MSF Public Health Engineering 2010 en

COVER+FOREWORD 17/05/10 11:23 Page 2
© Médecins Sans Frontières - 2010

All rights reserved for all countries. No reproduction, translation and adaptation may be done
without the prior permission of the Copyright owner.
Public Health Engineering

In Precarious Situations
Manual intended for the setting up of public health programmes in disadvantaged areas, particularly
in refugee and displaced people camps.
3
Draft 2010 edition
4
Draft 2010 edition
Public Health Engineering

In Precarious Situations
The realisation of this guide was coordinated by:
Joos Van Den Noortgate & Peter Maes.
Additional authors (in alphabetical order):

Jean-Francois Fesselet, Jan Heeger, Francisco Diaz, Patrick Laurent, Charlie Mcqueen, Saskia
Nijhof, Cecille Renaudin, Jordi Sacristan, Antoine Saintrain, Rutger Verkerk.
Additional contributions:
Emmanuel Baron, Jean Bourgeois, Marc Coosemans, Eric De Miniac, Claire Dorion, Marie-Claire
Durand, François Entin, Yannick Garbuzinski, Pierre Guillet, Henri Meyer, Peter Thomson, David
Weatherill.
Previous edition:
Yves Chartier, Michel Courvallet, Gilles Delmas, Guy Jacquier, Eric Laurent, Gérald Massis,
Stéphane Quinton, Pierre de Rancourt & Brigitte Renchon.
Illustrations:
Germain Péronne.
Layout:
Michaël Vanderyken, Philippe Maillot.
5
Draft 2010 edition
Foreword
This handbook is a collective accomplishment of the different sections of Médecins Sans Frontières
(MSF), and has been written to consolidate the broad experience of MSF in the field of public health
engineering. The first edition of this book was written in 1994 and is presently updated with a second
edition.
Public health engineering, long considered a specialist field by medical organisations is not an end in
itself. It has a direct influence on several major diseases related to poor water supply, hygiene or
sanitation like Diarrhoea, Malaria, Yellow Fever, Dengue, Chagas, Typhus, Guinea Worm, Trachoma,
Trypanosomiasis, Viral Haemorrhagic Fevers or Plague. It is important to consider water supply,
sanitation and hygiene, not simply in terms of technical programs, but as an integral part of medical
programs, in the same way as other preventive health work like vaccination, mother and child clinic,
home visiting, etc...
The techniques described in this guide were chosen for their simplicity of implementation and
maintenance and because they are financially affordable. It is a handbook supporting the
implementation of health programmes in deprived environments, in particular in closed settings like
displaced persons camps and in health structures. The purpose of the book is to increase the
effectiveness with which relief workers can provide sound water, hygiene and sanitation assistance in
precarious situations. To achieve this, the book provides pragmatic information to the field worker with
a minimum of theoretical background.
Nevertheless, it should always be borne in mind that, however good the techniques in theory, it is only
when they are correctly applied that they can have any impact on health. However important it is to
produce appropriate technical solutions, they have to be socially acceptable. The necessity for
complementary activities such as health promotion or training of local technicians can never be too
highly stressed.
The infrastructures described in this manual aim to improve the living conditions of populations in need
and to reduce mortality and morbidity of affected populations. Paradoxically, fatal accidents can occur
during the construction and/or the use of these infrastructures. Diggers can suffocate by natural gasses
during excavation of dire needed wells. People can be crushed during collapse of inappropriate deep
latrines. As such, the users of this manual are urged to take the provided security recommendations
at hart to avoid human dramas.
In addition to technical knowledge, the work of the "sanitarian" demands a good knowledge of the
population being worked with, and local hygiene practices. A few teaching skills and a sense of humour
are also a great help.
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Foreword - draft
Using this guide
The guide starts with an introductory chapter (Chapter 1, Introduction) covering the fundamentals of
assessments and situation analysis, strategy definition and planning, implementation, monitoring and
evaluation of projects.
Chapter 2, "Water Supply", covers several aspects of water supply in precarious situations: water
related diseases, basic human water needs, characteristics of water, different types of water resources,
quantity, quality and access, treatment methods and supply.
Chapters 3 to 8 cover the different aspects of sanitation in precarious situations: "Excreta Disposal"
(Chapter 3), "Disposal of Run-off Water and Wastewater" (Chapter 4), "Collection and Disposal of
Refuse" (Chapter 5), "Medical Waste Management" (Chapter 6), "Vector Control" (Chapter 7) and
"Dealing with Dead Bodies" (Chapter 8).
All the chapters of the guide are presented in a similar way. They start with a narrative section that
answers to several questions presented according to the following sequence: Why, What, Where,
When and by Who, and finally How. Each narrative section ends with a list of information sources
(References and Further Readings) that can be consulted if more information is required. Following
each narrative section, practical technical briefs describing different techniques commonly used in the
field are presented.
At the end of the guide, there is an English/French/Spanish glossary to give as clear as possible
definition of the technical terms used in the guide, or those which are used every day in this field. A
conversion table, allowing to pass from the US units system to the metric units system (and vice-versa)
is also presented.
This guide was designed as an user manual. The authors strongly advise the user first to read it
completely to have a good overview of what can be the water, hygiene and sanitation problematic in
deprived environments and then to take the issues needed, under the form of the Technical briefs.
Criticism and comments from users of this guide are invited. They are important to ensure that the
guide is as appropriate as possible to the realities and needs of the field. Please send your comments
to your Water, Hygiene and Sanitation advisors.
Please send comments to:
Watsan unit/Médecins Sans Frontières

94 rue Dupré,
1090 Bruxelles, Belgique
Tel: (32) 2 474 7474
7
Foreword - draft
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Management of Water,
Hygiene and Sanitation
activities
Narrative
Technical briefs
T.B. 1.01 Data collection methods

T.B. 1.02 Mapping
T.B. 1.03 Area sampling
T.B. 1.04 Health structure checklist
T.B. 1.05 Camp checklist
T.B. 1.06 Water, Hygiene and Sanitation checklist
T.B. 1.07 Basic Survey Form
T.B. 1.08 Essential water and sanitation requirements
for health structures
T.B. 1.09 Essential water and sanitation requirements in camps
T.B. 1.10 Site planning of camps
Chapter 1
Management of Water, Hygiene and Sanitation activities - draft 1 1

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Management of Water, Hygiene and Sanitation activities - draft
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1.1 Why are water, hygiene and sanitation activities important?

Humanitarian aid organisations are confronted daily with the deadly consequences of war, violence,
natural catastrophes, poverty and illness. The typical contexts where the humanitarian aid has to
intervene favour the spread of infectious diseases. In emergency situations, people are even more at
risk of infection, linked to a weaker health condition and to exposure to new pathogens (lack of
immunity to a disease or a particular strain of the disease in the settlement area). People are also
more exposed to contextual risk factors including poor housing and extreme weather conditions, poor
water, hygiene and/or sanitation conditions, population density, deterioration of health services and lack
of access to effective treatment, physical (injuries) as well as socio-economical insecurity. Furthermore,
people’s immunity can be weakened due to multiple infections and malnutrition.
Diarrhoeal disorders kill millions of people each year, almost all of them in low-income countries, the
vast majority children under five. Malaria is a major cause of morbidity and mortality in many parts of
the world. Other diseases related to poor water supply, hygiene and/or sanitation (e.g. Chagas, Guinea
Worm, Lassa Fever, Plague, Trachoma, Trypanosomiasis, Typhus, Yellow Fever) remain a major threat
to millions in low income countries, particularly for those who are displaced or otherwise affected by
conflicts and disasters.
Providing in these precarious situations the basic supply of water, hygiene and sanitation (WHS) has
a direct and documented impact on infectious diseases and should be included in the framework of
the medical strategies. Their objective is to contribute to the reduction of morbidity and mortality. It is
therefore important to consider water, hygiene and sanitation activities not simply in terms of technical
programmes, but as an integral part of medical programmes, in the same way as other preventive
work like vaccination, mother and child care and home visiting. Having access in these precarious
situations to decent sanitation facilities also adds to the protection of human dignity.
1.2 What are water, hygiene and sanitation activities?

Water, hygiene or sanitation activities aim to reduce the environmental disease reservoirs and interrupt
the transmission routes. Depending on the context, it means improving environmental hygiene and
health by increased access to an adequate drinking water supply, a proper excreta disposal, runoff and
waste water disposal, collection and disposal of refuse and medical waste, effective vector control
interventions and proper disposal of dead bodies.
WHS interventions, integrated within a more global medical project should be set up following the
different stages of the project cycle. For a maximum health impact, attention should be given to the
“technical aspect” as well as to the “human behavioural and cultural related aspect”. However good
the techniques are, it is only when they are correctly used and maintained that they can have any
prolonged impact on health. At the opposite, good health promotion programs can not function without
good quality infrastructures. WHS interventions have to answer to health problems but also to the
beneficiaries needs.
1.3 Where/when should water, hygiene and sanitation activities

be implemented and by who?
Water, hygiene and sanitation activities must be implemented in Health structures: this is to enable
curative interventions and to prevent patients from being infected with another disease while in the
health structure, as well as preventing health workers, visitors and neighbours from getting injured or
infected. These WHS measures taken in the health structure consist of the Essential Requirements
(T.B. 1.08) with regards to the provision of sufficient potable water, the provision of adequate excreta
disposal, waste water, medical waste management and vector control. Furthermore, infection control
measures must be respected and applied by all staff according to the universal / standard precautions.
Water, hygiene and sanitation activities must also be implemented in case of humanitarian crises to
prevent an increase of morbidity and mortality in the affected population. In acute humanitarian crises,

TECH-SAN-160_CH1 22/03/10 10:05 Page 4
the implementation of preventative water, hygiene and sanitation activities is mandatory. In chronic
humanitarian crises (e.g. repetitive outbreaks of cholera, malaria and other infectious diseases)
appropriate water, hygiene and sanitation activities must complement the other medical strategies to
reduce and ultimately stop the spread of the disease by blocking the routes of transmission.
The most appropriate water, hygiene and sanitation (WHS) implementation strategy will vary from
place to place and over time, and has to be established in close co-operation with the whole
coordination team and in close collaboration with the respective authorities. The involvement and close
collaboration of both medical and non-medical staff are essential for the successful implementation of
any WHS strategy. In case responsibilities are clear, this multidisciplinary approach increases largely
the quality and impact of the projects.
1.4 How should water, hygiene and sanitation activities be managed?

The project cycle allows prioritizing interventions, understanding how to establish them and to follow
up their evolution. It is important to analyse and define the real problems first and then to fix and define
the global objective, the specific objective(s) and the results that have to be reached during the life of
the project, the activities to implement and the means needed. Tools that help this process are the
problems and objectives trees, and the logic framework (section 1.5 Further Reading).
1.4.1 Assessment and analysis

According to the level of emergency, perform a rapid assessment (1 or 2 days) for an acute emergency,
or a rapid and then a more in-depth assessment (from a few days to a few weeks) in case of chronic
emergencies and stabilized situations.
The assessment phase allows the collection of:
■ population data (e.g. target population, hygiene practices),
■ health data, in collaboration with medical teams (e.g. mortality and morbidity figures, weekly cholera
incidence rates)
■ technical data (e.g. number of latrines, turbidity),
■ physical environmental data (e.g. monthly average rainfalls, high water table)
■ socio-political data (e.g. security, upcoming elections)
There are a variety of methods and associated tools to collect water, hygiene and sanitation related
data to complement the medical information. Data collections tools for assessments are described in
T.B. 1.01.
The environment must be studied and described. A map, even basic must be established to visualize
the global situation as well as the existing water, hygiene and sanitation facilities (T.B. 1.02). An area
sampling (T.B. 1.03) can also be organized to evaluate the global size of the population of concern as
well as the high and low population density areas within a camp.
The checklists presented in this chapter help to target the required information and to prepare data
collection methods that will be used during assessments:
■ from a general point of view, in the case of a health structure (T.B. 1.04),
■ from a general point of view, in the case of a refugee or displaced persons camp (T.B. 1.05),
■ from the more specific water, hygiene and sanitation point of view (T.B. 1.06; 1.07).
Even if these checklists help to target the information needed, they must however not be considered
as a limit in the type of information and in the way to collect them. One must be aware that bias can
exist in the information collected, specially if only interviews are used. A double crosscheck of the
information should thus be undertaken.
Once collected, those data must be analysed, notably by comparison with indicators like the Essential
Requirements (T.B. 1.08, 1.09), and be used in all the remaining steps of the project cycle.
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1.4.2 Strategy planning

On the basis of the assessment and analysis, the strategy planning can be initiated. A global objective
must first be established. From there, specific objectives and results that have to be reached must be
defined. Activities to obtain each of these results must be determined. During this phase, human and
logistic needs allowing to put the activities in place must also be defined.
Finally, a detailed budget must be joined to all proposals of intervention. This budget must be designed
on the basis of the human and logistic needs and of a chronogram of intervention.
From a general point of view and during all the duration of the project, it is extremely important to
maintain and/or to reinforce the links with the population and other actors, like institutions, traditional
social groups and/or other aid-agencies.
1.4.3 Implementation
The essence of the intervention lies in the tangible realisations and not in never-ending assessments
and planning. The period between the initial assessment (exploratory phase) and the first actions in
an acute emergency can be very short. The extreme seriousness of some situations (e.g. starvation,
conflicts, population displacement) requires a quick start-up with tangible realisations. It is not
compulsory to obtain all the means desired before starting up an intervention. Every action aiming to
rapidly improve the living conditions of an at-risk population is welcome.
For chronic emergencies and stabilized situations, the period covering the initial assessment to the
implementation phase can be longer because of the in-depth assessment and the longer strategy
planning phase.
Training modules for the staff should come with the start-up of the activities to be able to guarantee
their quality and their success. Every member of the team should know his responsibilities and must
have access to the information and the tools needed to achieve the tasks he is responsible for.
1.4.4 Monitoring
The objective of monitoring is to guarantee the permanent appropriateness between the objectives,
the means implemented, the expected results and the results reached in the frame of the chronogram
of the intervention. Monitoring is the regular observation and recording of activities taking place in a
project. It is a process of routinely gathering information on all aspects of the project. Here again,
activity reports, finance updates and permanent communication between the medical and logistical
teams allowing to present epidemiological data and related improvements are of utmost importance.
It is a very dynamic phase generating several questions but also proposing alternative solutions
allowing an increase in the performances. It requires a lot of flexibility to accept to modify point of
views or decisions no longer considered as pertinent and also a lot of energy to be able to locate the
elements blocking the project.
In the context of these guidelines dedicated to water, hygiene and sanitation, data collection methods
(T.B. 1.01) can also be used as a monitoring tool. The different checklists presented in this chapter (T.B.
1.04 to 1.07) can also be used to prepare the monitoring tools: by comparison between the data
collected based on the checklists during the assessment phase and during the implementation,
improvements in the water, hygiene and sanitation situation can be detected.
1.4.5 Evaluation
Evaluating a project is to look at its real impact (e.g. morbidity and mortality reduction) and at the
results of the activities. It is also to evaluate if the global and specific objectives and their specific
activities (e.g. WHS activities) are reached. The evaluation allows to highlight the strengths and the
weaknesses of the project and to correct the situation if needed. An evaluation can be done at any time
during the life of the project and is essential to allow improvements to occur and (potentially) a
redefinition of the specific objectives that have to be reached during an extension of the project.

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1.5 Further reading

A.M. Almedom, U. Blumenthal, L. Manderson
Hygiene Evaluation Procedures – approaches and methods for assessing water and sanitation
related hygiene practices.
INFDC / London School of Hygiene and Tropical Medicine. London, 1997.
A.S. Benenson (Editor)

Control of Communicable Diseases Manual
American Public Health Association, 1995
V. Curtis, B. Kanki
A manual on hygiene promotion
UNICEF / London School of Hygiene and Tropical Medicine. London, 1999.
S. Ferron, J. Morgan, M. O’Reilly

Hygiene Promotion. A practical manual for relief and development.
ITDG Publishing. Care International. London, 2000.
R. Sawyer, M. Simpson-Hébert, S. Wood

PHAST Step-by-step Guide: a participatory approach for the control of diarrhoeal disease
World Health Organisation, 2000
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T.B. 1.01 Data collection methods

Water, hygiene and sanitation activities are integrated in medical projects which are based on the
actual medical needs. There are a variety of methods and associated tools to collect water, hygiene
and sanitation related data to complement the medical information.
Procedure
■ Familiarise yourself and the data collection team with the methods prior to use. Use the methods that
the data collection team and the participants feel most comfortable with.
■ Introduce yourself, the team and the data collection method to be used to the beneficiaries.
■ Do the assessments by using all your senses.
■ Make good records immediately.
■ Be unobtrusive and considerate in your approach. Practitioners should be sensitive to the cultural
and social context and not raise unrealistic expectations from the beneficiaries.
■ Cross check the translator’s performance and neutrality with another translator.
■ Ensure that data is also collected from the more vulnerable groups of society.
■ Respect informant confidentiality and security; data collection should have the consent of the
community.
■ Divide beneficial groups into sub-groups according to gender or age, when appropriate.
■ Stimulate the data collection activity, but without “leading” the participants into a particular response
or direction.
■ Analyse all collected data. Therefore should only relevant information be collected.
Remarks
■ An initial assessment should always be made, even in an acute emergency. The initial assessment
is also important as the basis to prepare the in-depth assessment during chronic emergencies and
stabilized situations.
■ All the methods presented hereunder can also be used for assessments outside the water, hygiene
and sanitation field.
■ The participatory approach has the advantage to be in closer proximity with the beneficiaries, and
the discussions they have amongst themselves makes that they learn from each other, besides just
data collection. The inconvenience however is that the exercises the participants are asked to
perform do take a lot of time. When time is limited, the classic approach is more suited for the in-depth
assessment.
■ More assessment methods exist and can be found in more specialized literature (see 1.5 Further
Reading)
The tables hereunder present the data collection tools that can be used for rapid initial sanitary
assessments (Table 1) and for an in-depth sanitary assessments. In the latter case, two kinds of
methods can be considered: the classic methods (Table 2) and the participatory methods (Table 3).
Once collected, those data must be analyzed. Results of these analysis must be used to define the
strategy and to plan the project.

1
Table 1: Data collection methods for initial assessments
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TECH-SAN-160_CH1
Name Description Purpose Material / Tools

Desk based Reading of relevant information that is already available in: -To gain an insight of the situation before the assessment on -Reports (e.g. minutes of
literature -documents (e.g. medical, water, hygiene and sanitation). the field is started (this review can already start in the meetings, sitreps)
review -medical data sheets headquarters or on the way to the study site). -Medical data sheets
-books -Books / guidelines
22/03/10
-Media (e.g.
newspapers)
Key Interviewing informally anyone who can provide detailed -To gain a good overview of the relevant (water and sanitation) -List of topics to cover
informant information, on the basis of his special expertise or knowledge issues. (based on checklists)
10:06
interview of a particular issue: e.g. village leader, local health worker, -To feed the potential in-depth assessment. -Basic survey form
hospital director, head nurse, entomologist. -To identify issues to cover / validate in (structured) -Notebook and pencil
observations.
NB: Women (and children) can often be key informants in
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water, hygiene and sanitation matters.
Mapping and Drawing of a map of the study site, showing places or features -Different maps can be made of the area and used for -Compass / GPS
area that are important for the project: e.g. water sources, orientation and planning purposes. -Long tape measure
sampling defecation areas, roads/buildings,…. -The estimation of the population living in a closed setting helps -Hand clicker
(T.B. 1.02 and to determine important data such as Crude Mortality Rate, the -Note book and pencil
1.03) Area sampling permits a good estimation of the population quantity needed for water and latrines -Graph paper
number, the household size and the average available area -To feed the potential in-depth assessment. -Ruler
per person. -Calculator
-Rope
Health walk A walk through the study site(s) in a meandering fashion, to -To familiarise yourself with the physical context in which -List of topics to cover
gather information through (unstructured) observations and hygiene practices occur. (based on checklists)
informal talks with the population. -To investigate how people behave in their daily routines -Map if available
-To feed the potential in-depth assessment. -Basic survey form
NB: Most effective when carried out at dawn or dusk, when -Note book and pencil
most hygiene practices and water collection occur.
Spot-check Record information (defined on a clear but short list of topics) -To investigate the presence or absence of some clearly -Spot-check list
observation during the first moment of observation (e.g. quick observation defined (based on previous

of the issues on the spot-check list when entering a dwelling / hygiene / health behaviour and practices dataFROOHFWLRQ
hospital service or ward). -To feed the potential in-depth assessment. / checklists)
NB: A rapid method particularly useful when time is a major -Basic survey form
constraint.
Table 2: Classic data collection methods for in-depth assessments
TECH-SAN-160_CH1
Name Description Purpose Material / Tools

Desk based Reading of relevant information that is already available in: -To gain an insight of the situation before the assessment is -Reports (e.g. minutes
literature -documents (e.g. medical, water, hygiene and sanitation). taken back to the field again (this review can already be done at of meetings)
review -medical data sheets the office). -Medical data sheets
22/03/10
-books -Books / guidelines

-Information collected
during the initial
assessment
10:06
Structured (Continuous) observation to collect information defined on a -To see where water and sanitation-related facilities -Observation checklist
observation clear but short list of topics: e.g. are located. (based on previous
- Continuous structured observation (e.g. each time an -To obtain information on water, hygiene and sanitation issues dataFROOHFWLRQ
action listed on the observation sheet is done, it is marked and practices in and around these facilities, at peoples homes / checklists)
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on the sheet) or in their working environment, in health structures. -Ticketing schedule

- Ticketing (e.g. each time a person collects water, a mark -Pencil
is put on the ticketing sheet).
Structured Interviewing people based on a questionnaire with closed -To collect mainly factual and quantitative data -Written interview
interview ended questions on predetermined topics (e.g. the answer (Data is relatively easy to collect and to interpret as it is a with closed questions
can only be yes or no, or an option within the multiple choice preconceived questionnaire, which on the other hand is difficult on predetermined
question). to prepare). topics
(based on previous
dataFROOHFWLRQ
/ checklists)
-Pencil
Semi- Interviewing people based on a questionnaire with open -To investigate general as well as specific issues by asking -Written interview
structured ended questions on predetermined topics (e.g. person being questions, informally but systematically. with open ended
interview interviewed can answer with his own words). -To investigate which hygiene / health practices are ideal / questions
acceptable, and why (based on previous
NB: it is useful to have an assistant to take notes. -Collection of qualitative data dataFROOHFWLRQ
/ checklists)
-Notebook and pencil
Focus group Discuss a specific topic of interest to the investigator with a To investigate: -Written open ended
discussion small group of people having similar backgrounds or -A range of opinions / points of views on the topic of interest questions and/or

experiences -The wide variety of local terms and expressions linked to the pictures to introduce
topic of interest the topic of interest
NB: it is necessary to be at least two for the focus group -The meanings of survey findings that cannot be explained -Notebook and pencil
discussion: 1 moderator and 1 person taking notes (statistically) (and/or tape recorder)
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Table 3: Participatory data collection methods for in-depth assessments
TECH-SAN-160_CH1
Description Purpose Material / Tools

Name
Community / The participants are asked to make a map of their -To find out what facilities related to health and hygiene exist -Blackboard and
Health community / health structure, showing places that are and to which the community has access. chalk
22/03/10
structure important for them (e.g. market place) and to include -To find out about hygiene and sanitation resources in peoples -Paper and markers
mapping features of interest to the investigator (e.g. water homes or health structures (e.g. latrines).
sources, latrines). -To find out how the community / health staff perceives its
surrounding / working environment and what it prioritises within it.
10:06
Three pile Participants have to discuss and decide if water, -To break down social barriers and establish good -Sets of pictures
sorting hygiene and sanitation related activities presented on communication. showing water and
the pictures are good, bad or in-between and why? -To introduce potentially sensitive / personal topics (e.g. latrine sanitation related
Once consensus is reached, the picture is placed in use) that need to be investigated (knowledge / perception of the activities
the appropriate good, in-between or bad pile. The participants). -Good, bad and
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discussions between the participants will provide -To choose improved hygiene behaviour, based on people in-between signs
essential information to the investigator. perceptions and needs. -Notebook and pen
Pocket chart The participants can indicate individually and secretly -To investigate which resource / method is actually used for what -Sets of pictures
which water, hygiene and sanitation resources / purpose or which population group (e.g. investigation on showing water,
methods, depicted on a matrix, they are using. The defecation methods used). hygiene and
discussions between the participants afterwards will sanitation activities.
provide essential information to the investigator on the -Voting cards
actual water, hygiene and sanitation practices. -Pocket chart
NB: each picture should be defined and its meaning -Notebook and pen
agreed before a vote on a predefined aspect of
the picture takes place.
Gender / Staff An investigation of gender / staff issues, particularly in -To find out which activities or tasks are acceptable for / assigned -Sets of pictures
role task relation to task allocation and resource management. to men, women or both / medical staff, non-medical staff or both showing relevant
analysis Pictures on various water, hygiene and sanitation and why. activities / tasks
activities are passed around and the participants are -Picture of a man,
asked about who is performing the different tasks. woman and both
Once consensus is reached, the picture is placed in together / of
the appropriate man, woman or both / medical, non- medical, non-

medical or both pile. The discussions between the medical staff and
participants will provide essential information to the both together
investigator. -Notebook and pen
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T.B. 1.02 Mapping

This assessment method consists of drawing a simple map of the study site by means of a compass
or a GPS. This map can also show places or features that are important for the program in general
or more specifically for the water, hygiene and sanitation activities. The map can also help in project
orientation and planning purposes and is essential for area sampling.
Procedure
Recording the landmarks
■ Step in a normal pace along a preset length (e.g. 100 m) and count the number of footsteps needed
to cover the distance. The average footstep can then be calculated by dividing the preset length by
the number of footsteps: e.g. 100 m/119 steps = average footstep of 0.84 m.
■ Go to a specific landmark at the outskirt of the site.
■ Identify the north by means of the compass.
■ Point the direction arrow towards the next landmark and rotate the graduation ring until the graduation
ring arrow is in position with the magnetic needle indicating the north (0°).
■ Note the bearing (degrees of the angle in between the direction of the second landmark and the
north). The bearing can be read on the graduation ring at the position of the direction arrow.
■ Start walking in a normal pace towards the next landmark and count the number of footsteps needed
to arrive there. In order not to make mistakes during the counting of the footsteps, it is strongly
recommended to use a hand clicker.
■ Note the number of footsteps on the same line as the bearing.
■ Keep on doing the same procedure from landmark to landmark until the starting point is reached
again.
Drawing the map and calculating the total surface of the site
■ Choose a place on a graph (millimetre) paper to plot the first landmark. This first mark should be
chosen in order that all the other landmarks can be plotted on the same sheet, taking into account
that the north should be on the top of the paper. It is also necessary to decide the scale of the map
from the beginning.
■ Rotate the graduation ring until the correct first bearing (measured during the landmark recording)
is positioned exactly in front of the direction arrow.
■ Put the preset compass with one of its long edges on top of the first designated landmark on the paper
and turn it around this point until the graduation ring arrow points exactly towards the top of the
paper which is the north of the map (the parallel lines of the graduation ring should be exactly in
position with the vertical lines of the graph paper).
■ Draw a line on the graph paper starting from the first landmark following the direction arrow of the
compass. Drawing the line in the opposite direction of the arrow will be an error that is dragged along
in the remaining of the plotting, resulting in a faulty map.
■ Convert the number of footsteps between the first and second landmark into the actual distance,
which needs to be adapted for the map according to the chosen scale.
■ Measure the up-to-scale length from the first mark along the drawn line and plot the second mark.
■ Keep on doing the same procedure from landmark to landmark until the starting point on the map is
reached again.
■ Draw a grid on the map, using squares of 25 m by 25 m according to the map scale.
■ Count and number the squares within the perimeter. Partial squares with at least half of their surface
within the perimeter are calculated as whole ones, whereas those with less than half of their surface
within the perimeter are ignored. It is estimated that the partial squares that have been included as
whole ones compensate for the ignored partial squares. The total number of squares considered to
be within the perimeter of the figure equals 71.
■ Multiply the total numbers of squares (complete and accepted partial ones) with 625 m² (surface of
a 25 x 25 m square). This calculation will give an acceptable estimation of the total surface of the
site. For the figure, the total surface is estimated at 71 x 625 m² = 44,375 m² or 4.4375 ha.

