Northern Cameroon 2012 Flood EmergencyDRAFT
Report of WaSH Specialist
Table of Contents
Executive Summary
Background
Methodology
Context
General
Water Sanitation and Hygiene
Findings
General
Water Sanitation and Hygiene
Table of Observations
Recommendations
General
Water Sanitation and Hygiene,
Emergency Interventions
Transitional/Developmental Interventions
APPENDIX ONE: TOR – Responsibilities and Tasks
1.Assessment
2. Programme Design
3. Response Management and Implementation
APPENDIX TWO – Schedule .
APPENDIX THREE: - MAPS
APPENDIX FOUR - Miscellaneous Notes outside the formal TOR
Moral Hazard – Justification for continuing from Emergency to Development
Shelter – The major impact of the flooding
Disaster Risk Reduction – Building it into future programming
Missing Latrines - Advocacy for WaSH infrastructure at Schools,
ECOSAN Latrines – the value gap
APPENDIX Five – RESULTS from SUR-EAU Follow Up Testing, Details of CDC research on effectiveness of bucket chlorination in Far North Cameroon
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Northern Cameroon 2012 Flood EmergencyDRAFT
Report of WaSH Specialist
Executive Summary
The flood emergency is over but distressingly low levels of public health awareness especially in the rural population and urban fringe means the next public health emergency is only a matter of time. Good hygiene practices can play a major role in stopping the transmission of waterborne disease, as can point of use sterilization techniques. CARE has already started this effort during the emergency with distribution of Emergency Water kits that contain materials and equipment for water sterilization and hygiene promotion. Follow-up analysis has found an impressive level of adherence to instructions exhibited by chlorine levels at or exceeding WHO standard of 0.5mg/l. It is recommended that this effort is expanded to include any areas not yet reached by the initiative and additional Sur’Eau (Chlorine treatment) provided.
Future programming should have a sound basis in the public heath promotion (PHP) and the CHC (Community Health Club) approach should be further evaluated for applicability. Once the PHP program is in place support should be provided for CHC driven initiatives such as the repair/rehabilitation of protected water supply points.WaSH in Schools can be promoted to complement the CHC approach.
With a solid foundation of good hygiene practices and knowledge of the value of clean water and proper sanitation a sustained improvement health status can be achieved
Behavior change is the goal
Footnote: Shelter
It is clear that the major impact on both those displaced by and those affected by the floods was shelter. Thepoor were the most vulnerable, they live at lower elevations and their homes are made of mud rather than fired brick or cement block – materials that largely survived the standing water of the flood. It would be appropriate to include a Disaster Risk Reduction component in future programming to improve the survivability of structures in future floods. This can also be incorporated into CHC discussions
Background
Floods originating during August 2012 have affected northern Cameroon. As part of CARE’s emergency response Nigel Stuart was engaged as WaSH Specialist for the period of 5th October 2012 to 18 October 2012 (14days). The Terms of Reference (TOR) for this 14 day assignment were both broad and deep: “The Emergency WASH Specialist will be responsible for the assessment, design and implementation of the water, sanitation and hygiene component of CARE’s emergency response strategy” Further details of the TOR are included in APPENDIX ONE For details of the Emergency please refer to the Action Plan for the Response to the Floods in the North and Far North of Cameroon and the latest Emergency Situation Report - available on request to
Methodology
Due to time constraints the effort was prioritized in consultation with the Emergency Coordinator. The plan drawn up on the first day was largely adhered to and the resulting schedule of site visits, travel and partner/government meetings is included in APPENDIX TWO
There was not time to validate numbers of those displaced or affected. The decision was taken to visit sites that were indicative of the overall situation, those closest to district centers and the most remote.In this way the full spectrum was observed and recommendations offered in a structure to allow easy application for each situation.
As a result this report provides a selection of possible complimentary initiatives that, when combined with numbers of prospective beneficiaries from the government sources can be used to design and budget prospective programs. Government issued numbers can be validated using Google Earth as imagery is available to a definition that allows a count of homesteads for all areas.
The support and contribution of the Emergency Coordinator Mr. Leo Kortekaaswas instrumental to this effort and cannot be overstated.
Context
General
The emergency is now in the transitional phase (confirmed by the senior Unicef representative in Maroua), although the persistent risk of cholera may initiate a second emergency. Flood waters are receding at an increasing rate in the areas addressed by this report (although new flooding 200Km downstream on the Logone was reported 17th October).
