Alternative Sanitation in Protracted Emergencies

Grant awarded: £191,446

Lead organisation: National Foundation for the Centers for Disease Control and Prevention (CDC)

Partnering organisations: Oxfam UK; UNHCR

Project length: June 2014 – July 2017 (COMPLETE)

Study locations: Ethiopia

Principal Investigator: Thomas Handzel, Centers for Disease Control and Prevention


This project aimed to determine the safety and acceptability of urine-diversion toilets in a refugee camp setting in Ethiopia. Urine-diversion toilets are potentially valuable for public health in environments where pit latrines are not possible. Although these latrines have been in use for many years in non-emergency settings, they have only been implemented on a small scale in humanitarian crises. This programme of applied research sought to determine if these designs can be effectively utilised at scale in humanitarian contexts. Research focused on the refugee population’s acceptance and effective use of the latrines, and the performance of the toilets under real climatic conditions to create a safe end product. The research outcomes will help implementing agencies determine whether urine-diversion toilets, as currently designed, are an appropriate intervention in this type of setting.

Progress and outcomes achieved:

Both qualitative surveys and laboratory-based research were successfully undertaken. Surveys were carried out across 400 households representing both users and non-users of UDDTs, approximately 18-months apart, to determine user attitudes and practices. For the environmental samples, 20 UDDTs were seeded with known quantities of parasitic worms, and samples collected and analysed at regular intervals over a 12-month storage period to evaluate the performance of the UDDTs in the refugee camp setting. Research on additive use was undertaken in controlled lab settings by adding several combinations of lime/ash to stored waste to enhance microbial inactivation. The evaluation provided valuable insight into the current acceptability and usability of the Urine Diverting Dry Toilets (UDDTs) in Hiloweyn camp, several years into the programme and after considerable scale-up.

Key findings:

  • It was found that generally adoption and current, consistent and correct use of the UDDTs was high among users in the Hiloweyn refugee camp setting.
  • A number of factors were found to be associated with satisfaction of the sanitation system. These included the type of sanitation system that the targeted user is familiar with; the cleanliness of the UDDT; and the length of time available for users to become accustomed to this new type of sanitation system.
  • Results from the lab tests indicated that storage of waste within UDDTs for 12-months is a conservative approach for treatment in this setting, where waste is not currently being used for agricultural purposes. With appropriate use of personal protective equipment and reasonable precautions at the secondary storage location, waste stored for 12-months in-vault could be moved for land application.
  • The addition of lime was found to increase the rate of microbial inactivation, suggesting that this may provide an additional level of microbiological safety for vault emptying as well as potentially allowing decreased storage time.

 Key outputs:

  • Technical Report of findings published
  • Workshop in Ethiopia to share key findings with stakeholders (UNHCR, Oxfam and Norwegian Refugee Council)
  • 2 peer reviewed publications anticipated, focusing on acceptability findings and laboratory performance results
  • Presentation of findings at Emergency Environmental Health Forum 2016 and UNC Water and Health 2017 conference
  • Poster presented at R2HC Research Forum 2017

Next steps:

Study findings have helped to inform additional pilots of UDDTs by Oxfam and UNHCR in other locations in Ethiopia.


“Sanitation doesn’t always get the attention, or funding, it deserves even though it is fundamental to public health.  This has been a unique opportunity to study UDDT use over an extended period of time in a humanitarian setting where the provision of latrines is both difficult and expensive.  UDDTs are a potential alternative to latrines and documenting their use and safety is essential.”  Dr Thomas Handzel (PI), CDC


Elrha is a registered charity in England and Wales (1177110).

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