TECH-SAN-160_CH1 22/03/10 10:06 Page 12
C
Point Degrees (°) Meters
1 135 100
2 180 100
3 225 120
4 310 70
5 250 50
6 295 150
7 75 100
8 25 100
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Key Input
A. Compass
B. Hand clicker
C. Recorded coordinates
D. Finished map
1. Magnetic needle indicating north (red part) - Compass or GPS (with software)
2. Rotating graduation ring - Long measuring tape (e.g. 50 m)
3. Graduation ring arrow - Hand clicker
4. Direction arrow - Notebook and pen/pencil
5. Long edge of the compass - Ruler
- Calculator
- Graph (millimetre) paper

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Remarks
■ The study site will be mostly a refugee / displaced persons camp or a health structure, but it could
also be a village or even a sector of a town (e.g. slum area).
■ Walk as much as possible in a normal pace in order to stick to the average footstep length. However,
footsteps will vary in length when climbing / descending a steep slope or when the access of the
terrain is difficult.
■ All the landmarks should be more or less located around the external limits of the site. However,
don’t choose too many landmarks as this will increase the workload, not only to record them but
also to draw the map. Obviously, the more landmarks are taken, the more the final map will resemble
the reality of the field. But such precision is in most cases not necessary, and certainly not during
acute emergencies.
■ Be aware that the indication (precision) on the rotating graduation ring is often at 2 degrees interval.
■ During the plotting of the landmarks of the map, the magnetic needle of the compass doesn’t play
any role anymore.
■ Indicate the north on the map, as future users won’t know which is the top of the paper.
■ The scale of 1/10.000 is often chosen for a first map because 100 m on the field corresponds to 1
cm on the graph paper. This enables mostly to put the whole site on one A4 sheet, which is sufficient
for the first usages of the map. It is important that the scale is indicated directly on the map.
■ When the last line, plotted according the measured bearing and up to scale length, ends a long way
from the first landmark on the drawn map, it indicates that something went wrong during the mapping.
All marks should be verified according to their up-to-scale length and their bearing. A common
mistake is that a line is drawn in the opposite direction of what it should be (180° off). Once this has
happened, the map can’t be correct anymore. If after thorough verification and potential re-plotting
of the whole map, the final mark still doesn’t correspond at all with the first mark, it’s probable that
something went wrong during the recording of the landmarks on the field.
■ Small discrepancies in between the final and the first mark are common and mostly due to small
inaccuracies during the recording of the landmarks and the plotting of the map. These aren’t worrying
because the mapping technique can only provide a sketch of the actual situation on the field anyway.
■ The simple map of a camp will often be used as a basis for area sampling (T.B. 1.03). The initial map
or a more precise version with more landmarks in a later stage can also be used to indicate specific
places (e.g. river, wells) and facilities (e.g. latrines, health centre) that are important for the overall
program. These indications can be directly drawn on the map, but a legend should be added on the
paper to explain the symbols used.
■ Instead of using a compass, the mapping can also be done by means of a GPS (Global Positioning
System). Each time a landmark is passed, a simple click on the GPS will mark its coordinates
(latitude and longitude). It will have to be verified beforehand however if it is set in decimal degrees
(e.g. 39.4567 with 4 decimal place position). As it won’t be necessary anymore to count the steps,
nor to measure the angles in between sequential landmarks, the circumference of the site can be
covered a lot quicker. The plotting of the landmarks on paper can be done by introducing manually
all the coordinates of the landmarks into a computer or (even more rapidly) by connecting the GPS
directly to the computer to download them, using an appropriate software program. Be also aware
that the imprecision of a GPS can be as high as 10 m, which might be a problem for small study sites
but not for big ones.
■ A car could also be used to do the mapping, certainly for very big sites. The distances could be
measured with the odometer of the car, but be aware that the precision is only 100 m. The use of a
GPS is certainly recommended in this case.
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T.B. 1.03 Area sampling

Area sampling is an assessment method that, starting from the mapping method, provides the
possibility to estimate the number of people living in a particular area or to have an idea of the
magnitude of the population displacement towards a specific site. This population figure also
provides a denominator for epidemiological and program indicators. With the surface of the target
area and its estimated population, it’s even possible to analyse the average available area per
person.
Procedure
■ Count on the map that was obtained by the mapping method (T.B. 1.02.) from left to right and from
top to bottom all the complete 25 x 25 m squares. Do not include the partial squares, even if they
have more than half of their surface inside the perimeter. The number of complete squares on the
figure equals 50.
■ Select on the map through systematic sampling at least 15 complete squares (of 25 x 25 m) that need
to be visited to collect data (area sampling).
➞ Divide the total amount of complete squares by 15, and round off this result to a non-decimal number.
The rounded off number is the systematic sampling step (figure: 50/15 = 3,33 rounded off to 3).
➞ Start from the first complete square on top of the grid and add towards the right-hand side the
systematic sampling step to obtain the second complete square for area sampling. The systematic
sampling step can only be counted on complete squares, partial squares within the perimeter should
be ignored.
➞ Keep on adding the systematic sampling step from left to right and top to bottom until 15 complete
squares are selected. When the systematic sampling arrives at the bottom of the grid and there
aren’t 15 complete squares selected yet, the step is continued at the top of the grid.
■ Go to an outer landmark of the site.
■ Measure on the map the bearing from the outer landmark towards the lower left corner of the first
selected square. This is done by placing the compass with its long edge on the existing map along
the line formed from the chosen outer landmark until the lower left corner of the selected square,
making sure that the direction arrow is pointing towards the selected square. The rotating graduation
ring is then rotated until its arrow is pointing to the north (top) of the map (parallel lines of the rotating
graduation ring are exactly in line with the vertical lines of the graph paper). The bearing can be
read on the graduated ring at the position of the direction arrow (T.B. 1.02.).
■ Measure on the map the scale length in between the outer landmark and the lower left corner of the
selected square, adapt it to the real distance according the scale of the map and convert it in number
of footsteps (average length of footsteps should be known; T.B. 1.02).
■ Go to the selected square on the site by means of the measured bearing and distance (number of
footsteps), starting from the chosen outer landmark. By turning the rotating graduation ring until the
bearing is in position with the direction arrow and having the graduated ring arrow in position with
the magnetic needle indicating north, the direction to go in is determined.
■ Form a square of 25 x 25 m (4 ropes with marking at 25 meters can be of help to determine the
square), starting from the left bottom corner as indicated on the map. Shelters on the edge that don’t
fall completely within the 25 x 25 m square should only be included in the sample if they have at least
their south and east limits within the 25 x 25 m square.
■ Visit dwelling per dwelling within the 25 x 25 m square and note the number of persons who have
spent the previous night at each dwelling to determine the size of the household. Additional
information on the age and sex of the household members can also be collected. Keep on doing the
same procedure for all the selected squares.

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Calculations
■ Calculate the population of each square by adding up all household members per square. Note the
figures down.
■ Calculate the average size of a household by adding up all the figures of the population of each
square, divided by the total number of households visited. Note the figure down.
■ Calculate the average population per square by adding up all the figures of the population of each
square, divided by 15. Note the figure down.
■ Extrapolate the total population of the site by multiplying the average population per square with
the total number of squares within the perimeter (complete squares and partial ones which have
more than half of their surface included).
■ Calculate the average available area (number of m² per person) by dividing the total surface of the
site (T.B. 1.02) by the total population of the site. This figure should be compared with the site
planning indicator (T.B. 1.10.).
Key Input
A. Systematic sampling
B. Survey technique
1. Map obtained by the mapping technique - Map
2. Selected squares of 25 m x 25 m (at least 15) - Ruler
3. Direction from chosen landmark to selected square - Compass or GPS
(angle and distance; in occurrence square 10) - Long tape measure (e.g. 50 m)
4. Surveyors - Hand clicker
5. Persons delimiting square of 25 x 25 m - Notebooks and pens/pencils
6. Ropes - 4 Ropes
7. Hut with south and east limits inside 25 x 25 m square - Calculator
8. Hut with east limit outside 25 x 25 m square (excluded) - 2 surveyors
- 4 persons delimiting square.
Remarks
■ The calculated total population of the site is not an exact figure but a good estimation of the reality.
■ In order to obtain a representative figure of the total population of the site, at least 15 complete
squares are required to be investigated of which at least 10 need to be populated. Only habitats for
which at least half of the surface falls within the selected square should be included in the persons
count. It is strongly recommended to give each selected square a number in order to avoid confusion
afterwards (e.g. visiting the same square twice, mixing up figures of different squares).
■ In case there would be a clear distinction in population density within the site, the area sampling will
have to be done separately for the high and low density areas. Otherwise the calculated figures (e.g.
extrapolation of the total population) could give a completely false result.
■ When a big part of the study site is uninhabited (e.g. a lake), it should be mapped separately and
deducted from the total study site surface, in order not to falsify the extrapolated population
estimation.
■ The visit of the selected squares is also a good opportunity to do some informal talks with the
population and some spot-check observations inside and outside of the dwelling on issues that are
of interest for the program (e.g. water, hygiene and sanitation related).

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T.B. 1.04 Health structure checklist

This checklist helps to prepare general data collection during assessments within health structures.
The collection of unnecessary data is surprisingly easy to do, but frustrating and inefficient. So
always double-check the relevance of all the data to be collected.
Key criteria
Context
■ What is the field of intervention: e.g. assistance to victims of conflict or natural disaster, assistance
to vulnerable groups in post emergencies, epidemics or endemics, access to healthcare for excluded
groups?
■ Is it an acute or chronic emergency, or a stabilized situation? What is the foreseen project duration?
■ What is the location of the health structure: camp, rural, urban? Is it located on private or public
terrain?
■ What kind of health structure: e.g. out-patient (OPD), in-patient (IPD), hospital, therapeutic feeding
centre (TFC), cholera treatment centre (CTC) or unit (CTU)?
■ How many consultations and/or in-patients/day, number of beds (occupancy rate)?
■ What are the activities of the health structure: e.g. surgery, enlarged program of immunization (EPI),
maternity?
■ What is the (local) management organisation of the health structure? What is the involvement of
aid-agencies in the health structure: e.g. owner, technical support, continuous presence, training?
What is the role of MOH, others?
Land availability
■ Is there space available for a potential extension of the health structure, or to install temporary
emergency facilities: e.g. during an outbreak?
■ Is there space available to build new facilities: e.g. latrines, waste zone?
■ Is there a signature of agreement prior to the utilization of private ground?
Access
■ Is the health structure easy accessible for patients? What is the distance / time the patients have to
travel to arrive at the health structure?
■ Is the health structure always accessible by an ambulance?
■ Is access possible at all times of the year for heavy transport vehicles: e.g. medical material and
equipment, building material, water supply?
Legislation / land rights
■ To whom does the land of the health structure compound belong?
■ Can (additional) semi- and/or permanent structures be build on the compound?
■ Is there a national legislation concerning water supply, medical waste, insecticides use (try to get a
copy if existing)? Is it applied in the health structure?
■ Is there a Hygiene Committee?
Existing facilities on the health structures compound
■ Is the layout of the existing buildings and facilities appropriate? Does a map exist? (if not, make one;
T.B. 1.02).
■ Are there sufficient and appropriate latrines, showers, washing facilities, a waste zone, a kitchen?
Human resources
■ Is there a responsible for the correct implementation and follow up of the essential water and
sanitation requirements in the health structure (T.B. 1.08)? Is health promotion ongoing or planned?
■ What is the total number of staff present: e.g. doctors, nurses, lab technicians, cleaners, technicians?
■ What is their number, divided in national and expatriate staff?
■ Is all the staff aware about correct hygienic behaviour within the health structure (standard / universal
precautions)? Did they receive any training / information concerning this topic? Are there hygiene /
health promotion activities ongoing or planned for the staff?
■ Are needle stick injuries reported? How often does it happen? Is there a protocol for Post Exposure
Prophylaxis (PEP) available after the injury?
■ Has the national staff been vaccinated against Hepatitis B / tetanus (medical and non-medical staff)?
■ Does all the staff have protective clothing (medical and non-medical staff)?
■ Are there cleaning products, disinfectants and equipment available, and if so, which kinds? Are the
protocols of correct cleaning (e.g. latrines, wards) / disinfection / sterilisation available and practiced?
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Security / safety
■ Are there security considerations for the staff, the patients, the visitors or the surrounding population:
e.g. armed individuals trying to get access to the health structure?
■ Are there safety considerations for either the staff, the patients, the visitors or the surrounding
population: e.g. presence of open pits, waste exposed on the ground, location of the latrines /
showers?
■ Is there a big fire risk? Are there evacuation plans?
Climate
■ What is the period and duration of the rainy season / cold period (winter)? Does it have an influence
on the material and equipment supply? Does it have an impact on the drainage?
Water
■ Are water resources available within or around the health structure compound? The further the water
resource is away, the more complex and expensive the water supply will become.
■ What kinds of resources are available: surface water, groundwater, rainwater catchments? Are the
existing water resources available all year around?
■ Do the available resources provide all year around sufficient quantities for all activities within the
health structure (e.g. sterilisation, general hygiene, drinking, cooking, personal hygiene and
sanitation)? What is the quality of the water? Is water easy accessible for staff, patients and visitors?
Terrain
■ Is the land sloping gently for natural drainage?
■ What is the soil type of the health structures compound (important for its infiltration capacity, ease
and safety of digging)? What is the depth of the highest water table (at the end of the rainy season)?
■ Is the health structure located in a flood prone area, nearby a swamp, land with a high water table,
or at risk of land slides? Is or will the groundwater be used for the health structure or by the
surrounding population?
■ What is the dominant wind direction: e.g. for latrines or incinerator construction?
Environmental Health Risks
■ Are there any vector borne diseases endemic to the area and if so, is the health structure sited in a
high or low risk area?
■ Are there any visible signs of vectors (organisms, faeces, eggs), or nuisances related to them?
■ Is there stagnant water, or other potential vector breeding sites on site or in the close vicinity?
Local Communities
■ What is the distance in between the health structure’s compound and the neighbouring dwellings?
■ Are there any socio-cultural problems linked with the health structure (e.g. latrines, dead bodies)? Is
the population surrounding the health structure complaining about certain activities within the
compound (e.g. incineration of waste generating smoke)?
■ Do the wastes generated within the health structure have any commercial value for the population?
Do you find them back on the local market (e.g. needles and syringes, expired drugs)?
■ Is the community aware of the activities within the health structure?
Remarks
■ Although this checklist encloses the most essential health structure information, it is not exhaustive.
■ This checklist should be used in combination with the water, hygiene and sanitation checklist (T.B.
1.06).
■ Some of the collected data (based on this checklist) can be compared during the analysis with the
indicators listed in the essential water and sanitation requirements for health structures (T.B. 1.08).

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T.B. 1.05 Camp checklist

This checklist helps to prepare general data collection during assessments within refugees /
displaced persons camps. The collection of unnecessary data is surprisingly easy to do, but
frustrating and inefficient. So always double-check the relevance of all data to be collected.
Key criteria
Context
■ What is the field of intervention: e.g. assistance to vulnerable groups in post emergencies, epidemics
or endemics, access to healthcare for excluded groups, assistance to victims of conflict or natural
disaster?
■ Is it an acute or chronic emergency, or a stabilized situation?
■ What is the location of the camp: rural, urban? Is it located on private or public terrain?
■ What is the population size of the camp: e.g. total number of people, age/gender repartition?
■ Is there an integration or not within the resident population? What is the distance to residents
dwellings?
■ What is the involvement of aid agencies in the camp: e.g. medical infrastructure (in-patient/out-patient
departments), nutrition, technical support, water, hygiene and sanitation, training?
Land availability
■ Is there sufficient land area available (also for possible future extensions; T.B. 1.03)?
■ Is there the possibility of self-sufficiency for the population (e.g. the right to use the land for agricultural
purposes)? Is it easy to supply food and materials to the camp?
Access
■ Is access possible at all times of the year, particularly for heavy vehicles (e.g. water trucks)?
■ Are communal facilities always accessible by light vehicles?
Legislation / land rights
■ Are there any legal and/or traditional rights that have to be considered?
■ Can semi- and/or permanent structures be build on the site?
■ Will it be possible to install a landfill / cemetery and will there be enough space?
Existing facilities on the camp site
■ Are there health structures implanted on the site, or buildings that could be used as such?
■ Are there (large) buildings that could be used as an office / a warehouse?
■ Is there a market? What are the main goods that can be found (food and non-food items)?
■ Are there religious buildings (mosque, church, temple), even under temporary shelter?
Security / safety
■ Are there security considerations for either refugees, displaced persons or relief workers? It is
recommended that refugees will be settled at a reasonable distance from international borders and
other potentially sensitive areas.
■ Are there safety considerations for either refugees, displaced persons or relief workers: e.g. presence
of open pits, waste exposed on the ground, location of the latrines / showers?
■ How high is the risk of fire? Are there firebreaks? Are there evacuation plans?
Climate
■ What is the period and duration of the rainy season / cold period (winter)? Does it have an influence
on the material and equipment supply? Does it have an impact on the drainage?
Water
■ Are there onsite or nearby water resources available all year around? The further the water resource
is away, the more complex and expensive the water supply will become.
■ What kinds of resources are available; surface water, groundwater (including spring water), rainwater
catchments? Are the existing water resources available all year around?
■ Is there sufficient water quantity provided for drinking, cooking, personal hygiene and sanitation for
the projected population? How is the water quality? Is water easily accessible, also for vulnerable
people?
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Terrain
■ Is the land sloping gently for natural drainage?.
■ Is the soil type suitable for digging and water infiltration? The soil type determines which sanitation
and construction techniques may be used. Avoid rocks or areas with a high water table, as it will make
latrine construction difficult.
■ Are there sufficient grass shrubs and trees for shade and to prevent soil erosion?
■ Is the camp located in a flood prone area, nearby a swamp, land with a high water table (what is the
depth of the highest water table) or areas at risk of landslides?
■ What is the dominant wind direction: e.g. for latrine localization?
Environmental Health Risks
■ Are there any vector born diseases endemic to the camp area? Is the camp located in an area with
risks such as malaria, bilharzias (schistosomiasis), sleeping sickness (trypanosomiasis). Is it a high
or a low risk area?
■ Are there visible signs of vectors (organism, faeces, eggs; T.B. 7.01 to 7.09), or nuisances related
to them?
■ Is there stagnant water, or other potential (and avoidable) vector breeding sites on site or in the close
vicinity?
Local Communities
■ Does the camp create a negative (environmental) impact on its surroundings: e.g. deforestation, soil
erosion, poaching, sharing of scarce water resources? The possible impact this may have on local
communities is important and has to be taken into consideration.
■ Is there tension / collaboration between the local community and the refugees / displaced persons?
Human resources
■ Is it possible to recruit people within the camp population or from the local communities?
■ Are there skilled people (e.g. nurse, water and sanitation technician, hygiene promoter) amongst
the camp population or the local communities?
■ Are there other aid-agencies present (national and international)? What is their field of activities? Is
there a collaboration / coordination in between the different agencies?
■ Are there hygiene / health promotion activities ongoing or planned?
Remarks
■ Although this checklist encloses the most essential camp information, it is not exhaustive.
■ This checklist should preferably be used in combination with the water, hygiene and sanitation
checklist (T.B. 1.06).
■ Some of the collected data (based on this checklist) can be compared during the analysis with the
indicators listed in the essential water and sanitation requirements and the site planning for camps
(T.B. 1.09 and 1.10).
■ The selection and planning of a new site is usually done by official instances (e.g. UNHCR, local
authorities), but involvement of NGOs is recommended.
■ The selection (and planning) of a site should preferably be done by a multi disciplinary team that
consists of a medical person, a logistician and a water, hygiene and sanitation technician / engineer.
■ In the initial phases of the emergency it is very hard to gauge, with any confidence, the likely duration
of the camp. Therefore it is best to select, plan and install the site within the briefest delay possible.
However, as the camp may remain for many years, a long-term view is recommended from the
beginning.
■ Unused or unoccupied sites often have a good reason for not being used, and the appropriate site
often remains a dream.

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T.B. 1.06 Water, Hygiene and Sanitation checklist

This checklist helps to prepare specific data collection related to water, hygiene and sanitation
during assessments within health structures or refugee / displaced persons camps and communal
centres. The collection of unnecessary data is surprisingly easy to do, but frustrating and inefficient.
So always double-check the relevance of all data to be collected. The focus should mainly be on
the water, hygiene and sanitation issues that have a health impact.
Human resources
■ Who is in charge of the local water, hygiene and sanitation systems, and who is responsible for their
maintenance and repairs?
■ Is there local expertise for repair or rehabilitation of the different systems?
■ Which organisations are already involved, are realistically available and have the capacity to work
in water, hygiene and sanitation programs (e.g. NGO’s / Red Cross / UN / Ministry of Works)
■ Is there a need for a water and sanitation specialist?
Hygiene
General information:
■ Are there hygiene-related diseases present including faecal-oral diseases, trachoma, scabies? Cross
check morbidity statistics with medical staff.
■ Is there a presence of vectors that are related to lack of (personal) hygiene (e.g. fleas, lice)?
■ Is there sharing of beds, towels, clothes amongst people / patients?
■ Are containers, which may be mosquito breeding sites, removed, emptied regularly or covered?
Facilities:
■ Is soap available and used for hand washing, body washing and laundry? Are there alternatives
available/used to replace soap, like ashes?
■ Is there a sufficient quantity of water for personal hygiene and health structure / domestic cleaning?
■ Are hand-washing facilities available in sufficient number? Are they accepted by the beneficiaries?
If not, why? Are there some hand washing facilities located inside the health structure services /
wards and/or near the defecation facilities?
■ Are showers available in sufficient number? Are they accepted by the beneficiaries? If not, why? Are
they located in a safe and accessible place?
■ Are laundry facilities available in sufficient number? Are they accepted by the beneficiaries? If not,
why? Are they located in a safe and accessible place?
■ For all those facilities, is there a presence of an appropriate drainage system: e.g. grease trap, soak
away pit, infiltration trenches?
■ What goods are women using normally during menstruation? What supplies are available? Are there
special facilities foreseen where the (fabric used as) sanitary towels can be collected / washed?
0peration and maintenance
■ What is the general level of hygiene practised by the health structure staff, patients and accompanies
/ targeted population? If it is poor, why? Is it due to lack of soap or water, or other reasons?
■ What is the frequency and type of general cleaning (in health structures, communal centres): e.g.
cleaning of floors and surfaces with detergents, airing and cleaning of mattresses? Who is
responsible?
■ Are all the specific hygiene facilities used (correctly)? If not, why?
■ Are the specific hygiene facilities clean/maintained inside but also outside?
■ How is the cleaning organized? Who is responsible? What procedures are used? Is cleaning material
available (e.g. brooms, soap, chlorine)? What is the maintenance frequency?
■ What is the frequency and type of laundering clothes and bedding? Who is responsible?
■ How is the food hygiene: preparation, storage and cleaning of utensils / crockery? Who is
responsible?
■ Are hygiene / health promotion activities ongoing or planned? By who is it done and who is targeted?
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Water
■ Verify the quantity, quality and accessibility of the various water related facilities because the
combination of these factors determine their final usage and therefore have an influence on the
related health risks.
■ What is the amount of available water, in litre per patient / person per day? Is this amount available
every day or is the supply irregular?
■ Are there water-related diseases present, including faecal-oral diseases, guinea worm, bilharzias?
Cross check with the morbidity statistics of the medical staff.
■ Is the water free of charge? If not, is it affordable for all?
■ Is there a seasonal impact on the quantity, quality and accessibility of water?
Facilities
Quantity:
Determine the available water resource(s), the available water quantity and reliability of each resource:
River/stream
■ What are the estimated width and depth? Is the water moving fast or slow? These are all indicators
of the capacity of the resource; even a small and shallow river with a good flow has already a decent
water capacity.
■ Does water flow during the whole year?
Lake
■ Is it a big or a small lake? Be aware that when large amounts of water are taken for a prolonged time,
a small lake can dry up.
■ Are there any rivers discharging in the lake? Are they rivers with a high water capacity?
■ Does the lake reduces in volume or even dry up at certain periods of the year?
Hand dug wells/boreholes
■ What is the quantity of water that the hand dug well / borehole can deliver per hour or per day?
■ Does it give water all day or does it dry up during certain hours; if it dries up, for how long?
■ How many hours a day do people use water from this resource?
■ What is the static ground water level in the area (during dry and rainy season)?
Spring
■ What is the estimated discharge of the spring? Measure the time needed to fill up a bucket of known
volume.
■ Is the discharge of the spring stable during the whole year? Does the spring dry up during the year?
Rainwater
■ What is the rainfall pattern over the year? These figures might be available in meteorological stations,
universities or on the internet.
■ What are the periods of dry and rainy seasons?
Quality:
Check possible contamination of the water sources:
■ Is there a risk of micro-biological or chemical contamination: e.g. open defecation, latrines, laundry,
intensive agriculture (e.g. animals, pesticides, fertilisers), industry (e.g. mining)? What is the distance
of the resource to latrines, waste disposal sites, farms, workshops, industry?
■ How is the resource protected: e.g. intake system protection, zone fenced off, drainage ditch,
overflow, drainage channels?
Check the water quality:
■ How is the colour, smell, taste, turbidity (turbidity tube; T.B. 2.13), pH (pool tester; T.B. 2.22)?
■ Does the water contain a lot of minerals/salts? If the adapted equipment is available, check the
conductivity of the water.

TECH-SAN-160_CH1 22/03/10 10:06 Page 24
Check if water treatment is being done:

■ Is chlorine locally available? Is the water chlorinated? Measure the Free Residual Chlorine (FRC)
concentration (with a pool tester; T.B. 2.22) at different locations (e.g. water reservoirs, piped
systems).
■ Is assisted sedimentation performed? Is it a batch or continuous system?
■ Are there filtration systems installed and used? What type of filters is available? What is the frequency
of the backwashing?
Accessibility:
Check the water supply system:
Resources
■ Are the resources nearby or far away from the user point?
■ Are the resources foreseen with the necessary equipment to facilitate the accessibility (e.g. hand
pump on well, submersible pump on high-yield borehole, motor pump at river)?
Water trucking
■ Is there enough capacity to fulfil the water needs (e.g. number and condition of the available trucks,
condition of the roads, rotation time per fill up)?
■ How is the water trucking organized (e.g. private or authorities trucks, conditions of the contract
related to duration, human resources, running and maintenance costs)?
Piped water supply
■ How many hours per day is the water system providing water?
■ Is it a gravity or pumped system?
Water reservoirs
■ How many reservoirs are installed?
■ What is the capacity of the reservoirs? How many hours per day are the reservoirs full of water? How
often are they refilled?
■ Where are the reservoirs located (e.g. nearby the health structure, spread within the camp)? Are
they easily accessible for water trucks?
Check the location of water distribution points:
■ Are the water distribution points easily accessible to the beneficiaries, if not why?
■ Are taps (stands) available?
Check if everyone has the means to transport and to store water at their dwelling:
■ What is the number of water containers per household, their capacities and the average number of
refills (to estimate the total amount of water collected per day)?
■ What type of containers (e.g. plastic jerry cans, clay pots, tins) are the beneficiaries using? Are these
the kind of containers they would normally use?
■ What is the condition of the containers (e.g. clean, damaged)?
Operation and maintenance:

■ Is there safe and perennial access to water for all groups; especially the most vulnerable? Are certain
groups denied access? If so, why?
■ How long do the users wait for water: is queuing observed (e.g. empty jerry cans left behind), is
there crowding/fighting at water points?
■ How often is the water quality checked? What kind of checks are performed?
■ How often are the water quality treatment systems checked and maintained? What is the
protocol/procedure of the assisted sedimentation, filtration and chlorination processes (if applied) and
their frequency?
■ Is cleaning of the beneficiaries’ containers done (systematically)? What is the procedure?
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Excreta disposal
Verify the quantity, quality (including the maintenance) and accessibility of the various excreta disposal
facilities because the combination of these factors determine their final usage, and thus have an
influence on the related health risks.
■ Is there a lot of excreta laying around? Is wild defecation a normal practice? Are people defecating
in surface water (e.g. river, lake)?
■ Are there excreta-related diseases present, including faecal-oral diseases, bilharzias? Cross check
with the morbidity statistics of the medical staff.
Facilities:
■ What types of excreta disposal facilities are to be found: defecation areas / trench latrines / improved
trench latrines / simple pit latrines / VIP latrines / twin pit latrines / pour-flush latrines / flush toilets /
septic tanks / sewage system / others.
Quantity:
■ Number and layout of the defecation facilities in the concerned area.
■ What is the average number of persons per defecation facility? Are the defecation facilities provided
per family (or group of families) or are they communal facilities?
■ What is the defecation facilities’ capacity? Are there extension plans if the number of people increase?
Quality:
■ Are the defecation facilities adapted to the users’ preferences and limitations: e.g. physically impaired
people, staff – patient / gender – family separation, are people washers or wipers, squatters or
sitters)?
■ Is there a proximity of excreta disposal facilities to water sources and water distribution points? What
is the highest static ground water level in the area?
■ Is the latrine construction safe (e.g. pit not too deep, lined pit, lining and slab material that can’t rot
or being infested with termites)?
■ Do the defecation facilities prevent vectors from breeding / feeding in excreta (e.g. is the lid put back
on the defecation hole of a simple latrine, is the net on the ventilation pipe of the VIP latrines intact)?
■ Does the latrine superstructure provide any potential breeding sites for vectors?
■ Is local material used / available for the construction of excreta disposal facilities? Can the use of local
materials have a negative impact on the environment (e.g. deforestation)?
Accessibility:
Check the location of the defecation facilities in the concerned area:
■ What is the minimum and maximum distance in between the defecation facilities and shelters /
buildings? Are there defecation facilities foreseen at public areas (e.g. market, food distribution
points, health facilities)?
■ Is there safe and perennial access to the facilities for women, children, disabled or handicapped
people, as well as for vulnerable groups? Are the defecation facilities situated in a safe location to
avoid sexual violence? Is lighting provided for use at night?
■ Are (hand) washing facilities (with water and soap) and waste bin available in the direct proximity?

■ Are the defecation facilities used (correctly)? If not, why?
■ What are the materials used for anal cleansing?
■ Are the defecation facilities clean / maintained inside but also outside? Is there any visible open
defecation (look behind old buildings and outskirts)?
■ How is the cleaning organized? Who is responsible? What procedures are used? Is cleaning material
available (e.g. brooms, soap, chlorine)? What is the maintenance frequency?
■ Is there a significant presence of flies? Are there any visible signs of (other) vectors ( organisms,
faeces, eggs) in the latrines?

