Water, sanitation and hygiene in humanitarian crises: Setting the research agenda up to 2030

1. What are the best strategies for the maintenance and operational sustainability of handwashing infrastructures (eg, handwashing stations, facilities or stands) in crises?

2. What adaptations to WASH programmes or WASH services (including hardware and software) are appropriate, inclusive and effective for people with disabilities (PWDs) in crises?

3. What WASH non-food items (NFIs) are appropriate, effective and cost-effective for distribution to households during disease outbreaks (eg, cholera, Ebola, hepatitis E, typhoid, COVID-19)?

4. How can we improve consultation with women and girls to design and provide safe, accessible WASH facilities and infrastructure (eg, sufficient water access, locks on sanitation facilities, bathing areas, appropriate menstrual hygiene management (MHM) products and disposal appropriate to needs and cultural beliefs) in crises?

5. What additional features can improve the experience and use of sanitation in humanitarian contexts (eg, lighting, locks, privacy screens, space for menstrual hygiene management (MHM), roofs, torches), particularly by women and girls?

6. How effective are existing technologies and approaches in improving sanitation uptake among people affected by crises, particularly among people with disabilities (PWDs) and young children in humanitarian crises?

7. How can we identify, define and categorise the determinants and motives of hand hygiene behaviour in crises and among different population groups (eg, children, adults, people with disabilities (PWDs), etc), and at different stages of an emergency (acute, post-acute and protracted phases)?

8. How can we improve and sustain hygiene practices within different humanitarian contexts (e.g., natural disasters, protracted crises outbreaks (e.g., cholera, Ebola, Hepatitis E, typhoid, COVID19, etc.))?

9. How can we improve satisfaction with and use of sanitation facilities among people affected by crises, particularly among women and girls with regards to menstrual hygiene management (MHM)?

10. What are the effectiveness and cost-effectiveness of in-kind distribution of WASH items (eg, soap, hygiene kits, menstrual hygiene management (MHM) materials, chlorine water treatment, water containers, etc) on health and non-health outcomes among people affected by crises?

11. What are the most effective methods to identify/monitor WASH needs in host communities and urban centres impacted by population influxes?

12. How does poor access to WASH contribute to increased risk of gender-based violence in humanitarian settings?

13. How effective is improved access to safe water (eg, coverage of water points and distribution networks) in controlling and preventing disease outbreaks (eg, cholera, Ebola, hepatitis E, typhoid and COVID-19)?

14. How can hygiene promoters reduce disinformation or myths associated with outbreak-prone diseases (eg, cholera, Ebola, hepatitis E, typhoid and COVID-19)?

15. What are the health outcomes (eg, increased incidence of disease, increased morbidity, increased mortality and/or increased incidence of poor mental health outcomes, etc) related to WASH experienced by people affected by crises?

16. What designs or adaptations are required for climate change-resilient water supply and sanitation infrastructure that are appropriate and effective in humanitarian contexts?

17. How can organisations work with people to determine what are the most appropriate products to include in hygiene kits in different response phases (eg, acute, post-acute and protracted) or for different population groups (eg, families with young children, child-headed households, people with disabilities (PWDs), adults with incontinence, etc)?

18. What are effective mechanisms to build the capacity of WASH professionals who work in emergencies?

19. What are the effectiveness and cost-effectiveness of sanitation promotion campaigns on health and non-health outcomes among people affected by crises?

20. How can organisations support people affected by crises in accessing safe, sufficient and reliable drinking water supplies at reasonable cost?

21. What is the preference for and uptake of, and how can we encourage use of, water treatment technologies among people affected by crises?

22. To what extent are hygiene interventions (generally or by specific type of intervention) effective at improving personal and domestic hygiene behaviours among different population groups (eg, children, adults, people with disabilities (PWDs), etc), different types of displaced populations (eg, internally displaced people (IDPs), refugees, people on the move) and different settings (eg, camps, host communities)?

23. What are the most significant non-health outcomes (eg, reduced dignity, reduced income, increased inequality, etc) related to poor access to WASH services experienced by people affected by crises?

24. What are the specific factors during floods, droughts or other disasters triggered by natural hazards that lead to increased risk of cholera outbreaks?

25. What are the prevalence of and risk factors for sexual abuse and assault risks related to water and sanitation access in emergencies?

26. How does risk perception influence hand hygiene behaviour during disease outbreaks and how does this change over time? And can this information be used to inform programming?

27. To what extent do water resource-related conflicts exist between refugees/internally displaced people (IDPs) and host communities? And how can water services be designed to serve both refugees/IDPs and host communities in a sustainable manner?

28. What and how appropriate, effective and cost-effective are solid waste solutions in emergencies (including burning/incineration, recycling, reduction, biodegradable and other waste management options)?

