Health & Sanitation

  • Diseases from unsafe water and lack of basic sanitation kill more people every year than all forms of violence, including war. That’s wrong. We all have the right to clean water. Oxfam is providing life-saving clean water, and sanitation and hygiene education in some of the world’s poorest countries, as well as in areas struck by humanitarian crises.

The WASH specialist from Sihay: coronavirus insights from an ex-Oxfamer’s 15 years’ experience

Margaret (R) during a visit to Mahama Burundi refugee camp in Rwanda when a water storage tank was under construction by Oxfam in November 2015. Photo by Mark Chitelesi/Oxfam.

“My fear is that COVID-19 cases are increasing in the region when most countries are not very well prepared. Some countries are already weakened by multiple crises such as droughts, floods and locusts.” - Margaret

Margaret Apiyo Asewe grew up in a tiny village in Kenya called Sihay in Siaya County, Ugenya Sub-County. She grew up seeing children and adults suffer due to limited water access. She herself walked two kilometres every morning and evening to fetch water from river ‘Nyachim’. She saw how diarrhoea related diseases affected her community - this inspired her to work as a public health nurse. Margaret has just retired after working with Oxfam for 15 years - leading improvements in water access, sanitation, and hygiene for people Oxfam work with across the world.

Her credentials?

  • Strengthening dialogue between communities and Oxfam.
  • Championing a dynamic rethink of the humanitarian-development.
  • Supporting over 16 countries (including Afghanistan, Chad, DRC, Ethiopia, Haiti, Indonesia, Kenya, Pakistan, Philippines, Rwanda, Sierra Leone, Somali, South Sudan, Tanzania and Uganda) in emergency WASH programmes during droughts, Tsunami, earthquake, typhoon, floods, conflict and disease outbreaks such as Ebola, and recently, COVID-19.

Margaret lays all her achievements at the feet of the belief that everyone has a role to play in fighting inequality and in ending poverty and injustice - and she continues to rise, championing the need to utilise local systems during humanitarian responses.

Martin Namasaka, Oxfam’s Horn East and Central Africa (HECA) Regional Media and Communications Advisor, recently spoke with Margaret who is at her home in flood-hit Kisumu, western Kenya, from his home in drizzly Dar es Salaam, Tanzania.

HECA: Burundi, DRC, Ethiopia, Kenya, Uganda, Rwanda, Sudan, Somalia, South Sudan and Tanzania

Martin: Apiyo? Not a name I would say I heard before. What does it mean?
Margaret: Apiyo means the first twin. I have a twin sister, who works in the health sector too.

Martin: What have you been engaged in while working at Oxfam?
Margaret: I had the chance to work in different capacities during my time at Oxfam. These include the Public Health Promotion Team (PHP) Team Leader, PHP capacity builder, PHP coordinator and most recently as the HECA Regional WASH Advisor. In my capacity as the HECA Regional WASH Advisor, I was at the forefront of advocating for the community engagement approach in our programming in the region. I represented Oxfam in various high-level platforms such as the WASH cluster working group, cholera platforms, the WHO and health partners meetings and many more.

I was in West Africa during the 2014 – 2016 Ebola outbreak and I have been here during the COVID-19 pandemic, supporting country offices within HECA in prevention and preparedness. Besides supporting recruitment of WASH teams in the region, I also provided technical support, guidance, and capacity building to staff and partners. This strengthened programme quality and regional staff skills in humanitarian programming, disaster risk reduction and building links between long-term livelihood interventions and public health priorities.

Oxfam has a long history of developing new innovations and technologies, and since 2004 I have supported field testing and feedback of these innovations for emergency responses. It is important to listen to communities and when changing our programming we should always consider feedback from affected communities.

Some of the innovations and technologies that I have supported include hand washing practices especially for children, e.g. 'Mums’ Magic Hands' which encourages hand washing practices at critical times. Others include testing of sustainable sanitation – urine diversion toilets, tiger worm toilet and community engagement in WASH.

Handwashing nudges research in 2017-2018 to motivate handwashing outside latrines in Nduta camp in Tanzania. Photo by Margaret Asewe/Oxfam.

Martin: What challenges do you see in the WASH Sector and what does it mean for the COVID-19 response?
Margaret: Often, WASH works separately from the health sector, there is now a need for these activities to be considered an essential public health intervention.

The COVID-19 pandemic presents a challenge for those of us working in the water, sanitation, and hygiene sector – the current situation is a good time for WASH professionals to re-envision their strategies — and to do it quickly.

