of epidemics. Also, snowmelt
  waters are likely to be turbid making
  chlorination ineffective unless prior
  flocculation/coagulation has taken place.

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Commentary 3

• The most powerful set of indicators to test the
  effectiveness of water supply and sanitation
  interventions probably include the weekly
  statistics of cases reported of
• Watery diarrhoea
• Bloody diarrhoea
• Suspected infectious hepatitis
• Scabies
• but beware how these statistics are analysed and
  investigated if above the anticipated base load

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Recapitulate the Priorities

• Spontaneous tented villages
• Formal camps
• Un-served urban areas standby needs
• Clinics (and hospitals)
• Schools (particularly tented schools)
• Broken, long pipelines and eliminate spurious
  requests
• BEWARE THE SNOWMELT PERIOD WHEN TEMPERATURES RISE
  !