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WHO Relief Mission to the Gujarat Earthquake
ASSESSMENT OF THE WATER SUPPLY, SANITATION AND ENVIRONMENTAL HEALTH ASSISTANCE
OF THE
WORLD HEALTH ORGANIZATION TO THE GUJARAT EARTHQUAKE
26 JANUARY – 30 JUNE 2001
by
Dr Dennis B. Warner
Consultant
Bhuj, Gujarat, India
30 June 2001
Contents
1. Introduction
2. Purpose of the Assessment
3. Overview of WHO Water Supply and Sanitation Assistance, 26 January – 30 June 2001
4. Sources of Financial Support
· Director-General’s Fund
· Donor Funds
o US Office of Foreign Disaster Assistance (OFDA)
o UK Department for International Development (DFID)
o US Agency for International Development (USAID)
5. WHO Water Supply, Sanitation and Environmental Health Activities
· General Technical Assistance
· Equipment and Supplies
o Chloroscopes
o WHO office equipment
o Bhuj District Water Quality Laboratory
o Water quality laboratories in other districts
o Aquachlor chlorine generator
· Training
· Coordination
6. Cooperative Agreements
· Gujarat Water Supply and Sewerage Board (GWSSB)
o WHO office accommodations
o Laboratory equipment
o Water quality surveillance
· Dindayal Development and Charitable Trust
· German Federal Agency for Technical Relief (THW)
7. Progress in Implementing Recommendations of Consultant Mission of 16 February - 6 April 2001
8. Conclusions
· OFDA Support
· DFID Support
· USAID Support
· WHO’s Role in Water Supply, Sanitation and Environmental Health
9. Recommendations
Annexes
A. Officials Interviewed
B. DFID Proposal: Project Description
C. USAID Proposal: Project Description
D. Water Supply Services in Kachchh District
1. Introduction
On 26 January 2001 at 08:45 am, the State of Gujarat was rocked by a massive earthquake measuring 6.9 on the Richter scale. The epicenter of the quake occurred near Ludia Village, about 20 km north of Bhuj, the capital of Kachchh District. The resulting destruction and loss of life was enormous and widespread. Nearly 20,000 people died and 166,000 were injured. The casualty toll would have been even higher except for the fact that many people were out of their homes that morning to celebrate India’s Republic Day. The most severely-affected areas were in the District of Kachchh, especially the sub-districts (talucas) of Bhuj, Bhachau, Anjar and Rapar.
Destruction was widespread in all sectors. For the first several days, almost all public services were unable to function. In water supply and sanitation, pump houses collapsed and boreholes stopped operating, storage tanks, especially ground-level tanks, either collapsed or experienced serious cracking, and pipelines were severed. The impact of the earthquake was universal; it affected all people and all services in the severely-affected areas. Although Kachchh District with population of two million people bore the brunt of the earthquake, the Government of Gujarat states that over 15 million people in the state were directly affected by the event.
Response to the earthquake was relatively rapid and effective, considering the relative remoteness of Kachchh District. The Indian Army and international rescue services were the first to arrive on the scene for search and rescue operations. Within days, however, local and international NGOs, United Nations agencies and bilateral assessment teams began to appear and begin urgently-needed relief operations. Medical attention, shelter, drinking water supplies and communications were initial priorities. Slowly, but progressively over the first couple of weeks, public services came back on line. Government offices with their depleted staffs operated under canvas and in sheet metal shelters. External organizations generally set up their own tented camps to house their personnel. By the second week in February, the relief effort was beginning to take coherent shape through cooperation between local and state government agencies, UN organizations, local and international NGOs and bilateral donor agencies.
WHO was, and continues to be, part of this massive relief effort. From the first days following the earthquake, WHO personnel have been in the affected areas of Gujarat providing technical assistance and material support in the areas of water quality, disease surveillance and health coordination. These efforts have continued through the mid-point of 2001 and have evolved to meet the changing needs of the relief effort.
This report is an assessment of the WHO response to the Gujarat earthquake. The focus here is on water supply, sanitation and environmental health and how WHO contributed to relief measures in these areas over the period 26 January – 30 June 2001. The assessment also will describe the overall role WHO played and continues to play as part of a worldwide effort to assist the people of Gujarat. It concludes with observations on the WHO’s role in emergency responses and with several specific recommendations for future WHO water supply and sanitation activities in Gujarat.
