Sanitation Doesn't Have to be a Dirty Word

The silver lining in this summer’s devastating hurricane cluster may well be the disaster management lessons to be learned from failures exposed in federal and local preparations to deal with a major incident, and emergency sanitation is one of those lessons.

Emergency sanitation is one area generally overlooked in disaster planning, illustrated ignominiously at the Louisiana Superdome and Morial Convention Center. Not only were thousands of people in New Orleans not evacuated, they instead were relocated inside the danger zone to areas not designed to respond to the numbers or needs of people sent there.

“The required number of sanitation facilities, especially toilets, is much higher where people are housed overnight than when they merely attend a football game,” says Peter Harvey, assistant program manager of the Water, Engineering and Development Centre at Loughborough University in England (http://wedc.lboro.ac.uk/).  

Where possible, this needs to be taken into account when selecting and providing temporary shelter, to avoid the subsequent indiscriminate defecation reported in and around the Superdome and convention center, which can result in secondary problems that include the spread of diseases such as typhoid, dysentery and diarrhea, Harvey says.

Columbia University environmental health professor Marco Pedone says portable toilets should be prestaged based on the number of people requiring emergency sanitation facilities. “This may seem simple, but in the case of Katrina, the magnitude of the need was universally underestimated.”

The elephant in the room
Although proper preparedness requires that certain items be addressed with respect to sanitation, most disaster management plans don’t include a consideration for emergency sanitation, even though it’s a routine issue at disaster sites. Sanitation is the elephant in the disaster management planning room that no one seems to want to talk about.

Not only do disaster managers have no gee-whiz sanitation technologies to deploy, there are few if any on the drawing board. “I have never heard a discussion focused on sanitation per se,” says Robert D. Jaffin, chair of Public Sector and Critical Infrastructure Studies, American Public University System.

Jaffin says this is another lesson we need to learn. “Sanitation, as well as all public health, mental health, public water supply and even housing issues, has never received proper attention within the Federal Emergency Management Agency and is even less likely to now that fema is under the Department of Homeland Security, whose focus is fixated on political approval ratings and ‘bad guys,’ and not on addressing the long-term effects of anything other than radioactive fallout.”

Sanitation is always an immediate problem after a disaster, whether flood, hurricane or earthquake. And the fragile infrastructures in place, in some cases for 80 years or more, can’t withstand these types of events.

“Cities in this country have neglected upgrading water and sewer systems, and when disaster strikes, those old systems fail,” says Prof. Gerald V. Law­ver of the Center for Regional and National Security at Eastern Michigan University.

The cascade effect then leads to disease and increased health issues. “I’m surprised they didn’t realize that power would be lost due to the storm and that city water and sewer systems would fail as a result,” says Prof. Robert Schenck of the College of Lake County, Ill.

This was illustrated in the Biloxi-Gulfport area of Mississippi, where technicians were able to get water systems working almost immediately, but then could not put the systems online because sewage plants were still down and any potable water, once used, had nowhere to go.

Starting to plan  
Local communities, both those affected and those designated as reception areas, need to constantly re-evaluate their preparedness to reflect potential changes that might affect their response capabilities, Schenck says.

Sanitation programs are vital for tackling environmental-related disease and ensuring human dignity in emergency situations. If sanitation programs are to have maximum impact, they must be planned for rapid, systematic deployment.

Harvey, a specialist in emergency and low-cost water supply and sanitation systems, including post-disaster relief and rehabilitation, says a simple step that can be taken is to select a number of potential emergency accommodation centers in and around the community and to ensure that these are either permanently equipped with higher-than-normal sanitation services, including excess numbers of toilets and showers, or that additional facilities such as chemical toilets can be rapidly deployed to these locations in times of emergency.

Logistically, however, this would have been a recipe for failure in New Orleans, where most prestaged sanitation facilities would likely have been annihilated by the storm along with everything else.

Any adequate emergency sanitation program therefore must be geared for worst-case scenarios, which then effectively estimate and stage a reasonable amount of materials to deal with the inevitability of sanitation. However, unless support systems are in place to service (empty and sanitize) portable chemical toilet systems, even prestaging of adequate facilities won’t work.

This was evident in New Orleans, where flooded roads and a lack of vehicles and supplies prevented the effective use of even temporary sanitation measures.

Simpler is better
Pedone says the simpler the solution, the better, that in situations such as disasters, it’s necessary to use the least mechanical or service-intensive systems.

“Attention must be given to simple methods which, though imperfect, may still allow for emergency sanitation,” he says. Examples of these are having 5-gallon pails and waste bags that can be used as emergency toilets. These should be stored in adequate numbers along with toilet tissue and disinfectant sprays.

A few other low-tech options exist.
The Swiss Federal Institute for Environmental Science and Technology promotes a solar water-disinfection process called sodis (solar disinfection) that makes use of discarded clear plastic water bottles. (www.sodis.ch)

Contaminated water is poured into the transparent bottles and left in direct sunlight for a minimum of six hours, where solar uv-a radiation and relative temperature increases destroy diarrhea-causing pathogenic organisms and improve the quality of drinking water. This simple, low-cost method is widely used in developing countries, where one-third of the population has no access to safe drinking water.

Elsewhere, Tasmanian Environmental Solutions in Australia offers a septic system called BiPu, a low-cost, low-tech, easily installed, environmentally sensitive sanitation and wastewater treatment system that uses only natural processes, with no need for chemicals, external power or skilled labor. (www.tasenvirosolutions.com.au)  

The BiPu system (Bioremedial In-field Personnel Unit), originally designed to be used by Australian Defence Forces in remote, non-serviced or disrupted areas, connects to standard or oriental flushing toilet pans, but can also be installed in any location where no sewage service presently exists.

“BiPu can be effectively, efficiently and economically deployed in emergency relief operations and has been very successful in recent deployments to a wide range of relief situations throughout the world, including Uganda and East Timor,” Pedone says.

Dual priorities, not just one 
While these alternatives aren’t the only solutions, they are innovative in their simplicity. Still, more work needs to be done to expand the options for sanitation during disasters, and particular attention must be given to alternatives, Pedone says.

Harvey says one of the key issues faced when contemplating emergency sanitation preparedness is the need to conduct a comprehensive risk assessment and to balance the potential risk against the economic resources required to prepare for such a risk. “If the risk is relatively low, then preparedness measures may simply be unviable.”

Another challenge is the type of emergency to be faced. The preparedness measures required to respond to flooding, for instance, where sewerage systems may become dysfunctional, may be considerably different than those required in response to an earthquake, where sewerage systems may remain largely undamaged.

A third issue is the question of prioritization and dissemination
“The need for clean water in emergency situations is well understood and is often relatively easy to realize, but the need for safe sanitation is often less apparent and more difficult to provide,” Harvey says.

Consequently, more attention is given to water than sanitation. It’s therefore essential that public health agencies recognize and address the importance of sanitation provisions and provide the public with appropriate advice in times of emergency.

Schenck says all four phases of emergency management (mitigation, preparedness, response and recovery) need to be re-evaluated every time an incident occurs, either locally or elsewhere. “This is a golden opportunity to learn from what has happened and to make improvements.”