Health risks for people in the Greater Darfur region: the cocktail of environmental hazards
The outbreak of hepatitis E in refugee camps in the Greater Darfur Region and in eastern Chad and the risk of a cholera outbreak following an outbreak in the central and western part of the country highlighted the urgent need to speed up water and sanitation activities in internally displaced persons (IDP) camps. Improvements in access to clean water and sanitary latrines coupled with health and hygiene education and promotion has been set by the United Nations consolidated Appeal for the Sudan Assistance Programme (ASAP) as one of five life-saving strategic priorities for the remainder of 2004 along with food and agriculture, health, shelter and non-food items (NFI). Around US$ 33 million for 2004, of which US$ 18 million is for the Assistance in Darfur only, are needed.
While the number of deaths from the recent outbreak of waterborne disease is small compared to those from other conflict-related causes, hepatitis E is nevertheless adding to the death toll and morbidity in the Greater Darfur Region. The region plunged into conflict beginning in February 2003. To date, more than 1.2 million are estimated to be displaced people and probably more are affected.
WHO’s environmental engineers have inspected the three Greater Darfur IDP camps and describe here the cocktail of environmental hazards that are set to cause more casualties and human suffering, particularly to women.
Unprotected or open wells
Water from unprotected or open wells as seen in the camps is susceptible to contamination in a variety of ways including from: 1) containers which are used for retrieving water; 2) water that is spilled back into the well during the retrieval process; 3) various types of debris including garbage, dust, animal droppings; and 4) rainwater runoff which could contain feacal matter where sanitation conditions are poor.
In Kerenek camp in West Darfur, the State Ministry of Health ordered that open wells be closed until proper well improvements can be made. WHO recommends the closure of open wells, provided an adequate quantity of water is available to the population from other water sources, until they can be properly protected.
Some families use open jerry cans and other containers for water hauling and storage. Water that is transported and stored in open containers is at risk of becoming contaminated by unclean hands or objects. WHO recommends that containers be narrow-necked or closed because these types of containers limit opportunities for water to be contaminated.
Transportation of water
Water hauling by donkey is customary in all of Sudan and the Greater Darfur Region. Goatskin bags on donkeys are a traditional way of transporting water from one location to another. Water has the potential to become contaminated during the filling of the bag, during transport, and during the emptying processes. Health and hygiene community health workers must give directions as to the filling and storage of the water. If water is not from a chlorinated source, then chlorination is highly recommended. Also users must filter the water with a cloth to get rid of small and large objects. The water must be stored in cleaned and closed containers at the household level.
With limited quantities of water available, as is the case in the IDP camps in Greater Darfur, water is likely to be used very sparingly for personal hygiene purposes such as clothes and hand washing. Hygiene promotion campaigns are crucial for disseminating messages on the importance of improved hygienic behaviour such as hand washing with soap, safe handling and storage of water in the home, proper disposal of children’s faeces, importance of latrine cleaning, and safe food handling practices.