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.

COVID-19 recovery in West Africa is “austerity on steroids” and sets the region on a destructive path ahead

Posted by: BenClancy

 

Austerity, spiraling debt and vaccine inequity will bring the inequality crisis to levels never reached before, reveals new index.

West African governments are planning to “slash and burn” their way out of COVID-19 induced economic loss, reveals new analysis from Oxfam and Development Finance International (DFI) today. The organizations are calling for an urgent change of course as West African governments are preparing their annual budgets and participating in the Annual Meetings of the World Bank and IMF, which are crucial discussions to focus the recovery on fighting inequality and poverty.

The Commitment to Reducing Inequality Index (CRII) shows that 14 out of 16 West African nations intend to cut their national budgets by a combined $26.8 billion over the next five years in an effort to partly plug the $48.7 billion lost in 2020 alone across the entire region due to the pandemic. Such austerity has been encouraged by the IMF, through its COVID-19 loans. 

This massive raid on public finances could push millions more West Africans into poverty and hunger and potentially trigger the worst inequality crisis in decades.  Women will be impacted more severely due to their very high concentration in low paid informal jobs and unpaid care work.  Meanwhile, the collective net worth of West Africa’s three wealthiest men surged by $6.4 billion in the first 17 months of the pandemic ―enough to lift 18 million people out of extreme poverty.

This plan is austerity on steroids. Rather than investing toward a positive new future for the people of West Africa, the region’s governments are instead reaching back to a 1980s playbook ―despite it being a hugely discredited one. The danger is that these governments will cut their way into worsening poverty and skyrocketing inequality.

This comes at a time when the region has lost the equivalent of seven million jobs, infection rates are increasing, there is no vaccine in sight for the vast majority of people and the Sahel is facing one of its worst hunger crisis. This is not the time for governments to be ripping away the public goods, support and services that millions of people need.

The index ranks 15 member states of the Economic Community of West African States and Mauritania (ECOWAS+) on their policies on public services, tax, workers’ rights, smallholder agriculture and pandemic response spending, all areas pivotal to reducing inequality and weathering the COVID-19 storm. 

The index highlights that West African governments are again the least committed to reducing inequality in Africa. Most support measures in response to COVID-19 were temporary and did little to reduce inequality, while triggering a sharp increase in debt ―debt servicing in 2020-2021 will siphon off about 61.7 percent of government revenue in West Africa. The support programs have been replaced with austerity measures as COVID-19 infection rates are increasing in many countries of the region. Less than 4 percent of West Africans are fully vaccinated.

Sierra Leone ranks low (13th) on the index. Its government was trying to implement anti-inequality policies before COVID and sharply increased education and health spending. But large corporations pocketed 92 percent of government pandemic support funding, while only 1.5 percent was spent on social protection. Sierra Leone’s $860 million upcoming spending cuts (2022-26) are equivalent to two and a half times its annual healthcare budget.

Nigeria was the region’s worst performing country in tackling inequality going into the pandemic. Nigeria’s health budget (as a percentage of its overall budget) is the third lowest in the world (3.6 percent) and 40 percent of its population does not have access to healthcare services. Nigeria loses $2.9 billion a year from tax incentives to corporations but in 2021 increased value-added taxes (VAT), which apply to everyday products like food and clothing and fall disproportionately on poor people, from 5 percent to 7.5 percent.

Mali has the highest level of income equality among ECOWAS countries with a tax rate on the richest people that is 9% higher than the world average. But it ranks last on healthcare spending, devoting less than 5 percent of its annual budget on health. Nearly 38 percent of Mali’s population (8 million people) have no access to healthcare and 6.5 percent of households face catastrophic healthcare costs spending each year. Women’s labor rights are often not respected and they lack legal protection from marital rape and sexual harassment. Mali plans to slash its budget by $3.3 billion over the next five years.

Burkina Faso ranks middle (9th) on the Index. It spends nearly 23% of its budget on education, the highest share in the region and 9th in the world. But the wealthiest 20% of the population has 44% of the income, and in rural areas, 47.5% of the population lives in poverty. According to the IMF, such a level of inequality reduces Gross National Product growth by at least 1% per year. The government plans to cut $1.27 billion through 2026.

If the governments of West Africa were to increase fairly their tax revenue by 1 percent in the next five years, they would raise $56.89 billion. This is more than enough to cancel the planned $26.8 billion budget cuts and build 600 fully-equipped hospitals across West Africa.

West Africa is at a crossroads. Will the region come out of COVID-19 with policies which exacerbate inequality, or implement a recovery plan that works for everyone and not only for the privileged few?