TECH-SAN-160_CH1 22/03/10 10:06 Page 26
Runoff and wastewater

■ Are there any areas of stagnant water: e.g. puddles, blocked gutters, open (domestic) water
containers indoors and outdoors, plant pots, open water storage tanks?
■ Are there vectors present, breeding in/living around stagnant water (e.g. mosquitoes)?
■ Are there specific diseases present related to vector breeding in/living around stagnant water
including malaria, dengue, yellow fever? Cross check with morbidity statistics.
Facilities:
■ Are there any open drainage channels and if so are they maintained regularly to avoid blockage and
formation of standing water ?
■ Is there a separated evacuation system for runoff and wastewater?
■ How is runoff water controlled? Presence of drainage ditches, sewer system (open or closed), others?
■ Where is the runoff water led to (e.g. river, stream, lake, sea, water treatment plant)?
■ How is the wastewater controlled? Is there a presence of drainage ditches or pipes, a sewer system
(open or closed), others? Are there soak away pits / infiltration trenches / evapo-transpiration areas
/ gardens (only for spilled clean water) available? Are they all provided with grease traps?
Operation and Maintenance:

■ Do the people / staff use the right facilities to dispose of wastewater (e.g. sinks)?
■ Are the runoff and wastewater evacuation facilities correctly maintained? Is the grease layer of the
grease trap removed and at what frequency? Where is this grease layer disposed of? Who is
responsible for the maintenance of all the runoff / wastewater facilities? What are the procedures
used? Is maintenance material available?
Refuse (domestic solid waste) disposal
■ What types of solid waste are generated and in what quantity?
Facilities:
■ Are waste collection containers available and what types if present? Do they have holes to evacuate
the leachates? Do they prevent vectors from breeding/feeding in the waste e.g. garbage bins with
lids? What is the quantity and location of the waste collection containers?
■ What kind of waste collection and treatment/disposal system is available: a household or collective
system? What means are available for the collective waste collection? How is the waste
treated/disposed off (e.g. household refuse pits, open fire, incinerator, dumpsite, controlled landfill)?
Do these facilities prevent vectors from breeding/feeding in the waste (e.g. waste pits covered daily
with an compacted layer of soil)?
■ Is there a risk of contamination of water sources due to proximity?
■ Do the people put their waste in the household garbage pits or collective waste bins? If not, why? In
case of household refuse pits, do the people cover it with a lid / compacted soil each time new
garbage is introduced?
■ What is the frequency for the collective waste collection and the treatment/final disposal? Who is
responsible?
■ Is maintenance material for the collective waste bins, the transport means and treatment / final
disposal facilities available, and what kind? Is the maintenance done of these facilities and their
surroundings?
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Medical waste
■ Is the medical waste segregated in different categories? What are the different categories? How
much waste of each category is generated per day (kg/day)? What is done with hazardous waste
(e.g. lab waste, pharmaceutical waste)?
■ Are there any socio-cultural problems linked with medical waste?
■ Do the wastes generated within the health structure have any commercial value for the population?
Do you find them back on the local market (e.g. needles and syringes, expired drugs)?
■ Is there a national legislation concerning medical waste (try to get a copy if existing)? Is it applied in
the health structure?
Facilities:
Check the recipients used to collect the waste per category:
■ What materials are locally available for collection of waste: e.g. plastic 20 l buckets with tight fitting
lid of different colours? Are there specific containers for sharps? Are those safe?
■ Are there separate recipients to collect the waste of the patients, visitors and attendants?
Check if the treatment and/or final disposal of medical waste is done within or outside the health
structure compound:
Within the compound
■ How is the treatment and/or final disposal done for the different kinds of waste? Is there a presence
of a volume reducer or incinerator, safety box reducer and/or glass crusher? Are there sharps, soft
and/or organics waste pits available? If not, are materials locally available for the construction of the
different facilities: e.g. concrete rings for a sharps pit, refractory cement and bricks for an incinerator?
■ Is a waste zone present on the compound grouping all the facilities? Where is it situated within the
compound (distance to buildings, dwellings, dominating wind, good access)? Is the waste zone
protected to avoid non-authorized persons to enter?
Outside the compound
■ Where is the waste treated/disposed of? Is it done under safe and controlled conditions? Are there
appropriate vehicles to do the waste transport towards the treatment/disposal area? Who is
responsible for the transport and treatment/final disposal of the medical waste?

■ Is the medical waste being segregated by the medical staff in the treatment rooms / wards according
to the correct categories?
■ Are there disinfecting and cleaning facilities available for the waste recipients?
■ How often are the (different categories of) wastes being removed from the treatment rooms/wards?
Who is responsible? Is the person adequately trained and equipped for this job?
■ What is the treatment and/or final disposal frequency? Is it done in an acceptable way? Is there a
waste manager? If not who is responsible? Is the person adequately trained and equipped for this
job?
■ How is the waste zone maintained (e.g. procedure, frequency, maintenance of the material)?

TECH-SAN-160_CH1 22/03/10 10:06 Page 28
Vector control
Asses the risk of vector-borne diseases and verify the clinical evidence of the disease among the
affected population. Advice should be sought from local authorities on local disease problems and the
available vector-control resources. The assessment should focus on the following:
■ Is there a difference between epidemic and non-epidemic disease or risk?
■ Is the transmission all year round, or is it seasonal transmission at particular times?
■ What is the immune status of the population? What is the distribution of vulnerable groups (e.g.
children under five, pregnant women, movements of population from low to high transmission zones
or vice versa)?
■ What is the pathogen type and its prevalence?
■ What is the vector species’ behaviour (e.g. mosquito species that feed and rest indoors at night), and
habitat (e.g. stagnant water, open defecation areas, wet latrines, garbage)?
Vector density (e.g. seasonal influence, number of potential breeding sites)
■ Are there existing individual protection and avoidance measures (e.g. are the general water and
sanitation facilities in place and maintained?)
■ What is the knowledge, attitude and practice factors in the affected population (e.g. how do people
think the disease is transmitted, who is considered vulnerable, what do people know about prevention
activities, what are the perceptions about pesticides and Insecticide Residual Spraying, are mosquito
nets being used, how many mosquito nets are required per household considering the normal
sleeping pattern)?
Facilities:
Has the affected population the means to protect themselves from vectors that are considered to be
a significant risk to health:
■ Is control of the human body lice being carried out to an agreed standard where louse-borne typhus
or relapsing fever are a threat?
■ What is the number of households with Long Lasting Insecticidal Nets? Are they using them
(correctly)?
■ What is the number of households that is timely sprayed with appropriate, effective and safe
insecticide?
■ What is the number of households placing bedding in the sun daily?
■ Are rodenticides / rodent traps being used?
■ Are potential rodent / cockroach entrances (e.g. gaps in floors or doorframes) being sealed?
■ Are there fly / mosquito screens on doors and windows?
■ Are local approaches of vector control being used?

■ Are the vector control activities feasible (e.g. access, security, population mobility, logistics)?
■ Is the affected population established in areas with minimal breeding sites of the vector?
■ Is the personnel protected by providing training, protective clothing, supervision, and a restriction on
the number of hours handling pesticides?
■ Are the purchase, transport, storage, disposal of pesticides and application equipment following
international norms? Can they be accounted for at all times?
■ Are the people informed about the potential risks of pesticides and about the schedule for application?
Are they appropriately protected during and after the application of pesticides?
■ Are the choice of pesticide and application method conform to national and international protocols
(e.g. timing of application/re-application is respected)?
■ Is the quality of pesticide and Long Lasting Insecticidal Net conform to international norms?
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Dead bodies
■ What are the cultural practices regarding funeral procedures (e.g. specific funeral rites, type of
cremation, burial)?
■ Is there a health risk due to highly contagious diseases (e.g. cholera, Marburg, Ebola, plague)?
Facilities:
■ Is there a morgue with the needed facilities (e.g. water supply, working tables, safe storage for the
deceased belongings, electricity, refrigerator)?
■ Is there a cemetery / cremation area?
■ What is the distance in between the cemetery / cremation area and dwellings / public buildings /
water resources, others? Is there a risk of water resource contamination?

■ Who prepares the funeral procedures and who is performing them: relatives, local population, military,
aid-agencies?
Remarks
■ Although this checklist encloses the most essential water, hygiene and sanitation information, it is
not exhaustive.
■ This checklist should preferably be used in combination with the health structure and/or camp
checklists (T.B. 1.04; 1.05), according to the context.
■ The data that have been collected (based on this checklist) can be compared during the analysis with
the indicators listed in the essential requirements for health structures/camps (T.B. 1.08; 1.09.)
■ This checklist can also be of help during strategy planning (e.g. site planning for camps; T.B. 1.10).

TECH-SAN-160_CH1 22/03/10 10:06 Page 30
T.B. 1.07 Basic Survey Form

This basic survey form is a ready to use tool which can be applied within the data collection methods
during an initial assessment. It will only provide very limited information but the different checklists
presented here above can be of help to adapt this basic survey form to the specific context.
General
Surveyor: ........................................................................Date: .............................................................

Country:..........................................................................Location: .......................................................
Area surveyed (e.g. type of health structure, camp):............................................................................
Population size / patients: ..............................................Main ethnic group: ........................................
Main actors / programs at location: ......................................................................................................
Climate (e.g. precipitation details, temperature extremes): ..................................................................
Geography (e.g. altitude, type of terrain): .............................................................................................
Remarks: ..............................................................................................................................................
Water supply
Resources: ...........................................................................................................................................
Condition of the water resources: ........................................................................................................
Yield/resource: .....................................................................................................................................
Number of actual users/resource: ........................................................................................................
Users other than direct beneficiaries:...................................................................................................
Water quality: ................................Turbidity (NTU): .............................................................................
pH: .................................................................................................
Free Residual Chlorine (mg/l): ......................................................
Faecal coliforms CFU/100 ml): ......................................................
Type of water treatment: ......................................................................................................................
Centralized water storage (e.g. bladders) : ..........................................................................................
Distance of source / distribution points from users: .............................................................................
Condition of water distribution points: ..................................................................................................
Method of water collection: ..................................................................................................................
Method of household water storage:....................................................................................................
Remarks ( e.g. implementing organization / opinions and attitudes of beneficiaries / cultural
considerations):....................................................................................................................................
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Excreta disposal
General impression (e.g. open defecation / presence of livestock):

...............................................................................
...............................................................................
...............................................................................
Type of latrines: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Type of slabs: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lining of pits: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remaining depth of pits: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of latrines in use: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of actual users/latrine: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Condition and usage of latrines: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of latrines: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Hand washing facilities: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Availability of soap / ashes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Remarks ( e.g. implementing organisation / opinions and attitudes of beneficiaries / cultural
considerations): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Drainage / wastewater management

Number of showers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of actual users/shower: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Condition and usage of showers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of showers: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of washing / laundry places: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Number of actual users/washing or laundry place: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Condition and usage of washing / laundry places: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Location of washing / laundry places: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Slope of area (%): . . . . . . . . . . . . . . . . . . . . . . . .Drainage pattern: . . . . . . . . . . . . . . . . . . . . . . . . . .
Stagnant water sites: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Presence and quality of grease traps: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Presence and quality of infiltration systems (e.g. soak away pit at water points, at showers): .....
Remarks (e.g. implementing organisation / opinions and attitudes of beneficiaries / cultural
considerations): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

TECH-SAN-160_CH1 22/03/10 10:06 Page 32
Domestic waste disposal

Solid waste disposal system (household or collective) and general cleanliness: ................................
.............................................................................................................................................................
Number, quality and condition of public / household waste bins: .........................................................
Number and condition of refuse pits / landfill: ......................................................................................
Remarks (describe their situation / usage):..........................................................................................
.............................................................................................................................................................
Medical waste disposal
Segregation of medical waste (categories): .........................................................................................
Disposal system (onsite or offsite) and general cleanliness:................................................................
.............................................................................................................................................................
Type, number, condition and usage of waste bins and sharps containers: ..........................................
.............................................................................................................................................................
Number, condition and usage of sharps pits: .......................................................................................
Number, condition and usage of organic waste pits:............................................................................
Type, number, condition and usage of incinerator / volume reducer:...................................................
Number, condition and usage of ash pits: ............................................................................................
Remarks (e.g. implementing organisation / opinions and attitudes of beneficiaries / cultural
considerations): ....................................................................................................................................
Vectors
Identify species (if possible) and map sites where most of them are found
(☺: absent; : present; : problematic)
Mosquitoes: ☺// ....................................................Remarks:........................................................
Flies: ☺// ...............................................................Remarks:........................................................
Sand flies: ☺// .......................................................Remarks:........................................................
Fleas: ☺// ..............................................................Remarks:........................................................
Lice: ☺// ................................................................Remarks:........................................................
Rodents: ☺// .........................................................Remarks:........................................................
Mites (Scabies): ☺// ................................................Remarks:........................................................
Other vectors: ☺// .................................................Remarks:........................................................
Current control measures:....................................................................................................................
Remarks ( e.g. implementing organization / opinions and attitudes of affected population): ...............
.............................................................................................................................................................
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Hygiene
Availability and affordability of soap: ....................................................................................................
Describe the presence / absence, quality and functionality of:
Individual hygiene practices (e.g. hand washing, use of laundry):................................................
......................................................................................................................................................
Hygiene / health promotion activities ............................................................................................
......................................................................................................................................................
Staff: ..............................................................................................................................................
......................................................................................................................................................
Training:.........................................................................................................................................
......................................................................................................................................................
Hygiene committees in health structures: .....................................................................................
......................................................................................................................................................
Procedures, equipment, protective clothing for staff (hygiene, cleaning, disinfecting):
......................................................................................................................................................
Remarks: ..............................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................
Miscellaneous
Describe the presence / absence, general hygiene, sanitary facilities for:
Graveyards:...................................................................................................................................
......................................................................................................................................................
Schools:.........................................................................................................................................
......................................................................................................................................................
Markets:.........................................................................................................................................
......................................................................................................................................................
Remarks: ..............................................................................................................................................
.............................................................................................................................................................
.............................................................................................................................................................

TECH-SAN-160_CH1 22/03/10 10:06 Page 34
T.B. 1.08 Essential water and sanitation requirements for health structures
Adequate water and sanitation provisions are medical requirements, since they are essential for
many curative interventions; e.g. water for surgical procedures, maternity, and re-hydration. Water
and sanitation provisions are also essential for preventative interventions. The essential water and
sanitation requirements allow curative actions to be undertaken, and contribute towards reducing
nosocomial infections. The essential requirements are applicable to:
■ The smallest health post through to the largest health structure.
■ Acute emergencies through to chronic emergencies and stabilised situations.
They are linked to the Standard Precautions and respect the fundamental rule not to harm patients,
staff, visitors, and populations surrounding the health structures. In order to have a properly
functional health structure, the essential water and sanitation requirements should be reached, or
preferably even exceeded. However, the essential requirements are not stand-alone standards.
They need to be adapted to the context and should be seen as reference points, not as absolute
rules. They are means to come to a functional health structure from a water and sanitation point of
view.
Human-related activities required for assessment, planning, training, and promotion

The essential requirements list mainly technical criteria, but it is clear that no intervention can be
considered successful if facilities are inappropriate for local conditions, if they are incorrectly used, or
if they are not maintained (correctly). The human-related activities must go hand in hand with any
technical intervention.
Acute emergency Chronic emergencies and stabilised situations

• Initial assessment and analysis • Initial assessment and analysis
• Technical training to the staff • In-depth assessment and analysis with the beneficiaries
• Health education to the • General and technical training to the staff
beneficiaries • Health promotion to the beneficiaries
Staff management
Ensure that the staff are trained, equipped, and managed correctly:
■ Identify and train the Water, Hygiene and Sanitation (WHS) responsible(s)
Small health structures
➞ Cleaner / water and sanitation manager
Large health structures
➞ Technician / water and sanitation manager
■ Provide the necessary administrative and technical tools
➞ Job descriptions for all staff
➞ Appropriate protective clothing when they are involved in hazardous WHS activities
➞ Appropriate tools
■ Vaccination of the staff who are exposed to health risks: Hepatitis B and Tetanus
■ Provide access to the Post-Exposure Prophylaxis (PEP) kit for the staff exposed to HIV/AIDS risks.
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Water
Water quality
Provide water of acceptable quality
“No” pathogens Free residual chlorine concentration at distribution points

• 0.2 - 0.5 mg/l (if pH < 8) minimum 30 minutes contact time
• 0.4 - 1.0 mg/l (if pH > 8 minimum 60 minutes contact time
or max 10 E.Coli/100 ml at discharge points if chlorination is
really not possible (=> water filters highly recommended)
Low turbidity • < 5 NTU

• < 20 NTU is permissible in an acute emergency
Low concentration of Context specific; in case of doubt, contact your technical
compounds that are acutely referent
toxic or that have serious
long-term effects
Acceptable to users • Water is not rejected due to colour, taste, odour or salinity
Water quantity and accessibility

Provide adequate quantities of accessible and reliable water
Health structure / activity Quantity/patient day Max Min. storage

distance to capacity
water point in closable
reservoir
Mobile clinic: infrequent visits 2l 1 day
Mobile clinic: frequent visits 5l
(in fixed tents / existing buildings) 5l
Out-Patient Department (OPD)
In-Patient Department (IPD) / hospital 40 – 60 l*
Operating theatre / maternity 100 l/intervention
(sterilisation not included)
Blanket feeding 0.5 l
(5 l if long waiting time)
Supplementary Feeding Centre (SFC) 5l 100 m 2 days
Ambulatory Therapeutic Feeding Centre 5l
(ATFC)
In-patient Therapeutic Feeding Centre
(ITFC) 30 – 50 l*
Cholera Treatment Centre (CTC) 60 l
SARS isolation 100 l
Viral Hemorrhagic Fever (VHF) Isolation 300 – 400 l*
* Context dependent: e.g. climate, number of patients (for small number of patients, high quantity range)

TECH-SAN-160_CH1 22/03/10 10:06 Page 36
■ For chronic emergencies and stabilised situations, all quantities should preferably be higher. Keep also
in mind that up to 20 % of the water can get lost through leaks and spillage.
■ Water should be accessible to the staff, patients and visitors.
■ Reliable water points should be available within the health structure, certainly at the critical points.
➞ OPD: consultation room, dressing room, waste zone, nearby latrines, sterilization, Ante Natal Care and
immunization, pharmacy.
➞ IPD/hospital: operating theatre, maternity, sterilization, laboratory, waste zone, nearby latrines/toilets,
kitchen, morgue, all wards, laundry, pharmacy.
■ All water collection points must be maintained at least once a week.
Excreta disposal
Provide adequate and appropriate excreta disposal facilities
In-Patient health structures (e.g. IPD, ITFC)
In sufficient quantity • 1 latrine/20 users
➞ assume each patient has 1 visitor/attendant.
➞ (1 + 1 for staff) + (N° of beds x 2)/20
OPD:
• 1 for staff + 1 male + 1 female + 1 children’s latrine (or
potties)
Technically appropriate Acute emergency
(depending on local • Improved trench latrine
constraints) Chronic emergencies and stabilised situations
• Pit latrine / children latrine
• VIP latrine / Double pit VIP latrine
• (Pour) flush latrine (potentially with septic tank and infiltration
system or closed sewer)
Appropriate for users • Facilities must be culturally and socially appropriate
• Separate facilities for staff and patients
• Preferably a separation between male and female (certainly
if culturally necessary)
• In-patient health structures (e.g. IPD, ITFC): some latrines
provided with seats and handlebars for physically impaired
persons
• Children’s latrines provided near to paediatric ward and
feeding centres (or potties)
• Bed pans / urine flasks (or similar local material) for
bedridden patients
Easily accessible • Distance of pit latrines: > 5 m and < 30 m from buildings
At safe location • To avoid risk of sexual violence

• Night lights provided and operating (if feasible)
Convenient hand • Soap, hand washing and waste water facilities provided at
washing facilities exit of latrines
Prevent contamination • Latrines > 30 m away from water resources
of water resources
All excreta disposal facilities must be maintained at least once a day.
1 36
TECH-SAN-160_CH1 22/03/10 10:06 Page 37
Wastewater disposal
Provide bathing facilities
In-Patient health structures (e.g. IPD, ITFC)

In sufficient quantity • 1 (bucket) shower/40 users
➞ Assume each patient has 1 visitor / attendant
➞ (1 + 1 for the staff) + (N° of beds x 2)/40
OPD:
• (bucket) shower (in case of scabies or sexual violence)
Appropriate for users • The facilities must be culturally and socially appropriate
• Separate facilities for the staff and patients
• Separation between male and female (small children can go
to women’s showers)
• In-Patient structures: some showers provided with seats and
handlebars for physically impaired persons
Related facilities • Water supply close by (maximum 5 to 20 m walking

distance)
• Showers connected to wastewater facilities
All shower facilities must be maintained at least once a day.
Provide washing areas for In-Patients structures
• The dishes, if a kitchen is present

Separate washing areas for • The structure’s laundry (e.g. bed sheets) with sufficient
drying lines
• The patients’ laundry (if required)
distance)
• Washing areas connected to wastewater facilities
All washing areas must be maintained at least once a day.

TECH-SAN-160_CH1 22/03/10 10:06 Page 38
Provide adequate wastewater disposal facilities

Pre- Disposal Distance
Type of wastewater treatment between
disposal and
water resource
"Clean" wastewater e.g. from • Soak away pits
tap stand, hand pump (without (emergency)
soap, oil, grease) • Infiltration trenches > 30 m
No • Evapo-transpiration area
(arid zones)
• Properly sealed sewer
system.
"Dirty" wastewater • Soak away pits
(grey water with soap, oil, (emergency)
grease) • Infiltration trenches > 30 m
Grease trap • Evapo-transpiration area
(arid zones)
system
Black water • Soak away pits
(overflow of a septic tank) (emergency)
• Infiltration trenches > 30 m
Septic tank • Evapo-transpiration area
(arid zones)
system
Rain and runoff water No • Natural drainage No
All waste water collection systems and grease traps must be maintained at least once a week.
Medical waste disposal

Provide a safe and secure segregation, collection and temporary storage, potential
treatment and final disposal of all types of waste.
General
■ Install the waste containers for patients / visitors at maximum 5 to 20 m walking distance from where
the waste is generated
■ Provide 3 sharps, 3 soft and 3 organic waste containers per ward (with maximum 20 beds) / treatment
room, one for use, one for rotation, one for spare
Operating theatre
Nearby the operating table, install:
■ 2 sharps containers, 1 for the surgeon, 1 for the anaesthetist
■ 2 soft waste containers of 20 l, 1 for the surgeon, 1 for the anaesthetist
■ 1 big soft waste containers of 60 l (in case the sterilised material is kept in Kraft paper, which will help
to light the volume reducer / incinerator, if kept dry)
■ 1 organic waste container
1 38
TECH-SAN-160_CH1 22/03/10 10:06 Page 39
Sharps
■ Provide appropriate sharps containers in convenient locations (next to the examination table, on a
tray or trolley for mobile use in the wards)
➞ Modified drugs pot (or reusable sharps container if available); if lots of empty ampoules and vials
are generated, a separate glass container can be provided, for them to be crushed afterwards in a
safe glass crusher
➞ Safety box: in case of immunization or for specific waste (e.g. very long needles), possibly also in
the early stages of acute emergency (latter to be avoided if possible)
■ Ensure the regular collection and disposal of sharp waste
■ Provide an appropriate sharps pit:
➞ Concrete lined sealed pit or adapted drum / plastic container in case of acute emergency, small
health post, starting up phase of bigger structures, slum where there isn’t space to construct a
concrete sharps pit
➞ With a Safety Box Reducer if this kind of containers is used in the structure
➞ With a glass crusher if lots of glass waste is generated
Soft waste
■ Provide appropriate soft waste containers (plastic buckets of 20 - 60 l capacity with lid, all with the
same colour) in convenient locations (next to the examination table, on a tray or trolley for mobile
use in the wards)
■ Ensure at least daily collection of the soft waste, with safe temporary storage before (potential)
treatment
■ Ensure disinfection and cleaning of the emptied soft waste containers
■ Provide appropriate treatment and disposal facilities:
➞ Acute emergency
• Drum volume reducer and residues (ash) pit
- Ashes and residues deposited directly in the ash / residues pit
➞ Chronic emergencies and stabilised situations
• De Montfort incinerator (or equivalent) with:
- 2 ash / residues pits
- Ashes and residues deposited directly in the ash / residues pit
• Covered pit if (very) small quantity of waste and/or lots of space available
• Exceptionally, offsite disposal with appropriate transport facilities (e.g. containers, vehicles, waybills)
if urban zone / dense population / no space
Organic waste
■ Provide appropriate organic waste containers (plastic buckets with lid, all of the same colour, but
different than for soft waste) in a convenient location (next to delivery chair, the operating table).
➞ Maternity: 15 to 40 l.
➞ Operating theatre: 20 to 60 l.
■ Ensure immediate collection and disposal of the organic waste.
■ Ensure disinfection and cleaning of the emptied organic waste containers.
■ Provide appropriate final disposal facilities:
➞ Latrine (for placentas but only if very few deliveries, NOT to be used for body parts).
➞ Acute emergency
• Organic waste pit (closed pit, or open pit with contents covered with soil).
➞ Chronic emergencies and stabilised situations
• 2 organic waste pits, each with a fixed cover and a ventilation pipe.
• Exceptionally offsite disposal with appropriate transport facilities (e.g. containers, vehicles, waybills)
if urban zone / dense population / no space.

TECH-SAN-160_CH1 22/03/10 10:06 Page 40
Hazardous waste
■ Ensure that all hazardous waste is disposed of legally, and disposal practices and methods comply
with or exceed country legislation.
■ Ensure that all hazardous waste is disposed of safely (according to the WHO recommendations). If
required, ask advice from your technical referent.
Waste zone
■ Provide a defined waste zone with soft waste storage and all appropriate treatment and disposal
facilities located inside.
■ Install a fence around waste zone.
■ Install a washing area with water point within the waste zone.
■ Install facilities for wastewater evacuation via a grease trap to an appropriate disposal system.
■ Ensure management and supervision by designated and trained person(s).
■ Distance > 50 m from water sources (certainly when organic waste pits are included).
■ The complete waste zone must be maintained daily.
Dead bodies
Dead bodies related to war / famine / natural disasters DO NOT represent a major public health risk. A good
management is needed however to avoid proximity to the dead (psychological effects), odours and
scavengers / vectors. Dead bodies related to epidemics (e.g. cholera, Ebola, Marburg, typhus, plague) DO
represent a public health risk and strict rules have to be followed in order to avoid further disease
transmission (refer to specific guidelines!).
■ Ensure safe storage of bodies prior to burial / cremation

➞ Provide an appropriately sized and located morgue for In-patients structures, with a separate morgue
for the isolation units.
■ Ensure that dead bodies are handled safely, and that appropriate hygiene and disinfection measures are
taken when handling and preparing the bodies.
➞ General
- All persons handling and preparing bodies wear gloves.
- All persons handling and preparing bodies wash hands using water and soap after manipulation.
➞ Epidemics of contagious diseases (refer to specific guidelines!)
- All persons handling, preparing and burying bodies wear appropriate protective equipment
(disease specific).
- All persons handling, preparing and burying bodies wash themselves within the isolation centre
according the appropriate rules (disease specific).
- Safe leak-proof containment of bodies; e.g. body bags for cholera, body bags and coffin for Viral
Hemorrhagic Fevers (disease specific).
- Trained team carry out disinfection of bodies, structures and transport facilities.
- Trained team perform and/or supervise burial (with burial practices to be evaluated in every context).
- Cremation should only by done on specific demand of relatives.
➞ Ensure that handling, preparation, and burial of the bodies is done in a culturally sensitive manner.
Control of vectors
■ Prevent the transmission of vector borne diseases within health structures.
➞ Minimise the survival chance and density of vectors in health structures.
➞ Reduce contact of persons (e.g. patients, staff) with potentially infected vectors.
➞ Reduce contact of vectors with infected patients.
■ Prevent infestation of vectors and nuisance pests in health structures.
■ Provide appropriate vector control facilities, equipment and services in addition to the other water and
sanitation requirements (see table next page):
1 40
TECH-SAN-160_CH1 22/03/10 10:06 Page 41
Mites
Rodents
Fleas
Lice
Sand flies
Flies
Flies
Mosquitoes
Culex
mosquitoes
Aedes
mosquitoes
Anopheles
***: Only when skilled personnel is available.
**: 1 net for the woman & children and 1 net for the man.
*IRS: Insecticide Residual Spraying; LN: Long Lasting Insecticidal Net.
Comm on Ve cto rs
Scrub typhus, Scabies
Hanta Fever
Leptospirosis, Plague,
Salmonellosis,
Lassa fever,
Plague, Typhus
Fever, Trench Fever
Typhus, Relapsing
Leishmaniasis
Eye infections
Enteric infections
Filariasis, Encephalitis,
Dengue, Yellow Fever
Malaria
Comm on Diseas es
X
X
X
Measu res t o t ake f or end emic z ones and/o r h igh p resence of the ve cto r
Proper site selection
X
Vegetation control around health structure

X
X
Impregnated screens in doors and windows
X
2 X IRS* of health structure/year

X
2 X IRS of latrines/year
X
1 LN*/inpatient
X
Patient under LN whole day

X
1 LN/other people sleeping in health structure

X
2 LN**/prenatal consultation process

X
Limit vector breeding sites in and around health

t t
X
Fly traps and/or screens

X
General food hygiene (e.g. proper storage)

X
General hygiene management (e.g. proper waste

di l)
X
2 x per day face and hand hygiene for all patients

X
Insecticidal dusting of incoming patients

X
Airing bedding in sun

X
X
X
Floor washing with 0.2% chlorine solution

X
Poison and/or trap and disposal of rats

X
Insecticidal dusting of rat runs 1 x per week

X
X
Prevent entry of rats to buildings

X
Larviciding***
Extra measu res t o tak e du rin g
X
Space spraying in between and around health

t t ***
X
Insecticidal dusting of incoming patients & spare

l th
X
1 x insecticidal dusting per week - all patients

outbrea ks
X
1 x insecticidal dusting per week - all mats and bed

f
X
Insecticidal dusting of corpses and deceased clothes

X
1 x per week laundry >60°C of all linen and patients’

l thi
X
Laundry >60°C of incoming patients’ clothing

X
Floor washing with 0.2% chlorine solution

X
No animals in health structure

TECH-SAN-160_CH1 22/03/10 10:06 Page 42
T.B. 1.09 Essential water and sanitation requirements in camps

The essential water and sanitation requirements contribute towards reducing water, hygiene and
sanitation related diseases within camps (refugees and internal displaced persons). In order to
have a positive effect, the essential water and sanitation requirements should be reached, and
preferably even be exceeded The essential requirements are applicable to acute through to chronic
emergencies, until stabilised situations. Within the acute phase of an emergency in camps, the
potable water supply and safe excreta disposal are the highest priority within the water and
sanitation activities; vector control, wastewater and solid waste management should still start as
soon as possible. In order to have a positive effect, the essential water and sanitation requirements
should be reached, and preferably even be exceeded. However, the essential requirements are
not stand alone standards. They need to be adapted to the context and should be seen as reference
points, not as absolute rules. They are means to allow acceptable cohabitation of a big population
in a camp from a water and sanitation point of view.
Human-related activities required for assessment, planning, training, and promotion

