Water, sanitation and public health in post-earthquake Haiti: reflections on Oxfam’s experience

On 10 January 2010 Oxfam GB’s global humanitarian team spent the day reviewing our current approaches to humanitarian response in urban areas. We concluded that the most significant challenge we could possibly face would be a major earthquake in a densely populated urban area. We felt we needed to boost our capacity and understanding of what sort of assistance might be needed in preparation for such an event. Less than 48 hours later the earthquake struck Port-au-Prince, eventually leaving up to 220,000 dead and 1.5 million homeless. Within hours Oxfam’s team in Haiti was responding despite massive personal loss, and the global team was on its way to provide support. This article focuses on lessons learned from responding to water and sanitation (WASH) needs after the earthquake.  

The immediate response

Despite the collapse of half of the Oxfam office and the death of two members of staff, in the first few days following the earthquake Oxfam’s Haiti team began installing bladder tanks at a few sites where people were gathering, and supplying the tanks by water trucking. Some basic equipment was salvaged from Oxfam’s collapsed stores, and more was borrowed from other agencies.

Throughout those early days the team in Port-au-Prince worked without any formal structures, running on adrenalin, pre-existing personal contacts and relationships and a commitment to act. Contact with the outside world was limited to occasional satellite phone calls with the Regional Centre in Mexico and Headquarters in Oxford. While the organisational infrastructure (equipment schedules, staffing lists, funding streams) was being set up, Oxfam staff outside Haiti could do little more than offer moral support to the team on the ground. These early days demonstrated the importance of having the right staff and equipment in place in vulnerable areas before disaster strikes.

Oxfam GB’s team of senior specialist staff in WASH, shelter and logistics left the UK for Haiti the day after the earthquake. It took three and a half days to reach Port-au-Prince. All flights had to go through Santa Domingo in the Dominican Republic, from where the team hitched a ride with a Dominican Defensa Civil bus. Meanwhile, equipment was in very short supply. With the low operational capacity of the airport at Port-au-Prince, Santa Domingo airport soon became inundated with cargo, and getting equipment into Port-au-Prince was extremely difficult.

In the weeks immediately following the earthquake Oxfam’s immediate priority was to provide clean water, safe excreta disposal and shelter material to those who had lost their homes, and to clear the accumulated solid waste from camp sites. Prior to the earthquake only 15% of Port-au-Prince’s population was served by the existing water supply network areas. Oxfam initially assumed that the pipeline infrastructure would need huge amounts of repairs. However, it soon became apparent that, as in many other earthquakes, the underground pipe system was surprisingly undamaged relative to the enormity of the destruction above ground. Even so, there was enough damage for us to engage a French engineering company which had worked in Port-au-Prince before to assist us in supporting DINEPA, the Haitian government’s water and sanitation authority. Together we focused on re-establishing the water kiosks which were an important part of the water distribution system.

Water

Oxfam and other agencies installed a large number of bladder tanks at IDP sites in those first few weeks, and by the second month of the response 70% of water at the various camps was being supplied by tanker, at a cost of half a million dollars a month.[1] However, a recent water survey conducted by Oxfam established that communities are hesitant about drinking trucked water, largely because people had become used to purchasing water following a successful pre-earthquake government campaign to create safe water awareness. The survey revealed that people were continuing to buy water in small plastic bags or from water kiosks, as they had done prior to the earthquake. While agencies initially hoped that providing treated tankered water would have a significant health impact, the majority of people used it only for washing and cooking, and did not drink it.

Sanitation

During the first few weeks after the earthquake it quickly became clear that the key sanitation challenge was providing safe excreta disposal. Oxfam began by digging pit latrines wherever possible and constructing raised latrines sited over 1,000 litre plastic containers. In order to continue de-sludging the pit latrines, a large fleet of de-sludging trucks was required. The pits also needed to be lined to prevent collapse after repeated de-sludging. Our emergency trench latrines also needed to be lined. De-sludging the relatively small plastic containers was problematic: despite attempts to disseminate information to the contrary, people threw so much other waste into the pit latrines that the de-sludging trucks could not suck the slurry out.

The WASH cluster tried to solve the sanitation problem by bringing in portable toilets, but these proved more problematic than helpful as each one needed to be de-sludged every one or two days by local service providers at a cost of $20 per toilet. This quickly became prohibitively expensive and service providers could not keep up with demand due to a shortage of de-sludging tankers and chronic traffic congestion. Final disposal was also a major cause for concern, as waste was being put into open holes at dump sites rather than into protected waste stabilisation ponds or other treatment systems.