The pandemic has taught us it is urgent to invest massively in public education, health and social protection and to use more progressive taxation of income and wealth to pay for this. We also need to increase worker’s rights ― especially for women who disproportionately take on the most precarious jobs.

Oxfam and DFI published in 2019 the first “West African Commitment to Reduce Inequality (CRI) index” showing that West African governments were the least engaged across the continent in reducing inequality.

Download “Adding Fuel to Fire: How IMF Demands for Austerity Will Drive Up Inequality Around the World” for more in-depth analysis on austerity measures encouraged by the IMF through its COVID-19 loans. Between March 1, 2020 and March 15, 2021, all countries in West Africa received IMF emergency support to respond to the pandemic through various types of loans. For more information on austerity measures encouraged in the loans received by West African countries refer to Annex 1 and Annex 2 of the report.

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A different attitude towards waste in Jordan

Posted by: BenClancy

The saying goes "One person's trash is another person's treasure". Well, maybe not a treasure in this case but "an opportunity to provide for my family" as described by Om Ghazi.

Om Ghazi, a 38-year-old Jordanian mother, is one of the people we work with from Oxfam's "Improving livelihoods through green jobs project" implemented in the host community in Mafraq, 70km northeast of the Jordanian capital Amman.

Om Ghazi, along with 200 other Syrian and vulnerable Jordanians are given green job opportunities, where individuals collect recyclable materials from their surroundings. The collected material is then transferred to a nearby facility to be sorted, processed, and recycled to be reused in local and international markets.

Om Ghazi at her home, Al-Khaldeyah-Mafraq

Waste collection was never considered to be a stable job in this area. However, the economic situation substantiated in rising unemployment and poverty rates drove people to "cling on to any opportunity that comes their way," says 23-year-old Muath, another beneficiary of the project.

"People around here are desperate for an opportunity, they want to work but only a few find jobs," added Muath.

Muath at the backyard of his home. Al-Khaldeyah-Mafraq
Recycled materials sorted at the recycling facility. Mafraq/Jordan

 

Mafraq is Jordan's second largest governorate, it neighbors the Syrian borders and has seen a massive influx of Syrian refugees who resided there following a decade long war. This posed immense pressure on municipal services such as solid waste management.

Oxfam's project is designed to promote awareness of sound environmental practices while creating green jobs for vulnerable Jordanians and Syrians and supporting municipalities and host communities to better manage solid waste through an 800 square meter facility recycling plastic, cardboard, e-waste, and metals

Plastic waste sorted at the recycling facility. Mafraq/Jordan

Wafa, 39, a single mother of four, joined the program in July 2021 and started collecting recyclable materials from her surroundings in Khalideh-Mafraq. Little did she know that she would become an environmental champion within her community.

"I was oblivious to the applications of recycling, but I learned and received the knowledge and know-how on basic recycling methods. I learned how to make use of my household recyclables, and I now share this knowledge with my neighbors and friends,” said Wafa’a.

Wafa’a continued saying “my children are proud of what I do, and I am proud to be part of this environmental movement.”

Most participants battle a culture that undermines their ambitions, goals, careers, and motives dubbed in Jordan as the "culture of shame."

My eldest son -18 years old- and I usually stroll and collect cardboard from the nearby markets. At first, he used to tell me about the 'odd looks and comments from his peers' and so did I, but I grew past that because I believe that there is no shame in work," said Om Faisal, a mother of five.

6% of all green jobs provided through the project were allocated for people with disabilities who remain among the most vulnerable segments.

22-year-old Yusra, has speech and hearing impairment, but she maintains an active role in her community. She sat down with Oxfam staff to describe her experience.She signed her words as her father translated.

"I applied and after a couple of weeks I was told that I was accepted, it made me feel happy to have a role, to help and take part," signed Yusra as her father translated. The repercussions of the pandemic are most felt by the less fortunate, as they continue to battle new challenges in light of shrinking opportunities. To most, waste collection was never an option, but for some, it is an opportunity today and it "happens to make things better and cleaner around us," added Om Ghazi.

The project partnered with different grassroots and community-based organizations to raise awareness and engagement regarding recycling and upcycling."Yes, we live in a poor area, but it is rich with compassion, everyone helps around here, some would keep the recyclable material aside for me to collect later, I think it is because they saw the impact on the community," ended Om Ghazi.

Oxfam, funded by the Australian Aid (DFAT) continues to support Syrians and Jordanians in host communities to better their surrounding while providing green job opportunities and skills training helping them achieve self-sustainability. 

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World Water Day 2021: Keep the water flowing

Posted by: Caroline Reid
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."

Support water projects in CAR and beyond today

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

Posted by: Christine Bale
Picture of Margaret during a visit to Mahama Burundi refugee camp in Rwanda
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
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
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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