The essential requirements list mainly technical criteria, but it is clear that no intervention can be
considered successful if the facilities are inappropriate for local conditions, if they are incorrectly used,
or if they are not maintained (correctly). The human-related activities must go hand in hand with any
technical intervention.
Acute emergency Chronic emergencies and stabilised situations

• Initial assessment and analysis • Initial assessment and analysis
• Technical training to the staff • In-depth assessment and analysis with the beneficiaries
• Health education to the • General and technical training to the staff
beneficiaries • Health promotion to the beneficiaries
Staff management
Ensure that the staff are trained, equipped, and managed correctly.
■ Identify and train the WHS responsible(s)
■ Provide the necessary administrative and technical tools
➞ Job descriptions for all staff
➞ Appropriate protective clothing when they are involved in hazardous Water, Hygiene and Sanitation
(WHS) activities
➞ Appropriate tools
1 42
TECH-SAN-160_CH1 22/03/10 10:06 Page 43
Water
Provide adequate and appropriate water supply facilities
The main issues for water supply facilities are their:
■ Quality
■ Quantity
■ Accessibility
Water quality
Provide water of acceptable quality
Free residual chlorine concentration at distribution points
No pathogens • 0.2 - 0.5 mg/l (if pH < 8) minimum 30 minutes contact time
• 0.4 - 1.0 mg/l (if pH > 8) minimum 60 minutes contact time
or max 10 E.Coli/100 ml at discharge points if
chlorination is really not possible
Low turbidity • < 5NTU
• < 20NTU is permissible in an acute emergency
Low concentration of Context specific; in case of doubt, contact your technical
compounds that are acutely referent
toxic or that have serious
long-term effects
Acceptable to users • Water not rejected due to colour, taste, odour or salinity
Regular surveys done at all water points
Water quantity and accessibility

Provide adequate quantities of accessible and reliable water
Quantity/ Max. distance Min. storage capacity
Scenario person/day to source and distribution
Acute emergency: first days No max. distance • Min. collective storage
capacity:
5 l/person (so for 1000
3–5l persons, a bladder of 5 m³
is needed)
• Min. household transport
/ storage capacity: 40
l/household
Acute emergency: as soon as 15 – 20 l • Distribution:
possible
Chronic emergency and 15 – 20 l, but Max. 250 m ➞ 1 tap/200 - 250 persons
stabilised situation no restriction ➞ 1 hand pump/500 (- 750)
on quantity persons
■ Keep in mind that up to 20 % of the water can get lost through leaks and spillage
■ Water could also be foreseen for the beneficiaries’
➞ Cattle: 30 l/animal/day
➞ Small animals (e.g. goats): 5 l/animal/day

TECH-SAN-160_CH1 22/03/10 10:06 Page 44
Excreta disposal
Provide adequate and appropriate excreta disposal facilities
Acute emergency
In sufficient quantity • First days:
➞ Defecation field: 0.5 m²/user day (pathways not included)
➞ Trench latrines: 3.5 m/100 users
➞ 1 (improved trench) latrine/100 users
• As soon as possible: 1 latrine/50 users => 1 latrine/20 users
Chronic emergency and stabilized situation
• 1 latrine/20 users or 1 latrine/4 households
• Family latrines (preferable for hygiene reasons)
Technically appropriate Acute emergency
(depending on local • First days:
constraints) ➞ Defecation fields (arid zones)
➞ Trench latrines
• As soon as possible
➞ Improved trench latrines / pit latrines
Chronic Emergency and stabilised situation
• Pit latrine
• VIP latrine (only if people have already experience with these
facilities)
• (Pour) flush latrine: only if there is:
➞ Cultural acceptance / demand
➞ Enough water and recipients availability for anal cleansing
• Preferably separation between male and female (certainly if
it’s culturally necessary)
• Some latrines provided with seats and handlebars for less
able persons
• Some children’s latrines (1/5 of the population is < 5 years
old)
Easily accessible • Distance of trench latrines: >30m and < 50m from dwellings
• Distance of improved trench latrines / pit latrines: > 5m and <
50m from dwellings
• Guards at defecation fields and trench latrines
( also to explain correct use)
Convenient hand • Soap / ash, hand washing and waste water facilities provided
washing facilities at exit of latrines
Prevent contamination • Latrines > 30 m away from water sources
of water resources (> 50 m in case of defecation areas)
All excreta disposal facilities must be maintained regularly (preferably daily).
1 44
TECH-SAN-160_CH1 22/03/10 10:06 Page 45
Wastewater disposal
Provide personal hygiene facilities
In sufficient quantity • 2 (bucket) showers or washing facilities/community (about 80
persons)
• The facilities must be culturally and socially appropriate
Appropriate for the users • Separation between male and female (small children can go
to the women’s showers)
• The facilities must be culturally and socially appropriate
distance)
• Showers connected to wastewater facilities
Provide washing areas
Separate washing areas for • The dishes if kitchens are present: 1 area/community (about
80 persons)
• The laundry with drying lines (if required): 1 area/community
Appropriate for the users • The facilities must be culturally and socially appropriate
distance)
• Washing areas connected to wastewater facilities
All personal hygiene facilities and washing areas must be maintained regularly
Provide soap
The use of soap reduces the transmission of all kinds of diseases, so foresee soap distribution:
250 g per person a month
Provide adequate wastewater disposal facilities
Grease trap Disposal Distance
Type of wastewater between
disposal and
water resource
Clean" wastewater of water • Little vegetable garden
collection points e.g. tap • Animal drinking trough
stands, hand pumps • Soak away pit > 10 m
(without soap, oil, grease) No • Infiltration trenches
system.
"Dirty" wastewater • Soak away pit
(grey water with soap, oil, • Infiltration trenches
grease) • Evapo-transpiration area > 30 m
Yes (arid zone)
system
Rain and runoff water No Natural drainage
(to be planned from the start)
All waste water systems must be maintained at least once per week

TECH-SAN-160_CH1 22/03/10 10:06 Page 46
Domestic waste disposal

Provide safe and secure storage and final disposal of all types of waste.
Collective (emergency) Household (stabilized situation)

Temporary storage • 100 - 125 litre drums • Waste bin (e.g. bucket)
Collection • Teams • Household member
Transport • Cart / vehicle • By hand
Treatment • Not recommended • Not recommended
Final disposal • Controlled tip • Domestic refuse pit
In emergencies, it’s often easier for the aid-agency to install a collective system, because the
household system demands a good training and collaboration of the beneficiaries which might be
difficult to obtain, especially in the initial phase. However, in the long run, a household system is
cheaper and more “sustainable”.
Collective domestic waste management system:
Temporary storage Collection and transport Final disposal
• 2 bins/community • Establishment of circuits • Controlled tip

(about 80 persons) • Constitution of teams (2.5 • > 1 km from dwellings
• Lid on the drums (to avoid persons/1000 inhabitants) • Fenced
dispersion by wind and animals) • Allocation of circuit to each • Evacuation of runoff water
team
• Daily collection
Household domestic waste management system:
Temporary storage Collection and transport Final disposal
• 20 litre bucket with lid per • Good practice of population • 1 pit/household or several
household required, thus need for: households
➞ Training • Need for a fence
➞ Discipline • Waste covered (soil or lid)
after each disposal
• Need for the population to
re-dig a hole when the old
one is full
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TECH-SAN-160_CH1 22/03/10 10:06 Page 47
Dead bodies management

Dead bodies related to war / famine / natural disasters DO NOT represent a major public health risk.
A good management is needed however to avoid proximity to the dead (psychological effects), odours
and scavengers / vectors. Dead bodies related to epidemics (e.g. cholera, Ebola, Marburg, typhus,
plague) DO represent a public health risk and strict rules have to be followed in order to avoid further
disease transmission (refer to specific guidelines!).
War / Famine / Natural disaster Epidemics (cholera,

haemorrhagic fevers)
Body preparation • No disinfection of body needed • Disinfection of the body and
and dressing • Body dressing depending on (disease specific; according to the
local customs and/or availability: specific guidelines)
coffin / shroud (cloth) / blanket / • Sealed body bags (+ coffins)
sleeping mat / body bag (disease specific)
Burial / cremation • Relatives • Trained and protected personnel
procedures by: • Aid-agencies potentially in case of the aid-agency due to the very
of mass burial high contamination risk:
➞ Disinfecting the body, living
environment, health structure
➞ Burial team (at least supervision)
Personal protection Hand washing with soap According to the specific
guidelines related to the diseases
• Complete spraying of the staff
with a chlorine solution
• Complete protective gear for
staff
Other help from Providing / involved in (if needed): Providing / involved in:
aid-agencies • Morgue in health structure • Morgue in the isolation centre
• Selection of the burial / cremation • Selection of the burial site
site • Sealed body bags / impervious
• Body dressing material wrappings
• Potential transport of the bodies • Transport of the bodies
Ensure that the handling, preparation, and burial / cremation of the bodies is done in a culturally
sensitive manner

TECH-SAN-160_CH1 22/03/10 10:06 Page 48
Burial Cremation
Preferred option in all situations Only when strictly demanded by the population
for religious / cultural reasons
Burial site: Cremation site:
• > 50 m away from potable water resources • > 500 m away from the dwellings
• > 500 m away from the dwellings • of the dwellings
• 1500 m²/10.000 inhabitants
• Graves:
➞ Preferably individual graves
➞ Mass graves if really necessary (but trenches
for people to be buried head to toe)
• Respect local customs:
• Orientation of the graves
• Position of the body in the grave
• Separate burial areas for different religions
Burial depth: Needs:
• > 1.5 m under surface • At least 300 kg of firewood per body
• > 1.5 m above highest water table (rainy • Experienced people for the cremation
season)
Control of vectors
Provide appropriate vector control facilities, equipment, and services

■ Prevent transmission of vector borne diseases within camps
➞ Minimise the survival chance of vectors in camps.
➞ Reduce contact of population with potentially infected vectors.
➞ Reduce contact of vectors with infected persons.
■ Prevent infestation of vectors and nuisance pests in camp
■ Provide appropriate vector control facilities, equipment and services in addition to the other water and
sanitation requirements (see Table hereunder).
1 48
Lice
Flies
Flies
Mites
Fleas
Aedes
Rodents
Sand flies
TECH-SAN-160_CH1
Anopheles
Mosquitoes
Mosquitoes
Common vectors
Fever
22/03/10
Malaria
Scabies
Lassa fever,
Leptospirosis,
Eye infections
Leishmaniasis
Salmonellosis,
Plague, Typhus
Dengue, Yellow
10:06
Enteric infections
Common diseases
Typhus, Relapsing
Fever, Trench Fever
Plague, Hanta Fever

X
X
X
X
X
X
Proper site selection
X
X
X
X
X
X
X
vector
2 X IRS* of all dwellings / year

Page 49
**: Only when skilled personnel is available.

X
X
2 X IRS of all latrines / year
X
X
X
X
X
X
1 LN*/sleeping place
X
X
X
X
X
Limit vector breeding sites in and around camp
X
X
Fly traps and/or screens
X
X
General food hygiene
Measures to take for endemic
X
Airing bedding in sun
zones and/or high presence of the
X
Promote 2 X per day face and hand hygiene for entire camp
*IRS: Insecticide Residual Spraying; LN: Long-Lasting Insecticidal Net.

X
X
Poison and/or trap and dispose of rats
X
X
Insecticidal dusting of incoming persons
X
outbreaks
Larviciding** and/or promote emptying stagnant water every

X
Space spraying 300 m around dwelling of confirmed case

X
X
Follow-up insecticidal dusting on request
X
X
1 X insecticidal dusting mats, bed frames, clothes in
X
X
Insecticidal dusting of corpses and deceased clothes
1
Extra measures to take during
X
X
Promote absence of animals in dwellings
49
TECH-SAN-160_CH1 22/03/10 10:06 Page 50
T.B. 1.10 Site planning of camps

A large influx of people to a site requires the rapid installation of infrastructures, which meet the
priority needs of the population. The health status of refugees / displaced persons depends directly
on the operational capacity of those responsible for their protection and assistance. Proper selection
and planning of an appropriate site will make sure that good infrastructures can be achieved and
that the camp is situated in an environment that does not have a negative impact on people’s health.
Procedure
Having chosen the site according to key criteria (T.B. 1.05), there are a series of decisions and specific
activities that need to take place:
■ Prepare a map of the site including amongst others the water resources, the existing defecation areas,
the surface drainage patterns, the available space for a cemetery and potentially a controlled tip.
■ Determine the needs for services and infrastructures, based on the estimated population size.
■ Define the size of the camp and its sub-divisions to facilitate camp management.
■ Design the camp layout.
■ Define the responsibilities in the camp (e.g. which aid-agency is in charge of water supply).
■ List the resources needed (budgetary, logistic, human) according to the respective responsibilities taken
by the aid-agencies.
Mapping
In order to see how much land is available, it’s important to have a map of the available site. One way
of obtaining this map can is by the mapping method (T.B. 1.02.). In this stage, it might be interesting
to have a map with a bigger scale than 1/10 000 to be able to indicate more details. Information on the
slopes of the camp can be obtained by doing a topographic survey (T.B. 2.24). As such, the map will
also be an interesting tool for the camp design.
Needs
Listed below are the service and infrastructure needs that are common to most camps:
■ Water and sanitation facilities; a priority issue when designing the layout.
■ Roads
■ Warehouses, food distribution points
■ Shelter (type and number)
■ Administrative structures (e.g. screening, registration)
■ Medical and nutrition structures
■ Personnel accommodation
■ Community facilities (e.g. market, cultural centre, workshops, schools, religious structures, recreation
grounds).
Size definition
The size of the camp will depend on the available space of the selected site. But it’s preferable not to
make too big camps for management purposes, even if the availability of space would permit it. Ideally,
a camp should host maximum 20,000 people in subdivisions of 5,000 persons. Be aware that the site
should also offer space for firebreaks, a cemetery and a landfill. Additional space should be preserved
for a potential extension of the camp.
Area available/person : 30 m² (including area for dwellings, firebreaks, storage,

administration, market, dispensary, cemetery, landfill)
: 45 m² (if small vegetable gardens are required
additionally)
Dwelling space/person : 3.5 m² (4.5 – 5.5 m² in cold climates)
Firebreaks : 30 - 75 m strip every 300 m
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Camp Design
All the necessary structures / facilities should be added to the initial map and the way that shelters are
to be grouped decided. This decision will eventually affect the correct use of latrines and water points.
Security for the population and re-establishment of its social fabric should also be considered when
deciding on the shelter layout.
Water and sanitation facilities
Water and sanitation facilities are a priority issue when designing the overall layout of a camp. In case
the water resources are located inside or nearby the camp site, it is important to protect them from
(further) contamination; a correct location of the water intake and the evacuation places of runoff water.
Latrines, showers and washing facilities should be located at places that won’t contaminate the water
resources, but not too far and too isolated either in order to prevent sexual violence. These places
should preferably be well lighted at night. A landfill and cemetery / cremation site will have to be located
at appropriate places as well: away from water resources, and at a minimum distance and downwind
from camp dwellings and potential population housing.
Additional information on water and sanitation facilities within camps can be found in T.Bs.1.06 and
1.09.
Roads and direction signs
The road system within the camp should be organized according to structures / facilities that should
be easily reachable and according to the shelter layout. In order to preserve their condition, the roads
should have a drainage system which should be connected to the general drainage system of the
camp.
Direction signs / logos are also important within the camp: they should enable the easy identification
of zones with different activities and of each residential area, for visitors as well as for residents. Signs
/ logos should be understandable for everybody, given that not everybody knows how to read or
masters international as well as local languages. For large camps, a detailed plan placed at the
entrance may be necessary.
Shelter lay out and type of dwelling
Several blueprints for shelter layout exist, but the cultural habits of the population concerned should
be the guiding principle.
Avoid layouts in lines and rows; they increase distances from dwellings to latrines and water points.
On the other hand, this method can be implemented quickly and it is better than no planning at all. Give
preference to a shelter layout per community unit, without separating families. The basic community
unit is formed by grouping 16 shelters in a square or rectangle around a communal space. Latrines,
water points and washing areas may be placed around the community unit. Spaces for community
facilities and services are created by leaving out a number of basic units according to the space
required.
Distance between two tents / shelters : 2 m minimum, but preferably twice the size of the
overall height of the shelters (to avoid damage when
a neighbouring shelter collapses), or even 3 – 4
times the height if the shelters are made from highly
inflammable material (straw, thatch)
Distance between two rows : 10 m
Tents are often used in the initial phase. Apart the fact that they do not last long, they are expensive
to buy and to transport. It is often more feasible therefore, to use locally available construction materials
(e.g. planks, corrugated iron sheets).While more durable dwellings are being built, plastic sheeting
may be used stretched over ropes and poles for temporary shelters.

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Energy and lighting

Energy is needed essentially for cooking food, but sometimes also for heating. Wood is the most
common energy source used, but it may be logistically difficult to supply and it involves
politico-ecological problems because of deforestation.
Lighting is desirable in the camp as a whole because it reduces insecurity and allows better access
to sanitary facilities. Take into consideration however that the installation of an electricity supply system
in the camp may cause safety problems (e.g. illegal connections), as well as troubles with the local
population if they do not have access to electricity (which is often the case). Electricity is indispensable
though in health centres open at night like an isolation ward, a Cholera Treatment Centre (CTC) and
an In-patient Therapeutic Feeding Centre (ITFC).
Responsibilities
The selection and general planning is normally done by the official authorities (e.g. UNHCR, local
authorities), but involvement of Non Governmental Organisations (NGO) is recommended. The
selection and planning of a site should preferably be done by a multi disciplinary team that consists of
a medical person, a logistician and a water, hygiene and sanitation technician / engineer.
Besides the general planning, it will have to be decided what will be the respective responsibilities of
each aid-agency regarding the installation of the different services and infrastructures to respond to
the different needs of the beneficiaries. The aid-agencies should be accountable for the engagements
taken.
Resources
According to the responsibilities / engagements taken, budgetary, logistic and human resources will
be needed. These could be defined by means of the logic framework, which is an interesting tool in
the strategy planning.
Remarks
■ In the initial phases of the emergency, it is very hard to gauge, with any confidence, the likely duration
of the camp. Therefore it is best to select, plan and install the site within the briefest delay possible.
However, as the camp may remain for many years, a long- term view is recommended.
■ To avoid becoming overtaken by the events later, it is important to establish short and medium-term
plans from the beginning, allowing for a probable population increase.
■ Coordination in between the different aid-agencies (e.g. UN, Red Cross, international and national
NGO’s) and potentially the national and community authorities is of utmost importance in the
planning, implementation and running of a camp.
■ Where possible, encourage the involvement of women and men in the planning of the site.
■ Site planning has very often to be done for a camp which is already established. Therefore it becomes
a job of reorganization. This is much more difficult to achieve due to problems in doing topographical
surveys because of congestion, in overcoming reluctance to change from the beneficiaries and the
aid teams.
■ In case a reorganisation of the camp is necessary, it is recommended to do this section by section.
To do so, a new plot of land with the correct size of a section should be available and prepared, prior
to moving the population of a first section. The liberated space they have left behind them can then
be reorganized and prepared for a second section to move, and so on.
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TECH-SAN-160_CH2 17/05/10 11:19 Page 1
Water Supply
Narrative
Technical briefs
T.B. 2.01 Water intakes
T.B. 2.02 Description of a hand dug well
T.B. 2.03 Cleaning and disinfection of a well
T.B. 2.04 Protecting a shallow well
T.B. 2.05 Mortar and concrete preparation
T.B. 2.06 Fabricating concrete rings
T.B. 2.07 Jetting
T.B. 2.08 Protecting a spring
T.B. 2.09 Rainwater harvesting
T.B. 2.10 Water analysis
T.B. 2.11 Water sampling
T.B. 2.12 Water treatment methods
T.B. 2.13 Turbidity measurement
T.B. 2.14 Coagulants / flocculants
T.B. 2.15 Jar test for coagulants
T.B. 2.16 Assisted batch sedimentation
T.B. 2.17 Filtration methods
T.B. 2.18 Ceramic candle filters
T.B. 2.19 Chlorine-generating products
T.B. 2.20 Preparation and use of chlorine solutions
for disinfection
T.B. 2.21 Batch chlorination of drinking water
T.B. 2.22 Monitoring chlorination
T.B. 2.23 Controlled bucket chlorination
T.B. 2.24 Basic topographic survey
T.B. 2.25 Centrifugal pumps
T.B. 2.26 Information required to identify a centrifugal pump
T.B. 2.27 Determination of the maximum pumping rate of a well
T.B. 2.28 Motor pump kit installation
T.B. 2.29 Submersible pump installation
T.B. 2.30 Pipes for potable water supply
T.B. 2.31 Head losses
T.B. 2.32 Calculation of a simple pipeline
T.B. 2.33 Pipe installation
T.B. 2.34 Water trucking
T.B. 2.35 Emergency water tanks
T.B. 2.36 Installation of flexible reservoirs
T.B. 2.37 Cleaning of flexible reservoirs
T.B. 2.38 Ferrocement tank
T.B. 2.39 Distribution tapstand
Chapter 2
1
Water Supply - draft 2
TECH-SAN-160_CH2 17/05/10 11:19 Page 2
2
2 Water Supply - draft
TECH-SAN-160_CH2 17/05/10 11:19 Page 3
2.1 Why is water important to human beings?

Water is indispensable for human life, in adequate quantity and quality. Without water, human beings cannot
live for more than a few days. It plays a vital role in nearly every function of the body. But besides being a
vital element of (public) health and well-being, water is also related to most of human activities. Also, a health
structure cannot function properly without a reliable source of clean water.
Water is often also related to quite some health problems, so appropriate attention should be given to it.
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TECH-SAN-160_CH2 17/05/10 11:19 Page 4
Water related infectious diseases can be classified according to their transmission routes:
■ Water-borne diseases: caused by the ingestion of water containing pathogenic micro-organisms. Water can be
a transmission route of certain diseases when it has been contaminated by faeces or urine of human beings
or warm-blooded animals. But some of these diseases may also be transmitted by any of the other faecal-oral
routes like dirty hands and contaminated food, which are grouped in water-washed diseases.
■ Water-washed diseases: due to lack of proper domestic and personal hygiene. Insufficient water supply is
one factor leading to improper hygiene. The diseases linked to lack of water for hygiene are:
➞ Faecal-orally transmitted diseases: lack of hygiene, particularly of hands and food, allows the transmission
of these diseases from infected individuals and animals (sick or healthy carriers) to uninfected individuals.
This results in the so-called “dirty hands diseases”.
➞ Dermatological and ophthalmic diseases: lack of personal hygiene can lead to skin and eye infections.
➞ Diseases transmitted by lice: lack of personal hygiene and washing of clothes encourages the proliferation
of lice which, in addition to the problems caused by their presence (itching and scratching, skin sores), are
disease vectors.
■ Water-based diseases: their causal agent (pathogen) has to pass part of its life-cycle in an intermediate
organism (host) that is living in the water.
■ Water-related insect vector diseases: are related with an insect vector which develops in or lives near
water.
2.2 What is a safe water supply?

A safe water supply has the objective to ensure the access of the consumers to correct quantities of good
quality water.
2.2.1 Quantity
In tropical climates, the daily minimum volume of water required for survival (drinking and cooking) would be
around 3 to 5 litres per person per day, because the human body needs a minimum intake to sustain life
before mild and then severe dehydration occurs. It is estimated that 2.6 litres of water per day is lost through
respiratory loss, (insensible) perspiration, urination and defecation. In addition, a significant quantity of water
is lost through sensible perspiration if hard work is performed.
The need for domestic water supplies for basic health protection exceeds the minimum required for survival.
Additional volumes should be foreseen for maintaining domestic and personal hygiene through food and
hand washing, bathing and laundry. Therefore should the survival quantity be increased as soon as possible
because insufficient water quantities will induce poor hygiene, which in turn will cause all kinds of
water-washed diseases. Domestic water supply should thus be minimal 15 to 20 litres per person per day
(T.B. 1.09). Where possible, it is better not to put any limit on consumption as the health status of the
population is influenced by the quantity of water used. The quantities of water used worldwide depend on
many variables and cultural practices
In the first phase of an emergency, it is preferable to have a lot of water of average quality than a little
amount of water of very good quality. A soon as possible, high quantities of good quality water must be
delivered however.
Besides the water needed by the population itself, additional water might be necessary for special needs like
cattle (e.g. 30 l per animal per day) and certainly to cover the losses due to leaks and spillages (up to 20 %).
Health structures including inpatients and outpatients departments, and specific health facilities such as
cholera treatment and feeding centres will always require considerable amounts of water of good quality, even
in acute emergencies (T.B. 1.08). When these essential water requirements can’t be reached, the correct
functioning of the health structure will be jeopardized. In later phases of emergencies and in stabilized
situations, the water quantities should be increased because the water demand will most probably rise
(improved medical activities, but also more “domestic” activities by and for the patients and their visitors,
such as showering and doing the laundry).
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According to the needs, it is important to evaluate the amount of water that can be supplied to cover those
requirements. The objective should be to secure water sources that provide more water in 24 hours than the
strict daily volume required for the targeted purpose. In health structures, it is strongly recommended to have
a reserve storage capacity lasting for at least two days in order to cope with a water supply failure.
2.2.2 Quality
For water to be potable, it must have following characteristics:
■ Contains no pathogens (good microbiological quality).
■ Contains no or only a harmless concentration of toxic chemical products.
■ Has a low turbidity.
■ Has a low salinity.
■ Has no taste, colour or odour (smell).
■ Is not corrosive and doesn’t favour encrustation.
One has also to keep in mind however that there is no direct relationship between the appearance of a water
sample and its drinkability (a cloudy sample may be safe, whereas a clear sample may be both chemically
and biologically dangerous).
Microbiological quality
Water can be the cause of diseases, which can spread epidemically in a (concentrated) population. Five
categories of pathogens can be found in water: bacteria, viruses, protozoa, helminths (eggs) and fungi. Water
contaminated with (one of) these biological elements can cause a variety of communicable diseases through
ingestion or physical contact. The potential consequences are such that microbial contamination control is
always of paramount importance and can never be compromised (T.B 2.10).
Chemical quality
Chemical contaminants present in the water might have been introduced naturally, caused by the geological
structure of the underground, or man-made due to (intensive) agricultural and industrial activities. Removing
chemicals from water often proves to be an expensive and very difficult task. The choice of the water source
will therefore be of utmost importance.
The chemical quality of drinking water can have a direct health implication, due to the absence of necessary
chemical constituents (although very rare) or by the excessive presence of certain chemical elements. This
is a rapidly increasing problem in low-income countries. Most of the human intake of chemicals occurs
through the food, not via the drinking water however.
The health risk due to toxic chemicals in drinking water differs from that caused by microbiological
contaminants. The problems associated with chemical constituents at a low concentration within drinking
water arise primarily from their ability to cause adverse health effects after prolonged periods (years) of
exposure. High concentrations of chemicals in the potable water supply, and certainly massive (accidental)
contamination can cause serious (acute) health problems.
The chemical contaminants (T.B 2.10) can be harmful organics like pesticides or harmful inorganic products
such as:
■ Arsenic: which is widely distributed throughout the Earth’s crust, and of great concern for instance in
Pakistan and Bangladesh as it is carcinogenic.
■ Fluoride: which is an element of importance in eastern Africa. A high concentration carries an increasing
risk of dental fluorosis, and can lead to skeletal fluorosis.
■ Mercury: which presence should be suspected in areas where gold extraction is carried out. It is a toxic
heavy metal.
■ Nitrates: which are introduced by over-fertilizing or due to high amounts of excreta (mainly urine) being
disposed of in very dense population settings (e.g. a refugee camp). A relatively low concentration of
nitrates can already cause methaemoglobinaemia in newborn babies (blue-babies disease).
■ Nitrites: which is a reduced form of nitrates can be introduced by backfilling wells with termite hills and can
lead to immediate death.
5
Control measures for water related infectious diseases
2
Diseases Water-borne Water-washed Water-based Water-related
insect vectors
6
Faeco-oral Skin / eye Lice related
TECH-SAN-160_CH2
Cholera Cholera infections Louse-borne typhus Bilharzias Malaria

Dysentery Diarrhoeas Scabies Recurrent fever Dracunculosis Dengue
Giardiasis Dysenteries Conjunctivitis Tra- (Guinea worm) Yellow fever
Hepatitis A Hepatitis A choma
Poliomyelitis (Para)typhoid fevers
Typhoid fever Poliomyelitis
Various helminths
17/05/10
Control measures diseases

Improve water qua- X - - - X -
lity: source protec-
tion, water treatment
11:19
Increase water - X X X - -
quantity
Improve water X X X X X -
accessibility
Page 6
Reduction of the - - - - X -
contact with the in-
fected water
Improve the environ- X X - - X X
mental sanitation:
latrines, drainage,
waste (water)
Water Supply - draft

elimination
Choice of - - - - X X
settlement site
Correct household X X X X - X
water storage:
quality / quantity
Improve personal - X X X - -
hygiene
Improve food hand- - X - - - -
ling and preparation
Use of pesticides - - - X X X
e.g. snail control
Personal protection - - - X -
(e.g. bed nets)
Health promotion X X X X X X
TECH-SAN-160_CH2 17/05/10 11:19 Page 7
Turbidity
This characteristic is a measure of the amount of suspensible particles in the water (T.B. 2.13). The turbidity
of water is mainly of importance because it inhibits the effectiveness of disinfection (T.B. 2.13 and 2.21) and
hence the correct microbiological quality of the water. Turbidity will also directly affect the acceptance of the
water by the consumers.
Salinity
Salinity is a measure of the amount of dissolved salts in the water which should be low for the acceptability
of the consumers, and to avoid corrosion of the equipment. A high salinity concentration can also cause
negative health effects such as diarrhoea, vomiting and renal failure.
Colour, taste and odour (smell)
Colour, taste and smell are characteristics due to the presence of some micro-organisms and/or chemical
substances in the water.
Corrosion and encrustation
Corrosion can also be caused by the high acidity (low pH) of the water, and encrustation is due to certain
minerals (e.g. calcium carbonate). Both may affect the longevity of equipment (e.g. pipes, pumps). The pH
also has a serious influence on water treatment procedures (e.g. coagulation / flocculation, chlorination).
The chemical water quality and/or the above mentioned characteristics may affect a consumer’s acceptance
to drink that particular water, therefore turning to more palatable but potentially biologically unsafe water
from a contaminated source. As such, these factors can also become an indirect health hazard.
2.2.3 Accessibility
Efforts to obtain sufficient water quantities of correct quality are ineffective if the beneficiaries don’t have a
rather easy and nearby access to it. The further the distance in between the water discharge / distribution
point and the beneficiaries living area, the less water they will collect. In case water has to be paid for, it will
probably reduce the amount of water that is collected. To avoid problems of long queuing, which could result
in aggression, enough water points should be foreseen. Besides the installed procedures and facilities to get
the water unhampered in quantity and quality to the beneficiaries, correct transport and storage recipients
at household level are essential as well.
2.3 Where/When should a water supply system be implemented

and by Who?
2.3.1 Water supply for patients
Whatever the context, water is essential for the functioning of a health structure. From the start, even in
acute emergencies, it will be crucial for the aid-agency to provide the required quantities of high quality water
(T.B. 1.08). In case good quality water sources aren’t available on the spot, water trucking and/or appropriate
treatment procedures will have to be implemented. In stabilized situations, the preferred choice would be
water sources requiring as little as possible external interventions such as treatment involving chemicals, with
the possible exception of chlorine since its use is always recommended to disinfect water in health structures.
2.3.2 Water supply for populations
Water is needed in all places where people are living, such as camps, urban and rural areas. The choice of
the water sources and of the actors involved in managing the water system is very much context related. In
practice, there is rarely a wide choice between different water sources, particularly in (the first phase of)
emergency situations.
Population in an acute emergency situation
In the acute phase of an emergency, the main concern will be to provide enough clean water to the
beneficiaries. Therefore, if there is no available supply of good quality water (e.g. town water supply, spring,
borehole), the fastest way to extract water is usually to take surface water, and then to treat it. Be sure
however that the surface water is of sufficient quality in order to be treatable. In order not to diminish the
quality of the surface water by human actions, the first step is to foresee a protected drinking water collection
area upstream of dirty activities (e.g. laundry, personal hygiene), and a zone for animal watering downstream.
Often in emergencies, aid-agencies might have to support or install and run the water chain.
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Population in a chronic emergency / stabilized situation

Once the situation starts to stabilize, the investigation for a better quality and/or a more reliable water source
(like groundwater) should begin. The beneficiaries should be involved in this process as well. It might also
be important to provide water not only to the people affected by the emergency, such as the refugees, but
also to the host population.
For all the scenarios described above, it is strongly recommended to verify always if there are potential local
partners, such as national NGO’s, water companies, municipal water supplies or water committees. They can
be of help for instance in indicating existing water resources, in providing water, in monitoring water quality,
and be involved in operation and maintenance follow up.
When a new water source is put into service and if the infrastructures are available, water sampling and
analysis should be undertaken by the appropriate (national) authorities, according to the national standards.
In this way, the local government will be involved in the process and the responsibility transferred to them.
In acute emergencies however, this procedure might be more complicated.
2.4 How to set up a water supply system?

