Ensuring Hygiene and Sanitation in Disaster-Affected Areas

When disasters strike, the immediate focus often shifts to rescue operations and emergency medical care. However, one of the most critical yet frequently overlooked challenges is maintaining hygiene and sanitation in affected areas. Poor sanitation and contaminated water can trigger disease outbreaks that sometimes cause more casualties than the disaster itself. Understanding how to prevent these secondary health crises is essential for effective disaster response.

Why hygiene becomes a major challenge after disasters 🔗

Natural disasters create a perfect storm for disease transmission. The risk factors for outbreaks after disasters are primarily associated with population displacement, not the presence of dead bodies as commonly believed. When thousands of people are suddenly forced into temporary shelters with limited resources, several factors combine to create dangerous conditions.

Overcrowding in temporary settlements dramatically increases the transmission of communicable diseases. According to research published in Scientific Reports, overcrowding was reported in 10 out of 13 studies examining post-disaster disease outbreaks, making it one of the most significant risk factors. When people live in close quarters without adequate ventilation, respiratory infections, typhus, and scabies spread rapidly.

Contaminated water sources pose another major threat. Floods can contaminate wells and boreholes with faecal matter washed from the ground surface or from overflowing latrines and sewers. After the 2004 tsunami in Aceh Province, Indonesia, a health assessment found that 100% of survivors drank from unprotected wells and 85% reported diarrhoea within two weeks of the disaster.

Destroyed sanitation infrastructure forces people into open defecation, which contaminates the environment and accelerates disease spread. When sewage systems fail and latrines are destroyed, the risk of faeco-oral disease transmission increases dramatically. Diarrhoeal diseases including cholera, dysentery, and typhoid fever become significant threats, particularly in developing countries where pre-existing sanitation was already inadequate.

The three phases of hygiene measures in disaster response 🔗

Effective hygiene and sanitation management requires different approaches depending on the disaster phase. Understanding these phases helps responders prioritise actions and allocate resources appropriately.

Pre-disaster phase: preparation and planning 🔗

The foundation for effective post-disaster hygiene lies in preparation. This phase involves conducting risk assessments to identify endemic diseases in the area, mapping vulnerable water and sanitation infrastructure, and pre-positioning emergency supplies. Communities should identify alternative water sources and establish emergency sanitation plans before disasters occur.

Key activities during this phase include training community health workers on hygiene promotion, stockpiling water purification supplies, and developing communication plans to quickly disseminate hygiene messages when disasters strike. Emergency WASH planning resources from organisations like the CDC help communities prepare for water, sanitation, and hygiene emergencies.

During the disaster: immediate response 🔗

The immediate response phase typically lasts one to three months and focuses on preventing open defecation and providing basic water supplies. According to WHO guidelines, the three top priorities are providing sufficient quantities of safe water, establishing basic sanitation arrangements, and promoting good hygiene behaviours.

Water supply: A minimum of 7.5 litres per person per day is needed for survival, though 15 litres is recommended in emergencies. About 20 litres per capita per day is required to meet basic hygiene and food preparation needs. If water safety cannot be guaranteed immediately, the priority is providing adequate quantity while working on quality improvements over subsequent days.

Emergency sanitation: Where normal facilities are destroyed, designated defecation fields or trench latrines may serve as temporary solutions. These should be located at least 50 metres from water sources, downwind from living areas, and protected from flooding. Emergency sanitation standards specify that all excreta must be safely contained to prevent contamination of the environment.

Hygiene promotion: Even when water is scarce, handwashing at critical times remains essential. Messages emphasising handwashing with soap after defecation, after handling babies’ faeces, and before preparing food can significantly reduce disease transmission. When soap is unavailable, ash, sand, or other culturally acceptable substitutes can be used.

Post-disaster phase: recovery and sustainability 🔗

As the immediate crisis subsides, efforts shift toward more sustainable solutions. This short-term to long-term phase involves transitioning from emergency latrines to more permanent facilities, restoring damaged water treatment systems, and establishing regular waste management. The goal is ensuring 75% of the affected population has access to proper sanitation facilities, with 95% access targeted for long-term recovery.