As no piped water was available on the sites, sanitation had to be water-less. Oxfam used two new approaches. First, we brought in a partner called SOIL, with whom we had previously worked in Cap Haiten, to build compost toilets. Composting latrines are now working in five camps. Urine can either go to a soakaway or be stored for agricultural use. After each excreta deposit, users add a small amount of bagass (chopped sugarcane, a free waste product from the processing plants in Port-au-Prince). The mix goes into a plastic drum, which is removed weekly and taken to a composting site. The aim is to reduce the volume of solids that need to be taken off site. The secondary aim is to produce a demand for the urine and compost, which will make these systems sustainable for the future. So far, the feedback from users is extremely positive: people prefer the composting toilets to pit or raised latrines as they are considerably less smelly. More work needs to be done to stimulate demand for byproducts.

The second new approach we tried was to systematise a pre-earthquake, largely slum practice of ‘flying latrines’, whereby people defecate in plastic bags which they then throw away. We set up cubicles and gave out small containers for home use. People can either use a peepoo bag (a double bag system containing powdered urea which prevents bad smells and speeds up the biodigestion process) or simple biodegradable bags. Innovative male and female urinals were also part of this approach, whereby people use the urinals then defecate into a bag, tie a knot in the bag and deposit it in a covered plastic drum, which is emptied daily. The contents are then taken to a local composting site. This approach has also received very good beneficiary feedback, even from people who had flush toilets before the earthquake. It is good for sites that de-sludging trucks cannot access, or where it is impossible to dig pits.

Management issues

Oxfam, like many INGOs, struggled to ensure the smooth management of a vast programme which grew in the space of a few weeks from $2m a year and 100 staff to $50m a year and 450 staff. We were also working with a wide range of approaches and partners – national partners, newly formed and often highly politicised camp committees, local government and international private sector partners – and were also operational ourselves.

Because the geographic area was so small, Oxfam initially centralised programme, management and business support in one office. It was assumed that this would also help to achieve economies of scale, better team coherence and more efficient and cost-effective programme implementation. Within a few weeks it was clear that this was not working and that Oxfam’s traditional way of structuring programmes into small geographically defined units, each with its own manager and technical and support teams, was much more effective. Staff built up much better relationships with each other and were able to establish relationships with individuals in the communities with which they were working. This approach was also much more reassuring for communities themselves, as they could get to know individual staff and express their opinions much more freely, leading to a more accountable and appropriate response. In some cases, such as Corailles, the team opened a dedicated office in the area where they were working, to give people a focal point where they could discuss issues, needs and complaints with Oxfam. 

Looking to the future

The experience of the first months following the earthquake has given Oxfam the impetus to move on early from our crisis response ways of working. We have started a programme working with DINEPA, private companies and individual water vendors to increase the number of vendors across Port-au-Prince. The aim is to replace tankered water at each site by supporting private and public sector water vendors. The question now is how the poorest members of the camps can afford this water. Currently, we are carrying out Emergency Market Analysis (EMMA) surveys in many of the 47 camps where Oxfam is working, to determine how best to address this issue.

Variations in water pricing are another issue highlighted by the survey, which shows that the more affluent areas of Port-au-Prince pay on average 3–4 times less than poorer areas not on the piped system. Without new legislation, it is difficult to see how this disparity can be addressed. Lobbying work is underway to highlight the problem, but this will take time to have an impact.

Conclusions

Two lessons come out of Oxfam’s experience in Haiti. The first is that delivering water and sanitation services in urban areas poses very different technical challenges than those that arise in rural environments. As the urban population grows, so agencies will increasingly need to respond to urban disasters. Second, technical solutions need to be innovative and responsive to the specific physical, social and cultural circumstances of the disaster-affected population. Programmes are most effectively managed when they are implemented by dedicated groups of staff working with small communities with whom they develop clear reciprocal relationships and understanding. A balanced combination of these technical and management approaches can help to deliver an effective humanitarian response.

Jane Cocking is Humanitarian Director at Oxfam and Andy Bastable is Senior Public Health Engineer, Oxfam

[1] This work was originally funded by UNICEF and then subsequently through Oxfam International’s public appeal funds.