Humanitarian - Water at Risk by MSF_UK Report Study for MSFscience 2014 Problem of drinkable water at field assignments during emergencies. Methods and evidence for Water Quality and Purification Analyses by gathering data, a study. Improve guidelines and the way water supply is done in camps the world over

1. Syed Imran Ali, PhD
Humanitarian
Chlorine Decay in Refugee Camp
Water at Risk
Water Supply in South Sudan
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2. introduction: context
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Photo: Corinne Baker/MSF
Map: http://www.msf.org.au/
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3. introduction: problem
Chlorine guidelines at tapstands:
• Normal: 0.2-0.5 mg/l
• Outbreak: 0.8-1.0 mg/l
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Photo: Syed Imran Ali
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4. introduction: problem
• CDC & Oxfam: 40-58%
households have no chlorine
• University of Barcelona: human
adenoviruses in stored water
• MSF epidemiological data:
household clustering of hep E
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Photo: Syed Imran Ali
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5. introduction: problem
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
What was happening to chlorine between
distribution at the tapstand and consumption
at the household level?
Photo: Syed Imran Ali Photo: Syed Imran Ali
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6. introduction: problem
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Where did we get these
guidelines from anyway??
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7. introduction: problem
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Where did we get these
guidelines from anyway??
…from WHO guidelines for cities!
No evidence from
emergency settings
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8. methods: objectives
Study launched in Jamam, Batil, and
Gendrassa, March-April 2013:
1. Characterize chlorine decay to
develop evidence-based
guidelines for safe water supply;
2. Identify factors that preserve
the safe water chain
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Photo: Syed Imran Ali
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9. methods: data
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Water quality parameters:
• Free/total residual chlorine
(FRC/TRC)
• pH
• Oxidation reduction potential
• Turbidity
• Electrical conductivity
• Water temperature Photo: Syed Imran Ali
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10. methods: data
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Water handling practices:
• Tap type
• Container type
• Cleanliness of container
• Covering of container
• Method of drawing water
• Ambient air temperature
Photo: Syed Imran Ali
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11. methods: study design
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Direct from
tapstand
Water Quality
Photos: Syed Imran Ali
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12. methods: study design
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
In container
at tapstand
Direct from
tapstand
Water Quality Water Quality
Water Handling
Practices
Photos: Syed Imran Ali
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13. methods: study design
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
In container
at tapstand
In container
at household
Direct from
tapstand
Water Quality Water Quality Water Quality
Water Handling
Practices
Photos: Syed Imran Ali
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14. methods: study design
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
In container
at tapstand
In container
at household
In container
after storage
Direct from
tapstand
Water Quality Water Quality Water Quality Water Quality
Water Handling
Practices
Water Handling
Practices
Photos: Syed Imran Ali
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15. methods: analytical approach
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
• Model chlorine decay in
MATLAB
• “Reverse-engineer” evidence-
based guideline
• Linear regression models to
identify factors linked to decay
using STATA
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16. results: descriptive findings
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
• Wide range in initial
chlorine levels at tapstands
• Modelling had to be
stratified:
• 0.2-1.0 mg/l
• 0.2-2.0 mg/l