People living in densely populated settings — including urban areas, refugee and internally displaced people camps, and prisons — are especially vulnerable.

Margaret conversing with partners during a visit to IDP camps in Wau, South Sudan, to support the Ebola preparedness work.

There are also questions and concerns around the technical capacity of WASH workers. Travel restrictions limit the ability of organisations to send experts to countries struggling to control the virus. Because of this, we need to use the expertise that is already on the ground as much as possible. The scale of COVID-19 emphasises the need for localisation of humanitarian responses. We are now seeing how important it is to strengthen and utilise local systems, particularly given the operational constraints on aid agencies and the scale of this crisis.

Existing ways of accessing communities may not be feasible during the COVID-19 pandemic because of the emphasis on social distancing to prevent the spread of the virus. Reaching more communities through digital and other social media platforms is now necessary.

Martin: What’s the future of the WASH sector?
Margaret: The WASH sector will remain relevant in humanitarian responses especially in the HECA region - double crises, conflict, climate-induced drought and flooding, locust infestation and food insecurity dominate the humanitarian context of the region. Traditional approaches to humanitarian assistance are constantly challenged by protracted emergencies with populations remaining displaced and dependent on humanitarian aid for many years. There is need to move beyond handouts and leverage on local systems especially during the COVID-19 response.

Access to safe water and sanitation is a major priority in these crises; a human right and vital component of ensuring dignity especially for people afflicted by and made more vulnerable by emergencies. Without access to safe water and sanitation services, displaced people are at a high risk of disease outbreaks as they have little choice but to live in conditions that are overcrowded and have scarce hygiene infrastructure.

Beyond COVID-19, there will always be the need for WASH in most humanitarian programmes. However, we may need to do it differently. The future of Oxfam’s relevance in the WASH sector depends on its ability to continue looking at technologies that offer better returns; both in terms of quality and quantity for water and sanitation; systems that facilitate sustained access to safe water and sanitation. But, most importantly adoption of approaches that encourage continued engagement with communities, listening to the voices of those we work with so that they can be part of generating solutions to their challenges and implementing them.

This disease knows no borders and does not discriminate. For the world’s poorest and most vulnerable, the worst is yet to come as the coronavirus begins to establish itself and spread quickly through communities powerless to stop it, without access to water, sanitation or healthcare.

Together, we can save lives.

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As COVID-19 cases grow, displaced Rohingya face new threats that reflect continued persecution

COVID-19 has become an inescapable reality. At the time of writing, 28 April, there were 146-recorded cases Myanmar and 5,913 cases in Bangladesh. While for Oxfam, such announcements have been anticipated given the global nature of the pandemic, the spread of the virus in the both countries has nonetheless brought with it further fears and uncertainty for Rohingya refugees living on obth sides of the border.

Habiba* washes her son at an Oxfam water pump. Habiba lives in Kutupalong Camp with her three children. Oxfam installed four hand pumps near to her home. Credit: Tommy Trenchard/Oxfam (*name changed)

The virus is set to have a potentially devastating impact on the hundreds of thousands of people who have fled the violence and conflict.  

Oxfam has ongoing humanitarian programming in many internal displacement camps, including the confined camps in Rakhine where an estimated 120,000 displaced Rohingya people have remained for the past eight years.

We see first-hand the extremely limited access to health care and other essential services internally displaced people (IDPs) in Myanmar have, as well as the underlying health challenges they face, from chronic malnutrition to cramped living conditions in inadequate shelters. All of these factors could significantly worsen if there is a COVID-19 outbreak. In the confined camps in Rakhine, basic preventative measures, such social distancing and self-isolation, remain impossible - with ten or more family members often living in a single shelter that measures about nine by five foot.

Please send doctors

Even hand washing is out of reach for some in the camps in light of the extremely limited water supply. Based on our ongoing discussions with the Rohingya community, before the threat of COVID-19 became apparent, it was already clear that they faced major challenges in terms of basic health care:

“Living here in the camps, everything gives us diseases. The camp infects everyone with diseases, and I have no money to see a doctor. We must sit and bear it and suffer without any medication. We have no means to go see the doctor even when we are sick.” — Rohingya woman, 28 years old, displaced and living in the confined camps in central Rakhine, Myanmar.

