Academic journal article Bulletin of the World Health Organization

Effectiveness of Emergency Water Treatment Practices in Refugee Camps in South Sudan/Efficacite Des Pratiques D'assainissement D'urgence Des Eaux Dans Des Camps De Refugies Au Sud Soudan/La Eficacia De Las Practicas De Emergencia De Tratamiento del Agua En Los Campos De Refugiados De Sudan del Sur

Academic journal article Bulletin of the World Health Organization

Effectiveness of Emergency Water Treatment Practices in Refugee Camps in South Sudan/Efficacite Des Pratiques D'assainissement D'urgence Des Eaux Dans Des Camps De Refugies Au Sud Soudan/La Eficacia De Las Practicas De Emergencia De Tratamiento del Agua En Los Campos De Refugiados De Sudan del Sur

Article excerpt

Introduction

The late 19th and early 20th century saw rapid declines in mortality in industrialized countries. The introduction of chlorinated piped water supplies in cities was a major contributor to this achievement. (1) Today, chlorination is the most widely-used method for the treatment of piped water supplies, due to its simplicity, low cost and the residual protection it provides. (2,3) Low levels of residual chlorine in water supplies limit microbial contamination during distribution and storage, reducing the risk of waterborne infectious diseases. Drawing on decades of experience with municipal piped water systems around the globe, the World Health Organization (WHO) guidelines for drinking water quality recommend a minimum concentration of 0.2 mg/L free residual chlorine at water System delivery points. (4)

Humanitarian agencies generally use centralized batch chlorination for water treatment in settlements for refugees and internally displaced persons. (5) This treatment method entails dosing an experimentally-determined amount of chlorine solution into a known volume of clear water, and allowing adequate retention time to allow disinfection to proceed to completion. Ensuring access to adequate quantities and quality of water is essential in refugee camps as waterborne diseases are among the most significant threats facing displaced populations. (6-9) Drawing on WHO guidelines for drinking water quality, humanitarian organizations have developed several guidelines stipulating what residual chlorine levels should be at camp water distribution points. (10-16) Generally speaking, guidelines recommend free residual chlorine levels should be 0.2-0.5 mg/L under normal circumstances and 0.5-1.0 mg/L during outbreaks of diarrhoeal disease, or when the water supply is especially turbid or alkaline. A balance is required between having sufficient residual protection and preventing taste and odour-driven rejection due to excessive chlorination.

WHO guidelines for drinking water quality are appropriate when users drink directly from the flowing household taps of a municipal piped water system, (17) but are unlikely to provide sufficient residual chlorine protection in the fundamentally different reality of a refugee camp. In this setting, where environmental hygiene may be poor, water is collected from tapstands, transported in containers through the camp to shelters and then stored and used over 24 hours or more. Chlorine treatment based on WHO guidelines for drinking water quality may not ensure that water remains safe over its entire course in the setting of a refugee camp.

Studies in non-emergency settings in developing countries have shown recontamination of previously safe water does occur during collection and transport from distribution points, as well as during storage and drawing of water in the home, (18-21) representing a significant health risk to vulnerable populations. (22,23) Recontamination after collection of drinking water has also been documented in refugee camps in Uganda (24) and linked to the spread of diarrhoeal disease and cholera among camp populations in Malawi, (25,26) Kenya (27,28) and Sudan. (29) Humanitarian guidelines call for facilities and practices to preserve the safe water chain including the use of covered narrow-mouthed water containers with taps and their regular cleaning, disinfection and replacement. However, recontamination after distribution in camp settings remains poorly understood and is not explicitly included in guidelines for water treatment in emergency settings.

Recent experiences in refugee camps in South Sudan brought this knowledge gap to our attention. Surveys conducted in the Jamam camp in October-November 2012 showed that 40-58% of households that collected water from chlorinated tapstand sources had no detectable residual chlorine in their stored household water. (30,31) Another study carried out in Jamam and the nearby Batil camp in April 2013 found adenoviruses in stored household water, suggesting faecal contamination. …

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