2. Purpose of the Assessment
This assessment constitutes a review of the water supply, sanitation and environmental health activities in Gujarat State carried out by WHO in response to the earthquake of 26 January 2001. These activities were initiated, implemented and supervised by a variety of personnel within WHO, including epidemiologists, engineers, public health physicians and other health sector experts. The period of review is 26 January to 30 June 2001.
Although the environmental health activities of the WHO team included a range of health activities, such as health promotion, hygiene education and intersectoral coordination, the main focus of this assessment is on water supply and sanitation, with particular emphasis upon drinking water quality, human excreta disposal and solid wastes management. Where other significant activities of the team are clearly related to environmental health, they are described as needed.
The terms of reference for the assessment were approved by WHO/India and SEARO on 11 June 2001. They contained the following four specific points:
· Assess progress in implementing water supply and sanitation activities with financial support provided by USAID/OFDA.
· Review the status of proposals to DFID (UK) for a programme of water quality surveillance in Kachchh District and to USAID for a project to strengthen environmental sanitation facilities and sanitation promotion activities at rural health centres in Kachchh District.
· Assess the general role and relevance of WHO in providing water supply, sanitation and environmental health assistance to the earthquake-affected areas of Gujarat State. This should include both activities undertaken and relationships established with local and state governmental authorities, international development agencies and NGOs.
· Provide appropriate recommendations for future WHO programmes, proposals and technical assistance in water supply, sanitation and environmental health.
Thus, this assessment is a retrospective review of events and responses, culminating in suggestions for both future actions in Gujarat State and in emergencies in general.
3. Overview of WHO Water Supply and Sanitation Assistance, 26 January – 30 June 2001
The earthquake of 26 January 2001 caused a complete cessation of all public services in the most severely-affected areas of Gujarat. Electricity, telephone, water supply, hospitals and health facilities, schools, public administration and local government were all disrupted and ceased to function for periods ranging from a few days to several months. In the water supply and sanitation sector, most water systems in the worst hit areas of Kachchh District stopped functioning because of physical damage and interruptions in the electricity supply. Particularly hard hit were pumphouses and ground-level water storage tanks which were not built to earthquake-resistant standards.
Throughout Gujarat State as a whole, 274 boreholes, 336 pumps and 954 civil structures were damaged and 1614 km of pipelines were damaged and out of service. The worst-hit district, Kachchh, had serious water supply disruptions in ten urban areas, with another eight towns severely affected in the districts of Rajkot, Jamnagar, Ahmedabad and Surendranagar. A total of 1340 rural villages were
affected in these five districts, with 884 found in Kachchh District alone. The Government of Gujarat estimated the damage to the water supply systems at INR 2.9 billion (US$ 63 million).
WHO reacted quickly to the catastrophe. Dr Eigil Sorensen from SEARO/New Delhi arrived in Ahmedhabab on 27 January, the day after the earthquake, and Dr Bipin Verma from WHO/India arrived in Bhuj shortly thereafter. Dr Verma participated in the assessment of the United Nations Disaster Management Team (UNDMT), which completed its report on the affects of the earthquake on 8 February. The UNDMT report designated WHO as focal agency for the health sector and a cooperating agency for water and sanitation and for food and nutrition. Dr Verma also became team leader of the WHO health team and the coordinator of the overall WHO response to the earthquake.
Within the water and sanitation sector, international and national organizations rapidly mobilized to assist in the relief effort. The first water supply and sanitation (watsan) coordination meeting was held in Ahmedabad on 2 February and was attended by Oxfam (convener), Concern, USAID, SDC (Switzerland), DMI, WHO, MSF/Holland, ECHO, IFRC and Sadvichar Parivar. WHO was represented by Dr Luis Jorge Perez, an emergency expert from PAHO in Washington DC. This meeting and the frequent watsan meetings that followed in Bhuj were devoted to information sharing between organizations in order to better coordinate overall activities.
During the first weeks following the earthquake, WHO was represented in the Bhuj watsan meetings by Dr David Bradt, WHO Epidemiological Consultant, Mr M.M. Datta, WHO/India Sanitary Engineer and Dr Perez. WHO concerns during this period were focused on water quality, the chlorination of emergency water supplies and the distribution of chloroscopes for the testing of chlorine residuals. Several hundred chloroscopes were distributed to district health officials, NGOs and the GWSSB.
