Water Currents: WASH in Emergencies


Emergency water, sanitation, and hygiene (WASH) is a critical component of USAID’s humanitarian assistance for vulnerable populations, who are much more susceptible to diseases related to inadequate sanitation and water supplies.

USAID responds to emergency WASH needs through the Bureau for Democracy, Conflict, and Humanitarian Assistance, including the Office of U.S. Foreign Disaster Assistance (OFDA), responsible for leading and coordinating the U.S. Government’s response to disasters overseas, and the Office of Food for Peace, responsible for leading the U.S. Government's international food assistance efforts. Combined, these two offices ensure that emergency and life-saving WASH needs of vulnerable populations are met in disaster, conflict, and early recovery operations. Where appropriate, emergency WASH connects to, supports, or aligns with the work that USAID will carry out under its Water and Development Plan to increase water and sanitation access, and is an important complementary result.

This issue contains several reviews and evaluations of WASH in emergency interventions as well as recent manuals and guidelines on appropriate technologies, disease outbreaks, menstrual hygiene management, and other topics. In addition to producing Water Currents, the USAID Water Team also publishes a biweekly bulletin of the latest studies and events related to WASH in emergencies, so contact us if you would like to subscribe to the bulletin. Stay tuned for a new Emergency WASH page on the Globalwaters.org website in the near future.


Setting Priorities for Humanitarian Water, Sanitation and Hygiene Research: A Meeting ReportConflict and Health, June 2018. In June 2017, the Research for Health in Humanitarian Crises program convened a meeting of representatives from international response agencies, research institutions, and donor organizations active in the field of humanitarian WASH to identify research priorities, discuss challenges conducting research, and establish next steps.

Water, Sanitation, and Hygiene Interventions in Outbreak Response: A Synthesis of EvidenceWaterlines, January 2018. Research on commonly implemented but severely under-researched WASH interventions is recommended. It is also recommended that responders implement interventions that: are efficacious, simple, well-timed, community-driven; link relief and development; and address barriers and facilitators to use with communities.

Efficacy and Effectiveness of Water, Sanitation, and Hygiene Interventions in Emergencies in Low- and Middle-Income Countries: A Systematic ReviewWaterlines, January 2018. This study found that a majority of WASH interventions consistently reduced the risk of disease and transmission in emergency contexts; however, program design and beneficiary preferences were important considerations to ensure WASH intervention efficacy and effectiveness.
Community Engagement 
Community Engagement in Sanitation: A Landscape ReviewHumanitarian Innovation Fund (HIF)Oxfam, August 2018. Despite its perceived importance, the evidence suggests that community engagement in all sectors of humanitarian response is often limited and rarely monitored or evaluated. Sanitation projects usually involve the community only in the construction phase as a paid labor force, or as a cash-for-work initiative.
Why We Must Engage Women and Children in Disaster Risk ManagementSustainable Cities, March 2018. At the community level, disaster risk prevention should start with boys and girls. Success stories from Indonesia, the Philippines, Vietnam, Thailand, Cambodia, Nepal, and Bangladesh show the impact of involving children and youth in disaster risk preparedness. Children have successfully participated in mapping hazards; raising awareness through radio broadcasts and games; and influencing other children, teachers, parents, and communities on how to reduce disaster risks.
Persistence of Ebola Virus after the End of Widespread Transmission in Liberia: An Outbreak ReportLancet Infectious Diseases, July 2018. Investigation of the source of infection for a November 2015 outbreak provides evidence of Ebola virus persistence and highlights the risk for outbreaks after interruption of active transmission. These findings underscore the need for focused prevention efforts among survivors and sustained capacity to rapidly detect and respond to new Ebola virus disease cases to prevent recurrence of a widespread outbreak.
Exploring Droughts and Floods and Their Association with Cholera Outbreaks in Sub-Saharan Africa: A Register-Based Ecological Study from 1990 to 2010American Journal of Tropical Medicine and Hygiene, January 2018. Floods are more strongly associated with cholera outbreaks, yet the prevalence of cholera outbreaks is higher during droughts because of droughts’ long durations. The results suggest that droughts in addition to floods call for increased cholera preparedness.
Dynamics of Cholera Epidemics from Benin to MauritaniaPLoS Neglected Tropical Diseases, April 2018. Researchers found that at least 54 percent of cholera cases concerned populations living in the three urban areas of Accra, Freetown, and Conakry. Accra, Ghana, represented the main cholera hotspot in the entire study region. Findings indicate that the water network system in Accra may have played a role in the rapid diffusion of cholera throughout the city.
Handwashing/Household Water Treatment
Hygiene in EmergenciesGlobal Handwashing Partnership, January 2018. In emergency settings, handwashing is critical to preventing the spread of disease and has high potential to reduce the health impact of disasters. For example, diarrhea is responsible for 25 percent to 40 percent of child deaths in emergencies. Ensuring proper handwashing with soap in emergency settings can also protect the progress made before an emergency.

