Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea 

By Rebecca Beauregard

SOMALI Region, 20 April 2017 – When Basazin Minda was requested to support the acute watery diarrhoea (AWD) response in Somali region, he did not hesitate. In fact, within one week, he handed over his duties to colleagues in UNICEF Oromia team and was in Jigjiga office.

Complex emergencies are not new to him. He was in Gambella when a South Sudanese refugee influx necessitated immediate WASH response. And when an AWD outbreak threatened lives in the southern cross-border town of Moyale, Basazin led the AWD WASH response and coordinated joint Kenya and Ethiopia control mechanisms. This is part of why he loves working with UNICEF – there is full support and resources to take quick action as well as the flexibility to respond where needed when communities are facing crisis, such as the AWD outbreak.

One lesson he learned from those past emergencies was that to have an impact, it required extensive human resources in the affected areas. Recently hired WASH Information Management Officers (IMOs) were available to support his team and he soon learned about UNICEF Health section’s C4D (Communication for Development) consultants, which could help spread the critical WASH messages to stop the spread of AWD.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
On site community mobilization concerning poor drainage and optimal water collection methods. Lasoaano kebele, Shilabo woreda ©UNICEF/2017/Mualid

AWD describes infections that can result in easily transmitted and potentially deadly diseases. The spread of such disease is very high in areas with water scarcity and can have a devastating impact on children who may already be undernourished. Additionally, those living in crowded spaces with poor access to WASH facilities, like the many temporarily displaced families, also face a higher risk.

The recent AWD outbreak peaked in Somali region in February 2017 and now more than 50 per cent of the woredas (districts) are reporting active cases. Particularly due to the current Horn of Africa drought, there are refugees coming from neighbouring Somalia, as well as temporarily displaced Ethiopian Somalis, as people move in search of water, food and pasture for their livestock. The predominately pastoralist Somali region is the worst drought-affected area in Ethiopia with over 30 per cent of the region’s population requiring food assistance in 2017. Living conditions of these temporarily displaced people are often inadequate and widespread open defecation poses a risk of the spread of AWD, among other disease outbreaks.

Upon arrival, Basazin began a series of discussions with people from UNICEF, the Regional Water Bureau (RWB) and the zonal command post. What he learned immediately on the ground was a little different than he had prepared himself for. He came for mass chlorination of boreholes to stop the spread of AWD. However, he identified that boreholes are protected. “This is what can be so interesting about emergencies. You go in with one mind set and task and immediately are faced with a reality that may differ. The problem was not the water sources, so the contamination had to be happening at some point after water is collected, either during collection or storage,” Basazin explains.

Like detectives, Basazin and the newly formed team began contacting local water office staff and meeting with various community members to pinpoint where this contamination was coming from. The team concluded that contamination was occurring from water trucking, during the transport of water (usually by donkey cart) and at the household level, where dirty jerry cans were utilized repeatedly. Now the task has shifted to a multi-effort approach including mass chlorination of water trucks, community awareness campaigns to ensure clean jerry cans and training sessions for local water staff on chlorination standards.

The RWB staff know about chlorination, however at this critical time of drought and AWD, with a mobile team equipped with testing kits, jerry cans and barrels of HTH chlorine solution, everyone was eager to learn more from practical demonstrations. A key lesson that was missing before now was how to calculate correct measurements of chlorine according to the container size to ensure disinfection. Referencing UNICEF WASH guidelines, Basazin prepared a guideline of chlorination and turbid water purification with these specific calculations included and it was subsequently distributed to all water offices in the region.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
Basazin demonstrating residual chlorine with technical staff and community mobilizers at the Lasooano kebele health centre in Shilabo woreda ©UNICEF/2017/Mead

The feedback was positive after the training and RWB staff proliferated the learning by sharing demonstration photos through their Viber group, a mobile messaging application utilized by all Somali RWB staff.

One water office participant commented after a demonstration, “Assistance has come through here and sometimes guidance is offered, but not like this. Receiving evidence-based participatory training makes a big difference.”

Basazin did not always explain the calculations and guidelines. Another lesson his work has taught him is to tailor his WASH messages according to the audience. “AWD bugs will attack the water if it finds it without chlorine and consequently the attack will reach to human beings.” There was laughter when Basazin used this metaphor.

