Pakistan floods: innovations and guidance for the response.

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Oxfam Handwashing Stand (OHS). Photo credit: Joel Trotter

The floods in Pakistan have affected over 33 million people and is the worst natural disaster in years, with nearly one third of the country under water. According to the BBC “officials have said a little over a quarter of a million people are in shelters, a fraction of those who need help. Damaged infrastructure is also hampering aid and rescue operations, which cannot keep pace with demand. Some connecting roads in Sindh province have either collapsed, are flooded or are backed up for days with queuing traffic.”

As many people continue to find ways to respond to this acute crisis, we have summarised some of the research studies, guidance and innovations from our portfolio that are most relevant to the Pakistan response. We invite you to draw on these resources to support your response in Pakistan and other similar contexts.

Innovations generated through our Humanitarian Innovation Fund

Water, sanitation and hygiene (WASH) products and approaches

Faircap Family Filter Kits

Faircap Family is a small, robust, easy-to-use, high-flow and low-cost water purification device that can be screwed on or adapted to existing water containers such as locally available drums, jerry cans, buckets or tanks of water. It is a membrane filter system that works by gravity so that it can also be used as a two-bucket system with safe storage and weighs only 250g. The expected lifetime is 1–3 years depending on the water source. It has been piloted with ACF in Niger and 2,000 kits will be distributed in 4 countries. Faircap provides the filter kits at cost (around $7 plus about $2 for shipping) and all the support needed (logistic arrangement, tutorial, video calls, training, etc).

Faircap Mini

Faircap Mini is a low-cost, portable water filter screws onto a standard plastic bottle and helps provide safe water for refugees and internally displaced people across the world. It removes up to 99.99% microbiological pathogens such as bacteria, protozoa, cysts and sediment, turning cloudy water into transparent water and free of pathogens that can cause gastrointestinal diseases. Faircap has produced 11,000 units to date, some of which have been purchased by UNICEF to provide safe water for 6,000 refugees from Central America and Haiti, and others of which are being used by Oxfam, Action Against Hunger, Cesvi and IsraAID at refugee camps and rural settings in Iraq, Niger, Gaza, Uganda and Kenya. Faircap’s smallest filter, offered to humanitarian organisations at £3/unit, is at least £12 cheaper than comparable filters.

Safe Water Optimization Tool (SWOT)

The SWOT is an app that uses analytics based on machine learning to generate site-specific, evidenced-based chlorine targets for humanitarian responders. The SWOT team at Dahdaleh Institute for Global Health Research and Médecins Sans Frontières found that in 3 out of 4 settings, treating water with chlorine at collection points is not sufficient to ensure that water is safe for household consumption. The SWOT testing in South Sudan showed that using these targets meant that water was safe for household consumption in 71% of cases, as compared to 14% when existing Sphere standards were followed. So far, the SWOT has been used to guide safe water supply in Tanzania, Nigeria and Bangladesh, benefiting over 300,000 people.

Reemi Period Underwear and Menstrual Products

Reemi is a social enterprise that aims to provide sustainable and culturally appropriate menstrual products, together with education, for people in most need. Reemi developed the world’s first self-sterilising period underwear, along with menstrual hygiene management (MHM) drying bags and washing bags. The underwear are designed to be worn for up to seven hours (depending on menstrual flow), are leak proof, antimicrobial to prevent infections, are comfortable — made from fast drying nylon and designed for use in hot humid conditions. They can be reused each month resulting in cost savings on disposable products. The products have been successfully piloted these MHM products with 6,000 garment workers in Bangladesh, with 70% of women still using them after six months.

Oxfam Handwashing Stand(OHS)

The OHS is the result of four years of design and refinement and three field trials. It provides a low cost, easy-to-assemble, user friendly hand washing facility that can be installed in a first phase response to support sanitation and public health promotion activities. The OHS is supplied as a compact box of six units for standard air freight. The kit contains the tools and instructions needed to assemble the units. It has a 24 litre water reservoir and a separate 4 litre tank for soapy water to give over 200 hand washes per fill.

The OHS is specifically designed to meet the needs of marginalised groups. It is height adjustable for children and adapted for wheelchair users. The OHS was scaled up in 2020 in response to the unfolding COVID-19 pandemic and Oxfam have now distributed handwashing stations across nine countries experiencing humanitarian crises. Each of the stations (of which over 4,000 have been installed) provide handwashing facilities for 20 to 220 people. An evaluation across three of these countries found an increase of 40% in handwashing with soap after the handwashing stations were installed.