“Please send good doctors to the camps with enough medicine because here in the camps people here are losing their lives day by day. The camps make it very easy for people to contract diseases, but difficult to get medical treatment. The doctors do not see the patients and do not help us. And the patients are not receiving the right medicine for the illnesses they suffer.” — Rohingya woman, 35 years old, displaced and living in confined camps in central Rakhine, Myanmar

These women’s words reflect the extremely limited medical care in the camp, with doctors available only sporadically, and severe restrictions on the ability of people to leave the camps and access more specialised services at the nearby hospital. If someone in the camps falls ill and needs more specialised care, they must seek and receive official permission, which often takes several days, and they must pay a security escort to travel with them to the hospital located only a few kilometres away in town.

The complicated, time consuming and expensive process means that many are simply unable to access vital health care, even in an emergency. In this context, if people do become sick with the COVID-19 virus, it is likely they will have little to no ability to isolate themselves or seek professional care.

The possibility of an outbreak of the virus in these camps became that much clearer this week as a cases of COVID-19 were confirmed in Cox’s Bazar, the town located across the border in Bangladesh, which is home to the sprawling refugee camps where one million Rohingya refugees currently live after fleeing horrific violence in Myanmar in 2017.

Shim*, 12, holds an Oxfam food parcel she received from a distribution at Kutupalong Camp, Bangladesh. Credit: Tommy Trenchard/Oxfam

Oxfam is urgently scaling up humanitarian work

This is why we are urgently scaling up our humanitarian efforts in the Rohingya camps in Myanmar and Cox’s Bazar, Bangladesh.

With our partner Solidarités International, we are increasing public health promotion activities, including the urgent construction of an additional 1000 hand-washing stations, the distribution of 17,000 pieces of soap every month along with other basic hygiene items and sharing essential information about the prevention of the virus in Rohingya language through community networks and channels.

Similarly, in Cox’s Bazar, we have intensified and escalated hygiene promotion efforts, including prevention messaging with communities, while enhancing water and sanitation facilities. In a welcome move, the Office of the Refugee Relief and Repatriation Commissioner in Cox’s Bazar designated water and sanitation services as essential ones, enabling us to continue to deliver life-saving measures during the COVID-19 crisis. Continued humanitarian access for life saving activities in the camps on both sides of the border remains critical.

While Oxfam, along with governments and other humanitarian organisations are mobilising quickly to prevent the spread of the virus, another concern that could significantly worsen the spread of the COVID-19 virus is the shutdown of Internet services. Unlike most places in 2020, where we can check our mobile phones for immediate information about the virus, how to prevent it and what to do if you feel ill, Rohingya refugees have experienced the shutdown of internet services on both sides of the border.

Health crisis, human rights crisis

None of these issues — from the lack of protection, to the lack of essential services, to the lack of information — are new. Rohingya communities have been faced with an entirely precarious existence for years, struggling to access the very basics to survive. However, the threat of COVID-19 is putting the human rights crisis faced by Rohingya living in camps on both sides of the border into sharper focus. It starkly shows how equal rights are central to ensuring each human life is valued and protected, whether it’s amid a pandemic or not.

It’s by focusing on the rights of Rohingya and other displaced communities that we can increase the effectiveness of COVID-19 prevention efforts in the immediate and reduce vulnerabilities over the long term.

Alison Kent, Director of Advocacy & Communications, Oxfam in Myanmar.

This disease knows no borders and does not discriminate. For the world’s poorest and most vulnerable, the worst is yet to come as the coronavirus begins to establish itself and spread quickly through communities powerless to stop it, without access to water, sanitation or healthcare.
Together, we can save lives.

COVID-19: Why we need your support now more than ever

We just launched an appeal to support Rohingya refugees in Cox’s Bazar survive monsoon season – the day after the first case of COVID-19 was confirmed in that region of Bangladesh.

As appeal letters dropped through the letterboxes of our loyal supporters, some 900,000 people living in the biggest refugee settlement in the world began to panic about how they could practice social distancing and life-saving hygiene practises in a makeshift home without adequate sanitation and health infrastructure.

This is the news we dreaded – and it’s why we made the decision to still launch our appeal at a time of unprecedented challenge at home and abroad as COVID-19 threatens us all. For people living in cramped, flimsy shelters in over-crowded camps, the impact of an outbreak doesn’t bear thinking about.

It’s our job to let our supporters know how they can help the world’s poorest and most vulnerable, those facing poverty and disaster beyond our imagination.