The team is working through Good Friday, the big Easter holiday and weekends to curb the outbreak and spirits remain high. Basazin’s energy and commitment to ensuring his work has impact is easily detected as he speaks. “I like to learn today and implement for tomorrow,” he says. “Perhaps another idea coming from this mission is that we should highlight a jerry can and water truck washing day, just as we promote handwashing day.” He is also quick to admit this is not a one-man show. With the UNICEF Jijiga and Addis team and the community, mass chlorination is taking place exactly where needed to curb the AWD outbreak.

“Everything has a solution,” Basazin declares.

 

Giving a village in the Amhara region its own water supply transforms lives

By Ayuko Matsuhashi

WOIRU DIKALA, Amhara region, 7 August 2016 – The women of Woiru Dikala kebele (sub-district) used to spend much of their day searching for water, a mission that grew even more difficult as drought ravaged Ethiopia’s Amhara Region over the past year.

Women and children often walked for more than six hours to get the water their community needed, searching for scarce rivers and ponds among the dry, rugged gorges of Raya Kobo woreda (district).

Local women at Raya Kobo woreda, Woiru Dikala Kebele -Amhara National Regional State enjoys the newly inaugurated water supply.
Women in Woiru Dikala kebele spend much of their time looking for water.   Now they can easily access clean water thanks to the multi-village water supply system built with UNICEF’s support.  ©UNICEF Ethiopia/2016/Mersha

This area, near the borders of Tigray and Afar regions, is full of migrants from these parts of the country also searching for water for their family and herds and fleeing the recurrent droughts.

So it was with great rejoicing that the people of Woiru Dikala welcomed a joint UNICEF and DFID project introducing a multi-village water supply system drawn from a deep well with a total of eight water points around the village – including one for the primary school.

Comments we received from community members included “We can avoid the risks of abuse of women and children as they travel to collect water from the gorges including at night time,” and “Our children and even adults have been frequently affected by diarrheal diseases and intestinal parasites. We feel happy that our life will be changed.”

The new water system will help 5,000 people over the next 20 years, including the 2,100 living in Woiru Dikala kebele.

The El Niño-driven drought has hit much of the country over the past year, but eastern Amhara has been especially hard hit, with over 1.5 million people suffering from a critical shortage of water.

The shortage also has severe health implications. The kebele has seen an outbreak of the itching menace of scabies because the lack of water means poor sanitation and personal hygiene.

IMGL0844
Boys and girls in Woiru Dikala kebele can grow healthily as they have unrestrained access to clean water. They can also attend school more regularly without worrying about fetching water. ©UNICEF Ethiopia/2016/Mersha

The condition breeds in cramped, dirty conditions and can move quickly through a population causing a great deal of distress among children, who make up half the population of the kebele.

Poor water quality also led to an outbreak of Acute Watery Diarrhoea, which can be fatal for the young and infirm.

Regular access to clean water is key to combatting these diseases. There is no health facility in the kebele.

The inauguration of the new water supply for the area was attended by several regional officials as well as representatives of UNICEF.

“This water supply system provided from a deep well should support local resilience in times of climatic uncertainty,” said Jane Bevan, UNICEF’s manager for rural Water, Sanitation and Hygiene.

Ms. Gillian Mellsop, UNICEF Representative to Ethiopia visits and inaugurates the UNICEF/DIFID supported community emergency water supply scheme at Woiru Dikala Kebele, Raya Kobo woreda, Amhara region.
Attending the inauguration of the new water system were Ato Woldetnsae Mekonnen, head of the Water, Irrigation and Energy Department for North Wollo Zone, Jane Bevan, UNICEF’s Rural WASH Manager, Ato Ayenew Belay, head of Amhara’s Bureau of Finance, Ato Kedir Mustefa, administrator of Raya Kobo woreda, Gillian Mellsop, UNICEF representative to Ethiopia, Ato Yimer Habie, deputy head of Amhara’s Bureau of Water, Irrigation, and the Bureau of Energy. ©UNICEF Ethiopia/2016/Mersha

 

Ethiopia meets MDG 7c target for drinking water supply

Ethiopia meets MDG target for drinking water
Group photo with all partners who helped achieve Ethiopia meet MDG target for drinking water. ©UNICEF Ethiopia/2015/Sewunet

23 March 2015, ADDIS ABABA: Today, the Government of Ethiopia announced a remarkable achievement in the Water Supply, Sanitation and Hygiene (WASH) sector as it met Target 10 of the MDG 7c  for access to drinking water supply. The announcement was made in the presence of H.E Dr Mulatu Teshome, President of the Federal Democratic Republic of Ethiopia, H.E Engineer Wondimu Tekle, State Minister on behalf of His Excellency the Minister Ato Alemayehu Tegenu, Ministry of Water, Irrigation and Energy, Senior Government Officials, Ambassadors, UN representatives, WASH partners and members of the media.