Flooding resulted from rivers overflowing their banks/levees, this was caused by exceptional rains and the release of water from threatened dams. The damage to infrastructure (largely roads and homes, and some agriculture) and standing floodwater in poorly drained areas with low permeability of soils resulted in population being displaced to higher ground. Some were taken in by family/neighbors; others accommodated in Camps or sought refuge at schools which became de-facto camps. Most of the displaced lost their homes although possessions were largely recovered; those with fired brick or block homes generally have found these structures still standing on their return. All those living in the flooded were affected by the floods; some or all of the structures at their homesteads being destroyed, crops damaged, and commerce impacted through roads being cut. This difference between those displaced and those affected is used to differentiate levels of assistance.
Where water levels allow the displaced are returning to damaged or destroyed homes or are awaiting relocation from camps (either formal or ad-hoc) by the government
The most vulnerable members of communities tend to live on the fringe – both economically and physically and as a result they weredisproportionatelydisplaced/affected by the floods. This held true in every community visited, both Urban and rural. As communities in floodplains are centered on the highest point of the area the high ground always attracts a premium.
CARE has distributed emergency kits that include rice and oil in addition to water purification supplies to affected families. The location and numbers of beneficiaries are reported elsewhere (see BACKGROUND)
WaterSanitation and Hygiene
In all areas visited open defecation is practiced to varying degrees, in the rural areas it is endemic. In some area the feces is covered but in most it is left in the open. Latrines are used in the peri urban areas, being replaced by septic tanks as higher elevations and incomes permit. In rural area the almost total lack of latrines is underscored by schools being build/expanded by the government without any sanitation facilities.
Protected water supplies exist in all areas visited but roughly half those in rural areas are not functioning. In a number cases hand pumps ceased to function two years after installation. Unprotected sources are abundant throughout the year as the water table is rarely lower that 3m below surface. However due to high silt content in soil borehole screens get clogged and the boreholes/wells fill to the point of blocking the pump.
CARE has already distributed “Emergency Water Kits” containing point of use purification chemicals (Sur-Eau) together with the needed buckets, jerry cans etc.
Findings
General
The immediate impact of the flood was to displace people from their homes. They left for higher ground and formed ad-hoc camps which were later formalized, stayed with friends/families or at government building schools.
The longer term impact of the floods was not in direct proportion to depth of water but rather type of construction of home, this was largely dependent on means and to a lesser extent by geology (proximity of brick quality clay) the secondary criteria for structural survivability was elevation. Movement towards even marginally higher ground should be encouraged. The difference between homes destroyed and those left standing was only a matter of centimeters of elevation
The largest impact of the floods for both groups (displaced and affected) is shelter. As such it is outside the TOR but addressed in APPENDIX THREE.
In the Urban/Periurban areas of GarouaPitoa and Yagoua, the situation is further complicated as many homes are in flood prone areas and residents must be relocated by authorities. As this will take time the decision whether to expend capital, human or financial, on rebuilding is delayed and as a result recovery is takinglonger.
Care staff are well connected in the community and clearly well regarded. They are competent and effective: a great resource on which to build future programs.
Water Sanitation and Hygiene
The immediate impact of the flooding was to contaminate most unprotected water sources and some protected (but not flood protected) sources with floodwater. As the use of unprotected sources especially during the rainy season is common practice using floodwater for domestic purposes was widespread. In urban/peri-urban areas, where protected water was purchased from vendors sourcing from municipal supply, this practice was unchanged As open defecation is widely practiced and latrines were inundated with floodwater, sanitation facilities – whatever they were– became unavailable and so open defecation took place adjacent to areas of displacement.
CARE (and other agencies) have already distributed point-of use purification kits. This will have had an ameliorating effect on the situation where these distributions took place, however distributions are yet to take place in the most remote areas. APPENDIX FIVE details the field study taken to examine the effectiveness of the distribution and when compared to the findings from CDC study, also included in APPENDIX FIVE, it would appear that instructions on the use of “Sur Eau” are being adheredto (Chlorine levels at or exceeding WHO standard of 0.5mg/l) and as a result the disinfection should be effective
CARE included soap in the Emergency Water Kits and this will also improve the overall chances of interrupting the transmission of water borne disease in recipient families. Before the emergency, soap was used for washing clothes and bathing, occasionally for hands
Therefore, from a water and sanitation perspective, the Emergency had little impact on practices, and an unknown impact on water quality and hence prevalence of waterborne disease. Anecdotal evidence suggests any increase in waterborne disease was not noticeable.
With little immediate impact the longer term impact of the flooding on Water, Sanitation or associated Public Health practices is indiscernible.