Household Water Treatment and Cholera ControlJournal of Infectious Diseases, September 2018. This systematic review concludes that household water treatment interventions reduce the burden of disease in cholera outbreaks and the risk of disease transmission.
Mum’s Magic Hands: A Field Guide for Rapid Implementation of Handwashing Promotion in EmergenciesOxfam, June 2018. Oxfam developed this set of resources—Mum’s Magic Hands—based on research of handwashing promotion in first-phase emergencies. Tested in Nepal, Jordan, Uganda, Nigeria, and Tanzania, the field guide contains background information and tools for assessment, implementation, and monitoring.
Market-Based Approaches
Taking Emergency Water, Sanitation and Hygiene to MarketOxfam Voices, March 2018. Oxfam is working with other NGOs to share learning about providing emergency WASH using local markets. The author of this blog summarizes a recent working group meeting convened to discuss how to guide WASH actors to feel confident using market-based approaches and what studies of this approach are in the works.
Monitoring and Evaluation Framework for WASH Market Based Humanitarian Programming: Guidance DocumentOxfam, September 2017. This document discusses the evidence of the effectiveness and efficiency of market-based programmatic approaches compared with conventional humanitarian responses.
Menstrual Hygiene Management
Menstrual Hygiene Management in Emergencies ToolkitColumbia UniversityMailman School of Public HealthInternational Rescue Committee, 2017. Formative assessments were conducted in two humanitarian response settings (Myanmar and Lebanon) at the onset of the project in addition to interviews with global humanitarian experts and a desk review. The toolkit was then piloted in an ongoing emergency context (refugee camps in Tanzania) where it was evaluated.
Improving Menstrual Hygiene Management in Emergency Contexts: Literature Review of Current PerspectivesInternational Journal of Women's Health, April 2018. The review found that most studies agreed that hardware interventions should focus on the supply of adequate menstrual materials and adequate sanitation facilities, along with access to water and private space for washing, changing, drying, and disposing of menstrual materials.

Menstrual Hygiene Management in Humanitarian Situations: The Example of CameroonWSSCC; UN Women, January 2018. A study was conducted in refugee camps in Cameroon that investigated the difficulties that women experience during menstruation and produced an inventory of WASH infrastructure fixtures in the camp.

Briefing Note: Water Security in the Protracted Crises and Post-Conflict Reconstruction of the Middle EastODI, April 2018. This briefing note concludes that more evidence is needed on how to coordinate and phase different modes of support to ensure sustainable, resilient, and equitable water management and service during and after crisis situations. The role of water in supporting strategic reconstruction goals needs more attention and systematic treatment in reconstruction planning.
Water Management in Fragile Systems: Building Resilience to Shocks and Protracted Crises in the Middle East and North AfricaFAOWorld Bank, August 2018. This paper brings together these two issues—water and fragility—to discuss how they are related and how they should be addressed. It describes how institutional failures to address water-related challenges can act as risk multipliers, compounding existing situations of fragility, and how improving water management can contribute to building resilience in the face of protracted crises.
Other Studies and Reports 
Shedding Light on Humanitarian SanitationProceedings of the 41st WEDC International Conference, July 2018. Lighting should be provided for WASH facilities in humanitarian contexts according to several standards. A three-country research project looking at the impact of lighting on WASH use and gender-based violence (GBV) required a multi-disciplinary approach, combining OXFAM’s practical implementing expertise with WEDC’s research-orientated approach. A wide range of stakeholders welcomed the suggestion that lighting be considered, but noted other factors still influence both GBV and WASH outcomes.
Water Supply in a War Zone: A Preliminary Analysis of Two Urban Water Tanker Supply Systems in the Republic of YemenWorld Bank, July 2018. This discussion paper presents assessments of basic features of urban water supply systems in Sana’a and Aden, a detailed profile of the tanker truck service structure, including supply chain mapping, value chain analysis, and an assessment of changes to the sector since the war began. It also covers institutional support structure for the water sector, well-to-consumer supply chain, water quality, well operations, tanker trucks water delivery services, and household water demand.
Compendium of Sanitation Technologies in EmergenciesGerman WASH NetworkSwiss Federal Institute of Aquatic Science and TechnologyGlobal WASH Cluster; and the Sustainable Sanitation Alliance, 2018. This publication is primarily a capacity building tool and reference book. In addition, it supports and enables decision-making by providing the necessary framework for developing a sanitation system design.
USAID Sustainable Water Partnership (SWP) Toolkits – SWP has published six toolkits on water security that provide guideline on assessment, planning, funding, implementation, and monitoring. Water security is an important issue in dealing with droughts and other emergency issues.
Global WASH Cluster (GWC)  – The GWC was formed in 2006, building upon the successes of an existing WASH humanitarian sector working group. The GWC is an open and formal platform for humanitarian WASH actors to work together and now consists of 76 members. Some resources on the GWC website include the 2018 Mid-Year Report, January–June 2018, news and events, and additional information.
Sustainable Sanitation Alliance (SuSanA) Working Group 8—Emergency & Reconstruction Situations – The objective of this working group is to combine the knowledge from experts in the fields of sanitation with the knowledge from experts in the field of emergency response and reconstruction. Resources on the website include afactsheet, a library, and the report, Preferences for Accessing Emergency WASH Knowledge.
USAID Office of Foreign Disaster Assistance (OFDA) – OFDA is responsible for leading and coordinating the U.S. Government’s response to disasters overseas and responds to an average of 65 disasters in more than 50 countries every year. The latest OFDA Water, Sanitation, and Hygiene Sector Update provides a description of OFDA efforts to support WASH programs in more than 40 countries.
EAWAG—Water, Sanitation and Hygiene in Emergencies – The Strategic Environmental Sanitation Planning Group is leading various efforts to support the humanitarian sector in terms of emergency WASH. Resources include the online courseIntroduction to Public Health Engineering in Humanitarian Contexts.
Emergency WASH Google Group – The Global WASH Cluster and USAID manages this information sharing forum. Its purpose is to provide group members with current research, upcoming events, etc. related to WASH issues in emergency situations.


Water Currents
Publication Date
Produced By
USAID Bureau for Economic Growth, Education and Environment (E3) Water Office