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.

World Water Day 2021: Keep the water flowing

Bladder and water pump built by Oxfam on the Cesacoba site, near Bangassou, in the Central African Republic. Photo: Adrienne Surprenant/ Oxfam

On 3 January 2021, Bangassou – a small town in the south east of the Central African Republic – was attacked by a coalition of armed groups, forcing 14,000 people in the town and its surrounding areas to flee their homes to seek safety. More than two months later, 4,800 people are still living in a makeshift camp in the woods of Cesacoba, 5km from Bangassou, waiting for security to be restored so they can return home.

When they arrived, the only source of water was located deep in the forest and it wasn’t clean enough to drink. Yet they had no other choice than to make the dangerous journey into the woods each day to collect water. When Oxfam arrived in the camp, parents told us that their children had fallen ill with severe diarrhea from drinking the water.

Their living conditions completely changed when, on 10 January, Oxfam built a water-point on-site, providing the camp and its residents with 30,000 liters of chlorinated water each day , along with 50 toilets and 40 showers.

This World Water Day, when around the world people are celebrating the importance of water for us all, we share here the stories of three women – Marcelline, Yvonne and Leonie – who are fighting to survive, struggling to live in better conditions, and hoping for a better future for their children. We also spoke with Serge, a water and sanitation technician who builds forages for the community and for whom water really is life.

Marcelline Ngoumbeti poses for a portrait in the Cesacoba site, Bangassou, on March 3rd 2021. Photo: Adrienne Surprenant/ Oxfam

Marcelline

“I didn’t understand the gunshots, I did not know where they were coming from. I was scared, I could hear so many gunshots,” says the 36-year-old mother of four, as she recalls the attack on Bangassou on 3 January. In her panic and confusion, she ran in a different direction than her husband and children. Once she had arrived safely at the site, she cried, desolate and fraught with worry for her family. Several hours later Marcelline,  crying with relief, finally found them.

That evening, they slept on the cement floor of the church of Cesacoba. Hundreds of other displaced people shared the same dire conditions for almost a month. Some fell sick with diarrhea, malaria or influenza.

Like all the other women staying in Cesacoba, Marcelline had to walk two kilometers to access a small water source, surrounded by trees and “full of bacteria”, before Oxfam took care of the water supply on the site by building a bladder and water pump system.

“These days we have toilets, showers, and water we can drink. It’s made our lives much easier. And now we have all that, I’ve joined the hygiene committee. Because it is our responsibility – those of us who are staying in the site – to clean the latrines. And it does us good [to take on this responsibility].”

Marcelline’s work in the site hygiene committee involves participating in cleaning the facilities, as well as doing door-to-door promotion sessions about cleanliness on the site. According to Marcelline, “these are good ideas that tomorrow we can continue using at home, to educate our children for the future."

Yvonne Dangbonga holds a bucket of drinkable water on her head, in the Cesacoba site near Bangassou on the 3rd March 2021. Photo: Adrienne Surprenant/ Oxfam

Yvonne

“On 3 January I was five months pregnant, and I was terrified of the sound of firearms. I had problems with my heart, my whole body was aching. I didn’t lose consciousness but I was scared,” says Yvonne, 40-years-old and pregnant with her fourth child. “Bullets were flying over our heads.”

With her family, Yvonne left her village and walked until she found refuge in Cesacoba. However, once on the site, a new set of problems presented themselves: she could not earn money anymore, and had to walk long distances to collect water at a small source shared by dozens of other families. She missed being able to go alone to a nearby river to wash her clothes.

When Oxfam built a bladder and pump to provide drinkable water, she felt “like a weight was lifted”, saying it helped her and her family a lot. “Now, I do not need to waste my energy walking too much, and our health is better.” 

Léonie Lazo, 52 years old, poses for a portrait in the Cesacoba site near Bangassou in the Central African Republic. Photo: Adrienne Surprenant/ Oxfam

Léonie

“During the events of 2017, lots of people died. The recent attack brought back those memories and so we ran,” says Leonie, a mother of ten. She was still sleeping when gunshots woke her up and led her family to take refuge at Cesacoba.

“Once I arrived, I was in such a state… I fell badly and had to be brought to the hospital,” she recalls. And she has struggled to adapt to the difficult living conditions in the site. At home, Leonie told us that she had a proper well nearby, and a field she farmed to pay for her children’s school fees.

“But here there is nothing to do but sit and wait. At first, I was terrified for my children as they were falling ill from the water. Even the smallest one fell sick. But now that we have clean water it’s easier. When the water arrived, I was overjoyed. Now my kids can be happy, play ball and dance.”

Serge

Serge used to build houses, however since building his first well in 2019 he has assisted in the construction of more than ten wells around Bangassou. He told us that he is proud of working with NGOs, as it not only means that he is helping the people in his community but also allows him to earn enough to support his five children.

However, he told us that his work is nowhere near finished. “There still aren’t enough water pumps in Bangassou. In some neighbourhoods, people struggle to find water,” Serge told us.

“Here, people in the community come to tell us what an essential job we’re doing. It is important, because water is life."

Oxfam has been working in the Central African Republic since 2014. We respond to the humanitarian crisis by providing water, sanitation and hygiene services, food security and livelihoods, and by working with community-based protection networks. We also develop programs to strengthen civil society.

In Bangassou, our programs started in January 2020. We rapidly mobilized to respond to the ongoing crisis, when thousands of people fled from their homes on 3 January 2021. In the Cesacoba site, thanks to support from ECHO, GFFO and USAID’s Bureau for Humanitarian Assistance, we were able to provide 4 800 people with Aquatabs, drinkable water, showers and toilets only nine days after the settlement of IDPs, on 11 January. Since then, we have seen a dramatic reduction in serious diseases amongst children.

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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:

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