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Northern Cameroon 2012 Flood EmergencyDRAFT
Report of WaSH Specialist
Table of Observations
PITUOA / GAROUA II / PERI-URBAN YAGUOA, / NOULDAINA/DABANA - Gobo district / VELE (GUEME)Site / Flood plain, Peri-urban, Farming near-by lots, some grazing/browsing animals. Ave. plot size 250sqm. Multi Structure, Mud brick 60%, 20% Fired Brick 20% Cement block, 60% Grass thatch 40% corrugated iron Sheet. / Urban, Some agriculture. Ave. plot size 60sqm. Single Structure/Multi Structure, Mud brick 60%, 20% Fired Brick 20% Cement block, 60% Grass thatch 40% corrugated iron Sheet. / Peri-urban marginal community, Mud brick houses located to adjacent to government owned ridge to which population has currently relocated. / Ultra Rural (4hrs by Moto from paved Road) Mixed Fishing/Arable/Pastoral. Mud brick with thatch 95%. Community moved to school and temporary settlement on higher ground. Village is cluster of homesteads 60m apart stretching over 1kmx400m. / Rural, adjacent to levee Mixed Fishing/Rice Arable/ some livestock. Mud brick with thatch 45%, Fired brick 40% Block 15%. Displaced with families. Mud structures 30% destroyed. 100 destroyed when located river side of levee (homes of displaced)
Soil Conditions / Sandy clay, Granite outcrops 3 Km. Water table <1m below surface. Usual < 5m / Sandy clay, Water table 2m below surface. Usual unknown / Silty sand, isolated clay. Slow draining. Water table at surface. Usual <0.5M but seasonal / Silty sand, isolated clay outcrops. Slow draining. Water table at surface. Usual <0.5M but seasonal / Silty Sand, clay in many places. Large irrigated rice fieldsto west – away from river. Water table <0.5 m, seasonal
Public Health Awareness Indicator / Drinking water collected from (semi) protected supply, not from shallow well on compound. P / Hand washing before eating is practiced reinforced by fatality of neighbor in 2010 Cholera outbreak. / Open defecation initially denied , but with latrines under water and no tempory latrines dug it was confirmed / Showed shallow "latrine" as location of defecation only after first response of open defecation / Feces on shovel in compound awaiting disposal no latrines expect at chief’s house. Jerry can in need of internal cleaning
Water Supply / Sunk Caisson Wells (no cap/pump household buckets dipped) Hand pump (indiaMkII) in operation <100m between water source. No wait observed. Poor maintenance / Town supply up to 200m, water vendors, some private connections at higher elevations. Use of stream water for bathing/laundry. / Town supply available at 30CFA per 20l used for drinking/cooking – flood water used for balance. Unprotected wells in area are soiled with trash / 2 hand pumps - both broken. Floodwater used. Normal supply is river water (plus shallow ponds near house for watering animals and perhaps…?) / Hand pumps (India MkII)/foot pump(Vergnet) functioning. 100CFA charge per person per month Pumps locked 5pm-6am. More distant homes have unprotected well for washing water/watering animals
Sanitation / Household latrines collapsed or structurally compromised. Field defecation with hoe. Rebuild on hold pending rumored relocation by authorities. / Reputed that household latrines still in operation, smell of excretaclose to stream, suspected use plastic bags.
/ No latrines at displaced camp. Flooded homes inaccessible at present did not have latrines despite proximity to town / Reported use of shallow "latrine" of 0.25m depth. High water table prevents traditional latrine construction. Open defecation in abundant evidence / No evidence of latrines in any compound except chief. Latrines at school not functioning. Washing performed in river..
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Northern Cameroon 2012 Flood EmergencyDRAFT
Report of WaSH Specialist
Recommendations
General
It is difficult in an emergency to resist the urge to “do something” but any interventions must be carefully scrutinized for unintended consequences, and perhaps the Hippocratic line of “first do no harm” is worth remembering. Latrines can be built (and have been by some agencies – both in rural areas and camps) but with open defecation being common practice they are unlikely to be used. This was confirmed by field observation and by asking ‘beneficiaries” of these facilities. Likewise the number of inoperable protected water points and the standard of care of the surrounds of some that were functioning indicate a lack of awareness of the value of clean water and good hygine.
Given the increasing likelihood of similar flooding in future years, increasing population densities, and increasing pressure for arable land means the bad situation that currently exists will only worsen. But with a program of public health promotion and targeted interventions in both water supply and sanitation this trend can be reversed.
Water Sanitation and Hygiene,
There are a number of interventions, both short term (emergency) and longer term (transitional/developmental) that may have a positive impact.