Dr. Mulatu Teshome, President of the Federal Democratic Republic of Ethiopia on the occasion said. “I would like to congratulate you of this great achievement of meeting the Water Supply MDG target and ensure you of the commitment of Ethiopian Government to make realistic its responsibility of providing access to safe water supply and sanitation services at appropriate service level to all its citizens. I call upon all of you to continue joining hands with the Government on reaching to the unreached”.

Ethiopia meets MDG on clean water

The 2015 assessment report by the UNICEF/WHO Global Joint Monitoring Programme for Water and Sanitation (JMP) indicates that Ethiopia has met the target of 57 per cent[1] of the population using safe drinking water and has attained the target by halving the number of people without access to safe water since 1990.

H.E Engineer Wondimu Tekle, State Minister on behalf of His Excellency Ato Alemayehu Tegenu, Minister, Ministry of Water, Irrigation and Energy said, “Thanks to the great leadership of the government, the diligent effort of WASH actors in particular and Ethiopian communities at large for reaching the have-nots in water supply; the country has achieved MDG 7c target”.

“Today’s event represents a great milestone to us, development partners, civil society, NGO, bilateral, multilateral, public and private sector professionals as we have joined hands to make this achievement a reality.  It is also a historic moment, where Ethiopia demonstrates its political commitment to resolving challenges in the Water and Sanitation Sector,” he added.

Ethiopia has embarked on an ambitious Growth and Transformation Plan (GTP) which placed water supply at the core of all future development agenda. The Government’s heavy investment in the Millennium Development Goal (MDG) fund combined with increased donor contribution enabled the rapid acceleration of water supply coverage in many parts of the country. In addition, Ethiopia has developed a ONEWASH programme designed to ensure universal access to WASH services by 2015. The plan has a budget of US$ 2.4 billion and involves the collective contribution of public, private, NGO and donor investments.

Ethiopia meets MDG target for drinking water
Ms Leila Pakkala, Regional Director, Eastern and Southern Africa, speaking on behalf of the Joint Monitoring Programme (JMP) during the celebration event of Ethiopia’s MDG achievement on drinking water supply. ©UNICEF Ethiopia/2015/Sewunet

 

Ms Leila Pakkala, UNICEF Regional Director, Eastern and Southern Africa, speaking on behalf of the Joint Monitoring Programme said, “In 1990 only 6 million people had access safe water. Today, over 55 million people access clean and safe water. The progress that has been made has been impressive, to say the least. But we know that the progress we are celebrating today comes as a result of many years of consistent investment, time and resources at all levels. It has not been an easy achievement”.

The JMP estimates for Ethiopia were updated following a joint mission to Addis Ababa from 26-27 November 2014 and include data from the most recent nationally representative surveys. The current JMP estimates show that in the 1990 baseline year access to drinking water was 14 per cent and access to sanitation was 3 per cent. This means that Ethiopia’s MDG target for drinking water was 57 per cent and for sanitation was 52 per cent. The current JMP estimates show that by 2015 access to improved drinking water has increased to 57 per cent and access to improved sanitation has increased to 28 per cent.

Accordingly to the JMP, the total population reached with safe water between 1990 and 2015 is 48 million. There are still 42 million Ethiopians without access to safe water.  Of the 42 million Ethiopians who are not using improved water supplies, an estimated 33 million people are residing in rural areas and peri urban communities and 9 million are living within towns and cities.

UNICEF provides much needed clean water to new refugees from South Sudan and the local communities hosting them

By Elissa Jobson

Refugees cross the Baro river
South Sudan refugees cross the Baro river, which is the border between South Sudan and Ethiopia. Crossing the river means that they have reached Burebiey entry point in Gambella, Ethiopia . ©UNICEF Ethiopia/2014/Sewunet

GAMBELA, ETHIOPIA, 27 JUNE 2014 – The swollen Baro river marks the border between Ethiopia and it western neighbour, South Sudan. It’s fast-flowing waters are all that stand between those fleeing the brutal civil war in their home country and safety in Gambella. Dotted along the banks on the South Sudanese side are men, women and children, clutching their meagre possessions, waiting to be transported across the muddy-brown waterway in white plastic canoes. With battered suitcases and woven baskets on their head, those refugees – dusty, exhausted and in need of food and water – who have successfully made the river-crossing trudge towards Burebiey and the UNHCR registration tent, half a kilometre away.