2.4.1 Planning and organisation
For correct planning and organisation of a water supply system, it is necessary to follow all the different
steps described in chapter 1, even for acute emergencies.
As water is essential for human survival and the good functioning of a health structure from the very first
phase of an emergency already, only simple and rapid (often temporary) water supply solutions should be
chosen in the beginning. An initial assessment to collect some basic data on the demography, the practices
of the population (e.g. where and how do they collect water and where do they defecate, do they have a
private water source), the physical nature of the site, the available water sources (and their capacity to
respond to the needs) and the available material are sufficient to determine the acute emergency strategy.
The first implementation priority will be to protect the source from (faecal) contamination, with amongst other
basic means, the installation of simple defecation facilities (T.B. 3.01, 3.02 and 3.03) far enough from the
water source. In case the storage capacity of the users would be insufficient, recipients should be provided
immediately as well.
Within days, it should be possible to augment the water availability by setting up a basic supply system with
increased protection of the water source (possibly more than one at this stage), potential treatment (at least
chlorination), reservoirs and distribution points. As the situation changes daily, the monitoring will be essential
to adapt the system rapidly to the actual needs. The first evaluation should have as an objective to look if
the time has come to install less vulnerable systems.
Chronic emergencies and stabilized situations often demand less vulnerable water supply systems. This
means that a lot more information needs to be collected and analyzed (e.g. topographic survey, T.B. 2.24)
during an in-depth assessment before the strategy can be completely developed. As there isn’t a real urgency
(anymore), a lot more time and care can be spent on the implementation, monitoring and evaluation of the
complete water supply system.
Whatever the context, the chosen strategy will depend largely on the selected water source. Three potential
drinking water sources can be distinguished: surface water, groundwater and rainwater.
Surface water
Water that does not infiltrate into the ground is called surface water. As the water flows at the surface, it is
exposed to all kinds of microbiological, chemical and physical contaminants, which may be harmful to
humans. All surface water is considered to be contaminated unless proven otherwise. Common types of
surface water include runoff water, rivers, streams, lakes, and swamps. Because of its easiness to locate and
to access, it is often the primary water source in acute emergencies. This doesn’t mean however that other
water sources shouldn’t be considered from the start as well
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Water running in the top layers of the soil are also considered as surface water, because the filtration process
through the soil has not been completed. An arbitrary limit of 3 meters is usually considered as the limit
between surface and groundwater. Even if a river is dry, there may be an important quantity of surface water
underneath the river bed.
Groundwater
Groundwater is water that is stored in porous underground layers, called aquifers. Most groundwater
originates from precipitation that soaks into the ground. Generally the groundwater will progress in the
direction of the oceans, either by movement through the ground or by flowing out (becoming surface water)
and joining rivers or streams.
Groundwater is found in most parts of the world and can be a reliable source of drinking water. It is generally
free from microbiological contamination, if it is protected correctly and no contamination sources are in the
neighbourhood. However, groundwater can pick up minerals from the underground, which have a potential
influence on the correct chemical and physical quality of the water. For deep groundwater, there is a lower
seasonal flow variation than for surface water.
A well is a hole that pierces an aquifer so that groundwater can be pumped or lifted out. Usually, the hole that
pierces the aquifer is called a hand dug well (T.B. 2.01; 2.02) if it has been excavated manually, and a
borehole or tube well if it is made with special equipment (e.g. drilling rig, jetting; T.B. 2.07). Capitalize as
much as possible on local knowledge for the right localisation of a new well and/or ask advise to your technical
referent. Protecting a well is of utmost importance to avoid its contamination (T.B. 2.04).
Springs and seeps may be the resurgence of groundwater. These sources are interesting as they often
combine good microbiological water quality with reasonably easy access. The protection of springs will be
of prime importance to avoid its good quality water getting contaminated (T.B. 2.08). An inconvenience of
springs might be their variable water yield over the different seasons, or they may even dry up completely.
Precipitation (mainly rainwater)
Rainwater in non-industrialized and non-urban areas presents good quality characteristics. It may represent
an important source of water, although its variability in quantity over the seasons is important. Rainwater
can be collected from any clean surface, with roof catchments being used most often. The contamination of
harvested rainwater comes primarily from the first rains, rinsing away the accumulated dirt on the roof. Correct
techniques of rainwater harvesting will remove this contamination first (T.B. 2.09) before the water is stored
in reservoirs (e.g. T.B. 2.38) that potentially need to be (very) big.
Table 2.1: comparison between advantages and disadvantages of the different water sources
Advantages Disadvantages
Surface water • Relatively big quantities • Usually contaminated, and to be
• Easier extraction considered as unsafe.
• Easy to discover • Always need for treatment
Groundwater* • Generally of good microbiological • May be subject to chemical
quality if correctly protected contamination;
• Needs to be extracted,
except for springs
Precipitation • In rural areas, it is of drinking • Very important variability in quantity
(rainwater) quality if correctly collected • Needs big storage capacity
• Easy to collect to cover dry periods
* An aquifer less than 3 m deep has the characteristics of surface water.
All water sources can potentially be taken into account for water supply, possibly even a combination of
different ones. It is always better to use non-polluted water than to try to treat polluted water. But it is useless
to focus on water quality alone if all other faecal-oral transmission routes are open: e.g. excreta is scattered
everywhere and flies have unhindered access to food.
Operation and maintenance procedures are often forgotten when a water supply system is installed. This
should already be taken into consideration when the water source is chosen, certainly if the beneficiaries
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(water committee) will have to operate and maintain the system themselves.Surface water will always
demand a treatment and potentially a distribution system, thus intense operation and maintenance will be
required. But also a protected well with a hand pump needs operation and maintenance, as well as a
protected spring, certainly when it’s connected to a water distribution system. People responsible for the
maintenance should be trained, and a system providing sufficient consumables / spare parts should be
installed.
2.4.2 Technical process

The consumption of sufficiently clean and safe water can only be achieved by actions at all levels, with global
activities on water supply, sanitation (e.g. safe excreta disposal) and health promotion. Pollution at the source
and/or during the collective transport can be more dangerous than contamination of the water at home,
because it affects the whole population at once and consequently encourages large scale epidemics.
To ensure that the quality characteristics of drinking water are obtained and/or preserved from the source until
it is consumed, several technical steps might need to be integrated within the water supply system. Where
people take water immediately from a safe source, like for instance from a protected well with a hand pump,
the number of technical steps is reduced. But for surface water that needs treatment and that is located
away from the beneficiaries, different technical steps will be needed to get it safely to the consumers.
Intakes
Intakes are wells and boreholes, but also collection boxes and pipes through which water from springs, rivers or
lakes enters a water supply system and goes either to treatment and/or storage, or in some of the cases, directly
to the users. Infiltration galleries are an interesting alternative, except for acute emergencies given the time and
expertise that are required for their construction (contact your technical referent). Water moves through the intake
either by gravity, either it has to be lifted (T.B. 2.01). It is an important stage because it has to be well designed
to avoid loss and (further) contamination of the water. Source protection (T.B. 2.04; 2.08) is nearly always the best
and simplest method of ensuring safe drinking water and has to be preferred over treatment of contaminated
water. It is important to avoid pollution of the water source by providing latrines, bathing areas and animals
watering places at the correct location, thus downstream / downhill of the intake. Surface water can be made more
accessible and treated to a certain extent by means of shallow wells, infiltration galleries and the diversion of rivers.
Water Treatment
The main objective of water treatment in precarious situations is the elimination of microbiological pathogens.
Several principles exist: proper boiling, appropriate filtration methods, UV-radiation (solar or lamps) and
chemical disinfection. For the pathogen elimination to be effective, certain of these principles will require the
removal of the particles in suspension (turbid water) first. The main turbidity reduction principles used in
emergencies are (assisted) sedimentation and/or filtration. All the above mentioned principles have their
specific advantages and disadvantages (T.B. 2.12).
For health structures and closed settings, the treatment will mainly be done on a centralized level. Be aware
that treated water can potentially be dangerous in case there is a (hidden) failure in the treatment system.
For open settings, household treatment would be ideal, but the (rapid) distribution of equipment and/or
supplies to the population needs to be planned carefully. Another difficulty (certainly in emergencies) is the
correct usage of the household treatment method, therefore needing an intense promotion campaign to
provide the essential knowledge and skills, and to do a close follow up. For these reasons, semi-centralized
systems like bucket chlorination (T.B. 2.23) are sometimes set up during (acute) emergencies in open
settings.
Water Transport
In case the water source isn’t nearby the beneficiaries, it will have to be transported where the people are
based. In a first instance, water can be carried with tanker trucks (T.B. 2.34). This system can be set up
rapidly and can be very effective. However, it is usually the most expensive way in delivering water, and
should only be considered in the very first phase of an emergency (few days or weeks).
Although it might take some time to install, a piping system to carry the water over reasonable distances
(some km) should be considered. Water flows through pipes either by gravity, either by assistance of a pump.
In the first phase of an emergency, the pipes, such as spiralled (Heliflex) pipes or flat hose, may be laid on
the surface, but this results in the water getting hot, which renders the water less palatable and potentially
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reduces the remnant effect of the Free Residual Chlorine. In a later stage, the pipes will have to be buried
at a depth of at least 0.5 m (deeper in cold climates), laying on a sand bed of a few centimetres thick. Although
spiralled pipes could still be used for buried systems, it’s preferable to install PVC or polyethylene (PE) pipes.
Well designed and installed systems (T.B. 2.30; 2.31; 2.32 and 2.33) can last for several years.
Storage
Correct storage ensures that a sufficient quantity of drinking water is available when the consumers need it.
Storage is required for:
■ balancing the water demand and water production (certainly at peak moments);
■ providing a back up when there is a break-down or when maintenance is required in the system;
■ ensuring a constant supply to or from a treatment process.
All kinds of pre-fabricated (emergency) reservoirs are available with their specific volume, use, advantages
and inconveniences (T.B. 2.35; 2.36; 2.37). In case a reservoir would be constructed on the spot (e.g. T.B.
2.38), use plans that are approved by your technical referent in order to avoid accidents.
Water delivery point
The water delivery point is crucial in the water chain as it might be a point where a lot of water is lost and
(re-)contamination occurs. Water may be delivered through individual connections or at public water points.
■ Individual connection: Ideally, water should be provided inside or near each house. It will usually lead to a
significant increase in water consumption, even if only a single tap is installed. Individual connections
should be considered when managing long term water supply in a grouped habitat area, and certainly for
health structures in chronic emergencies and stabilized situations. However, keep in mind that for each
water delivery point, an evacuation of the spilled water needs to be foreseen as well.
■ Public water point: In many cases, it won’t be possible to construct individual connections. It is known
however that once the distance from the water point to the dwelling exceeds 100 m, the quantities collected
decrease drastically, to reach a point where only the survival minimum is taken. The waiting time at the
delivery point is also of importance; the longer it is, the lower the potential amount of water that will be
collected. It is recommended to allow at least one tap per 200-250 persons, certainly in closed settings such
as camps. Sufficient taps should deliver enough water to the consumers within a reasonable time, in order
to avoid pushing and shoving at the distribution point. This implies as well that the delivered flow should
be high enough (minimum 10 l per minute per tap), especially during peak hours. In case wells are provided
with a hand pump, there should be one pump per 500 persons (maximum 750 persons during acute
emergencies). Queuing at water points should be organised and controlled by community members,
certainly during acute emergencies. Special attention should be given to the access to water for vulnerable
groups (children, physically impaired people and the elderly).
Collection and household storage
To be able to collect the water that is provided to them, and to store and use it correctly at household level,
the beneficiaries should have enough appropriate recipients with a sufficient capacity. If this isn’t the case,
it is a top priority to distribute containers.
A water storage capacity of 40 l per household should be considered as a strict minimum, with suitable
recipients having a volume of 10 to 20 l. In order to avoid internal contamination, the containers should ideally
have a small opening for the water to be poured out instead of dipping into them. The cap should always be
replaced on its opening when the container isn’t in use to prevent contamination by dirty hands, dust and
animals. Closable empty plastic cooking oil jerrycans and traditional clay containers may be suitable as long
as they are covered. Regular cleaning and potential disinfection of household storage is necessary.
In case taps with a continuous water supply are available within the health structure / dwelling, the technical
step of “household storage” seems less important. However, it is always wise to have a back up storage
with some recipients when the water supply system needs maintenance, or in case it would fail.
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2.5 Further reading

Action Contre la Faim
Water, sanitation and hygiene for Populations at Risk
Hermann, 2005
S. Cairncross, R. Feachem
Environmental Health Engineering in the Tropics
Willey, 1993
J. Davis, R. Lambert
Engineering in Emergencies: a Practical Guide for Relief Workers
Intermediate Technology, RedR, 2002
S. House, B. Reed
Emergency Water Sources
Water, Engineering and Development Centre (WEDC), 1997
T.D. Jordan
A Hand Book of Gravity-Flow Water Systems
Intermediate Technology, 1980
S.B. Watt
Ferrocement Water Tanks and their construction
Intermediate Technology, 1993
S.B. Watt, W.E. Wood
Hand Dug Wells and their Construction
ITDG, 2003
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T.B. 2.01 Water intakes

Intakes are facilities to collect water from its source, which goes either to treatment and/or storage, or in
some cases directly to the users. Water moves through the intake either by gravity, or it has to be lifted.
It is an important stage because it has to be well designed to avoid loss and (further) contamination of
the water.
Surface water
Rivers and streams usually have a wide seasonal variation, and this will affect the location of the intake.
During the raining season, floods can occur that may destroy the intake, and during the dry season, the flow
may disappear completely. In a fast flowing river, erosion may be a problem. The intake should be located
away (preferably upstream) from contamination sites such as bathing and washing zones, animal watering
places and latrines.
A direct intake with motorised (surface) pumps is the most common method used during emergencies (T.B.
2.28). The intake should be placed at least 0.3 m below the water surface, to minimize floating debris, algae
or aquatic plants to be pumped up. Water containing a lot of plant life and organic matter may have
unacceptable taste and odour, and will drastically increase the chlorine demand for disinfection. The pump’s
intake should not be placed too close to the bottom either (preferably a minimum distance of 0.5 m, and
certainly not less than 0.3 m). It may disturb the sludge and/or the settled particles, which render the pumped
water very turbid. In practice, the intake equipped with a strainer should be kept in place by means of a
floater and some kind of an anchor or a rope. In case a (small) river would be less than 0.6 - 0.8 m deep, its
depth can be increased by constructing some kind of dam, called a weir. In acute emergencies, simple
materials such as sand bags (possibly mixed with some cement) can be used for the construction of a weir.
A division on a river can sometimes be sufficient as an intake. But open channels don’t provide any protection
against (further) contamination of the surface water. Piped systems provide better protection if they are fitted
with a screen and possibly with a structure that helps retaining the water (e.g. a dam), in order that the inlet
always stays under the water level.
In chronic emergencies and stabilised situations, time is a less critical factor. Thus it is recommended to
invest in more sustainable solutions such as infiltration wells and galleries if surface water has to be taken
from rivers. These alternatives provide several advantages:
■ One can be sure that there is water available because they are located nearby (visible) water sources.
■ A certain quantity of water is most of the time accessible, even in seasons when the river itself would dry
up.
■ They improve the water quality by filtering out debris and sediments, and in some cases also quite some
pathogens (chlorination stays recommended however).
In fine or compacted soil, the infiltration wells should be placed at least 2 m from the river. In coarser soil the
distance might have to be increased to 15 m. To increase the yield of the infiltration well, infiltration galleries
can be added. These infiltration galleries are pierced water collecting ducts that are specifically designed for
that purpose or locally made out of PE or PVC pipes with a diameter of at least 100 mm. They are buried in
the river bed itself, or in a trench dug parallel to the river. The trench will have to be about 1 m below the water
level in the dry season, and filled with a filtering layer of gravel and/or coarse sand around the pipe. Another
possibility is to drive pierced galvanised iron pipes perpendicular to the river. This method is much more
difficult to install, as solid pipes are not easily available and driving them may be problematic.
Obviously, the water will have to be lifted out of the infiltration well. This can be done with the same means
as for normal wells (as described below).
Groundwater
Groundwater often has a better physical and microbiological quality than surface water. It is therefore very
important that the quality of the groundwater stays guaranteed by means of correct intakes. Amongst the
different groundwater sources, only springs can have a direct gravity flow system by means of one or several
spring catchments (T.B. 2.08).
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To collect real groundwater (at least 3 m deep), hand dug wells can be constructed (T.B. 2.02; section 2.5
Further reading). Tube wells (boreholes) can be an interesting alternative because they can be made rapidly,
at least if the required drilling equipment is available. Several methods, as well manual as motorised
techniques exist to construct tube wells. With the exception of jetting (T.B. 2.07), constructing tube wells with
motorised techniques is a specialised work that should be left to professionals. Advice should always be
looked for from your technical referent before contracts are signed with local companies.
Wells will require a mechanism to lift the groundwater to the surface, such as a pulley, a windlass or a shaduf.
Alternatives to lift the water are hand or motorized pumps, being indispensable for small diameter boreholes.
The common aim of all these lifting mechanisms is to ease the task, while avoiding that the water source gets
contaminated.
Hand pumps can be divided in suction pumps and deep-well pumps. Suction pumps have their piston above
the water level, which makes them simple in design and maintenance, but have the inconvenience that they
certainly can’t be used if the water table is more than 7 m deep. When they haven’t been used for some hours,
it might be necessary to re-prime them to be functional. Unfortunately, the re-priming is often done with water
that has been polluted (e.g. by a dirty recipient) and therefore contaminates the whole well.
Deep-well hand pumps are preferred over suction pumps under all circumstances, and are the only possibility
anyway if the water table is more than 7 m deep. Different kinds of deep-well pumps exist with all their own
specifications. The choice on the most appropriate deep-well hand pump depends on physical factors such
as the depth of the water level and the yield of the well, but also on the pump’s characteristics (yield), its price,
its lifespan, and most importantly its existing presence in the region. The latter is an indicator if spare parts
might be available within the region, and if some people know how to maintain and repair the pumps. In
case several models would respond to the above specifications, choose the VLOM type (Village Level
Operation and Maintenance), if available.
The choice of a motorized pump type (T.B. 2.26) will depend on the required flow, but also on the kind of
groundwater intake (hand dug or tube well) and the water table depth. Certain motorized surface pumps
(T.B. 2 25) can be used to lift water from shallow wells (less than 7 m deep). For deeper hand dug wells,
professional de-watering pumps (T.B. 2 25) can be used. Deep tube wells will demand mostly a real
submersible pump (T.B. 2.25), if motorisation is required.
Rainwater
Rainwater, collected far away from industrialized and urban areas, represents normally good quality
characteristics, if it’s harvested correctly. It may represent an important source of water, although its variability
along the seasons is generally important. Rainwater can be collected from any clean surface, roof catchments
being one of the most used. The water is then transferred to tanks via gutters and pipes. The contamination
of harvested rainwater comes primarily from the first rains, rinsing away the accumulated dirt on the roof.
Correct catchment techniques will discard the contaminated rinsing water before the rainwater is stored in
completely closed reservoirs (T.B. 2.09).
Remarks
■ There are many factors that will influence the choice of the water intake. It will depend mainly on the source,
the topography, the context (acute or chronic emergency, stabilised situation), the quality of the water (e.g.
turbidity) and the preference of the beneficiaries.
■ Where simple intake facilities might be sufficient in the beginning of an emergency, they most probably will
have to be improved over time, as the intake itself can have a serious influence on the quality of the water.
Source protection should be preferred over water treatment, certainly in stabilised situations.
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T.B. 2.02 Description of a hand dug well

A well is a hole that pierces an aquifer so that the groundwater can be lifted out, potentially by a pump.
Usually, the hole that pierces the aquifer is named a hand dug well if it has been excavated manually. Hand
dug wells can provide important quantities of water, if their location is properly assessed and chosen,
and if they are constructed correctly. This technical brief provides a description of the most common parts
of a hand dug well and their purpose. It doesn’t explain the construction of a well itself, because there are
numerous techniques that are well described in many existing technical books. The selection of a
construction technique will depend on the soil conditions, the local knowledge and expertise, and the
availability of material and equipment.
Principle parts of a well

Properly constructed wells give not only access to the groundwater, but they also prevent its contamination.
Therefore should a correct well consist of an underground and an aboveground part.
Underground part
Intake: As it is the part that pierces the aquifer, the intake is the most important component of the well. To
allow groundwater to get inside the well, the intake lining should be made of permeable or perforated
(concrete) rings (T.B. 2.06) bolted and/or mortared together, or of open-jointed (honeycombed) masonry
walls. The lining allows the groundwater to trickle through, while it avoids the well to collapse and soil (e.g.
sand and/or gravel) to enter. It is important that the intake has enough wall surface for sufficient quantities
of groundwater to enter the well. For a well with an intake diameter of around 1 m, it is recommended that
it pierces the aquifer by about 2 m during the dry season, or even more in case of a low soil permeability.
In addition, the quality of the intake lining has a direct influence on the well’s yield, and sometimes also on
the quality of the collected groundwater. Permeable concrete rings will retain fine aquifer particles from
intruding into the well. These fine particles may also damage pumping systems.
Graded aggregate filter: Water should enter mainly by the vertical walls of the intake and not too much
via the bottom of the well. The graded aggregate filter, positioned on the bottom of the well, catches particles
settling down which may otherwise get / stay in suspension while the groundwater is withdrawn. This
graded aggregate filter is especially useful in fine sand aquifers as it won’t be swirled up from the bottom
when water is retrieved from the well.
Shaft: The underground part of the well above the water table is called the shaft. To avoid that the well
collapses and that there would be a direct ingression of polluted water from the surface, the shaft lining
should be reinforced with impermeable (concrete) rings or sealed masonry walls. If made of (concrete)
rings, they should be bolted and/or mortared together.
Aboveground part
Wellhead: The extension of the shaft raised aboveground is called the wellhead. It should be about 0.3 m
above the apron for closed wells with a hand pump and at least 0.8 m for (open) wells without a hand
pump (still preferably with a safe lifting mechanism and closable). Made out of impermeable concrete rings
or sealed masonry walls, the wellhead should protect the well water from surface pollution. It is also a
safety measure to avoid users falling into an open well.
A lid on the wellhead protects the well from becoming contaminated by (dust) particles and bird droppings,
and it can provide a support for the lifting mechanism. The lid can be completely removable, but for closed
wells equipped with a (hand) pump, it is advised to foresee a manhole, permitting future maintenance and
repairs.
Apron: A concrete slab around the wellhead, called the apron, together with an anchorage should be made
as an extra protection to avoid contaminated water (e.g. water used to rinse the users’ recipients) polluting
the well water. The slope of the apron (at least 1%, preferably 2%), together with the protective kerb lead
the wastewater away from the well, via a drainage channel (2 % slope) towards an infiltration system (T.B.
4.06; 4.07; 4.08), a garden or a drinking trough for animals. Certainly in cold countries, it is advised to
have some kind of foundation underneath the edge of the apron. This should avoid water getting
underneath the apron, which could crack if the water starts to freeze.
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Key
Hand dug well with telescoping principle

A. Wellhead (with lid / lifting mechanism) 1. Impermeable concrete rings or sealed
B. Apron with protective kerb and anchorage masonry lining
B. Apron with protective kerb and anchorage 2. Reinforced concrete slab with anchorage
C. Shaft 3. Foundation anchorage
D. Intake with graded aggregate filter 4. Perforated / permeable concrete rings or
E. Water table (static water level) open-jointed masonry lining
F. Aquifer 5. Graded aggregate filter (cleaned gravel)
6. Cutting ring
7. Backfilling (cleaned gravel)
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Remarks
■ For the well water to be of drinking quality, it should have gone through the natural soil filtration process
and be considered as “groundwater” as opposed to “surface water”. As an approximate value, if the water
level is at 3 m or deeper, it can be assumed that it is groundwater.
■ Correct siting of a new well requires (local) expertise because there are several parameters to take into
consideration (e.g. presence of vegetation, other water sources, geological parameters, safe distances
from pollution points). A geologist, geophysical equipment and hydrological maps can be helpful to find the
right spot to construct a well (for more information, contact your technical referent).
■ Under normal conditions, the time required for the complete construction of a proper hand dug well could
be a matter of several weeks. However, it may take much longer if the aquifer is situated very deep and/or
in adverse soil conditions, such as hard rock.
■ Hand dug wells should normally be constructed during the dry season when the water table is at its lowest
level. If constructed during the rainy season (when the water table is mostly higher), there is a considerable
risk that the well will run dry during the dry season and that it will have to be deepened using the telescoping
method.
■ The intake can be constructed with its outer diameter smaller than the shaft’s inner diameter, which is
called telescoping. This technique permits deepening the well when it would run dry, because additional
intake rings can be installed which will “slide“ downwards in the shaft when further excavation takes place.
If this kind of well would be constructed during the rainy season, it is recommended to foresee some
additional porous or perforated intake rings in case the well would dry up in the dry season.
■ It is important to install a correct water lifting mechanism on a hand dug well. A recipient (e.g. bucket) with
rope is a simple and cheap lifting mechanism, but has several inconveniences:
➞ The person lifting the water stands at the edge of the open well and risks to fall in.
➞ When the recipient and rope are not in use, they will often be lying on the ground, thus picking up dirt and
pathogens that will be introduced in the well and contaminate it.
■ A windlass will avoid that the rope comes in contact with the ground and therefore reduces the risk of well
contamination. It also permits to hoist bigger and heavier recipients in a safe manner.
■ A shaduf is a lever permitting to lift water out of (very) shallow wells. The counterweight on the shaduf will
make it easier to lift a heavy recipient out of the well. The counterweight will also avoid that the recipient
touches the ground when it is not in use, which helps to keep it away from contamination.
■ Installing a hand pump makes water collection easier for the users, but it also prevents potentially
contaminated objects like buckets from being introduced into the well. On top of that, the well can be
completely closed (with access via a manhole), avoiding dust and bird droppings falling in. Suction hand
pumps can still be found on the field. They have their piston above the water level, which makes them
simple in design and maintenance, but have the inconvenience that they certainly won’t work if the water
table level is more than 7 m deep. When they haven’t been used for some hours, it might also be necessary
to re-prime them in order to be functional. Unfortunately, the re-priming is often done with water that has
been polluted (e.g. by a dirty recipient) and therefore contaminates the whole well.
■ Deep-well hand pumps are preferred over suction pumps under all circumstances, and are the only
possibility anyway if the water table is more than 7 m deep. Different kinds of deep-well pumps exist with
all their own specifications. The choice on the most appropriate deep-well hand pump depends on physical
factors such as the depth of the water level and the yield of the well, but also on the pump’s characteristics
(yield), its price, its lifespan, and most importantly its existing presence in the region. The latter is an
indicator if spare parts might be available within the region, and if some people know how to maintain and
repair the pumps. In case several models would respond to the above specifications, choose the VLOM
type (Village Level Operation and Maintenance), if available.
■ Motorized pumps offer the same advantages as hand pumps but have most often a higher capacity, which
is interesting to cover bigger water demands. However, the pump capacity should not be too high and
certainly not surpass the maximum pumping rate of the well (T.B. 2.27). Over-pumping will (drastically)
increase the turbidity of the well water, and might even cause the surrounding soil to sink. The latter can
cause serious damage to the well and certainly to the apron that starts to crack as there isn’t any supporting
ground underneath anymore.
■ Backfilling around a well can be done, but only with concrete or non-contaminated earth (e.g. the use of
earth collected at termite hills is prohibited as it contains a lot of nitrates, which is potentially harmful).
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T.B. 2.03 Cleaning and disinfection of a well