The most important short term intervention would be the continued provision of Point-of-use sterilization using “Sur-Eau” a sodium hypochlorite solution marketed in Cameroon for this purpose. An alternative would be SOLDIS – solar disinfection using sunlight (for one day) and PET plastic (soda and mineral water) bottles, but this requires some training and provision of bottles (in the rural areas even the usually ubiquitous black plastic bags are missing – sometimes used as fiber reinforcement in mud walls).
Before any longer term interventions are implemented a program of Public Health and Hygiene Promotion (PHP) should be launched. There are many different methodologies; PHAST, CLTS etc. The recommended approach is CHC (Community Health Clubs). Details are at an organization dedicated to promoting this approach having validated it through formal research,quantitatively analyzing the resulting behavior changes. Without such an approach any further intervention is unlikely to either yield results or be sustainable. This does not need to be the only PHP approach, WaSH in schools is complementary and should also be pursued (which highlights the need for latrines to be constructed at new and expanded schools – not current practice).
The full toolkit of possible interventionssplit into Emergency and Transitional/Developmental is provided in the following table and the applicability of these approaches to CARE’s areas of responsibility are tabulated thereafter.
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Northern Cameroon 2012 Flood EmergencyDRAFT
Report of WaSH Specialist
Emergency Interventions
Scenario / Intervention / Benefits / Possible negativesWater / Populationusing flood/standing water for all purposes. Normal situation is use of (semi) protected supplies / EW1 / Provision of chlorination/purification chemicals and filter cloth / Improve quality of water at point of consumption. Effectiveness borne out by initial follow-up testing / Those now using improved sources (Municipal/Borehole/Protected well) may attempt to purify standing/floodwater. "improved" water may then be of inferior to existing
PHP program to change behavior
Without accompanying PHP program diversion of material to other uses, or insufficient dosing for efficacy.
Long term cost prohibitive
Ditto / EW2 / Provision of PET bottles for SODIS / Improve quality of water at point of consumption / As Above - but lower cost- higher sustainability
Sanitation / Open defecation - in area where OD is normal practice / ES1 / Communicate increased risk due to Emergency. Suggest hoes used to cover feces. Suggest designated defecation zone. / Reduced vector risk, faster decomposition / Missed opportunity for UV/solar sterilization,
Open defecation - in area where latrine use was standard pre-emergency practice / ES2 / Communicate increased risk due to Emergency. Suggest hoes used to cover feces. Suggest designated defecation zone. / Reduced vector risk, faster decomposition / Missed opportunity for UV/solar sterilization, Needs PHP program to change behavior
Ditto / ES3 / Subsidize construction of temporary latrines - where water table allows / As above and - return to pre-emergency standard of hygiene/privacy norm / Encourages residents to remain in flood affected areas (floodplain). Need PHP program to change behavior
Ditto / ES4 / Subsidize construction of elevated latrines in area of high water table / As above and - return to pre-emergency standard of hygiene/privacy norm / In addition to above...Flood level may have returned to normal level before construction starts of what is non-traditional structure
Transitional/Developmental Interventions
Scenario / Intervention / Benefits / Possible negativesWater / Areas of low quality of water being available in close proximity (floodwater), no improved supply in reasonable proximity / TW1 / Subsidize minimal protections of well; wall to 0 .7m, cement surround, windlass and dedicated bucket / Allow phase-out of Emergency Intervention EW1 / PHP effort required to communicate value proposition of investing time/money. In event of improved sources being available in future, the transition to them will be more problematic
Ditto / TW2 / Support repair/rehabilitation of existing boreholes/protected wells.
Schools first. / Improved water quality, Moral Hazard managed through careful incorporation of Disaster Risk Reduction component. / Encourages residents to remain in flood affected areas (floodplain). Need PHP program to change behavior, as existing sources are on average much closer
Ditto / TW3 / Support provision of permanent improved sources,
Schools first / Encourages residents to remain in flood affected areas (floodplain). Need PHP program to change behavior, as existing sources are on average much closer
Sanitation / Open defecation - in area where OD is normal practice / TS1 / Promote Sanitation field where defecation occurs in rows at a spacing to match crop planting (red Millet) / Reduced vector risk, faster decomposition / More difficult to move to latrines
Ditto / TS2 / Promote use of above ground latrine – possibly ECOSAN / As above and - return to pre-emergency standard of hygiene/privacy norm / Cost of above ground latrines – especially ECOSAN
Damaged latrines in areas of pre-emergency latrine use / TS3 / Sponsor construction of above ground latrine – possibly ECOSAN / Latrine use should be associated with status. Provides benefit to affected persons not only displaced. / Cost of above ground latrines – especially ECOSAN -
School without functioning Latrine / TS$ / Wash in Schools – model ECOSAN construction / Children can initiate behavior change at home / If not kept clean then a negative for Sanitation promotion
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