• 0.5-1.5 mg/l
• All [FRC]i
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17. results: descriptive findings
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
• Wide range in initial
chlorine levels at tapstands
• Modelling had to be
stratified:
• 0.2-1.0 mg/l
• 0.2-2.0 mg/l
• 0.5-1.5 mg/l
• All [FRC]i
ative
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18. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs
[FRC]i Camp
k
(Lmg-1min-1)
n R2
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60
Jamam 3.997 x 10-3 2.16 0.74
Batil 4.998 x 10-3 1.94 0.59
Gendrassa 5.884 x 10-3 1.92 0.51
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19. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs
[FRC]i Camp
k
(Lmg-1min-1)
n R2
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60
Jamam 3.997 x 10-3 2.16 0.74
Batil 4.998 x 10-3 1.94 0.59
Gendrassa 5.884 x 10-3 1.92 0.51
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20. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs
[FRC]i Camp
k
(Lmg-1min-1)
n R2
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60
Jamam 3.997 x 10-3 2.16 0.74
Batil 4.998 x 10-3 1.94 0.59
Gendrassa 5.884 x 10-3 1.92 0.51
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21. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs Co Solutions (mg/l) t Sol’n (hr)
[FRC]i Camp
k
(Lmg-1min-1)
n R2 C24hr =
0.2 mg/l
C12hr =
0.2 mg/l
Co=
1 mg/l
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60 No sol’n 0.84 12.6
Jamam 3.997 x 10-3 2.16 0.74 No sol’n 0.37 19.7
Batil 4.998 x 10-3 1.94 0.59 No sol’n 0.86 12.5
Gendrassa 5.884 x 10-3 1.92 0.51 No sol’n 2.19 10.4
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22. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs Co Solutions (mg/l) t Sol’n (hr)
[FRC]i Camp
k
(Lmg-1min-1)
n R2 C24hr =
0.2 mg/l
C12hr =
0.2 mg/l
Co=
1 mg/l
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60 No sol’n 0.84 12.6
Jamam 3.997 x 10-3 2.16 0.74 No sol’n 0.37 19.7
Batil 4.998 x 10-3 1.94 0.59 No sol’n 0.86 12.5
Gendrassa 5.884 x 10-3 1.92 0.51 No sol’n 2.19 10.4
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23. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs Co Solutions (mg/l) t Sol’n (hr)
[FRC]i Camp
k
(Lmg-1min-1)
n R2 C24hr =
0.2 mg/l
C12hr =
0.2 mg/l
Co=
1 mg/l
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60 No sol’n 0.84 12.6
Jamam 3.997 x 10-3 2.16 0.74 No sol’n 0.37 19.7
Batil 4.998 x 10-3 1.94 0.59 No sol’n 0.86 12.5
Gendrassa 5.884 x 10-3 1.92 0.51 No sol’n 2.19 10.4
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24. results: decay modelling
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
Model permutations Model outputs Co Solutions (mg/l) t Sol’n (hr)
[FRC]i Camp
k
(Lmg-1min-1)
n R2 C24hr =
0.2 mg/l
C12hr =
0.2 mg/l
Co=
1 mg/l
0.5 – 1.5
mg/l
All Camps 5.149 x 10-3 1.97 0.60 No sol’n 0.84 12.6
Jamam 3.997 x 10-3 2.16 0.74 No sol’n 0.37 19.7
Batil 4.998 x 10-3 1.94 0.59 No sol’n 0.86 12.5
Gendrassa 5.884 x 10-3 1.92 0.51 No sol’n 2.19 10.4
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25. results: decay factors
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
• Covering household water storage
containers is protective
• Inconsistent evidence on other
water handling practices
• Study not sufficiently powered for
container or tap type effects
Photo: Syed Imran Ali
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26. conclusions:
recommendations
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
• Chlorine decay in camp setting is rapid
• Tentative recommendation: 1.0 mg/L in all
situations
• Will provide at least 0.2 mg/L FRC for 10 hours
or more post-distribution
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27. conclusions: next steps
Syed Imran Ali Humanitarian water at risk: Chlorine decay in refugee camp water supply in South Sudan
• Need to “ground-truth”
• Generalize evidence base to
other refugee/IDP camps
• Summer 2014: Zaatari or
Azraq, Jordan
• Early 2015: two more camps
• Improve guidelines and the
way water supply is done in
camps the world over
Photos: Syed Imran Ali
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28. Humanitarian
Water at Risk
Photo: Robert Höglund
Special Thanks to: Field research team members (Simon Juma Choul, Thomas
Bashir, Alfaki Yusif, Abdalbagi Madani, Mark Onna, Sebit Khalil and Issa Wallah),
Jean-Francois Fesselet, Syed Sa’ad Ali, Biserka Pop-Stefanija, Matt Arnold, Cono Ariti
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