29. What are the costs and cost-effectiveness of repairs to damaged water points or water trucking programmes compared to installation/construction of new water supply systems in crises?

30. How do we improve the choice of, access to and availability of menstrual materials or menstrual hygiene management (MHM) products among women and girls affected by crises?

31. What are new innovative, appropriate and sustainable technologies, products or infrastructure that could facilitate hand hygiene in crises?

32. What WASH products and services are appropriate to meet the needs of adults with incontinence who are affected by crises?

33. What are culturally appropriate and effective MHM interventions (e.g., MHM materials and supplies, MHM education and promotion, disposal options and waste management, bathing and laundering areas, etc.) for women and girls affected by humanitarian crises?

34. What are the water use patterns (eg, drinking, cooking, personal and domestic hygiene) among people affected by crises (in various scenarios)?

35. What are the WASH risk factors and risk factor cascades for communicable disease outbreaks in specific humanitarian settings?

36. What WASH interventions are available, adaptable and effective at improving household resilience to climate change-induced shocks (eg, floods, droughts) in crises?

37. What is required to ensure timely, appropriate and high-coverage delivery of WASH non-food items (NFIs) (eg, hygiene kits, soap, water treatment, cleaning products, etc) to people affected by crises?

38. What is the impact of intermittent water supply on diarrhoeal disease in crises and how can we ensure the microbiological quality of intermittent piped supply?

39. To what extent are hygiene interventions (generally or by specific type of intervention) effective at reducing the incidence of faecal–oral-transmitted diseases among different population groups (eg, children, adults, people with disabilities (PWDs), etc), different types of displaced populations (eg, internally displaced people (IDPs), refugees, people on the move) and different settings (eg, camps, host communities)?

40. How can we improve water source planning and hydrogeology in humanitarian contexts?

41. What are the efficacy, effectiveness and cost-effectiveness of non-centralised water treatment (eg, bucket chlorination, in-line, well water chlorination, etc) on health and non-health outcomes among people affected by crises?

42. What is the effectiveness of different handwashing products to prevent Ebola or cholera transmission within healthcare facilities?

43. What types of technical assistance (eg, trainings, toolkits, guidance documents, etc) yield the greatest improvements in the design and implementation of hand hygiene interventions in crises?

44. What are the current types, availability or accessibility of hand hygiene services in crises (eg, handwashing stands, infrastructure, materials and products used to perform hand hygiene)?

45. Under what conditions are cash/vouchers more effective than WASH non-food item (NFI) distributions (eg, hygiene kits, menstrual hygiene management (MHM) materials, soap, cleaning products, etc) at reducing poor health outcomes among people affected by crises? And what are the advantages and disadvantages of cash/vouchers versus distribution?

46. What are appropriate, effective and cost-effective options for centralised water treatment in emergencies, and what barriers are there to centralised treatment across crises?

47. What systems can be used in humanitarian contexts to monitor and regulate the quantity and quality of water supply systems?

48. How do we engage people affected by crises with wastewater and faecal sludge management (FSM), including the operation and maintenance of services?

49. To what extent do current hand hygiene interventions in crises address known behavioural determinants (ie, barriers and facilitators), and how do those determinants mediate adoption of improved hand hygiene behaviours?

50. To what extent are hygiene interventions (generally or by specific type of intervention) effective at improving personal and domestic hygiene behaviours among different population groups (eg, children, adults, people with disabilities (PWDs), etc), different types of displaced populations (eg, internally displaced people (IDPs), refugees, people on the move) and different settings (eg, camps, host communities)?

51. What are the social, behavioural and cultural facilitators and barriers that impact menstrual hygiene management (MHM) among women and girls in crises?

52. What are the effectiveness and cost-effectiveness of sanitation construction and repairs to sanitation facilities on health and non-health outcomes among people affected by crises?

53. What are effective ways of working with (formal and informal) water service institutions in emergencies?

54. What are the barriers and facilitators to enabling funding that transitions from emergency WASH response to recovery and long-term programmes?

55. What level of coverage for relevant WASH interventions is required in cholera hotspots to control and ultimately eliminate the risk of cholera?

56. What are appropriate, effective and cost-effective food safety and food hygiene interventions for crises?

57. What are effective approaches that can be used to integrate menstrual hygiene management (MHM) into existing emergency responses and different phases of an emergency?

58. How can climate change actions be effectively integrated into WASH in crises programmes?

59. What are the most effective practices and technologies (including identifying alternative technologies) to collect, treat and dispose of cholera and Ebola effluent?

60. What evaluation measures, indicators and frameworks are applicable to measure uptake and use of WASH interventions in crises? And can the reliability, usability and availability of data be improved?

61. What are the current coordination mechanisms, enabling factors for and barriers to transitionary handover of WASH services from response agencies to national governments and/or other development actors?