The cleaning and disinfection procedure is done with the objective to eliminate pathogens (bacteria and
viruses) that could be present in the well. This procedure is implemented after the well is built or after
maintenance or rehabilitation works have been done inside the well or on the pump. It can also be done
when there are some reasons to suspect that a contamination was (punctually) introduced in the well
(e.g. floods), or if a sanitary inspection shows a risk of an existing pollution.
Operation
Technique A.
If it is possible to empty the well completely, it’s the preferred method as it gives the best results.
■ Empty the well by means of a pump. Be aware that the well depth can’t exceed 7 m (at sea level) if a
surface pump (e.g. motor pump) is used. If the water table is deeper, a dewatering pump will be needed
(T.B. 2.25). The sludge can potentially be removed by putting the “suction” pipe / dewatering pump very
close to the bottom of the well and swirl the groundwater to put the mud in suspension.
■ Remove all the potential debris that has entered the well (after an accidental event like a flood), using a
strong metal bucket lifted by means of a winch and tripod. Make sure to follow all the safety prescriptions
(see hereunder). Deepen the well in case of a massive influx of sludge.
■ Prepare a 0.05% chlorine solution (T.B. 2.20). The amount of chlorine solution needed will depend on the
total surface of the wellhead, shaft and intake.
■ Scrub the complete lining with the chlorine solution, following the safety prescriptions (see hereunder).
■ Wait at least ½ hour during which the well refills.
■ Pump the water carefully out of the well again, while measuring the turbidity (T.B. 2.13) and the Free
Residual Chlorine (FRC) concentration (T.B. 2.22). The pump can be stopped when the turbidity is lower
than 5 NTU and the FRC concentration lower than 0.5 mg/l.
Technique B.
If it is not possible to empty the well completely, this method is the most effective.
■ Try to remove as much sludge and debris as possible (after an accidental event like a flood) by means of
a surface pump (if the water table < 7 m deep) or a dewatering pump (water table even > 7 m deep).
■ Prepare a 0.05% chlorine solution (T.B. 2.20). The amount of chlorine solution needed will depend on the
surface of the lining above the water table, including the wellhead.
■ Scrub the lining above the water level with the 0.05% chlorine solution according to the safety prescriptions
(see hereunder).
■ Determine the volume of water inside the well: volume = (π x d²/4) x h
with π = 3.14; d = inner diameter of the well; h = depth between the water table and the well bottom
■ Prepare a 1% chlorine mother solution (T.B. 2.20). The amount of chlorine solution needed will depend on
the water volume in the well.
■ Add 10 l of the 1% solution per m3 of well water, mix and leave the well closed for at least 12 hours.
■ Pump the water carefully out of the well after this period, while measuring the turbidity (T.B. 2.13) and the
FRC concentration (T.B. 2.22). The pump can be stopped when the turbidity is lower than 5 NTU and the
FRC concentration lower than 0.5 mg/l.
Key Input
A. Well cleaning of shallow well with motor pump (technique C)
B. Well cleaning of well with dewatering pump (technique C)
1. Lining -Chlorination kit with a chlorine-generating product

2. Water level -Scrubbing brushes (short and long handled)
3. Surface (motor) pump -Extension for the handle of the scrubbing brush
4. Dewatering pump -Hoses and disinfection tube (pierced sleeve)
5. Suction pipe -Ropes, buckets
6. Delivery pipe -Pump kit (motor or dewatering pump)
7. Sleeve with small diameter holes -Tripod and winch
8. Water jets -Harness / seat
9. Generator -Mask
-Goggles or face shield
-Heavy duty gloves
d = diameter of the well -Overall
h = depth between water table and bottom -Temporary fencing material
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Technique C.
If a lot of wells need to be cleaned and disinfected in a short period (e.g. after a big flood), this method is
preferred because it’s the fastest, but it’s also the least effective.
■ Try to remove as much sludge and debris as possible by means of a surface pump (only if the water table
< 7 m deep) or a dewatering pump (even for a water table > 7 m deep).
■ Determine the volume of water inside the well: volume = (π x d²/4) x h
with π = 3.14; d = diameter of the well; h = depth between the water table and the well bottom
■ Prepare a 1% chlorine mother solution (T.B. 2.20). The amount of chlorine solution needed will depend on
the water volume in the well.
■ Add 100 l of 1% chlorine solution per m3 of well water, mix and leave the well closed for 30 minutes.
■ Equip the delivery hose of the pump with a disinfection tube, which is a pierced sleeve (small holes of 4 -
6 mm diameter), closed at one extremity. The highly chlorinated well water being pumped through the
small holes of the disinfection tube will result in strong jets, permitting the cleaning and disinfection of the
well lining above the water table.
■ Start the pump and move the disinfection tube up and down for at least 15 minutes, in order to spray
thoroughly the shaft and the wellhead (T.B. 2.02) with a high flow of the highly chlorinated well water. When
the well is completely cleaned, wait 30 minutes for the chlorine to act.
■ Pump the water carefully out of the well after this period, while measuring the turbidity (T.B. 2.13) and the
FRC concentration (T.B. 2.22). The pump can be stopped when the turbidity is lower than 5 NTU and the
FRC concentration lower than 0.5 mg/l.
Safety prescriptions
Safety measures must seriously be considered before starting the cleaning of a well. This includes the safety
of the workers and the equipment, but also the surroundings of the working area:
■ The working area should be fenced all the time, with no access to people other than the authorised
personnel.
■ Supervised by a competent and trained team leader, there must be a minimum of three trained workers per
well. Two workers should be at the surface, one operating the winch and the other watching the third person
inside the well. All three workers should rotate, every 15 minutes ideally. A clear and simple system of
communication must be used between the person inside the well and the workers remaining at the surface.
■ All workers should wear a helmet, an overall, heavy duty gloves and boots. When manipulating chlorine
products, goggles or a face shield, a respirator and rubber gloves should be added.
■ The staff should be trained to use the material correctly, including the safety equipment present on site like
the lifting apparatus with harness and the first aid kit.
■ Chlorine is a dangerous product that must be stored and handled with great care (T.B. 2.19). The manual
disinfection (scrubbing) of the lining should be done as much as possible with the staff being outside of the
well, by means of long handled hard brushes.
■ All tools and safety equipment should be checked daily and replaced when necessary.
■ Electric dewatering pumps can be used to empty a well before cleaning. However, a dewatering pump
should be stopped and disconnected from its electricity source before people enter the well, as faulty
equipment could cause electrocution.
■ A generator used to provide power to electric pumps, should always be earthed.
■ Generators and motor pumps should be located as far as possible away from the well to avoid exhaust
gases entering, potentially causing asphyxia of people working inside. For the same reason should motor
pumps never be lowered inside a well.
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Remarks
■ The cleaning techniques described above are meant for lined wells. The cleaning and disinfection of an
unlined well is not very useful, except perhaps after being flooded. Unlined wells should not be entered,
especially not after they have been flooded because they might collapse. In such a case, it can be tried to
remove the sludge by pumping, although it will be impossible to take out the potential big debris. The dirt
layer on the unlined walls can be removed by technique C, but care should be taken not to erode the walls
(any further), as this could lead to (partial) collapse.
■ In general, a properly protected well (T.B. 2.04) is considered as being non-polluted. Nevertheless, a
biyearly maintenance before and after the rainy season, including cleaning and disinfection is strongly
recommended.
■ The described types of cleaning / disinfection do not have any permanent effect. These kinds of
interventions are effective on punctual contamination linked to maintenance or construction works, or
accidental pollution (e.g. floods), but not for unprotected wells. If the source of contamination is not
removed, water taken out of the well will not be disinfected due to the very temporary impact of chlorine.
■ In any case, possible contamination sources must be searched and corrective measures applied before
the disinfection of the well can occur.
■ Microbiological contamination of a well through the ground by latrines or cattle is quite rare, unless the
contamination source is located at a short distance from the well (the minimum recommended distance for
latrines is set at 30 m, and 10 m for cattle). If the contamination really occurs through the ground, it could
be necessary to close the well or to eliminate the source of contamination (e.g. latrines), knowing that it
will take a minimum of 60 days before the adverse microbiological effects have disappeared. If the well is
the only water source, implementation of bucket chlorination (T.B. 2.23) can be considered to reduce the
risks and to give time to seek and implement an alternative solution.
■ Potential damages to the outside (TB. 2.04) and the inside lining of the well, discovered during or after the
cleaning, should always be repaired. The repaired patches should be disinfected before the well is put
back into function.
■ When a well has to be emptied, the first (non-disinfected) water pumped out of the well should preferably
be disposed of via a soak away pit (T.B. 4.06) or infiltration trenches (T.B. 4.07).
■ In case a well has to be emptied during of a cholera outbreak, it is strongly recommended to hyper-
chlorinate the well water before, because of the environmental contamination risk by the potentially polluted
groundwater. Per m³ of well water, 100 l of 1% chlorine solution should be added.
■ Since this chlorination method does not guarantee a continuous disinfection, it is strongly recommended
to implement controlled bucket chlorination (T.B. 2.23) as long as the well is not properly protected or if there
is a strong suspicion that the well is the origin of infection of several people.
■ Debris and sand inside a tube well (borehole) can’t be removed manually, but can be blown out by means
of a compressor. Other techniques exist but fall out of the scope of these guidelines. Contact your technical
referent for more information when required.
■ The disinfection of a tube well (borehole) can be done by pouring 10 l of 1 % chlorine solution per m³ of
water within the well (as described for technique B). For the whole casing to be disinfected, it is advised
to pour the chlorine mother solution over the whole circumference of the tube well. Pump the water carefully
out of the tube well after a minimum period of 12 h while measuring the FRC concentration (T.B. 2.22). The
pump can be stopped when this concentration is lower than 0.5 mg/l. Do not forget to pour an abundant
amount of potable water afterwards in the tube well to rinse stagnant chlorine solution on the couplings of
the raising main.
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T.B. 2.04 Protecting a shallow well

A well should normally be protected as soon as it is dug. But existing wells are often found without
protection or even without lining. Protection consists of preventing contaminants getting into the well, and
preventing the infiltration of runoff and wastewater which could carry contaminated material. Lastly,
protection strengthens the structure of the well, resulting in a longer lifespan.
Operation
■ Prepare the site: remove all debris, install a fence and bring in the needed material and equipment.
■ Line the existing well completely. Ideally, some kind of foundation (e.g. concrete 300 kg/m³; T.B.2.05) should
be made first at the bottom, but emptying the unlined well completely could lead to its collapse. This means
that the concrete foundation should be poured under water or be prefabricated and then lowered inside the
well. Concrete rings that are bought or fabricated locally (T.B. 2.06) should be placed on top of the
foundation. The rings underneath the water table should be perforated. All rings should be bolted and/or
mortared together. The uppermost ring should extend well above ground level.
■ Place a layer of gravel, the graded aggregate filter, on the bottom of the well. This layer of about 0.1 m thick
will avoid the re-suspension of settled particles.
■ Fill the gap between the (perforated) rings and the sides of the well with gravel. The height of this gravel
pack should reach (just) above the water table level.
■ Compact a thick clay layer above the gravel. In case of limited availability of clay or a difficult access within
the gap, pour cement grouting (viscous liquid mortar) on top of the clay (a thin layer at least).
■ Backfill the pit with compacted soil. If cement grouting has been used, the backfilling should only be done
once it has hardened enough (at least 3 days).
■ Excavate around the wellhead to a radius of at least 1.5 m, until all vegetal (black) earth is removed. This
excavated area will be the basis of the apron. At the circumference of the future apron, a deeper trench
can be made for a foundation. This foundation is mandatory for cold countries to avoid that water can get
underneath the apron, which could crack if the water freezes.
■ Continue to dig a triangular trench around the wellhead (as per figure C) with a depth of at least 0.3m, in
order to prepare the construction of the obligatory anchorage.
■ Dispose of all the removed material.
■ Bend reinforcing bars into triangles for the anchorage.
■ Prepare a horizontal grid of reinforcing bars for the apron, with meshes of 0.2 x 0.2 m. The size of the grid
depends on the excavated area.
■ Interconnect the triangles in a circular pattern to the horizontal grid with metal wires. The diameter of the
circular pattern should be slightly bigger that the outer diameter of the wellhead.
■ Fit the assembly inside the excavated area around the wellhead. The reinforcing bars should be minimum
30 mm away from the concrete ring and the bottom of the excavation.
■ Cast the anchorage and apron in homogeneous concrete layers (300 kg/m³) and vibrate the concrete.
Once the concrete starts to settle, the apron’s cone should be created, sloping itself towards the foreseen
drainage channel. Both the tilt of the cone, as the cone itself should have a slope of minimum 1, preferably
2 %.
■ Build on the apron’s circumference a protective kerb with a minimum height of 0.1 m. The protective kerb
helps to direct the spilled water via a cemented / concrete drainage channel (slope 2 %) towards a soak
away pit (T.B. 4.06), infiltration trenches (T.B. 4.07) or potentially an evapo-transpiration area (T.B. 4.08),
which should be at least 10 m away from the well. When the well area isn’t used for activities needing
soap such as laundry and personal hygiene, a grease trap isn’t necessary, and interesting alternatives for
the evacuation of spilled water can be an irrigated garden or a cattle drinking trough.
■ Extend the height of the wellhead if needed. This can be done with a concrete ring or masonry-work. A
closed wellhead provided with a hand pump should rise about 0.3 m above the apron, whilst one without
at least 0.8 m.
■ Provide a (concrete) cover (either removable or fitted with an inspection hole), on which to mount a lifting
mechanism.
■ Install preferably a complete pumping system, according to the pump manufacturer’s instructions. A pump
makes the retrieval of the water easier for the users, and is also useful because it prevents contact between
contaminated objects like buckets and the well water.
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Key Input
A. Unprotected well
B. Protected well with an apron and a drainage channel
C. Completely protected well with a hand pump
D. Minimal safety distances
1. Possible entrees of pollution -Cement, sand and gravel (300 kg/m³ concrete)
2. Well -Reinforcing bars (minimum 6 mm), metal wires
3. Water surface -Clean, non salty water (to prepare concrete)
4. Well entrance -Tools to make and cast concrete
5. Wellhead -Bricks (to make protective kerb)
6. Concrete apron -Concrete rings; diameter depending on:
7. Protective kerb -the dimensions of the existing well
8. Drainage channel (to infiltration system) -the availability on the local market (local purchase)
9. Infiltration system / garden -the size of the mould (local fabrication)
10. Pump -Perforated concrete rings
11. Cover slab -if not available on market drill holes in plain ring
12. Impermeable concrete rings -local fabrication
13. Anchorage -Cover that fits on the wellhead
14. Apron with protective kerb -Tripod and lifting equipment
15. Perforated concrete rings -Safety gear
16. Graded aggregate filter (about 0.1 m) -Hand pump with fixtures and fittings
17. Houses / dwellings -Construction materials for the drainage system
18. Well -Fencing material
19. Latrines -Experienced mason
20. Run-off direction
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Remarks
■ The technique described above is to protect an existing shallow well.
■ Respect the minimum safety distances: no latrines closer than 30m from a well, no cemeteries or (medical)
waste zones that include organic waste pits closer than 50 m. Latrines, cemeteries and (medical) waste
zones should be downhill from the well.
■ A fence around the well is strongly recommended:
➞ before the works start, in order to avoid non-authorised people entering the site. This will reduce the risk
of accidents.
➞ after the works have finished to protect the improved well even more, certainly if there are animals (e.g.
cattle) around.
■ Lowering rings in the well should be done with a tripod, security equipment and by an experienced team.
■ A skilled mason is required to make the apron with the correct cone and tilt slopes. A square apron is
slightly easier to construct as it only needs to be tilted (no cone), but special attention should go to the slope
at the corners. When the slopes aren’t correct, spilled water will be stagnating, which could become a
breeding ground for several vectors.
■ Before the first use, after maintenance or after accidental pollution, disinfect the well with a chlorine solution
(T.B. 2.03).
■ It is strongly recommended to avoid (domestic) activities like dish washing, laundry or personal hygiene
directly around the well site, as this could potentially lead to the contamination of the well water. Separate
services like showers (T.B. 4.01) or a washing area (T.B. 4.02) should be installed with their own waste
water facilities; a grease trap (T.B. 4.04) and an infiltration system.
■ The apron should be cleaned regularly, together with the drainage system. Possible cracks of the apron
should be repaired. Regular check-ups, preventative maintenance and potential repair of the pump system
should be done.
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T.B. 2.05 Mortar and concrete preparation

Mortar and concrete are frequently used in construction. In complying with some preparation and
implementation recommendations, these materials will have a life span exceeding 20 years, while keeping
up their properties. They ensure a good bonding between the materials, a distribution of the loads whilst
being resistant to them, and a low deformation. Mortar is a mix of cement, sand and water. Concrete has
the same ingredients and includes additional gravel.
Composition
Sand
it must be clean and washed, without silt or impurities (soluble, soft or carbon materials). Sand used for
masonry-work can contain a little bit of clay, but none at all for cement plaster (river sand is therefore
recommended). Avoid sea sand because salt impairs with the bonding of the cement.
Gravel
originates naturally from river beds or from crushing rocks. It cannot contain earth or plants.
The selected grain size of the above products varies according to the use:
Grain size (mm) Quality Use

0.1 - 0.5 Fine sand Smooth cement plaster
0.5 - 2 Medium sand Cement plaster, mortar for masonry
2-5 Grainy sand Mortar for masonry
5 - 20 Gravel (Reinforced) concrete
Cement
it is a mixture of clay (5 to 25%) and limestone (75 to 95%), fired at 1400°C. Afterwards the mixture is finely
pulverized.
Mixing water
it must be clean, without impurities. Avoid sea water and water containing organic or chemical matters.
The addition of water to cement creates a chemical reaction (hydration) and produces hydrates with a crystal
formation. When water is added, a malleable mixture should be obtained and the appearance of crystals
causes the setting phenomenon (from 1 to 4h), followed by the hardening. During the hardening process, the
mortar / concrete will acquire its resistance. The time rate at which concrete hardens depends a lot on the
ambient temperature.
Proportions and uses
The respective proportions of the different constituents depend on the planned use of the mortar or concrete,
as presented below. The quantity of cement is often mentioned to define the proportioning. Practically
speaking, proportions are usually indicated in kg for the cement (generally provided per 50 kg bags) and in
litre for sand and gravel. Masons often work with proportions of a number of wheelbarrows of sand (and
gravel) per bag of cement (50 kg).
Cement Sand Used for:
Mortar 20 kg 60 l • making cement blocks
• masonry-work, joining:
2/5 of a 50 kg bag 1 wheelbarrow - fired bricks
- cement blocks
Cement plaster 25 to 30 kg 60 l • smoothing surfaces

• watertight masonry surfaces
half a 50 kg bag or more 1 wheelbarrow • watertight unions between
pipes and masonry-work
(1 wheelbarrow = 60 l).
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The total quantity of water to be included in mortar or concrete depends of the natural humidity level of the
sand. For 150 kg/m³ concrete, about 90 l of water will be needed for 1 m³ of concrete. For 300 kg/m³ concrete,
the amount of water required will be about double.
Amount of the different constituents needed to make 1 m³ of concrete with crushed rock or river gravel:
Cement Sand Gravel Used for:
Lean concrete 150 kg 400 l 800 l • base of lined pits
150 kg/m³ • floor slabs like:
3 x 50 kg bags 7 wheelbarrows 14 wheelbarrows - washing areas
- showers
- tapstands
Concrete 300 kg 400 l 800 l • latrine slabs

150 kg/m³ • foundation
6 x 50 kg bags 7 wheelbarrows 14 wheelbarrows • ring beams
• concrete rings
(1 wheelbarrow = 60 l).
In case of doubt what proportions to use for concrete, keep it as simple as possible in all the situations:
■ Lean concrete: 1 part of cement, 4 parts of sand and 8 parts of gravel (parts in volume).
■ Concrete: 1 part of cement, 2 parts of sand and 4 parts of gravel (parts in volume).
Preparation of mortar / concrete

■ Prepare a clean, plane and level surface, like a screed, slab, metallic plate or wooden board.
■ Put the required amount of sand on the surface.
■ Deposit the required amount of cement on top of the sand heap (and not the other way around). Some
prefer to put only part of the cement in the beginning and to add the remaining quantity once there has been
a first mixture.
■ Move the complete heap of sand and cement by shovelling it to a second spot on the surface. This is to
get a mixture of the sand and cement.
■ Repeat this action several times until a homogeneous colour is obtained (preferably at least three times).
When concrete is prepared, the second time the heap is moved, it should be shovelled on top of the
required amount of gravel. The complete heap, gravel included, should be moved at least another two
times until a homogeneous colour appears, in order to ensure a good mixture.
■ Make a crater in the middle of the cement - sand (- gravel) heap.
■ Fill the crater with clean non-salty water.
■ Mix the water immediately with the heap by pushing the crater’s edges downwards in its centre.
■ Keep on mixing in a similar way, and add little by little water until a homogenous and malleable paste is
obtained. Don’t add too much water because it can cause significant shrinking afterwards. This
phenomenon occurs during the evaporation of the water. The particles will get closer to each other, causing
thus a volume reduction of the mortar / concrete. Shrinking can be detected through the appearance of
cracks. Other factors influencing shrinking are a too high cement dosage, the use of sand that is too fine
and unclean, and working during the hot hours of the day.
■ Use the mortar / concrete before it starts setting, meaning within half an hour following the introduction of
the water to the mixture. During the setting (solidification period), the mortar / concrete will lose its plasticity
(beginning of the setting), and finally won’t be deformed anymore under finger pressure (end of the setting,
around 4 hours after the water has been introduced to the mixture).
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Remarks
■ When big quantities of constituents have to be ordered, their weight and volume have to be taken in
consideration for transport reasons. The following table gives the approximate weight of:
Cement (loose) Sand (dry) Gravel (loose)
1200 – 1440 kg/m³ 1875 – 2595 kg/m³ 1745 kg/m³
■ The way cement is stored is crucial for its properties because it easily absorbs ambient humidity. If the
storage is too long or uncared-for, a lack of resistance of the cement will occur: e.g. a 40 % reduction in
resistance can be measured after 12 months.
■ Cement is expensive. Contractors sometimes try to reduce its proportion when preparing mortar or
concrete, thus rendering the construction weaker.
■ When considerable amounts of concrete are needed, it is recommended to use a concrete mixer.
■ Concrete is very resistant against pressure, but not against tension. Therefore should concrete be reinforced
with iron reinforcing bars at the places where it will be under tension.
■ Once concrete has been cast, it should be “vibrated” by tapping on the mould, by ramming its surface with
a wooden rammer or by poking (compacting) it rigorously with a reinforcing rod. A vibrating rod improves
the removal of oxygen within thick layers of cast concrete.
■ Concrete should be kept coffered and shored up during a certain time, depending on the size of the element
(contact your technical referent if needed). This is to allow the hardening of the concrete, during which the
resistance of the mixture will increase.
■ Too much water in the mortar / concrete mixture will decrease its resistance and is therefore harmful. A
minimum quantity of water must thus be added to the mixture. Adding some more water 30 minutes after
the mortar / concrete has been prepared is absolutely prohibited.
■ Setting and shrinking processes need hydration water, thus a quick evaporation of the water should be
avoided. Mortars and concretes must therefore be watered twice a day during one week to obtain a correct
shrinking process and thus a better mechanical resistance. Additionally, slabs and ring beams must be
protected from wind and draughts with plastic sheeting as this would increase the evaporation rate and thus
the risk of cracks. Walls must just be moistened by watering.
■ If cement blocks can’t be purchased locally, they can be made with a normal mortar composition. When a
lot of cement blocks are needed, a fabrication team should be set up, consisting of one mason (supervisor)
and six unskilled workers, divided in three posts:
➞ 3 workers to prepare the mortar,
➞ 2 workers for the moulding of the blocks and to remove them from the mould,
➞ 1 worker for the watering of the blocks and for their stocking.
■ A well-trained and organized team can produce up to 400 cement blocks per day. For this quantity, 16
bags of cement, 40 wheelbarrows of sand and 2 m3 of water (including watering) are needed. Foresee that
5 to 10 % of the blocks will be lost (being broken).
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T.B. 2.06 Fabricating concrete rings

Concrete rings are needed to line and protect hand dug wells. The concrete rings used for well intakes
may be perforated during fabrication, or made of porous concrete. Porous concrete rings are preferred
for use in decomposed rock, sand or gravel, but they are a lot more fragile than perforated reinforced
concrete rings. The concrete rings used for the shaft and wellhead should obviously not be porous or
perforated. Concrete rings may also have other purposes, such as making a spring box, a rainwater
collection tank and pit reinforcements for latrines or sharps pits.
Construction
■ Order, purchase or make locally (contact your technical referent) the needed moulds:
➞ The mould set should be composed of two parts: the internal and external elements. Each of these elements
is generally made of three or four sections which are bolted together. In order to be able to remove the inner
mould once the cast concrete ring has hardened enough, a separate spacer element has to be available that
will be removed first.
➞ The moulds should be made of steel plate, at least 3 mm thick, reinforced with angle steel.
➞ The inner diameter of a concrete ring (thus the outer diameter of the internal mould element) should be at least
1 m (strict minimum 0.8 m), so that a person can dig inside the ring. The external element should have an
adapted inner diameter, permitting to make rings of 0.15 m thick.
➞ Moulds are generally between 0.5 – 1 m high. A reduced height is compulsory for very big rings to keep their
weight reasonable (e.g. a ring with a diameter of 1.60 m should maximal be 0.5 m high).
➞ Tube-shaped templates for the moulds should be present, allowing to leave big openings in the concrete rings
that will facilitate their lowering inside the well.
➞ In case perforated concrete rings have to be made, the elements should have holes every 0.15 m and smooth
metal pegs should be provided. Once inserted in the assembled moulds, the pegs should form an angle of
45° upwards from the outer to the inner side. This angle is important to limit sand entering into the well, once
the perforated concrete rings are installed.
➞ The mould set should be provided with two ground pedestals and a cover, all permitting to make positioning
grooves (stepped concrete rings that fit together once installed).
■ Make sure that all mould parts that will be in contact with the concrete are coated abundantly with an special
oil for concrete casting (food graded) or an alternative (e.g. olive oil) to prevent concrete sticking to them.
■ Position a ground pedestal on a flat, clean and solid surface (e.g. concrete slab).
■ Bolt the internal mould sections with the spacer together and install the assembly over the pedestal.
■ Prepare a circular network of reinforcing bars around the inner mould, placed 0.1 m above the bottom and
halfway between the internal and external mould elements.
➞ Ordinary / perforated rings: the re-bars’ length equals the mould’s height minus 0.2 m, with a mesh size of 0.15
x 0.15 m. Be careful not to have the re-bars positioned in front of the perforation holes.
➞ Porous concrete rings should not be reinforced with iron re-bars.
■ Bold the outer mould sections together in a concentric way around the inner element, and introduce the
tube-shaped templates. Insert also the oiled metal pegs if a perforated concrete ring is to be made.
■ Prepare the concrete mix for the rings.
➞ Ordinary and perforated rings should be made in similar concrete (at least 300 kg/m³; T.B. 2.05).
➞ Porous concrete rings should have the same cement and gravel composition, but the amount of sand should
be halved. This concrete should not be too wet either.
■ Cast the concrete in between the inner and outer mould elements in layers of 0.25 m high, and position the cover
when the mould is almost full of concrete, to create the upper positioning groove.
➞ For ordinary and perforated rings, poke the concrete with a reinforcing bar to drive the air out.
➞ Vibrate porous concrete rings by tapping on the mould, instead of poking (compacting).
■ Remove the tube-shaped templates and potential metal pegs before the concrete sets completely (maximum
4 hours after the concrete has been prepared). Clean and oil all the templates and pegs.
■ Remove all the mould sections about 24 hours after casting. The mould sections should be scraped and
brushed to remove the concrete residues, and their contact surfaces oiled abundantly.
■ Wash the concrete rings to remove all oil residues.
■ Cure the concrete rings in the shade for at least 1 week, during which they should be kept damp (wetted twice
a day and covered with jute sacking or plastic sheeting). Porous rings should cure longer than ordinary /
perforated ones. They are more fragile and should be handled with care.
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Key Input
1. Internal mould element (minimum outer diameter 1 m) - Reinforcing bars (8 mm), metal wires
2. External mould element (minimum inner diameter 1.15 m) - Cement, sand and gravel
3. Cover to create positioning groove (alike ground pedestal) - Clean, non-salty water
4. Bolts and nuts - Ring mould set with all accessories
5. Holes to insert wooden or metal pegs (for perforated rings) - Shovels, buckets, trowels
6. Reinforcing angle steel - Specific oil or olive oil
7. Tube-shaped template - Spanners, lump hammer, wire brush
8. Wooden or metal pegs (for perforated rings) - Plastic sheeting or jute sacking
9. Spacer (to maintain concentric distance between moulds)
10. Big holes for tube-shaped template
Remarks
■ In case of telescoping, porous concrete rings can be used for the intake, certainly in decomposed rock, sand
or gravel. If telescoping is not used, porous concrete is prohibited for the intake because it is too fragile to
withstand the weight of the complete concrete shaft (porous rings might crack over time).
■ For rings that need to be bolted together (e.g. instable soils), three long metallic rods with thread on top
should be inserted vertically into the concrete, with their parts sticking out of the ring as long as the height
of the mould itself. Three metallic pipes with an inner diameter slightly bigger that the rods should be
imbedded vertically in the concrete rings with their length exactly equal to the height of the mould (thus not
sticking out of the ring). Make sure that the rods and pipes are put in an alternating way every 60°, assuring
their alignment during the installation and bolting together of several rings.
■ Moulds used for making well rings should not be coated with used engine oil, for health reasons.
■ When the rings are produced in series for a program of well protection, it is recommended to use a sheltered
area for curing and storing the rings.
■ A tripod and pulley should be used to lower the rings safely into the well.
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T.B. 2.07 Jetting