On 19 February, Dr Dennis B. Warner, WHO Consultant and former head of water supply and sanitation at WHO/Geneva, arrived in Bhuj to strengthen WHO’s assistance in the areas of water supply, sanitation and environmental health. That same day he was joined by Dr Jagdish M. Barot, former Chief Engineer with the GWSSB and formerly head of the Gujarat Jalseva Training Institute, who was hired by WHO as a National Professional Officer. Together, they formed the WHO watsan team until 4 April when Dr Warner left Bhuj. Dr Barot has remained in Bhuj throughout the emergency period and continues to direct WHO water and sanitation activities associated with the earthquake.
The initial efforts of the WHO watsan team were directed at issues of water quality. Additional chloroscopes were provided to the GWSSB for use by water quality personnel in the field, and over the following months efforts were made to systemize and compile the testing and reporting of chlorine residuals by health, water and municipal officials. Field visits were made to identify problems in the outlying municipalities and rural areas, and contacts were established with the GWSSB, the Kachchh District water quality laboratory, offices of the Relief Commissioner Kachchh, Relief Commissioner Bhuj, Collector for Kachchh District Development Office, Bhuj Municipality, UN agencies (UNICEF, UNDMT, UNDP), bilateral agencies (THW, DFID, JICA) and NGOs (Oxfam, IFRC, MSF, Dindayal, Abhiyan and Swaminarayan Trust).
These initial investigations revealed that existing water quality surveillance capabilities in the field were not adequate to monitor the safety of drinking waters in the affected areas and that the Kachchh District water quality laboratory in Bhuj did not have sufficient equipment and personnel to support the necessary programme of surveillance. On 1 March, a proposal was submitted to DFID (UK) for a total of US$ 125,700 to support the establishment of a programme of water quality surveillance in all earthquake-affected areas of Kachchh District. The programme included new staff, personnel training, field equipment, water sampling and a system of reporting results to the GWSSB. At the same time, the WHO watsan team submitted a request to WHO/India for laboratory equipment for the Kachchh District water quality laboratory in Bhuj. (This equipment was delivered to the laboratory in May.)
The growing cooperation between the WHO watsan team and the GWSSB was highlighted in early March when the GWSSB allocated WHO an office in the district laboratory. WHO furnished the office with computer equipment, office furniture and supplies.
Another concern of the WHO watsan team was with the sanitary conditions in campsites, urban areas and rural villages. Many people had taken refuge in open, tented campsites in Bhuj, but few locations had adequate facilities for excreta disposal, trash collection and insect control. On 10 March, the WHO watsan team proposed that WHO contract with a local NGO, the Dindayal Development and Charitable Trust, to provide emergency sanitation services in 13 campsites within Bhuj Municipality. This proposal was supported by a letter from the President and Chief Officer of the municipality.
Sanitation conditions in the rural areas were found to be very poor, but most problems pre-dated the earthquake. Village sanitation systems were limited, as few households even had a latrine. In rural areas, government health facilities are primarily responsible for preventive health, but few rural centres had proper sanitary facilities for excreta disposal, bathing, handwashing or drainage. The sanitation conditions were further aggravated by the earthquake, which damaged 40% of the rural health centres (primary health centres, sub-centres and anganwadis) in Kachchh District and perhaps 80% of the centres in the most severely-affected talucas of Bhuj, Bhachau, Anjar and Rapar. Because of the poor environmental sanitation conditions found in many rural areas, it was feared that the coming monsoon rains would pose great risks to public health through the spread of gastro-intestinal illnesses, worm infections, skin and eye infections and vector-borne diseases.
To address these problems, WHO on 30 March submitted to USAID/India a proposal to strengthen environmental sanitation facilities and sanitation promotion activities at rural health centres in Bhuj, Bhachau, Anjar and Rapar talucas of Kachchh District. Totaling US$ 444,700 and extending over a period of 18 months, the project is designed to provide sanitation facilities and training for health staff at PHCs, sub-centres and anganwadis and resources for the promotion of sanitation and healthy sanitation behaviours in the surrounding villages.
Beginning in late-March, there were increasing reports of jaundice (hepatitis) linked to water supplies. Over the next several weeks, Dr Barot organized teams of officials from the GWSSB, Department of Health and the affected municipalities to investigate the quality of water supplies in Bhuj, Gandhidham, Adiphur, Anjar and Rapar. It was concluded that water provided by the GWSSB was properly chlorinated, but chlorine residuals in the systems often fell to zero because of contamination in hotels, restaurants and underground storage tanks. Moreover, it was noted that chlorination was not generally practiced at private boreholes and by private tankers.