We usually tell these stories and how you can be part of them face-to-face, through our fundraising activities and our network of shops in communities across the country. To protect us all, we can’t do that right now and we’re are urgently appealing for your help. 

We need your generous support now more than ever.

In addition to helping Rohingya refugees prepare for monsoon season, we’ll be helping them and communities all over the world to stay safe and healthy as COVID-19 threatens the poorest and most vulnerable.

Please donate what you can today:

Bangladesh: A treacherous journey for Rohingya people

From clean water and sanitation to advocacy, Oxfam is assisting hundreds of thousands of Rohingya refugees from Myanmar who fled the brutal attacks of 2017.

It's has been almost three years since over 700,000 Rohingya from Myanmar became refugees. Targeted by the military with mass violence that the United Nations describes as ethnic cleansing, they left behind everything they owned. They carried with them a heavy burden: the memories of atrocities carried out against their loved ones, and of the harsh abuse that they themselves endured. The emotional wounds are still fresh; ask a refugee a question about the present day, and you will likely hear a haunting personal story of what happened in August 2017.

Khalida lives in a refugee camp in Cox's Bazar, Bangladesh. Like hundreds of thousands of others, she was driven from her country by Myanmar's military. Photo: Elizabeth Stevens/Oxfam

"We saw with our own eyes people tied up and thrown into police trucks," says a woman who lives in a refugee camp in Cox's Bazar. "Blood flowed from the trucks like water."

"They killed my brothers and raped my sisters and mother and killed them," says Abu Musa, another refugee. "We get up every morning and wonder how we can go on."

Yet, somehow the life of the community does go on. The camps bustle with activity, with roadside market vendors selling everything from vegetables to pots and pans to brightly coloured clothing. Trucks arrive with goods and make their way slowly along brick roads, crafted by hand to survive the monsoon rains. Children surround new visitors, eager to interact and play. Someone tells a joke, and someone laughs.

Protecting lives, rights and dignity

When refugees began their exodus in 2017, protecting lives was Oxfam's priority. The camps that formed to accommodate the refugees quickly became overcrowded, creating perfect conditions for the outreak and spread of deadly diseases. With your support, we helped prevent a public health emergency by constructing latrines, providing access to clean water and distributing hygiene materials, such as soap and sanitary pads. Over time, we constructed the largest sewage treatment plant in a refugee camp anywhere in the world.

"Before learning about hygiene from Oxfam, I didn't know how to use soap properly," says a young woman named Saitara. "I didn't know about washing hands before eating and cooking. Now, I'm cooking food safely."

"After Oxfam's work," says a mother of three named Hamida, "our children didn't get diarrhea so often.

Safety - particularly for vulnerable groups like women and girls - was also a key priority, so Oxfam installed solar-powered lights around the camp and provided families with solar torches and lanterns to help residents move around safely at night.

"We use the solar torches to get to the latrine at night or to find a lost child," says Saitara, "or to help people who are elderly or disabled."

To ensure people had access to food, clothing and other essentials, we distributed vouchers that families could use in local markets.

Thanks to your support, we're also helping to create safe spaces for women to gather and make their voices heard, and through women's groups and musical performances, we're working with local organisations and communities to raise awareness about wider issues, such as early marriage, gender-based violence and harmful traditional gender roles.

The influx of refugees has been hard on the host communities. Among other things, already-low wages have dropped, while the cost of living has risen. To help address local poverty and ease tensions between hosts and refugees, Oxfam has employed more than 1,800 Bangladeshis in construction projects, such as building roads, schools and water points.

Saitara signs her name. She had never touched a pen before Oxfam showed her how to sign her name. "I used to feel small, but after learning to sign my name, I felt bigger," she says. Photo: Elizabeth Stevens/Oxfam

We also worked with partners to improve livelihoods of particularly vulnerable families in the host communities. For example, when pirates attacked the vessel of fisherman Nurul Hoque, they blinded him, and he was reduced to begging on the street. Oxfam partner Mukti stepped in, providing funds and business training that enabled his familiy to start up a roadside food stall.

"Now, we eat three times a day," says his wife, Mumtaz Begum, "and we have bought four goats."

In all, Oxfam and our partners have reached more than 360,000 people with aid.

Refugees experience fear and longing

But nothing we do will make the camps feel like home, and despite the violent past, the refugees' longing for their homeland is palpable.

They're deeply grateful to the government and host communities of Bangladesh for providing them with shelter and safety, but they don't want to live out their lives as refugees.