62. What is the impact of distributing hygiene kits or WASH non-food items (NFIs) to reduce severe acute malnutrition (SAM) and improve recovery?

63. How is wastewater collected, treated, reused and disposed of in closed emergency contexts (ie, camps for refugees/internally displaced people (IDPs))?

64. How can WASH non-food item (NFI) distributions for disease outbreaks (eg, cholera, Ebola, hepatitis E, typhoid, COVID-19) and other health crises (malnutrition) be better standardised between agencies?

65. What are feasible options for faecal sludge management (FSM) in the different phases of emergencies (ie, acute phase solutions or sustainable options) for scaling up?

66. What are hand hygiene interventions (eg, educational messages, psychosocial messages, nudges, etc) used for people affected by crises?

67. What interventions or design changes to sanitation facilities, laundry spaces and bathing areas are required for people with incontinence in emergencies?

68. What other supplies around managing menstruation are needed to support women and girls’ menstrual hygiene management (MHM) practices in emergencies (eg, torch, bucket, soap, washing line, etc)?

69. What is the global coverage of key WASH indicators in camps for refugees/internally displaced people (IDPs), and what are key factors in not meeting Sphere Standards?

70. What is the experience of water insecurity of people affected by crises, and what affects the availability, accessibility and quality of water they use (eg, during disease outbreaks, disasters triggered by natural hazards or climate change-induced shocks)? And what options are available for water conservation and reuse?

71. What is the effectiveness of existing menstrual hygiene management (MHM) tools to inform, encourage and enable safe and dignified MHM among different population groups, including menstruating women and girls, young children, boys and men?

72. What solutions, including non-conventional options, are available, effective and sustainable to improve water security in crises?

73. What water treatment methods are effective at treating uncommon pathogens such as hepatitis E and other viruses, and are applicable in crises?

74. What are the most essential – or the minimum set of – infection, prevention and control (IPC) interventions in cholera and Ebola treatment facilities and oral rehydration points to reduce risk of transmission within these facilities?

75. What would enable improved integration and delivery of menstrual hygiene management (MHM) interventions (including education, promotion, distribution of supplies and building of MHM-appropriate WASH infrastructure) among humanitarian workers?

76. What are the options for no-touch handwashing devices in emergency settings?

77. What specific WASH interventions at household, community or facility level can contribute to improved maternal and neonatal health outcomes?

78. What are the minimum quality standards (physical, chemical and biological) required for safe faecal sludge plants in crises, and how can we monitor safe faecal sludge plants?

79. What specific WASH interventions can contribute to: reduced rates of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) among infants and children aged 0–59 months; relapse rates; duration of treatment; and overall mortality due to acute malnutrition among children affected by crises?

80. How frequently do WASH non-food items (NFIs) need restocking among people affected by crises and what is the cost-effectiveness of different intervals for restocking (eg, 30 days or 60 days)?

81. What are current practices around safe food hygiene in crises?

82. What multi-use water systems are appropriate, effective and cost-effective in humanitarian contexts, and how do they affect the rates or burden of disease (eg, diarrhoeal disease, acute malnutrition) and poor health outcomes in crises?

83. What are the efficiency and effectiveness of different faecal sludge treatment regimens (including lime) or wastewater plant designs on pathogen reduction?

84. What are the barriers, enablers and contextual influences that affect the use of cash and markets in humanitarian WASH programmes?

85. What combinations/interactions of WASH risk factors (and their prevalence) by age/sex contribute to severe acute malnutrition (SAM) or moderate acute malnutrition (MAM) or relapse to SAM/MAM in a given humanitarian context?

86. How can solid waste be managed in the absence of recycling in crises? How is solid waste managed by households in crises, and how willing are households to separate waste or recycle?

87. What is the burden of outbreak-prone diseases (eg, cholera, Ebola, hepatitis E, typhoid, COVID-19) in crises?

88. How do agencies/organisations/government partners make decisions around hand hygiene programme design and delivery during emergencies?

89. What WASH interventions are most suitable for market-based solutions in various humanitarian settings?

90. Under what conditions are cash/vouchers an effective means to improve access to water among people affected by crises?

91. What types of materials should be included in desludging kits?

92. What specific WASH interventions can be implemented to support safe delivery practices at home or facility level to reduce maternal and neonatal morbidity and mortality?

93. To what extent are market-based modalities more cost-efficient and effective than direct service delivery for the WASH sector in emergency settings, and what specific WASH interventions are most suitable for market-based approaches?

94. What are appropriate and effective treatment strategies, disposal options or collection processes for menstrual hygiene management (MHM) waste that factor in disposal behaviour and absorbent material types in crises?