WASH guidance and toolkits

Selecting Household Water Filters in Emergencies Manual

There are a large range of filter technologies available, but how do practitioners know if a filter is working and which is the best for their context? The Selecting Household Water Filters in Emergencies ManualFHNW has developed a simple, user-friendly practical tool for evaluating filter performance and selecting the optimum filter for the context. This tool has been tested in Palestine and Iraq with filter distributions to over 500 households.

International Federation of Red Cross (IFRC) MHM Toolkit

In humanitarian emergencies, the hygiene needs of women and girls are often overlooked or not considered at all. To address this, IFRC collected global evidence about the challenges of MHM in humanitarian settings and product use and preferences. The findings and new best practice tools and guidelines have been translated and adapted in Spanish, French, Arabic, Bahasa, Portuguese and Creole, integrated into the IFRC Hygiene Promotion in Emergency Operations Guidelines and reached 192 local partner organisations. In 2020, IFRC published a compilation of around the world who have used IFRC’s tools and guidelines. These case studies provide examples of how the tools and guidelines have been used as a core part of a wide range of MHM activities and programming.

IFRC Accessible WASH Facilities Manual

The Inclusive WASH Menstrual Hygiene Management Friendly and Accessible WASH Facilities for Emergencies manual aims to address the lack of evidence-based tools and guidance for rapidly designing MHM and disability-friendly WASH facilities in humanitarian context. In partnership with Lebanese Red Cross, British Red Cross and ARUP we developed and piloted a disability and female friendly latrine and bathing area designs for the first 4–5 months of the emergency response, based on user preferences and feedback. Drawings and step by step construction manuals are also available for an accessible raised latrine block (pdf), bathing block (pdf) and trench latrines (pdf).

Sani Tweaks (Oxfam)

Lack of access to appropriate, safe, and dignified sanitation puts people at increased risk of infectious diseases and gender-based violence — a fact reflected in recent research from across five camp settings that on average 40% of women are not using the latrines provided. Sani Tweaks, a programming innovation from Oxfam, is a campaign to change focus from quantity to quality through a process of repeated consultation and adaptations with affected communities. Oxfam has trained 570 humanitarian WASH practitioners from a broad range of humanitarian organisations and across 11 countries in using the approach. The Sani Tweak Checklist (pdf) is available in French, Spanish, Portuguese, Amharic, Arabic and Bengali.

Research from our Research for Health in Humanitarian Crises (R2HC) programme

This research highlights the importance of effective needs assessments in the acute stages of crises.

HESPER WEB

The Humanitarian Emergency Settings Perceived Needs Scale (HESPER) aims to provide a quick, scientifically robust assessment of perceived needs of people affected by humanitarian emergencies or disasters. The instrument assesses many physical, psychological and social needs. A web-based version has been validated and will be made available via WHO. It enables a quicker way to collect data on experienced needs among a large number of people in all phases of a humanitarian response.

MHM in Emergencies Toolkit

A critical resource to ensure menstrual hygiene needs are considered from the outset of emergency response. The toolkit includes a specific chapter on conducting a needs assessment.

Community Perception Tracker (CPT)

The CPT tool (pdf) was used by Oxfam and Action Contre le Faim during the pandemic to track community perceptions during outbreaks. Community perceptions were found to change over the course of the pandemic in response to transmission dynamics, government trust and policies, the spread of misinformation and community norms. The CPT was found to be an interactive and feasible way of learning from populations that can be used to complement standardized approaches to programmatic learning, monitoring or accountability.

Child Friendly Spaces (CFS)

CFS are safe spaces set up in emergency settings to help support and protect children. Their objective is to restore a sense of normality and continuity to children whose lives have been disrupted by war, natural disaster, or other emergencies. R2HC-funded research has informed the development of tools and resources to support agencies to effectively plan, deliver, and evaluate these interventions. A 2022 summary of the research by World Vision International explores the outcomes for children of different CFS approaches.

R2HC research has also investigated effective responses to cholera outbreaks and safe drinking water to aid SAM treatment.

Interventions to reduce cholera spread

A study (pdf) has tested the effectiveness of commonly used interventions recommended to prevent interhousehold transmission of cholera when an outbreak occurs: bucket chlorination programs and household spraying. Key recommendations include conducting more frequent dosing (jar) tests, regular monitoring of chlorine residual at the household level and safely storing chlorine solutions away from heat and sun.

Safe drinking water for SAM treatment

An evaluation has been conducted in Pakistan of three household water treatment technologies (a chlorine water treatment called Aquatabs; a flocculent disinfectant; and ceramic water filters) amongst households where children were being treated for SAM. Water treatment combined with SAM treatment reduced the time taken for children to recover from SAM, compared with SAM treatment alone. This was particularly the case for Aquatabs and the flocculent disinfectant, whereas the locally available ceramic water filters were found to be less effective.

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