"We used to be farmers. We grew rice and chilies, and our sons fished. My husband had a snack stall," says Hamida. "We want that life back." Many others say the same, but always with a caveat.

"We can't leave until we have a promise. We need security and citizenship in our country," says Faruk, who has a young daughter. "Our people have been killed before, and we don't want to face that again."

Oxfam is committed to doing more than simply provide aid in the camps. With advocacy staff positioned in capital cities around the world, we're urging governments to put pressure on Myanmar to provide the Rohingya people with the rights and citizenship they've been denied for decades, and with a chance to return to their home country when the refugees themselves deem it safe.

In the meantime, the Rohingya people are doing their best to recover, and to hang onto their hopes and dreams.

"We're asking for our country back," says a woman named Azara. "And for a chance to lie there in peace."

Your help is urgently needed this monsoon season. Please send essential preparation kits to refugees like Azara, Saitara and Khalida today.

Rohingya refugees: Finding hope amongst the hopelessness

In 2018, I completed three weeks working for Oxfam's Rohingya crisis response team in Cox’s Bazar and can remember one moment, standing in the pouring rain in the confined camp.

Everywhere I looked, ramshackle shelters made of bamboo and tarpaulins stretched into the distance.

People old and young were trying to find shelter from the downpour, and large puddles were quickly forming across the narrow brick road, with water running down sandy hillside paths.

As I was trying to take photos of a deep tube well Oxfam was drilling to provide clean water, numerous Rohingya refugees offered to take me into their shelters to stay dry, or brought me umbrellas.

Such was the kindness of people who had endured unspeakable horrors that forced them from Myanmar into neighbouring Bangladesh.

Before monsoon season, the camps endured what they call the pre-monsoon rains, where every couple of days a ferocious storm will hit for an hour or so.

This rain was nothing like I’m used to.

The falling water had an almost physical quality, beating down on you, so heavy that you would struggle to see the other side of a road.

Trees were often blown over in the wind, and almost immediately, huge puddles formed everywhere, slowing cars and trucks on the sandy, brick roads and draining into refugees' flimsy shelters.

Almost one million people live in the Rohingya refugee mega camp. When I was there, what was at the forefront of aid workers' minds was how the full monsoon would impact such a huge population living in such desperate conditions.

Yet despite this, I was struck by the way in which Rohingya refugees could find hope in what appeared to be a hopeless situation.

Denied citizenship in their country, they felt they didn't belong anywhere and had nowhere to call home. They had no idea what their future would hold.

In the meantime, they were awaiting monsoon rains likely to bring floods, landslides and potentially deadly water-borne diseases. At the time, the United Nations (UN) estimated that up to 200,000 people were living in at-risk areas of the camps.

As much as 2.5 metres of rain could fall on the camps during the monsoon season.

But the refugees I met certainly weren't hopeless or despairing.

Parents were working hard to strengthen their shelters or volunteering for charities like Oxfam as community health trainers, or with the UN as camp labourers helping prepare the camps for the coming heavy rain.

This included a young woman I met called Ayesha*, who was 18 years old. She fled to Bangladesh with her mother and three siblings after their father was killed in the violence in Myanmar.

Ayesha (pictured left). Photo: Dylan Quinnell/Oxfam

It took them nearly 5 days to get to Bangladesh by boat and foot; others weren’t so lucky and drowned when their boats sank.

Life is tough in the camps without a father or husband - women can get missed or sidelined at aid distributions, and culturally, young women are not supposed to go out alone.

None of this had dampened Ayesha’s spirit. She had put up her hand to volunteer, and was running community health trainings with her neighbours and other women. 

She told me, "Now I work as an Oxfam volunteer, I teach people how to maintain good hygiene and I tell people what to do to have a good life. I feel good about it".

As for the children, they played football wherever they could find space, and ran through the camps in happy bunches and practised English phrases such as "goodbye, how are you, I am fine" with aid workers.

Oxfam is in Bangladesh, providing food and life-saving clean water to those who have fled Myanmar and the host communities that have opened their doors to them. But we desperately need your support as the deadly monsoon season approaches.

You can send monsoon preparation kits today: https://www.oxfamireland.org/monsoon

Dylan Quinnell was the Media Manager for Oxfam’s Rohingya Crisis Response for three weeks. He is currently the Senior Media Coordinator at Oxfam Australia.

*Name changed to protect identity.

Kutapalong Rohingya refugee camp: preparations for monsoon season

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