95. Are household spraying programmes and household disinfection programmes effective, cost-effective and acceptable, and do they reduce cholera or other outbreak-prone diseases (eg, Ebola, hepatitis E, typhoid, COVID-19)?

96. What are the treatment methods to remove high chemical content from water in areas affected by crises?

97. What is the viability of treating rainwater in protracted crises? And is the treatment of rainwater scalable in protracted crises?

98. What are the most effective ways of engaging with WASH markets before, during and after emergencies to ensure adequate linkages between humanitarian interventions and long-term development approaches?

99. How is inadequate access to WASH related to psychosocial stress in crises?

100. How can intra-agency coordination aid or standardise the selection, promotion and monitoring of WASH non-food items (NFIs) (eg, hygiene kits, soap, water treatment technologies, etc) used in crises?

101. What are appropriate and effective faecal sludge management (FSM) technologies (eg, geotubes, bio-additives) that can serve both people affected by crises and host communities?

102. What approaches can be used to involve men and boys in menstrual hygiene management (MHM) programme delivery in crises settings?

103. What are successful strategies for transitioning from distribution of household water treatment (HHWT) products to ensure access to local markets in humanitarian settings?

104. What approaches can be used to reach child-headed households, orphaned children or people with disabilities (PWDs) with menstrual hygiene management (MHM) information and supplies in emergencies?

105. What are the best practices for developing successful partnerships between humanitarian actors, local governments, cash-based organisations (CBOs) and the private sector for market-based WASH programming in humanitarian settings?

106. What are appropriate, effective and cost-effective vector control tools for use against Anopheles spp. mosquitoes (malaria) by people affected by crises?

107. Can practitioners generate site-specific and evidence-based chlorination targets for water systems in camps for refugees/internally displaced people (IDPs), and evaluate whether these site-specific free residual chlorine (FRC) targets could increase the proportion of households that have safe water at the point of use (POU), compared to the status quo Sphere Standards FRC target?

108. To what extent do hygiene interventions have an effect on non-health outcomes among people affected by crises?

109. What WASH interventions are most appropriate during typhoid outbreaks in crises, and how can WASH interventions be successfully integrated into typhoid vaccination campaigns in emergencies?

110. What is the added value of combining market-based and WASH-specific modalities (such as hygiene behaviour change communication or WASH market support), compared to interventions that use one approach or the other?

111. What are the post-distribution chlorine decay and household water safety in humanitarian response, including camps for refugees/internally displaced people (IDPs)?

112. To what extent are hygiene interventions (generally or by specific type of intervention) effective at reducing soil-transmitted helminths (STHs) among children in crises?

113. What is the association between groundwater access and quality with rates of malnutrition in water-scarce areas?

114. What are the effectiveness and cost-effectiveness of case-area targeted interventions (CATIs) using WASH alone, oral cholera vaccine (OCV) alone, or WASH and OCV combined to reduce cholera transmission?

115. What frameworks, such as the Household Water Insecurity Experiences (HWISE) scale, can be used as a household water insecurity measure across crises in low- and middle-income countries?

116. What are appropriate, effective and cost-effective vector control tools for use against Aedes and Culex spp. Mosquitoes (dengue fever, chikungunya, yellow fever, lymphatic filariasis) by people affected by crises?

117. What are appropriate, effective and cost-effective vector control tools used for scabies, lice and other vectors in crowded camps for refugees/internally displaced people (IDPs)?

118. How much waste is produced from menstrual hygiene management (MHM)?

119. Do simple, targeted messages in an SMS (text message) campaign have an impact on chlorine purchase and use in crises?

120. What disinfection by-products (DBPs) are generated from emergency water supply interventions?

121. What is the relationship between poor WASH conditions and mental health outcomes, and the effect of improvements to WASH conditions on mental health among people affected by crises?

122. What factors affect the ability to make faecal sludge management (FSM) profitable for refugee/internally displaced person (IDP) camp settings?

123. How do body bag technologies compare in performance, safety and appropriateness to the local context?

124. How efficacious is chlorine on different types of surfaces found in low-resource households and healthcare settings against SARS-CoV-2, Ebola and other viruses?

125. Can individual or combined WASH interventions contribute to lower prevalence, intensity and reinfection rates of soil-transmitted helminths (STHs) among children affected by crises?

126. What is the prevalence and characterisation of multidrug-resistance and other antimicrobial resistance (AMR) in environmental samples (eg, water, faecal sludge, wastewater, food) collected from camps for refugees/internally displaced people (IDPs)?

127. What are the optimal strategies, including behaviour change strategies and engaging religious leaders, for delivering interventions related to safe burial practices and funeral hygiene during disease outbreaks?

128. What are the minimum requirements for safe and culturally appropriate dead body management for outbreak-prone diseases (eg, Ebola, cholera, plague, other haemorrhagic fevers)?