Since August 2017, around 700,000 Rohingya people have fled ethnic cleansing in neighboring Myanmar to seek refuge in Bangladesh. The majority of these refugees are living in very fragile conditions in 34 densely populated camps in the Ukhiya and Teknaf Upazilas (subdistricts) of Cox’s Bazar. Together with Rohingya who fled earlier Burmese government persecution, there are approximately one million displaced people currently living in camps in southern Bangladesh.
The camps are overcrowded, with an average population density of less than 15m2/person, well below the international guideline of 30-45m2/person for refugee camps. There are also problems with the quality and uneven distribution of water, with many people walking long distances to water sources. A 2019 report on the challenges facing Rohingya refugees highlighted inadequate sanitation facilities and the lack of safe and adequate water supplies. Cholera, typhoid, and diarrhea, particularly Acute Watery Diarrhea (AWD), are very common among the refugees. Over 64,000 cases of AWD were reported in April 2019 alone, among which over 40% involved children under five.
Against this backdrop, the global COVID-19 pandemic raises further concerns: if handwashing with soap is one of the key COVID-19 prevention strategies, it is crucial to address the water needs of refugee populations, for whom frequent handwashing may not always be easy or possible. Tackling the problems of water provision in refugee settlements is necessary not just for the immediate threat of COVID-19, but will be beneficial long-term, providing the refugees with safe water and inhibiting the outbreaks of waterborne diseases.
Water, both at source and storage, has been found to have high levels of contamination. One study reviewed in our 2020 paper (Ahkter et al 2020) analyzed 12,650 drinking water samples from the camps and found fecal contamination in 28% of the source samples and in 74% of the storage samples. Other testing programmes have returned similar results, This suggests that the high population density in the camps, along with inadequate hygiene practices, is resulting in secondary contamination of drinking water during collection, transportation, and storage. Although 97% of respondents surveyed in by the authors in 2019 said they cleaned their water containers every day, they did not always use soap, which is the most effective way to kill pathogens. At water collection points, it was observed that people tend to rinse the container and clean them by rubbing their hands around the inside. If these hands have not been washed with soap, this attempt at hygiene could contaminate the water seconds after collection, even if it is otherwise coliform-free at the source.
Responsibility for fetching drinking water falls disproportionately on women and girls. In 57% of the households who were questioned by the AUW team, women were the sole collectors of water, while in 15% of households it fell to women and girls. The hours lost collecting water could be spent on childcare, informal education, voluntary work, or other productive activities. Children as young as six were found to be undertaking water collections. Moreover, women and children largely restrict water collection activities to daytime hours, since night brings dangers of sexual assault.
Another issue facing the camps is the inadequate distance between water sources and latrines. 40% of households reported a distance of fewer than 30ft, which is regarded as the safe minimum distance to prevent groundwater contamination by coliform bacteria. During the emergency phase of camp construction in 2017 and 2018, many water points were installed too close to latrines, and had to be moved later. However, some tube wells remain within unsafe distances of latrines due to the shortage of space in the camps.
Summer in Bangladesh used to last from March to June, but weather patterns have changed in recent years, with the dry season now extending into August, which is usually monsoon season. The longer summer heat combined with limited rainfall exhausts groundwater resources. With only sporadic rainfall since November 2018, the groundwater table upon which the refugee population in Teknaf depends was critically lowered during 2019, driving up costs related to water tinkered in from ever-further away.
Led by Professor Chad Staddon, the research team undertook a second survey (N=328) of three camps during December 2020. Combining HWISE questions with further questions about water services availability, psycho-social stress and wellbeing the team is working to improve the empirical knowledge base around the water-health nexus as experienced by displaced communities.