Jetting is a low-input “drilling” technique, suited to make rather shallow tube wells within unconsolidated
soil formations, in particular sand. Lots of water is pumped by a simple surface centrifugal pump through
solid tubes with limited diameter, which creates a jet that is introduced vertically into the soil. This will lead
to the soil eroding underneath the jet and the water will bring the loose particles to the surface as the tubes
sink further downwards. Due to its simplicity and rapidity, this technique can be very useful within
emergencies at locations where the water table is relatively close to the surface (e.g. tube wells made in
river banks). With the right equipment, it is possible to use the same tubes as raising main and the same
surface centrifugal pump to develop and exploit the jetted well.
Operation
■ Assemble the pre-jetting rod (½” GI pipe, 1 m long) and jetting rods assembly (self-launching strainer, rigid
pipes, connections, valve, elbow and rapid coupling) as per figure A. Although jetting is possible without a
self-launching strainer, it is a strongly recommended accessory. It concentrates the jet during the jetting
operation and functions as a strainer when the flow will be reversed for developing and exploiting the tube
well (if the water level is not deeper than 7 m at sea level). Kits, containing all these elements, are available.
■ Make sure enough water will be available during the jetting procedure. In case the jetting takes place
nearby a high yield river or a lake, the water can be taken directly from the source. When the yield or the
available water quantities on the spot wouldn’t be sufficient, a big reservoir (e.g. 15 m³ bladder) will have
to be filled (potentially from an external water source) to cover the jetting needs.
■ Install a surface centrifugal pump (e.g. motor pump) and perform all its checks according to the
manufacturer’s instructions.
■ Connect with spiralled pipes the pump’s inlet to the water supply and its outlet to the pre-jetting rod.
■ Start the pump and rev it up in order to create a good jet at the pre-jetting rod.
■ Introduce the pre-jetting rod vertically into the soil where the tube well will be installed and let it sink over
its complete length (about 1 m), before removing it and stopping the pump.
■ Replace the pre-jetting rod with the jetting rods assembly after having drained the spiralled pipes that are
connected to the pump’s outlet (weight reduction).
■ Insert the jetting rods assembly in the pre-jetted hole and start lifting it in the vertical position. When GI pipes
are used, it will take several persons to perform the lifting, due to the weight.
■ Start the pump and rev it up in order to create a good jet, whilst the others keep the rods assembly in a
vertical position.
■ Guide the jetting rods assembly as it is sinking. In soft soil, take care that the assembly doesn’t sink too
fast as this could lead to the collapse of the jetted well. In case the jetting rods assembly doesn’t sink, it
can be wiggled a bit to remove some harder objects (e.g. small stones) blocking the rods from sinking.
Under all circumstances, keep the pump working to remove the “cuttings”.
■ Monitor the composition of the soil that comes out of the hole and take samples.
■ Stop and disconnect the pump when the desired depth is reached (at least 3 m under the ground surface).
The jetted well should be deep enough for the self-launching strainer to be completely in a water baring
layer with good permeability (e.g. sand).
■ Stamp on the elbow of the jetting rods assembly if a self-launching strainer is used. As a result, the ball foot
valve of the self-launching strainer should be closed.
■ Connect the pump’s inlet to the sunken jetting rods assembly, and its outlet to a long pipe draining the
water away from the jetted well.
■ Start the pump and keep it at low speed for 15 minutes. The fine (sand) particles will rise to be discarded,
while the heavier particles (e.g. coarse sand, gravel) will remain down. This phase allows the creation of
a filtering medium around the self-launching strainer.
■ Monitor the yield and the turbidity (T.B. 2.13) of the water coming out of the jetted well.
■ Rev up the speed of the pump and keep on monitoring the yield and the turbidity.
■ Pulsate the speed of the pump and keep on monitoring the yield and the turbidity. After some time, the
turbidity should normally decrease to levels under 5 (N)TU.
■ Disinfect the jetted well once the obtained yield and turbidity are satisfactory (T.B. 2.03).
■ Connect the jetted well via the pump to the water supply system (e.g. bladder).
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Key Input
A. Jetting procedure (self launching strainer in jetting mode)
B. Developing / exploiting the jetted well (self-launching strainer in “suction” mode)
1. Water jet - Jetting kit
2. Connections - Motor pump kit
3. Self-launching strainer - Reservoir (e.g. 15 m³ bladder)
4. Rigid pipes (2” GI or PVC) - Chlorination kit
5. Valve with elbow and rapid coupling - Protective gear (e.g. heavy-duty gloves, boots)
6. Motor pump - (Temporary) fencing material
7. Water supply (e.g. bladder reservoir)
8. Spiralled pipe
9. Water table
10. Aquifer
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Remarks
■ The jetting technique doesn’t work for consolidated soils. It will be able to pass through thin layers of gravel
and clay, but the latter will not provide a high yield, even when it contains plenty of water.
■ The sites where jetting will be performed have to be carefully chosen: the alluvial ground of river banks and
around lakes might be a good area. Also jetting in or around a dry wadi can give good results, but be aware
that the jetted well might be lost or at least flooded when the wadi fills up again.
■ The jetted well should be at least 30 m away from latrines, and 50 m away from waste zones (with organic
waste pits), landfills and cemeteries.
■ The area where the jetting takes place should be fenced off in order to avoid accidents to bystanders.
Unauthorised personnel should not be allowed on the site.
■ The jetting rods are often made of galvanised iron (GI) pipes because of their strength. They have the big
inconvenience however to be very heavy, which is not only a burden during their transport. It is also difficult
to lift and keep the GI pipes in the vertical position during the jetting procedure. It will take several persons
to lift a 2” jetting rod assembly of 5-6 m length, and potentially even ropes. One person will initially be
needed to keep the self-launching strainer in the pre-jetted hole, while the others push the assembly in the
vertical position.
■ A (4x4) car can be used to push a 2” galvanised jetting rods assembly (longer than 6 m) in the vertical
position. Besides the driver, one person will still be needed in the beginning to keep the self-launching
strainer in the pre-jetted hole and at least two others to hold the assembly in position with long ropes.
■ An alternative for galvanised pipes are rigid PVC tubes that resist high pressures (at least PN 10; T.B.
2.30). PVC pipes will bend a lot when long lengths are lifted from a horizontal to a vertical position,
especially with the spiralled hoses connected. Introduce therefore short lengths of PVC pipe (e.g. 2.5 m)
with threaded connectors on both sides (female on one side, male on the other). This means as well that
the spiralled hoses coming from the pump and the elbow / valve will have to be disconnected each time a
new rod is installed. Connect a short piece of spiralled pipe (e.g. 1m) to the elbow to ease the installation
of every new rod.
■ Special attention should always go to the jetting rods assembly not falling sideways, potentially causing
damages and/or injuries. This entails as well that protective gear such as a hardhat, heavy duty gloves and
boots should be worn by all personnel present during the jetting procedure. An overall is strongly
recommended as well.
■ Once the development of the jetted well is completed, it should be disinfected. This can be done by adding
10 l of 1% chlorine solution per m³ of water inside the jetting rods assembly (for 2” rods, this would mean
pouring in 20 ml of 1 % solution per meter of tube well under the water table level). After 12 hours, the
hyper-chlorinated water should be pumped out of the jetted well and wasted until the Free Residual Chlorine
concentration (T.B. 2.22) has dropped to 0.5 mg/l.
■ Shallow high yield jetted wells, located in the neighbourhood of a surface water source (e.g. river), will
often improve the turbidity enormously in comparison with the raw surface water. As such, the need for
assisted sedimentation and/or filtration might be avoided (e.g. in emergencies). But its micro-biological
quality might still be inadequate. Hence, such water should always be disinfected before consumption,
according to the drinking water standards (T.B. 2.21).
■ One motor pump can be connected at the same time to several jetted wells to increase the yield. However,
the jetted wells should be spread out by at least 5 meters.
■ Jetting can also be used to probe the soil rapidly to decide on the construction of (shallow) hand dug wells.
Not only will the depth of the water table be known, some simple pumping tests on the jetted well can give
information on the potential well yield that can be obtained.
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T.B. 2.08 Protecting a spring

A spring needs to be captured and protected at its points of resurgence, also called the spring eye. A
correct spring catchment will maximise the quantity of groundwater that can be collected, and prevent it
from becoming contaminated when it nearly reaches the ground surface. A spring box can be added
because it permits the sedimentation of heavy particles (e.g. sand) coming from the resurgences. The
spring box could be constructed directly around the resurgences, but it is often cheaper and simpler to
build or to install a separate one. A storage reservoir (potentially integrated within the spring box) is
essential when the yield is low and groundwater also needs to be accumulated during the night to cover
the real water demand.
Construction
■ Clean and excavate the area around the spring to catch all the resurgences, in order to obtain the maximum
yield. From the start, it will have to be decided if a separate spring box will be constructed downhill, or if the
people will collect the water directly from the spring.
➞ For a separate spring box, excavate only around the spring eye until the impermeable layer is reached and
foresee a trench for the foundation of the dam wall.
➞ For direct collection (as presented in the figure), similar excavation works need to be done. But the excavation
works will have to be deeper in order to install a slightly sloping platform, where the users will be able to fill
their recipients.
■ Calculate the quantities of materials that are needed (e.g. concrete, stones, bricks) according to the size of the
spring and the local construction means. The amounts of materials also depend on the decision to build a
spring box nearby the resurgences or not.
■ Divert the spring water during all the construction works.
■ Make a clay or concrete (150 kg/m³, T.B. 2.05) bowl-shaped slab just above the trench for the dam wall
foundation, but below the spring eye.
■ Construct the dam wall foundation within the trench, using concrete (300 kg/m³) or masonry-work.
■ Erect the dam wall with masonry-work without forgetting to insert the outlet and overflow pipes;
➞ The outlet pipe (galvanized iron) should be imbedded with clay or mortar in the bowl-shaped slab and slightly
inclined along the slope of the hill. The bowl-shaped slab should be covered with a large stone or a concrete
slab.
➞ The inlet of the overflow should be just underneath the level of the spring eye and its pipe (with a bigger
diameter then the outlet pipe) inclined along the slope of the hill.
■ Make the dam wall watertight on the inside (side of the spring eye) with a clay coating or two layers of cement
plaster (each 10 mm thick; T.B. 2.05). The second layer should only be applied once the first one has dried.
Pay particular attention around the pipe passages. Put preferably also one layer (10 mm) on the outside of the
dam wall.
■ Imbed sharp stones on top of the dam wall to discourage people sitting or standing on it.
■ Backfill the remaining gap in between the dam wall and the excavation with small stones so as to avoid erosion
and collapse.
■ Place clean pebbles (gravel) between the bowl-shaped slab and the spring eye in order to allow the spring water
to flow freely.
■ Cover the pebbles with large stones (or concrete slabs) and a clay layer (at least 0.1 m thick) that continues
until the dam wall. This clay layer prevents the spring being contaminated by surface or runoff water. It is
recommended to pour a 1 % chlorine solution on top of the bowl-shaped slab and the pebbles, before the
protective clay layer is applied.
■ Backfill the remaining part behind the dam wall with the excavated soil, and cover with topsoil.
■ Make a concrete floor just underneath the dam wall. This concrete floor will avoid erosion (e.g. caused by the
spring overflow) and will provide a clean area in case the people will collect water directly at the outlet pipe.
■ Make a drainage channel to drain the spilled / overflow water away.
■ Make also drainage canals above the catchment area leading the runoff water around the spring. This prevents
the runoff water damaging or contaminating the resurgences.
■ Install a fence (e.g. bushes) around the site, with a radius of at least 10 m to avoid access of animals that can
contaminate and/or damage the spring area.
■ Plant short rooted vegetation (e.g. grass) on top of the spring catchment to stabilise the soil and to protect it
against erosion.
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Key Input
1. Impermeable dam wall - Concrete and/or fired bricks / cement blocks / big stones
2. Sharp stones - Cement, sand, gravel, pebbles, clean non-salty water
3. Foundation of the dam wall - Clay
4. Impermeable soil - Large flat stones (or concrete slabs)
5. Bowl-shaped slab - Top soil and grass
6. Clean pebbles - 1½ or 2” galvanised iron outlet pipe(s)
7. Large flat stones or concrete slabs - 2” galvanised iron overflow pipe(s)
8. Clay layer - Fence material
9. Backfill soil - Digging equipment (shovels, hoes, pick axes)
10. Topsoil - Masonry tools
11. Outlet pipe - Plumber tools
12. Overflow pipe (case depending)
13. Cemented platform
14. Drainage channel
15. Water container
16. Backfilling (gravel)
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Remarks
■ It is important before any construction work starts to do a sanitary survey to identify the pollution risks, and
to determine the real water demand. Before the start-up of a big spring construction, specialised literature
should also be consulted and a site-specific plan drawn.
■ A real spring should have a constant water temperature. If this is not the case, it is probably surface water
that went underground somewhere uphill and is re-emerging. The yield of such a re-emerging “spring“ will
most often rise rapidly if it rains.
■ Be careful not to divert the spring in another direction or into another fissure when digging around it.
Terracing should start at the point where the water comes out of the earth. Dig by working upstream the
water bearing layer, while ensuring that the spring water can flow freely away.
■ The excavation should continue until the impermeable soil layer is reached. This is the level from where
the spring water should be captured, thus it also indicates where the outlet pipe should be installed.
■ In case the underground wouldn’t be (completely) impermeable (e.g. fissures), the bottom of the excavation
should be made watertight by plastering it with a layer of clay or lean concrete.
■ For larger springs with a yield higher than 30l/min, several outlet pipes will be required. For small springs
with a yield lower than 20l/min, one 1½” outlet pipe is sufficient.
■ Never let the water level inside the catchment rise above the spring eye as this could produce a back
pressure which can make the flow emerge elsewhere. Therefore is the correct level of the overflow pipe
crucial for the good functioning of a spring, meaning that it should never be positioned above the level of
the spring eye.
■ In case the water collection is done directly at the outlet pipe, there should be a sufficient height difference
in between the outlet pipe and the platform for (large) water recipients to fit in between (0.5 m is often
enough).
■ When a spring box is added to an existing catchment where water is collected directly, the outlet pipe
should preferably be covered with soil. Therefore will it be necessary to backfill the platform until the outlet
pipe is covered and a new concrete floor should be constructed to drain the overflow water away without
causing erosion.
■ A (separate) spring box is recommended because it will permit heavy particles coming from the resurgences
to settle down, which will protect the pipeline downhill from getting clogged and/or people having dirt in their
water. It is recommended to have the spring box divided into two compartments by a ¾ high wall. The
particles will settle in the first compartment and the water flowing over the wall into the second compartment
should be exempt of dirt. The settled particles will have to be drained once in a while from the spring box,
therefore a separate drainpipe with valve (besides the outlet and overflow pipes) will have to be foreseen.
■ A spring box can also function as storage capacity (during the night). This is essential in case the spring
has an insufficient yield to cover the actual water demand with daytime collection only. However, it might
be difficult or even impossible to transport all building materials or a pre-fabricated reservoir (e.g. plastic)
to the spring site. A storage reservoir can then be located nearby the consumption area (e.g. village, health
structure). Another advantage of having the reservoir close to the consumption point is that it is easier to
chlorinate the water (to protect it from post-contamination). Often a combination of a relatively small
(separate) spring box at the catchment and a storage reservoir nearby the consumption point is the
preferred option for long-term use.
■ Once the construction is finished or maintenance works have been done, the spring box / reservoir should
be disinfected. This can be done in a similar way as hand dug wells are disinfected (T.B. 2.03, technique
A), at least once a year.
■ A spring will require a minimum of maintenance; the collection area and drainage channels should be kept
clean and vegetation should be kept under control not to damage the structure (e.g. plants with long roots
starting to grow on the spring catchment should be eliminated).
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T.B. 2.09 Rainwater harvesting

Rainwater in non-industrialized and non-urban areas presents normally good quality characteristics.
Although its variability along the seasons is generally important, rainwater harvesting can be interesting
to cover the whole water demand, or to complement other water sources that are insufficient in quantity
and/or quality. Rainwater can be collected from any clean surface, with roof catchments being used most
often. The rainwater is then transferred to a tank via gutters. The contamination of harvested rainwater
comes primarily from the first rains, rinsing away the accumulated dirt on the roof. Correct techniques of
rainwater harvesting will remove this contamination first before the water is stored.
Demand / supply analysis

3
■ Determine the total daily demand (m /day), based on the number of consultations and number of beds of
a health structure for instance.
■ Verify the total ground surface covered by the roof (including the eaves) that will be used for the rainwater
collection; this “horizontal” collecting roof surface (R) equals the length (L) x breadth (B).
■ Collect monthly rainfall data for the region. This data can be found at meteorological stations (e.g. at
airports), or potentially in universities and on the internet (e.g. )
■ Calculate the average daily supply based on the annual rainfall and the collecting roof surface according
to the formula:
ADS = (AR x R x C)/365
With ADS (m3/day) = average daily supply
AR (m) = annual rainfall
R (m2) = collecting roof surface (plan area)
C = runoff coefficient (it considers mainly evaporation, wetting and leakages, and it
depends on the roof material and its age; apply a coefficient of 0.8 – 0.9 for tiles, 0.7 – 0.9
for corrugated metal sheets and 0.7 – 0.8 for plastic sheeting)
■ Compare the total daily demand to the average daily supply (ADS). If the supply is higher than the demand,
rainwater harvesting can fully be used to provide sufficient water over the whole year, as long as there is
enough storage capacity. If the supply is lower than the total demand, the collecting roof surface should be
increased, augmenting the costs significantly, or the rainwater will only be used:
➞ Occasionally: the very limited storage capacity only permits to cover the demand with rainwater when it’s
raining; one or two days without rain means that another source has to be used. This system can be useful
in areas with a uniform rainfall pattern, with a limited investment.
➞ Intermittently: the storage capacity is such that the demand is covered during the whole rainy season, but during
the dry season another source will have to be used. This system can be useful in areas with a long rainy
season.
➞ Partially: the storage capacity permits to cover the demands partially over the whole year (e.g. good quality
water for drinking and cooking), while the other needs (e.g. laundry) have to be covered with another source
of lesser quality (or the other way around). This system can be achieved for areas with a uniform rainfall
pattern by a relatively small storage capacity, but needs a big reservoir if the pattern isn’t uniform.
■ Estimate the needed reservoir size.
➞ Occasional: its storage capacity should be for 1 or 2 days, the latter certainly for health structures.
➞ Intermittent: its capacity should be able to cover the total daily demand over all the days the rainy season lasts.
Be aware there might be some days it doesn’t rain, even during the rainy season.
➞ Partial: its storage capacity should cover the specific demand (e.g. drinking) over the whole year.
➞ Full: the storage capacity should cover the total demand over the whole year, knowing there will be months
with a supply surplus and others with a deficit. The calculation of the needed reservoir capacity falls outside
the scope of these guidelines (contact your technical referent).
■ Make a final choice to invest in rainwater harvesting systems or to exploit other sources, depending on:
➞ The demand / supply analysis: high demands can significantly increase the investment costs for the collection
and storage capacity, as do long dry seasons.
➞ The comparison between the development and operation costs of alternative water sources and the costs of
the rainwater harvesting system, including storage costs.
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Key Input
A. Rainwater catchment system
B. Detail of a roof washer (pipe system)
C. Detail of a collection reservoir
D. Detail of a deflector on a gutter system
1. Roof (plastic, metal or tiles) - Electrical drilling machine or hand drill with bits
2. Gutter - Rounded and half-rounded files
3. Down-pipe towards the reservoir - 4” PVC pipes, elbows, Tees, caps
4. Descending pipe towards the roof washer - PVC glue and de-greaser
5. Draining holes (2 mm diameter) - Gutters (e.g. halved PVC pipes)
6. Removable end cap of the roof washer - Supports for pipes and gutters
7. Small ventilation pipe - Saw and hammer
8. Inlet pipe of the reservoir with elbows - Other carpentry and masonry tools
9. Water reservoir - Nails and screws
10. Overflow pipe with siphon and screen - Screens
11. Screened outlet - Reservoir (size according to the needed volume)
12. Drain of the reservoir - Roof washer (size according the volume needed)
13. Manhole with a removable cover
14. Evacuation for dirty water and overflow
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Installation
Traditional system
■ Install a water reservoir with the correct size. The reservoir can be constructed in masonry-work, concrete,
or ferrocement (T.B. 2.38), or it can be prefabricated (e.g. plastic, fibreglass). It should be a completely
closed reservoir with a covered manhole. It should have an inlet at the top, a sludge drainpipe with a valve,
an outlet with an individual tap or a connection to a distribution system via a valve, and an overflow that is
covered with a mosquito screen. Its location should be as close as possible to the roof where the rainwater
is harvested. A correct evacuation system should be foreseen for the overflow and the spilled water from
the tap, with the aims to avoid stagnant water and erosion around the reservoir.
■ Prepare a roof washer system (also named first or foul flush device) to avoid that the first rains rinsing the
roof would enter into the water reservoir. Several foul flush devices exist, like factory made models based
on the principle of a vortex which keeps the dirt particles in suspension, while only clean water can pass
into the reservoir. It is also possible to make some simple systems locally, like:
➞ a vertical pipe with a diameter of at least 4” descending at every 10 m of gutter length, closed at the bottom
with a watertight but removable cover (as per figure B). The first (dirty) rainwater will be collected in the
descending pipe until it is full, and then clean rainwater will overflow into the reservoir. A small hole (2 mm
diameter) should be made about 0.2 m above the removable cover, and another two on top of each other
with a distance of 0.1 m (as per figure B). These holes will allow the descending pipe to drain completely
once the rainfall stops. In this way, this simple but automatic device will be ready again for the next rainfall.
➞ a grease trap alike design (T.B. 4.04, model A with elbow and T-piece) placed on top of the water reservoir,
in which the dirt particles will settle. A screen (e.g. metallic mosquito netting) can be added in the middle
of the device to stop leaves from getting into the water reservoir. Some small drain holes should be
foreseen again to empty this roof washer automatically.
■ Install the gutters at the edge of the roof, with a 0.2 to 1 % slope towards the roof washers and down-pipes.
The gutters can be factory made (e.g. PVC, metal) or locally made of a cut-in-half PVC pipe or a galvanised
metal sheet folded in a rectangular section. The gutters must be solidly fixed in order to withstand a sudden
and violent water influx, like is frequently occurring in tropical areas. In order not to loose too much rainwater
during heavy rainfall, it is recommended to install deflectors at the edge of the roof (as per figure D).
■ Connect the gutters with the roof washers and the down-pipes. The connections should be watertight.
■ Foresee also additional leaves separators. These can be cones with holes that are installed in the gutter,
one over each inlet of the descending and down-pipes.
Alternative for emergencies
■ Rainwater can also be an interesting (additional) source for (acute) emergencies. Following are two ways
of installing a simple emergency rainwater harvesting system:
➞ Suspend a piece of plastic sheeting in a large U-shape to form some kind of a big gutter, which is hanging
with its lower side inside an open reservoir (T.B. 2.35; 2.38). The upper corners of the plastic sheeting are
potentially connected to an existing roof. If the roof is of poor quality or in case of a tent, new plastic
sheeting can be used to cover it.
➞ Install on a gentle slope several complete rolls of plastic sheeting overlapping each other (e.g. 5 rolls =
60 x 16 m catchment area), with a big gutter at the lower end. A surface pump can transfer the rainwater
that is collected inside the gutter to a reservoir for disinfection and storage.
■ For these temporary solutions, it won’t be possible to install an automatic roof washer. Thus the first rains
will have to be discarded by draining the dirty water away.
Operation and Maintenance

■ Disinfected the water reservoir and other cisterns of the rainwater harvesting system before they are
commissioned and after they have been cleaned. This can be done in the same way as described for wells
(T.B. 2.03, technique A). Every 2 – 3 years, they should also be examined for sludge accumulation.
■ Fill the reservoir with potable water from another safe source after cleaning and disinfection works have
taken place. Otherwise, it will take too long before the reservoir is filled up again with rainwater, certainly
during the dry season.
■ Clean the roof washers frequently to avoid accumulation of materials like leaves or sand that will block the
drain holes. The gutters and the leaves separators must be cleaned regularly too.
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Remarks
■ In urban and/or industrialized areas, it is strongly recommended not to use rainwater for drinking, feeding
(cooking, washing dishes) and personal hygiene activities because the atmospheric pollution has an
important impact on the water quality. In these contexts, it should thus be avoided to implement rainwater
harvesting systems, unless the water will only be used for other purposes (e.g. flushing of toilets, laundry).
■ The amount of rainwater that can be harvested is relatively limited. If partial and full systems are required,
substantial investments will be needed for the roof and the storage reservoir. In order to reduce the needed
storage capacity, the rainwater should be harvested on all the available roofs. Under certain circumstances,
it will be cheaper to construct an additional roof (which in a health centre could be used as a waiting area
for the patients for instance) than to build a big reservoir.
■ The slope of the roof itself and its actual number of square metres are not important to determine the roof
surface. It is only the ground surface covered by the roof that should be determined.
■ Painted or corroded iron sheets and thatch should be avoided for rainwater harvesting. Good quality
galvanized iron or plastic sheets and tiles are the preferred choice for rainwater collection. Existing
asbestos-cement roofs in good condition could be considered as well. The asbestos-cement micro-fibres
don’t represent any health risk when swallowed. However, they are very dangerous when inhaled. Thus
the risk would be a lot higher to remove the existing asbestos-cement roof to be replaced by another
material than using it directly for rainwater collection. Serious attention should still be given not to cut,
break or drill in the existing asbestos-cement sheets during the installation of the gutters.
■ In case rainwater is the only source of water, the reservoir size should be calculated correctly, based on
the monthly rainfall data. Extreme over-sizing is too expensive and under-sizing will lead to a water shortage
at the end of the dry season.
■ The storage reservoir must imperatively be closed to protect the harvested rainwater from any external
contamination. A manhole with a well closing lid is essential however to permit regular maintenance. The
overflow of the reservoir should always be equipped with a screen to avoid that vectors would breed inside.
■ Roof washers are essential, certainly if the harvested rainwater will be used as drinking water without
treatment (although chlorination is always recommended for health structures). Their capacity must be
sufficient for the roof to be cleaned and for the harvested rainwater not to contain impurities anymore.
Their capacity should be calculated according to the surface of the roof and the environmental conditions;
e.g. intensity and frequency of the rainfall, surrounding vegetation. A rule of thumb for correct rinsing is to
foresee about 1 l/m2 of roof surface, although this will not be possible for areas with limited rainfall. At least
5 l of the first rains need to be discarded for roofs of small houses, whereas at least the first 25 l can’t be
used for medium sized buildings (e.g. health centres with a roof surface of 150 m²).
■ The drain holes of a roof washer have to be small not to interfere too much with the system filling up, even
during light rainfall. However, due to their small size, they might get clogged rapidly which will hamper the
automatic drainage of the roof washer. Therefore is a very frequent cleaning of the device of utmost
importance.
■ In areas where avian flue is present or suspected, it is strongly recommended to chlorinate the rainwater
to a free residual concentration of at least 0.5 mg/l, after a minimum contact time of 30 minutes with the
water at a pH < 8.
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T.B. 2.10 Water analysis

