The COVID-19 pandemic has exacerbated the need for universal access to safe drinking water, sanitation, and hygiene. As such, at the 73rd World Health Assembly, conducted in May last year, member states have been called to take action in support of access to safe water, sanitation, hygiene, and infection prevention and control, whilst ensuring that adequate attention is paid to the promotion of personal hygiene measures in all settings. These included humanitarian settings and particularly in healthcare facilities.
Essential for healthful drinking, cooking, washing, bathing, and effective handwashing, good water quality is especially important in humanitarian contexts, such as Cox’s Bazar, where refugee and host community families strive to avoid COVID-19 and other infectious diseases while health facilities push for quality care in a complex setting.
Acutely aware of the value of water - this year’s theme on World Water Day - for Cox’s Bazar vulnerable populations, and its role in ensuring dignity, equity and quality care for all, WHO reflects on achievements of WASH services’ strengthening to date.
A Rohingya refugee boy washing hands and drinking water aided by his little friend in Ukhiya, Cox’s Bazar. WHO Bangladesh/Tatiana Almeida
It has been three years since WHO together with Health and WASH partners first introduced WASH FIT in Cox’s Bazar. A continuous improvement framework, the water and sanitation for health facility improvement tool (WASH FIT) is a practical guide for improving quality of care through water, sanitation and hygiene in health care facilities. Just recently, WASH FIT started covering healthcare waste management, management and workforce, as well as energy and environment. To date, three phases of implementation have been successfully completed.
“In the face of the COVID-19 pandemic, the third phase of WASH FIT was especially tailored to help strengthening the fight against spread and transmission of the virus in the refugee camps but also amongst host communities. More than 100 health staff from Ukhiya and Teknaf Upazilas have benefited from the training provided by HEKS/EPER and WHO in 2020”, says WHO WASH Officer, John Secondo Onama.
WHO WASH Officer, John Secondo Onama, and WHO National Consultant for Healthcare Waste Management (HCWM), Dr Muhammad Irfanul Alam, during an orientation training on WASH and HCWM at GK health facility at Camp 22, in Ukhiya. WHO Bangladesh/Tatiana Almeida
Following the trainings, WHO conducted an assessment in all 186 functional healthcare facilities (HCFs) in Cox’s Bazar, including in the Rohingya refugee camps, to apprise water, sanitation and healthcare waste indicators against national and global standards.
Overall, 40% of HCFs met water related standards such as safe and sufficient water supplies; 11% followed some but not all requirements and 49% needed improvement. Most of the facilities had their own water sources inside its premises (59%) or within 500m (34%), while 89% had adequate water. Indeed, water was available at all times in 95% of the cases however only 60% had water supplies to meet the needs of two days. As for drinking water, 62% of the HCFs had drinking water stations but compliance was low in terms of water quality testing.
The role of water in health care facilities, schools, workplaces and households is critical. Water quality surveillance activities are frequently conducted at household and community levels in the world’s largest refugee camp as part of a WHO/ UNICEF cofunded project and implemented through the Department of Public Health Engineering ((DPHE). Such activities are especially strengthened during pre-monsoon, monsoon, post-monsoon and winter seasons.
At Camp 12, Rohingya refugees used to stay long hours in the queue to bring water home. Today, they say, the situation has improved in terms of accessibility but also safety and quality. WHO Bangladesh/Tatiana Almeida
“We used to suffer from gastro-enteritis and watery diarrhea but since a water pump was installed here [she points at the structure just in front of her shelter], we no longer had these health problems”, recalls Sona Bibi. “Some 100 families come here to collect water every day”, she adds.
Water sample collector from the Department of Public Health Engineering (DPHE) in Cox’s Bazar District, Nayan Kanti Dhar, collects water for the early detection of E. Coli, a type of gut bacteria that can cause acute watery diarrhea and other water-borne diseases. WHO Bangladesh/Tatiana Almeida
Armed with batches of testing kits and plastic sample bags, Nayan Kanti Dhar is a water sample collector from the Department of Public Health Engineering (DPHE) in Cox’s Bazar District. Water quality surveillance is key to ensure that Rohingya refugees can rely on clean water for drinking, cooking, showering, cleaning and toilets.
“An improved water source is defined as one that, by nature of its construction or through active intervention, is likely to be protected from outside contamination. This includes piped water, tube wells/boreholes, protected wells, protected springs, rainwater and packaged or delivered water”, explains WHO National Consultant for Healthcare Waste Management (HCWM), Dr Muhammad Irfanul Alam.
Joining such activities as a way to provide supportive supervision, the WHO WASH and HCWM team is a consistent presence in the refugee camps. Whenever possible, they prioritize feedback from the community as they are best placed to report any challenge in accessing safe water.
A Rohingya refugee, Rahmatullah (at the center) explaining that the drainage of the water pump facility needs to be cemented. WHO has raised the issue with the Site Management and WASH sectors who, meanwhile, have solved the issue. WHO Bangladesh/Tatiana Almeida
Water samples collected in the camps are tested at the laboratory of the Department of Public Health Engineering (DPHE), in Cox’s Bazar. WHO Bangladesh/Tatiana Almeida
A UN observed day since 1993, World Water Day celebrates water and raises awareness on the 2.2 billion people living without access to safe water.