This phase also involves addressing the increased vector breeding caused by stagnant water. Draining pools, eliminating mosquito breeding sites, and implementing vector control programmes help prevent malaria, dengue, and other mosquito-borne diseases that can surge after flooding events.

Implementation strategies for effective sanitation measures 🔗

Successful WASH (Water, Sanitation and Hygiene) interventions require coordinated implementation strategies that combine pre-planning with adaptive responses.

Disaster mapping and risk assessment 🔗

Comprehensive assessments should identify endemic and epidemic diseases common in the affected area, evaluate living conditions of displaced populations, assess availability of safe water and sanitation facilities, determine the nutritional status and immunisation coverage of the population, and gauge access to healthcare services. This systematic evaluation helps prioritise interventions and allocate resources effectively.

Applying WHO and Sphere standards 🔗

International guidelines provide benchmarks for emergency response. The Sphere Handbook establishes minimum standards including a maximum of 20 people per toilet, at least 15 litres of water per person per day, and specific requirements for hygiene promotion. These standards help agencies measure the adequacy of their response and identify gaps.

Key Sphere indicators for sanitation include ensuring the environment is free from human excreta, providing adequate access to toilets that are safe and secure, and properly managing excreta collection, transport, and disposal. Meeting these standards significantly reduces the risk of disease outbreaks.

Community engagement and coordination 🔗

Effective hygiene promotion requires community participation. Establishing user committees for water and sanitation facilities, training community members in hygiene practices, and involving local leaders in planning all improve outcomes. Research from the Global WASH Cluster confirms that community engagement enhances both the effectiveness and sustainability of WASH interventions.

Coordination among responding agencies is equally important. The cluster system, which groups humanitarian actors by sector, helps avoid duplication and ensures comprehensive coverage. WASH cluster activities include coordinating water supply efforts, standardising sanitation approaches, and harmonising hygiene messaging.

Surveillance and early warning 🔗

Establishing disease surveillance systems helps detect outbreaks early. Monitoring diarrhoea cases, tracking water quality, and observing hygiene practices provide early warning signs that allow rapid intervention. Even without baseline data, detecting cases of epidemic-prone diseases should trigger immediate control measures.

Common diseases and prevention strategies 🔗

Understanding which diseases are most likely to occur helps focus prevention efforts. Research examining disease outbreaks following disasters found that diarrhoeal diseases were most commonly reported after floods, followed by leptospirosis and malaria. After earthquakes, respiratory infections predominate due to overcrowded conditions and dust inhalation from collapsed buildings.

Prevention strategies should target these specific risks: ensuring water treatment to prevent diarrhoeal diseases, promoting wound care and avoiding contaminated floodwater to prevent leptospirosis, and providing mosquito nets and eliminating breeding sites to prevent vector-borne diseases. Vaccination programmes for measles and other preventable diseases should continue or resume as quickly as possible.

Building resilient communities 🔗

The most effective disaster hygiene response starts before disasters occur. Communities that invest in robust water and sanitation infrastructure, train residents in emergency hygiene practices, and develop clear response plans experience fewer disease outbreaks when disasters strike. Building this resilience requires sustained investment in both physical infrastructure and human capacity.

Recovery offers an opportunity to build back better, creating water and sanitation systems that are more resilient to future disasters. This might include elevating water sources above flood levels, installing backup treatment systems, or establishing multiple water supply options to reduce vulnerability.

What do you think? How prepared is your community to maintain hygiene and sanitation during an emergency? What steps could local authorities take to improve disaster preparedness for water and sanitation infrastructure?

References

1. https://pmc.ncbi.nlm.nih.gov/articles/PMC2725828/
2. https://www.nature.com/articles/s41598-021-85146-0
3. https://wwwnc.cdc.gov/eid/article/13/1/06-0779_article
4. https://www.cdc.gov/water-emergency/php/training/index.html
5. https://www.who.int/teams/environment-climate-change-and-health/water-sanitation-and-health/environmental-health-in-emergencies/humanitarian-emergencies
6. https://emergency.unhcr.org/emergency-assistance/water-hygiene-and-energy/emergency-sanitation-standards
7. https://spherestandards.org/handbook/
8. https://www.washcluster.net/node/29501
9. https://www.sciencedirect.com/science/article/pii/S2590061724000243