Shaping the future: Our strategy for research and innovation in humanitarian response.

A global organisation that finds solutions to complex humanitarian problems through research and innovation..
Our purpose is clear: we work in partnership with a global community of humanitarian actors, researchers and innovators to improve the quality of humanitarian action and deliver better outcomes for people affected by crises.
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MSF pit emptying team ensuring safe disposal of clinical waste at a healthcare facility.


Safely managing faecal sludge in bulk during humanitarian crises can be particularly challenging due to fluctuations in the volume and composition of excreta inputs, combined with variations in the quality of lime, plus uncertainties in the survival of pathogens. This can lead to departure from existing standard operating protocols and results in increased operating costs. Project SMaRT focuses on these aspects in order to identify and optimize lime-based treatment, to improve operator safety, minimize costs and reduce risks associated with the handling and disposal of faecal sludge. The project utilises two faecal sludge treatment plants operated by MSF and BRAC.


Project SMaRT involves two separate MSF/BRAC-run Faecal Sludge Treatment Plants (FSTPs) processing excreta from communal latrines and clinical settings. The project is dedicated to implementing practical, innovative adaptations and interventions to address inconsistencies and shortcomings associated with existing lime treatment approaches. Our key focus areas include:

  1. Development of Novel Field-Based Kits: We are actively working on creating field-based kits to establish and characterise available lime quality.
  2. Production of Simplified Dosing Protocols: Our team is developing simplified dosing protocols based on available lime content and microorganism survival, reducing uncertainties surrounding lime dosing.
  3. Assessment of Pathogen Removal: Through laboratory and field-based microbe kits, we assess pathogen removal, ensuring effective treatment.
  4. Suitability of Lime in Healthcare Settings: We explore the potential suitability of lime for managing and controlling excreta in healthcare settings, particularly during disease outbreaks like cholera.

These activities are designed to ensure that lime can be optimised for rapid, cost-effective excreta management during the acute phase of emergencies. Lime serves as a readily deployable, reliable emergency back-up to complement longer-term biological treatment during the stabilisation phase and beyond.


Field-based lime purity kits and associated protocols (diagrammatic handbooks) are being created following lab-based development at the University of Brighton (UoB) and further optimisation following deployment in Cox’s Bazar. Microbe test kits are being adapted for use with faecal sludge from domestic and healthcare sources and protocols for their field-based deployment developed. Monitoring and evaluation of user-friendliness and efficacy of the field-based tools is being assessed by MSF/BRAC treatment staff on the ground and optimised via iterative improvements.

Controlled lab-based survival studies involving pathogen surrogates (Vibrio’s, phages and indicator organism) combined with assessments of lime purity are resulting in simplified lime dosing and the publication of guidance material (handbook, graphical instruction sheets). Outputs including a lessons-learned document (following user-feedback) and peer reviewed journal submissions describing the survival studies, field-based monitoring and lime suitability will also be produced and made available to regional/international humanitarian actors via existing WaSH platforms and forums (e.g. Octopus, GWC).

Latest Updates

Insights from Kutupalong–Balukhali Mega Camp Cox’s Bazar Initial Site Visit

Jan 2024

This initial site visit to Kutupalong–Balukhali Mega Camp Cox’s Bazar sought to transfer lab-based approaches to the field setting and allow the project team to address 5 key research questions.


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