Health officials and aid workers have expressed concern over increased levels of open defecation and a higher risk of disease in typhoon-affected areas of the Philippines, where water and sewage systems were destroyed and access to sanitation facilities is often difficult.
“In the absence of proper toilets, more people are defecating in the open, which poses serious health concerns,” Jose Llacuna, director of the Department of Health (DOH) for Region VIII, told IRIN in Tacloban, the capital of Leyte Province. The region comprises six provinces - Leyte, Southern Leyte, Biliran, Northern Samar, Samar and Eastern Samar - and is one of three regions struck by Typhoon Haiyan on 8 November 2013.
“What we are seeing is visible open defecation in the cities and evacuation centres,” said Tim Grieve, chief of the Water, Sanitation and Hygiene (WASH) section at the UN Children’s Fund (UNICEF) in the Philippines, which is leading the humanitarian community’s WASH efforts. “When you have dense populations and open defecation, along with people not washing their hands afterwards, you have an increased risk of an outbreak of disease.”
Open defecation can result in a host of diseases, including diarrhoea and cholera, which are transmitted from faeces to humans via contaminated hands, soil, water, animals and insects, say experts.
According to the World Health Organization (WHO), when people defecate in the open, flies will feed on the faeces, which contain bacteria, and can carry away small amounts of it on their bodies and feet. When they touch food, the faeces and the germs are passed onto the food, which may later be eaten by someone who is not aware that it is contaminated.
More than 6,000 people lost their lives and more than 14 million were affected when Typhoon Haiyan slammed into the central Philippines, where more than one million homes were damaged or destroyed in an area approximately the size of Portugal.
More than four million people are still displaced, with over 100,000 living in 381 evacuation centres, many of them schools. The rest of the people are staying with family and friends, the National Disaster Risk Reduction and Management Council (NDRRMC) reported on 19 November.
The authorities and aid agencies have undertaken a number of measures to provide sanitation services, including the construction of a large number of portable toilets and temporary latrines in evacuation centres, but in a country where open defecation is still common, much more is needed.
Almost 10 million people in the Philippines - around 50 percent of the bottom 20 percent of the population - continue to practice open defecation, according to the UNICEF/WHO progress figures for 2013.
DOH assessments reveal that before the typhoon, just 60 percent of households in Tacloban had indoor toilets, meaning access was already low. This is creating a much bigger challenge when planning what interventions are needed.
“Not only do we have to provide toilets, we also need to create demand to use them,” Grieve said, noting that even if toilets are built, people will continue to defecate in the open if they are not properly educated on their importance. “We need a big hygiene promotion community mobilization campaign to match that.”
Action Against Hunger (ACF), an international NGO, is piloting a project that will temporarily address the lack of latrines with Peepoo bags, a personal single-use toilet in the form of a bag that is easy to carry. "It's a temporary solution which we will be distributing to areas that have no more existing sanitary facilities," said Jesus Baena, a water and sanitation specialist with ACF.
Some 42,000 Peepoo bags will be given to around 300 families over a one- to two-month period. The bag is made of bio-degradable plastic and acts as a micro-treatment plant that sanitizes faeces shortly after defecation. After use, the Peepoo is closed with a knot and the dangerous pathogens in the faeces are instantly isolated from the environment, preventing contamination, the organization’s website says.
To date, Peepoople, based in Stockholm, has distributed more than one million Peepoos to four international aid organizations in the typhoon-affected area, including the Swedish Red Cross and ACF.
However, Baena stressed that the bags are not a substitute for regular latrines or sanitary toilets. "Our main strategy is to provide proper latrines - sanitary facilities - in all affected areas as soon as possible," he said, noting that eradicating open defecation will play a key role in the welfare of the affected population.
According to the United Nations Strategic Response Plan (SRP) for Typhoon Haiyan, which is looking to raise US$791 million to provide assistance to areas affected by Typhoon Haiyan through November 2014, access to clean water and adequate sanitation in the affected areas has been severely impaired, increasing the risk of communicable disease outbreaks.
Relief agencies are aiming to provide three million of the most affected people with sustainable access to safe water, sanitation, and hygiene services. Programmes will also focus on hygiene promotion activities, in particular for children in schools.