Aid workers are calling for stronger interventions to expand access to water, sanitation and hygiene (WASH) in western Rakhine State, where sectarian violence more than a year ago has left close to 200,000 people in need.
“WASH activities need to be scaled up and dramatically improved by all aid agencies and government partners working in Rakhine,” Vickie Hawkins, deputy country director for the medical charity Médecins Sans Frontières (MSF) in Myanmar, told IRIN, describing current standards and coverage as “very uneven”.
“WASH is a critical issue for Rakhine because of the health implications it can have for the whole community,” said Bertrand Bainvel, country representative for the UN Children’s Fund (UNICEF), the cluster lead for WASH. “We’ve made progress, but sustaining and expanding it requires a lot of work.”
According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), more than 176,000 people are in need following two bouts of inter-communal violence between Buddhist ethnic Rakhine residents and Muslim Rohingyas in June and October 2012, which left 167 people dead and more than 10,000 homes and buildings destroyed.
Of these, 140,000 internally displaced persons (IDPs), mostly Rohingya Muslims, are living in more than 70 camps and camp-like settings, with another 36,000 vulnerable people living in 113 isolated and remote host communities in Minbya, Myebon, Pauktaw, Mrauk-U, Kyauktaw and Sittwe in Rakhine State.
Poor sanitation exacerbates the health situation, and in the rainy season (from mid-May to the end of October) results in high levels of diarrhoeal disease and skin infections amongst the camp population, Hawkins noted. In 2012, MSF reported a diarrhoea outbreak at the Kyein Nyi Pyin camp in Pauktaw Township where 446 people - around 10 percent of the camp’s population - were affected.
Since the conflict in June 2012, UNICEF, WASH partners, and Myanmar’s Department of Rural Development have established some 3,700 latrines and more than 800 water points, and so far more than 20,000 hygiene kits have been distributed in 2013, but much remains to be done.
About 7 percent of IDPs in the camps have insufficient access to water, 28 percent are using treated water, and around 40 percent are accessing water from ponds, WASH data from June revealed; numbers that will likely worsen when the dry season begins in November.
“As we change seasons towards hotter temperatures, the problem of drinking water shortages could begin to rear its head, which brings with it increased risks of water-borne diseases, as people resort to untreated water,” Hawkins warned.
At the same time, access to latrines continues to prove a challenge, compounded by the usually limited space in the camps, and high water tables and flooding in some of the camps.
In the initial months after the conflict, emergency latrines were erected in most camps, but as the situation becomes more protracted and people move into long houses, activities will need to refocus on maintenance as well as the provision of semi-permanent latrines and other sanitation services, aid workers say.
Today only a quarter of the camps have enough latrines (at least 1 latrine for every 20 people) to conform to Sphere standards. Nearly half the camps have a ratio of 1:20 to 1:50, while 5 percent the IDPs don’t have access to a latrine at all.
Hygiene promotion needed
But even if Sphere standards - which set out best practices in the delivery of humanitarian aid - are met, this won’t necessarily equate to usage.
“Even if you have the required number [of latrines], it doesn’t mean they are used,” UNICEF’s Bainvel confirmed, citing the ongoing issue of open defecation. “This is where we need to reinforce health promotion interventions for the population to understand the benefits of using them."
According to a Knowledge, Attitude and Practice Study on WASH in 24 Townships of Myanmar, published in 2011 by the Burmese Government and UNICEF, more than 75 percent of respondents in Rakhine State practice open defecation.
“Hygiene practices were already low before the displacement and, especially during the current rainy season, poor practices leave people vulnerable and at risk,” Catherine Dennis, humanitarian programme coordinator for Oxfam in Myanmar, confirmed.
At the same time, many women have expressed fears of using latrines at night due to their location or the lack of door locks. Solid waste management systems are also lacking outside the Sittwe area (including collections systems, refuse containers or pits, incinerators and dumping sites), and there is a limited capacity for proper drainage, particularly in the rainy season.
Moreover, preparedness for a potential disease outbreak is low among WASH partners due to a lack of funding for stockpiling critical supplies in the event of floods, epidemic outbreaks or new unrest.
The Humanitarian Country Team's US$109 million revised interagency Rakhine Response Plan, indicates another $1.7 million is needed for WASH interventions through the end of 2013.