Effective systems keep diarrhoea in check even during floods

Appropriate technology, strong government maintenance and repair structures, and good preparedness are mitigating the humanitarian impact of perennial flooding in Bangladesh.

In the latest crisis, more than 10 million people were affected and hundreds of people killed, after torrential monsoon rains battered much of Bangladesh over the past month. Hundreds of thousands of people were left homeless and vulnerable to water-borne disease - making access to safe drinking water all the more critical.

Every year on average, according to government statistics, 1,000 people die from diarrhoea and a further 1.5 million get diarrhoea.

This year between 30 July and 21 August some 80,000 cases of diarrhoea were reported from the flood-affected area, including 16 deaths from the disease, according to the Bangladeshi Ministry of Health. The number of cases may seem high but up to one third of the country was flooded, poverty is widespread, and Bangladesh has a population of some 153 million.

Also, in three years of particularly severe flooding (1988, 1998 and 2004), from July to December, which includes the actual flood period and its recovery period afterwards, the average number of diarrhoea cases was 300,000-400,000. Neither the government nor the World Health Organization are, therefore, unduly concerned about the level of diarrhoea cases this year.

One of the reasons for relative success in keeping diarrhoea and other water-borne diseases in check is Bangladesh’s extensive network of tube wells and effective government maintenance and repair systems. These allow a reliable supply of safe drinking water from uncontaminated groundwater sources - even in the midst of serious flooding.

Tube wells

Tube wells are the most common clean water source in Bangladesh following a major push in the 1970s and 1980s. Prior to that, people were largely drinking only surface water - often contaminated - which resulted in an even larger number of diarrhoea cases than presently.

There is a strong tube well culture in the country. In this country, it’s a technology that has proven cost effective. It’s low tech, low cost and it’s working.

“There is a strong tube well culture in the country,” Louis-George Arsenault, country representative for the UN Children’s Fund (UNICEF), told IRIN in Dhaka. “In this country, it’s a technology that has proven cost effective. It’s low tech, low cost and it’s working.”

There are an estimated 8-10 million tube wells throughout the country.

According to Bangladesh's Department of Public Health and Engineering (DPHE), there are some 500,000 tube wells in the flood-stricken areas, of which between 10 and 15 percent are estimated to be affected.

Yet given their sheer numbers and coverage, even if a well is flood-affected, people can easily shift to another well that is not affected, experts say.

“It’s not like these tube wells are sparsely spaced,” Paul Edwards, chief of UNICEF’s water and environmental sanitation section in Bangladesh, explained. “And if you got 10 or 20 people using a tube well, that’s way below its capacity to serve more people.”

Photo: Shehzad Noorani/UNICEF

A young boy takes a bath using water from a hand pump (tube well) in the village of Bolarampur in Narandrapur Union of Jessore district, Bangladesh

Additionally, fairly routine now is the capacity of the DPHE to identify those wells that are affected, as well as dispatch trained personal to raise the tube wells above flood levels in a timely manner.

Raising a tube well above flood water levels requires only an extension pipe to be added, combined with a disinfection process if necessary. To date, 4,586 tube wells have already been raised above flood levels, while 13,564 have been repaired.

While most tube wells are privately-owned, “these would be government tube wells that hadn’t gone under the floods or perhaps were slightly damaged. Normally these repairs are pretty minor,” Edwards said. “The government has a good capacity for this. It’s really the core business of the Department of Public Health and Engineering,” Edwards said, adding: “They really come into their own in situations like this.”

A further 29,129 tube wells have been disinfected, the DPHE reported.

Assuming that 150 people could be provided with water from a given well, just taking the number of tube wells raised and repaired, represents access for 2.7 million people.

“In Bangladesh you get into big numbers quite quick,” Edwards noted.

Preparedness

UNICEF has assisted in constructing another 3,380 tube wells in flood shelters in areas deemed particularly flood prone areas.

But it is not only tube well coverage that is ensuring satisfactory access.

The pre-positioning of 20 million water purification tablets, bleaching powder for disinfection, as well as the earlier procurement of a number of mobile water treatment plants, are already paying dividends.

Photo: David Swanson/IRIN

Each year, low lying areas of Dhaka, the Bangladeshi capital, are flooded during the annual summer monsoon - affecting scores of the city's poor. About one-third of the country floods annually

Following the mega-floods of 2004 which affected more than 30 million people, the government, in collaboration with its international donor and development partners, made significant efforts to enhance emergency preparedness capacity.

Another reason for the low incidence of deaths from diarrhoea is the widespread use of oral rehydration salts (ORS) in homes.

Hygiene concerns

Describing the water access situation as “under control”, Edwards said:
“We’re not alarmed, but we’re still cautious,” citing the relationship between diarrhoea and issues of hygiene and sanitation.

“It’s really not so much the water coming out of the tube wells at this point for us, but rather what happens to the water between the tube well and the mouth,” he said.

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