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Handwashing in emergencies, Global

Preventing the spread of disease among displaced communities through effective handwashing

For those living in informal settlements as a result of humanitarian crises, diseases such as cholera, pneumonia and diarrhoea can spread quickly and with fatal results. Something as seemingly simple as handwashing with soap is one of the most effective ways to prevent these deaths, however while many handwashing units have already been developed, none of these meet the British Red Cross’ (BRC) requirements for the acute phase of an emergency.

The BRC stated "The lack of a durable, quickly deployable and effective communal handwashing unit has been the main obstacle to maintaining public health in humanitarian interventions."

This led to BRC approaching Arup to co-create an innovative new handwashing solution to support vulnerable communities living in informal settlements with a focus on ease of use, transportability and accessibility for all.

Project Summary

68.5 million forcibly displaced people worldwide (UNHCR)

85%of the world's displaced people are in developing countries (UNHCR)

40%of all deaths are due to diarrhoeal disease during the acute stages of an emergency

Why handwashing?

According to joint research from UNICEF, UNHCR and WHO, diarrhoeal diseases cause up to 40% of all deaths during the acute stages of an emergency and up to 80% of deaths among children under two years old. While finding a safe water supply is a priority in these situations, sanitation and hygiene are often neglected – even though their absence risks contaminating that same water supply.

Handwashing with soap has a greater impact on the number of deaths caused by diarrhoeal disease than any other water, sanitation and hygiene (WASH) intervention. Clean hands are the last line of defence in the transmission of disease-causing germs, either directly by hand-to-mouth contact or indirectly by handling food or water. 

The challenge

During the acute phase of a humanitarian emergency, numerous organisations have found the lack of a suitably robust and standardised communal handwashing units limits the effectiveness of humanitarian WASH interventions among displaced populations. 

The facilities currently provided are often not durable and are difficult to maintain for a high number of users. In many cases, they are also not suitable for children or people with disabilities, and issues such as maintenance, theft and damage have led to a number of handwashing units falling out of use. 

There is a growing demand for the development of an affordable solution that can cope with many users without frequent refilling, as well as being attractive and simple to use. The new product would need to be transported many thousands of kilometres, often by land and by air, so would need to be light, compact and durable to reduce the financial and environmental cost.

The journey

To better support humanitarian efforts around the world and reduce the transmission of disease, British Red Cross approached Arup to collaborate on the creation of a new handwashing unit suitable for rapid deployment. 

Arup then invited the London School of Hygiene and Tropical Medicine (LSHTM) to join the team to include their expertise in the transmission of diseases. The British Red Cross also included Butyl Products due to their expertise in manufacturing equipment for disaster response missions.

The team visited the Kyangwali refugee camp in Uganda to gain insight from refugees and volunteers.

Understanding those affected

The first step was to understand the problem and what would set a new design apart from what had been done before. This meant understanding the target population – refugees and displaced people; the setting – informal settlements and camps; and the context – the acute stages of a humanitarian crisis. During a visit to the Kyangwali refugee camp in Uganda, the team observed existing handwashing facilities to understand their common failings and gained valuable insight from refugees and volunteers. 

A number of factors had to be taken into account in the design, including the problem of limited water supply, harsh environments, heavy usage, and the need for rapid deployment and efficient shipping. The team did further research into the strengths and shortcomings of existing products to feed into their new handwashing unit design, actively collaborating with experts in the humanitarian sector to validate their findings along the way.

Throughout this process we have kept crisis-affected populations and frontline humanitarian staff at the heart of what we are designing. This has led us to view the ‘simple handwashing facility’ as something that can bring change and enhance dignity and agency in circumstances where it is otherwise lacking. ” Sian White Research Fellow, LSHTM

An open source design

In-depth research, design and development work led to a range of innovative new handwashing units that provide an effective, durable and convenient way for displaced people to access safe handwashing. Called ‘Jengu’, the design is open source, so anyone working in this field around the world can use the design to improve the situation for the communities they work with. The mirror, soft rubber foot pump and familiar basin arrangement draws water from a water container and units are available in a range of heights making Jengu an inclusive, user friendly and robust solution.

To measure Jengu’s effectiveness, we carried out independent testing in different contexts, from training weekends with the British Army Reserves, to large scale deployments across informal settlements in Kenya and Uganda.

In 2021, Save the Children integrated 250 Jengu units in Nairobi’s Kibera and Mathare communities. The independent effectiveness study demonstrated that 97% of users were satisfied or very satisfied with the locally made units and 88% found it easy to use. Handwashing in the community increased from 39% at baseline to 58% at endline.

This unique collaboration represents a new way of working within the sector to tackle complex challenges. The team comprised experts from across Arup’s international development, product design, water and human factors teams; British Red Cross’ WASH and health advisors; and LSHTM’s hygiene and behavioural change researchers. 

The project was undertaken as part of Arup’s Community Engagement Global Challenge initiative, which aims to collaborate with others to co-create innovative scalable solutions that address systemic challenges aligned with the UN Sustainable Development Goals (SDGs).  It has already been awarded the International Society for Neglected Tropical Diseases: Programs category award.

This unique collaboration between our organisations represents a new way of working within the sector to tackle complex challenges which require a range of expertise. We are confident that this style of working will ultimately create greater outcomes in effective handwashing, supporting refugees and displaced people in times of crisis around the world. ” Martin Shouler Martin Shouler London Water Leader