Deng Gatek spent three days waiting to cross the Baro as he tried to scrape together the 30 birr (USD$1.5) fee he needed to secure passage for himself, his wife and his four children. He silently fills his yellow plastic jerry can with crystal clear water from UNICEF’s EM-Wat (emergency water) facility.

“We walked through the bush with hyenas and snakes. Many bad things happened,” Mr Gatek recalls, weariness and relief etched on his face. He can’t remember how many days the journey took from his home in Walang, in Jonglei State, to the border. “It was difficult to find water on the way. When we arrived at the border we were able to drink the river water. The water from the tap is much better than the river water – there is no dirt in it. I can take clean water to my wife and children now. They are at the registration centre,” he adds, pointing to a clutch of tents in the distance.

WASH Gambella region South Sudanese refugees  reception centre
David Luk Both, himself a refugee from South Sudan, is in charge of the EM-Wat treatment plant. Here he tests quality of the water pumped out of the river before going through the process making it ready for drinking. 26, June 2014 Burbiey South Sudanese Refugees Reception Centre in Gambella, Ethiopia. ©UNICEF Ethiopia/2014/Ayene

David Luk Both, himself a refugee from South Sudan, is in charge of the EM-Wat treatment plant. Before the fighting broke out he had worked as a technician for MSF Holland for seven years. “The water is pumped from the river Baro into two 12,000 litre sedimentation tanks,” Mr Both explains. “The water sits in the tank until all the debris and mud has sunk to the bottom; aluminium sulphate is added to help the process. The pH of the water is tested to check the levels of acidity before it is pumped into a chlorination tank that kills all the bugs and germs in the water. It is then ready to drink.”

If needed, Mr Both and his team can provide up to 36,000 litres of clear water a day. “The refugees come all day to the taps. If I don’t treat the water they can’t drink it. I’m very happy because I’m helping my people,” he says.

Conflict prevention

More than 147,000 South Sudanese asylum seekers have arrived in Gambella since fighting erupted in Juba in December last year. This has placed a tremendous burden on local authorities which were already stretched – Gambella is one of the poorest regions in one of the most food insecure countries in the world, and was host to around 76,000 refugees from South Sudan before the current influx began.

Pel Puoch is head of the Water, Energy and Resources Office in Mokoey woreda (district). Nyien Nyang town, close to Leitchor refugee camp, is under his responsibility. “Before the provision of shallow wells in Leitchor camp, the refugees had started to use the water pumps in Nyien Nyang. This created a burden for the community,” Mr Puoch says. “UNICEF immediately understood the problem and increased its support to the wordea and the burden has been greatly reduced.”

This year UNICEF has installed 9 pumps in Nyien Nyang. There are 35 in total, serving a population of around 18,000, nearly half of which were constructed by UNICEF, including two at the local the hospital.

“The focus of all the NGOs and UN agencies has been on the refugees. At UNICEF, our focus is always on both the host community and the asylum seekers,” says Basazin Minda, WASH officer. “We identified the burden on the local services at an early stage and decided to increase the number of shallow wells in the area in order to create a balance between the host community and refugees.” He believes that the creation of the additional shallow wells and pumps has prevented potential conflicts over this precious resource between the indigenous community and the refugees they have provided sanctuary too.

A new lease of life

Mr Puoch has seen many benefits from the construction of water pumps in the heart of the community. “Having the pumps close to their homes means that the women will save time collecting water. Previously, when they had to go to a faraway pump they would not use the water for hygiene. But because they can access water in the local area at any time, sanitation has improved,” he insists.

“When the pumps were some distance away they would break often. Now they are close to the homes the community takes better care of them.

At Dobrar village, Nyarout Jok, a mother of four, uses the UNICEF water pump twice a day.
At Dobrar village, Nyarout Jok, a mother of four, uses the UNICEF water pump twice a day. It’s just 300m away from her home and fetching water now takes less than 20 minutes a day. ©UNICEF Ethiopia/2014/Ayene

At Dobrar village, Nyarout Jok, a mother of four, uses the UNICEF water pump twice a day. It’s just 300m away from her home and fetching water now takes less than 20 minutes a day. Before the tap was installed she had to walk over a kilometre each way to the nearest water source, which took at least an hour. “I use the extra time to grind flour and take care of my children,” she says. “I have also returned to education. I’m a grade 5 student.”

So why did she decide to go back to school? “I need to do my own job,” she says. “I will be able to earn my own income and I will become more confident. I want to be either a doctor or an engineer.”

Click here for latest update on South Sudan refugees status in Ethiopia.