Potable water should be absent of pathogenic organisms and have low concentrations of toxic chemicals.
Unfortunately, these two criteria can not be assessed by simple tests. There is no direct relationship
between the appearance of a water sample and its drinkability; for example, a cloudy sample may be safe,
whereas a clear sample may be both chemically and microbiologically contaminated. The presence of
pathogenic organisms is a more frequent and acute problem than the presence of chemical substances
at toxic concentrations in non-industrialized and in non-intensive agricultural areas.
Microbiological analysis
The pathogenic organisms which may be present in water are too numerous and too various to be identified
individually in practice. As their presence is mostly linked to faecal contamination (except for e.g. Guinea
worm), it is preferable to look for organisms that are “indicators” of this pollution. These indicators should be
universally present in large numbers within the faeces of humans and other warm blooded animals, should
be readily detectable with relatively simple methods and should not grow in natural waters.
The indicator organism of choice for (recent) faecal pollution is the Escherichia coliform (E. coli).
Thermo-Tolerant Coliforms (TTC) can also be used as an alternative in many circumstances and certainly
under field conditions, because a very high percentage (more than 80 %) of the TTC’s are E. coli anyway.
The kind of indicator that will develop during a bacteriological analysis depends mainly on the culture media
and the incubation temperature.
Water for human consumption should not contain indicator organisms. The presence of Escherichia or
Thermo-Tolerant Coliforms in water indicates the probable presence of pathogenic organisms, where their
absence indicates the possible absence of pathogens, but is no proof of this. Certain pathogens like protozoa
and some enteroviruses are more resistant than faecal coliforms to unfavourable environmental conditions
and disinfectants like chlorine.
The count of Escherichia or Thermo-Tolerant Coliforms per 100 ml gives an indication of the degree of faecal
pollution. Where the ideal is set at 0 E. coli/100 ml of water, a count of up to 10 E. coli/100ml may be
admissible without treating the water. Counts above this level require at least a disinfection (e.g. chlorination)
that will have to be preceded with other forms of treatment when the turbidity is high (T.B. 2.12). Following
table gives an appreciation of the health risk related to the amount of coliforms that are present in a 100 ml
water sample.
Health risk Class E. coli

or TTC/ 100 ml
None – conform 0
Low risk 1–9
Intermediate risk 10 – 99
High risk 100 – 999
Very high risk ≥ 1000
Bacteriological analysis are mostly performed by means of the membrane filtration method or the Most
Probable Number (MPN) method. Both methods have their advantages and inconveniences. The membrane
filtration method gives direct and more precise results (on non-turbid water) when performed by experienced
people, where the MPN method is less but sufficiently accurate and a lot easier to perform and to interpret.
Both methods can be implemented as well under laboratory as under field conditions.
When water is (mass) distributed via taps, it should normally be treated, at least with chlorine. In these cases,
the indicators (e.g. E-coli) will be eliminated by the disinfectant and the count of coliforms is less relevant.
Where disinfection isn’t possible, a bacteriological analysis is strongly recommended, even in some acute
emergencies (e.g. a hand pump installed on a well that has been flooded). A positive count of coliforms in
the water indicates the presence of (faecal) pollution. For chronic emergencies and certainly for stabilised
situations, the source of the pollution should be found and prevented first, rather than starting to treat the
water. For accidental events, the pollution should be retrieved if possible and preventative measures installed.
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Chemical analysis
The chemical analysis method differs for each element that needs to be examined. As each element requires
specific tests, refer to more specific literature. These tests and their interpretations are to be carried out by
properly trained personnel. Based on experience, appropriate analysis must be carried out, preferably by the
national authorities:
■ when a long-term water supply is being planned and/or
■ when chemical pollution is suspected (intensive agricultural area, industries).
The way the water samples for chemical analysis have to be taken is presented in T.B. 2. 11.
Physical analysis
Two main physical water characteristics are to be measured, certainly when chemical treatment like
coagulation / flocculation (T.B. 2.15) and/or chlorination (T.B. 2.21) is required:
Turbidity
indicates the amount of suspensible particles present in the water. Turbidity is commonly expressed in
(Nephelometric) Turbidity Units or (N)TU. It is considered that a turbidity under 5 NTU permits the “most
effective disinfection possible” with chlorine, at least under field conditions (T.B. 2.21). A turbidity up to 20 NTU
is still acceptable to chlorinate drinking water during the acute phase of an emergency. The turbidity might
also be an important factor for the acceptability by the consumers. T.B. 2.13 presents the detailed procedure
to measure turbidity.
pH
is a logarithmic scale of the hydrogen ion (H+) concentration and indicates in practice if the water is acid
(<7), neutral (=7) or basic (>7). Although the pH has no direct (health) impact on the consumers, it is one of
the most important operational water quality parameters as it has an influence on some chemical water
treatment procedures and on the corrosion / incrustation of the equipment (e.g. pumps, pipes). T.B. 2.22
presents the detailed procedure to measure the pH with a pool tester.
Remarks
■ Bacteriological and/or chemical analyses are not always necessary. It is generally much more important
and useful to do a sanitary survey concerning amongst others; the origin of the water, the protection of the
water point, its location in relation to defecation areas, cemeteries and waste zones, the protection of the
water during transport and storage. Such a survey will often make it possible to determine if the water is
polluted, or has strong chances of getting polluted at one time or another. Analyses only give an indication
of pollution at the precise moment of sampling, and not of the potential risk of pollution. However, it can be
relevant to do a bacteriological analysis of a well protected water source: e.g. in case there is a sudden
increase of faecal-oral diseases.
■ The health risk due to toxic chemicals in drinking water differs from that caused by microbiological
contaminants. There are few chemical contaminants of water that can lead to acute health problems,
except through massive (accidental) contamination of the supply. Most chemical contaminants of drinking
water cause adverse health effects after prolonged periods (years) of exposure.
■ In case water treatment is performed with chemicals, field test kits (for iron / aluminium or chlorine residual
measurements) should be available to do a regular follow up of the treated water.
■ Laboratories that can perform bacteriological and chemical analysis can often be found in the capital of
low-income countries, and also in water treatment plants or in breweries. The main problem, in particular
for bacteriological analysis, is to get the water sample on time in the laboratory. Samples should reach the
analytical laboratory within the hour of sampling if they are kept at ambient temperature, or within 6 hours
if they are kept at a temperature between 4 and 6 ˚C (but not frozen).
■ Always work with clean hands (washed with water and soap) when performing sampling (T.B. 2.11) and
water analysis. Any contamination by dirty hands can / will distort the results.
■ When a new water source is put into service and if the infrastructures are available, the water sampling and
analysis should be undertaken by the appropriate (national) authorities, according to the national standards.
In this way, the local government will be involved in the process and the responsibility transferred to them.
In acute emergencies however, this procedure might be more complicated.
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T.B. 2.11 Water sampling

In order to obtain correct results from the water analysis, it’s important to strictly respect the whole
procedure, starting from the moment a water sample is taken. The way the sampling is done depends on
the water “source”, but differs also slightly whether it is for bacteriological or chemical analysis. It is
recommended to double all samples to rule out as much as possible any mistakes.
Sampling Techniques
Sampling for bacteriological analysis
A. From a tap: step 1 - 8
■ Clean the tap with an unsoiled cloth impregnated with alcohol or soap.
■ Let the tap run fully for about 30 seconds.
■ Flame it with a pad soaked in alcohol if it’s a metallic tap.
■ Let it run fully again for 30 seconds.
■ Remove the protection (seal) from the sterile bottle and take off its cap. Don’t put the cap down where its
inside could get contaminated.
■ Take the water sample.
■ Replace the cap and the protection (seal) without touching the inside of the bottle / cap, nor the water.
■ Label the sample bottle and record the essential information in a notebook.
B. From a water course:

■ Turn the bottle upside down and introduce it in the river.
■ Turn the bottle upright when it is at about 0.2 m under the water surface. This should be done in such a
manner that the inlet is facing the current (water flow direction), in order to avoid that the water sample gets
contaminated by your hand.
■ Let the bottle fill up completely with water and take it out of the river.
■ Label the sample bottle and record the essential information in a note book.
C. From a well:
■ Attach a disinfected weighting ballast and string to the closed sterile bottle.
■ Lower the bottle in the well until it is about 0.2 m under the water surface. The weighting ballast will help
the bottle to sink.
■ Lift the bottle carefully to the surface again.
■ Remove the weighting ballast and string from the closed bottle.
Sampling for chemical analysis

The sampling techniques for chemical analysis are similar to those for bacteriological analysis. However, even
if it is still necessary to let the tap run for about 30 seconds, there is no need to respect the measures for
sterile sampling (e.g. sterile bottles, flaming of the tap). A water sample for chemical analysis requires at
least 2 glass or plastic bottles of 1 to 1.5 l (e.g. mineral water bottles), which must be clean and airtight.
■ Prepare the bottles to collect the water sample:
➞ Attach a rinsed weighting ballast and string to the closed bottle if the sample needs to be taken from a well.
➞ Remove the cap from the bottle.
➞ Rinse the cap and the bottle 3 times with the water to be analysed, according to the sampling techniques
described for bacteriological analysis.
■ Fill the bottles right to the top according to the sampling techniques described for bacteriological analysis
and put their cap back on (remove the weighting ballast and string from the closed bottle if necessary).
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Key Input
A. Sampling from a tap (bacteriological analysis) Bacteriological
steps 1 - 8 - 2 sterile 100ml bottles per sample
B. Sampling from a water course - Cotton wool / forceps (hair tweezers)
9. Water surface - Alcohol and lighter (if tap)
10. Current - Cool box and icepacks
C. Sampling from a well Chemical
11. String coil - 2 x 1 l glass or plastic bottles per sample
12. Weighting ballast (e.g. stone) Common
- Thermometer
- Marker pen for labelling
- Notebook and pen
- String and weighting ballast (if well)
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Remarks
■ Always work with clean hands (washed with water and soap) during sampling and water analysis. Any
contamination by dirty hands will distort the results.
■ The described measures for sterile sampling are not necessary for chemical analysis, but are absolutely
essential for bacteriological analysis.
■ Sterile 100 ml sample bottles can potentially be obtained from a laboratory or from the sterilisation
department of a hospital. An alternative is to purchase sterile bottles or sterile single use sachets. If these
solutions aren’t possible, it is still possible to sterilise the bottles yourself according to the following steps:
➞ Foresee at least 2 x 100ml bottles per sample. Glass and polypropylene (PP) bottles can be sterilised, but
polyethylene (PE) and PVC bottles won’t resist the temperatures that will be reached in the autoclave.
➞ Remove the cap from each bottle.
➞ Immerse the bottles and the caps in a 0.1 % chlorine solution for 15 minutes.
➞ Rinse the bottles and caps with clean water.
➞ Wash the bottles and caps with clean water and soap.
➞ Rinse all of them with clean water and dry them.
➞ Pack the bottles and caps together in a double layer of crêpe paper (don’t put the caps back on the bottles,
to allow the steam to enter).
➞ Put the package upside-down in the autoclave, in such a manner that the opening of the bottles are
pointing downwards.
➞ Sterilise the package at 1.05 bar (121 °C) for 20 minutes according the instructions of the autoclave’s
manufacturer. This should preferably be done by an experienced person (e.g. in a health centre).
➞ Keep the crêpe paper package at a safe place until the sterile bottles are used, which should be within
the 2 weeks following the sterilisation (if not, the procedure should be repeated).
■ If there is no autoclave, the bottles may be “sterilized“ by boiling:
➞ Place each bottle and its unscrewed cap in clean water and let it boil for 20 minutes.
➞ Take them out of the water after 20 minutes of boiling, and let them cool, whilst protecting the opening with
flamed aluminium foil or a sterile compress.
➞ Use the bottles as soon as possible.
■ Never touch the inside of the sterilized bottle / cap. When sampling, hold the cap by the outside; never put
it down unless it is upside down. It is better, for security and reliability, to double each sample.
■ The weighing ballast should be disinfected before the water sample is taken: remove all the potential dirt,
boil it for 20 minutes or flame it with alcohol.
■ For a bacteriological analysis of water that has been chlorinated, sodium thiosulphate solution has to be
added to each sampling bottle before sterilizing. This product will neutralize the chlorine of the water
sample, which would otherwise affect the results. Single use sterile sachets with integrated sodium
thiosulphate are also existing. Contact your technical referent for more information.
■ Certain chemical tests require special sampling. Enquire about these with your technical referent.
■ Mark the following on each water sample (and keep a copy in a notebook):
➞ an identification number, the sampling place and the water source type (as accurately as possible);
➞ the date and time of sampling and dispatch;
➞ the substance(s) or organism(s) to be identified; specific techniques wanted
➞ treatment, if any, of the water (treatment product and dose);
➞ water temperature at the time of sampling (if possible).
■ Laboratories that can perform bacteriological and chemical analysis can often be found in the capital of
low-income countries, and also in water treatment plants or in breweries. The main problem, in particular
for bacteriological analysis, is to get the water sample on time in the laboratory. Samples should reach the
analytical laboratory within the hour of sampling if they are kept at ambient temperature, or within 6 hours
if they are kept at a temperature between 4 and 6 ˚C (but never frozen).
■ In case it isn’t possible to get the water samples on time in the laboratory, the only alternative to perform
a bacteriological analysis is with field testing kits (e.g. membrane filtration or the Most Probable Number
methodology; see the respective user’s manuals).
■ In case water treatment is performed with chemicals, field test kits are essential to do a regular follow up
of the treated water (iron / aluminium and/or chlorine residual measurements).
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T.B. 2.12 Water treatment methods

The objective of treatment methods is to obtain potable water; meaning being “free” of microbiological
contamination, having a low concentration of toxic chemical products and a low turbidity. Although they
have a smaller direct health impact, factors as salinity, colour, odour and taste should not be neglected
because they play an important role in the acceptability of the consumers.
Water treatment methods

To remove microbiological contamination:
The main objective of water treatment in precarious situations is the elimination of pathogens. The treatment
methods to obtain this objective are:
Physical disinfection
■ Heating can destroy the pathogens. Boiling water is an effective way to disinfect small quantities of water
(even when turbid) if it is performed correctly, but it doesn’t protect against any further contamination (no
remnant effect). To be completely sure that all pathogenic organisms are destroyed, the water should be
brought to a rolling boil for at least one minute (although there is a lot of discussion on the minimum time
needed), augmented by one minute for each altitude increase of 1000 m. This treatment method consumes
a lot of energy and influences the taste of the water (which can be remedied by re-oxidizing the water by
means of stirring or pouring it into another clean recipient).
■ UV light has the capacity of eliminating most pathogens, but it does not give a remnant protective effect
to the treated water. However, UV irradiation can be a very interesting treatment method against pathogens
which aren’t affected by chlorine at normal drinking water concentrations; e.g. Hepatitis E virus. Another
interest for UV irradiation (on big scale treatment) is when adding chlorine gives a significant colour variation
of the treated water.
Special UV- C lamps have been developed to disinfect big quantities of non-turbid water in very short times,
but they are rather fragile. After their foreseen lifespan (information provided by the manufacturer), they
should be replaced, even when they still seem to function. The reason is that their irradiation frequency has
shifted too far away from the ideal bactericidal wavelength (254 nm).
For small quantities of non-turbid water (<20 - 30 NTU; T.B. 2.13), the principle of UV irradiation can also be
achieved by the sun. Water stored in smooth, scratch free and transparent plastic (PET) 1 - 1.5 l bottles will be
disinfected, but it requires long periods of full sunlight to be effective. This can be improved by painting one side
of the bottle black or by placing it on a black corrugated iron sheet in order to increase the temperature of the
water as well. The exposure time to full sunlight still needs to be 6 - 8 hours.
■ Certain filtration procedures are able to eliminate pathogens from raw water. Surface filters will remove
all particles, including the pathogens that are bigger than their pore size, whereas smaller particles will remain
in the water. These filters include ceramic candle and membrane filters. To avoid clogging, a frequent cleaning
or replacement of the filters will be required. Slow sand filtration on the other hand uses a mechanical filtration
combined with a natural biological membrane of micro-organisms that feed on organic matter, including
pathogens. They are capable of removing suspensible particles as well, but if the turbidity is higher than 30
NTU, rapid clogging of the filters will occur (T.B. 2.17). A pre-treatment like roughing filters is thus required
in order to have a cleaning frequency of once every two months. None of the filters gives a remnant protective
effect.
Chemical disinfection
■ Several chemicals such as chlorine, ozone and iodine can disinfect water. All products have their advantages
and inconveniences, but most of the aid-agencies will disinfect water with chlorine (T.B. 2.19 to 2.23). The
disinfection procedure with chlorine is rather easy to perform, relatively cheap and efficient against most bacteria
and viruses. Another big advantage of chlorine is that it gives a remnant protective effect. It means that if a correct
chlorine concentration has been added, a small accidental contamination of the treated water will be eliminated.
However, at the concentrations used for drinking water, chlorine will not harm the protozoan cysts (Giardia or
Cryptosporidium) nor the helminth eggs, which cause still a health hazard.
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Chlorine won’t be effective either if the water is turbid. Therefore is it important to measure the turbidity and
if needed to remove it before the water is chlorinated. Disinfecting drinking water with chlorine, alone or in
combination with pre-treatments, should systematically be done, certainly in emergencies and health
structures.
To remove chemical pollution:
Because of the existence of huge amounts of different chemical substances, it is difficult to determine if the
water is polluted and even more so by what substance (although a lot of different chemical analysis kits are
existing; for more information, contact your technical referent). Additionally, the removal of chemicals is often
difficult and expensive. Most of the water treatment methods available on the field are only capable of
removing few chemical substances, but which can have their influence on taste, odour and colour. Hence,
it is recommended to change water sources as soon as possible if there is a suspicion of chemical pollution.
To remove turbidity:
Turbidity is a measure indicating the amount of suspensible particles in the water (T.B. 2.13). As such, it will
directly affect the acceptance of the water by the consumers. Most disinfection methodologies are only really
effective when no or a little amount of particles are present in the water. When measured (with a turbidity
tube), the value should be less than 5 (N)TU, and certainly less than 20 (N)TU (for acute emergencies). If
the turbidity exceeds these recommended values, a pre-treatment such as sedimentation (natural or assisted)
and/or filtration should be done before disinfection can be initiated.
Sedimentation processes
■ Natural sedimentation is a process where the raw water is stored in a recipient over a certain period for
the particles in suspension to fall down by gravity. The longer the period, the more particles will settle at the
bottom of the water recipient, although this can take a very long time. These falling particles will also trap
some pathogens and carry them to the bottom of the recipient where they will die over time. The long waiting
times (several hours up to several weeks) make that this procedure is not very practical, and even unfeasible
for emergencies. Water stored for longer periods also has to be protected from the sun to avoid algae growth,
from breeding mosquitoes, from dust and other contaminants entering the recipient.
■ To speed up the sedimentation process, biological or chemical products (e.g. aluminium sulphate, ferric
chloride) can be added to the water (T.B. 2.14 to 2.16). These products, the so-called coagulants, help the
very small particles in suspension to aggregate into bigger and heavier flocks (higher density), so that they
fall faster to the bottom of the recipient. As the process is assisted by adding coagulants, it is called assisted
sedimentation.
Assisted sedimentation reduces the turbidity drastically, but to get under 5 NTU (the appropriate value for an
effective chlorination) requires a waiting time that is often still too long for emergencies. The addition of
flocculants or the use of polymers can reduce the sedimentation time (T.B. 2.14).
The residual concentration of chemical coagulants after assisted sedimentation without filtration are often too
high according to the WHO directives. These residuals may have a negative impact on public health or on
the acceptability of the drinking water by the beneficiaries. Assisted sedimentation does not completely
remove pathogens like protozoan cysts and helminth eggs either. For all these reasons, water should
preferably also be filtered before disinfection, certainly if a very low turbidity is required (e.g. for health
structures).
Filtration processes
■ Filtration processes (T.B. 2.17) use a porous environment to separate the solids from the water. The porous
environment lets the liquid pass while the solids are stopped. As described above, the surface filters and
slow sand filters can reduce the turbidity, but they will clog (rather) rapidly. As the clogging isn’t such a big
problem for rapid sand filters, they are often considered as the preferred choice for filtration in emergencies.
This filtration method can either be the next step following assisted sedimentation, or it can be direct but
assisted with a coagulant (coagulated / flocculated water directly filtered on the sand) and then followed by
chlorination.
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Remarks
■ Sources that are completely protected (e.g. protected wells or boreholes equipped with a good hand pump)
and providing safe water can be exempted from treatment. However, when these sources are equipped
with a motorised pump and a centralised storage system (e.g. health centres), it is recommended to
chlorinate their water anyway to obtain the remnant effect.
■ Only non-turbid raw water can be considered for simple chlorination, although that protozoan cysts and
helminth eggs often survive this disinfection method and still cause health hazards. Thus different treatment
methods will have to be combined in certain situations, certainly when the raw water is turbid. Some
different scenarios as examples:
➞ Acute emergency: turbidity < 20 NTU => simple chlorination (still risk of cysts / eggs)
➞ Acute and chronic emergency: turbidity > 20 NTU
- assisted sedimentation + chlorination (still risk of cysts / helminth eggs)
- assisted direct rapid sand filtration + chlorination (good quality water, limited to 300 NTU)
- assisted sedimentation + rapid sand filtration + chlorination (good quality water)
➞ Stabilized situation: preferably water sources not needing any treatment (except chlorination)
Natural Assisted Ceramic Membrane Slow sand Rapid sand Chlorination

sedimentation sedimentation candles ultra / nano filtration filtration (with normal
filtration (assisted with concentrations
coagulant) used for
potable water)
Turbidity 1 3 3 3 2 3 0
(long waiting (rather long (rapid (rapid (max 30 (up to 300
time) waiting time clogging, clogging, NTU, need NTU)
to reach very frequent frequent for roughing
low turbidity) cleaning) backwashing) filters)
Bacteria 1 1 3 3 2 to 3 0 3
(+/-0.1-20 (long waiting (1 if assisted
µm*) time) with a
coagulant)
Viruses 0 to 1 1 2 3 1 to 2 0 2
(+/-0.01-0.25 (long waiting (1 if assisted (some
µm) time) with a viruses will
coagulant) survive)
Protozoa & 0 to 1 1 3 3 3 3 1
Helminth (long waiting
eggs time)
(+/-1-100
µm)
Salt 0 0 0 1 0 0 0
Colour, 1 1 1 2 2 2 1
odour and
taste
Remarks - not often - turbidity -small -rather fragile -slow -camps -camps
used due to its reduction in production -expensive production -health always
low efficiency emergency. -staff houses -post-chlorinati -small health structures -recommende
-post rapid -small health on structures -post-chlorinati d in health
sand filtration structures recommended post-chlorinati on compulsory structures
desirable -domestic on -domestic
-post-chlorinati treatment recommended treatment
on compulsory -remnant
effect
In grey: the treatment procedures most commonly used by aid-agencies, often in combination with other methods
0: no impact, 1: low impact, 2: medium impact, 3 high impact - * µm = micron = 10-6 m
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T.B. 2.13 Turbidity measurement

Turbidity is an important characteristic of water. It is an expression of the optical property that causes
light to be scattered and absorbed by suspensible particles and molecules, rather than being transmitted
in straight lines through a water sample. The particles in suspension that interfere with the clarity of the
water may include clay, silt, finely divided inorganic and organic matter, soluble coloured organic
compounds, plankton and other microscopic organisms. Turbidity plays a major role in the chlorination
efficacy. The objective of measuring the turbidity of water is to determine if there is a need for a
pre-treatment such as natural or assisted sedimentation, and/or filtration.
Principles
The simplest and cheapest method to measure the turbidity is to use a turbidity tube, but it is unfortunately
also a subjective measurement. A turbidity tube is often available in aid-agencies’ chlorination kits and in
some bacteriological analysis kits. The turbidity tube is a long and narrow graduated tube, in transparent
plastic with a black ring or cross printed on the bottom. The measurements with a turbidity tube are expressed
in (Jackson) Turbidity Units, or (J)TU.
To measure the turbidity in a more objective manner, electronic instruments are required. Several electronic
measurement principles are existing, each with their own precision and price tag. The most precise electronic
turbidity meters measure under 90° the remaining intensity of the light that has been emitted by a specific
lamp through a water sample, potentially compared to a light intensity measurement at 180°. With this
principle, the measured values are expressed in Nephelometric Turbidity Units (NTU), which is also the most
commonly used unit.
Because extreme high precision is mostly not needed on the field and due to the prize, most turbidity
measurements will be done with the tube. Note that some turbidity tubes have wrongfully a NTU scale, but
as it’s a similar scale to JTU, it doesn’t really matter. Anyway, other turbidity units than JTU and NTU exist
(depending on the electronic measurement system), all with a similar scale.
Operation
■ Rinse the turbidity tube 3 times abundantly with the water to be tested.
■ Fillthe turbidity tube completely (until the 5 TU mark) with the water to be tested.
■ Wait a few seconds for the water to stabilize and the air bubbles to disappear.
■ Try to detect via the opening and through the mass of water the black ring or cross at the bottom of the tube.
This has to be done with the tube in vertical position.
■ Remove gradually water from the tube (if necessary) until the black mark on the bottom can be detected.
■ Read the result by comparing the water level in the tube and the graduation present on the tube wall. This
has to be done with the tube in vertical position.
■ Empty the tube and rinse it three times with clean water if it’s available.
Remarks
■ Never chlorinate turbid water because the particles in suspension can protect micro-organisms from the
disinfectant action. Water to be chlorinated must have a turbidity lower than 5 (N)TU, but in acute
emergencies, a turbidity up to 20 (N)TU is permitted. If the turbidity exceeds the recommended values, a
pre-treatment such as sedimentation (natural or assisted; T.B. 2.14 and 2.16) and/or filtration (T.B. 2.17)
should be done before the chlorination procedure can start.
■ The reading of a turbidity tube must be done in good illumination conditions (natural day light), but avoid
sunlight shining directly on the turbidity tube as this might falsify the readings. Use your own shadow in a
non-shaded area. Sun glasses must also be taken off during the measurement.
■ Some turbidity tubes are proposed in several sections that have to be fitted into each other. In this case,
take care to hold the turbidity tube by its lower section to avoid that it would fall and break during the filling
up process or during the reading.
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Key Input
A. Black ring (or cross) detection
B. Gradual removal of water from the tube
C. Reading of the result
1. Turbidity tube (not to scale) - Turbidity tube
2. Black ring or cross on the bottom of the tube
3. Graduation
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T.B. 2.14 Coagulants / flocculants

When the turbidity of the (raw) water is high, chlorination isn’t effective. The recommended turbidity value
for effective chlorination is set at 5 (N)TU, although turbidities up to 20 (N)TU are still acceptable during
the acute phase of an emergency. If these values are exceeded, the turbidity of the (raw) water has to be
reduced. If the particles responsible for the turbidity are rather big and heavy (high density), they will
settle down in a natural way when the water is standing still. If they don’t settle naturally, a chemical or a
biological product called a coagulant can be added to assist the sedimentation process or the direct rapid
sand filtration. Flocculants can be added separately or are integrated in a combined coagulation /
flocculation product to speed up the process.
Principles
Coagulation / flocculation
Coagulants have the potential to neutralise the electrical repulsion phenomena that keep the particles in
suspension within the raw water. Once the right amount of coagulant (often under the form of a solution) has
been added and well mixed with the water to be treated, the neutralised particles can join each other and
start to grow into flocks (flocculation). Some additional products, so-called flocculants (sometimes a combined
product) can be added to speed up the flocculation process. In order to determine the right dose of the
coagulant / (flocculants) to be added, a jar test has to be performed on the raw water (T.B. 2.15).
Assisted sedimentation
As these flocks have become bigger and heavier (higher density) than the original particles (due to the
coagulation / flocculation processes), they will start to settle down within the water recipient / reservoir. This
will improve the turbidity of the treated water drastically (T.B. 2.16).
Direct Rapid Sand Filtration

It is also possible to retain the formed flocks directly from the water by means of a rapid sand filter, without
having to pass the sedimentation process (T.B. 2.17). Direct Rapid Sand Filtration will improve the quality of
the treated water even more in comparison with assisted sedimentation, but is limited for very high turbidities
(the filtration periods become very short if the turbidity of the raw water exceeds 300 NTU).
Assisted sedimentation combined with Rapid Sand Filtration

A combination of assisted sedimentation with rapid sand filtration is possible as well when water with an
extremely high turbidity needs to be treated and high quality water is required.
Commonly used products in relief work

■ Aluminium sulphate, Al2(SO4)3 is the best-known coagulant worldwide and it can be found in most
(low-income) countries (e.g. often stored in water treatment plants).
■ Ferric chloride, FeCl3 is less known, but does have several advantages over aluminium sulphate.
■ Polymers are very effective coagulants / (flocculants). These products become available as well under
powder and tablet form, which makes their transport easier in comparison with the liquid polymers.
■ Some biological products such as grinded Moringa oleifera (tree seeds) exist as well. They are not
commonly used for big scale treatment, but rather at domestic level.
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The following table gives a comparison of different chemical coagulants, often used by aid-agencies:
Product Advantages Disadvantages

Aluminium • crystallised (sometimes lumps) • available only at low
sulphate • often available on the field concentration (a.i.*: 17 - 18%)
• not expensive • mainly usable within a pH-range
• no expiry date of 6.0 to 7.4 (T.B. 2.10)
• often known • rather difficult to dissolve
by national counterparts
Ferric chloride • crystallised • rarely available on the field

(but also available as a liquid) • importation needed
• high concentration (a.i.*: 60%) • water might turn yellowish
• usable in a wide pH-range • corrosive
of 5.0 to 9.0 (T.B. 2.10) • granules absorb very quickly
• not expensive at purchase humidity, becoming a wet paste or
• no expiry date (stable, even dissolved) a solid block when dried out again
• easy to dissolve (resulting in difficulties to prepare
• no (IATA) air transport regulation a mother solution)
Polymers • extremely good coagulants • often low concentration available

/ flocculants • dosage can be difficult
• usable in a very wide pH-range • rarely available on the field
of 4.0 to 9.0 (T.B. 2.10) • importation needed
• normally little amounts needed • not stable during long period
• possible (IATA) air transport regulation
* a.i. active ingredient • possibly expensive
Preparation of the mother solution

■ Polymers are often used under their pure form because their coagulation / flocculation procedure starts
already with the elements of the water that is used to make the mother solution.
■ Ferric chloride and aluminium sulphate must be used under a liquid form, mostly a 1% mother solution,
although other concentrations might sometimes be required as well. The preparation is similar as for
chlorine solutions (T.B. 2.20):
X = Y x N x (100/C)
With X = grams of product to be added per litre of water to reach the desired solution concentration (g/l)
Y = desired solution concentration (%)
N = 10 g/l: equal to the amount of coagulant needed to make 1 litre of 1 % mother solution
if its active ingredient would be 100%
(calculation: 1 l of water weighs 1000g ; 1 % of 1000g = 10g and 1% solution = 10 g/l)
C = concentration of the coagulant’s active ingredient (a.i.); as mentioned on the packaging (%)
Examples:
Make 1 litre of 1 % mother solution with FeCl3 containing 60% active ingredient
➞ X = 1 x 10 x (100/60) = 16.7 g/l (about 17 g/l)
Make 1 litre of 1 % mother solution with Al2(SO4)3 containing 18% active ingredient
➞ X = 1 x 10 x 100/18 = 55.6 g/l (about 56 g/l)
Make 1 litre of 2 % solution with Al2(SO4)3 containing 18% active ingredient

➞ X = 2 x 10 x 100/18 = 111.1 g/l (about 111 g/l)
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Remarks
■ Based on effectiveness, polymers are by far the best coagulant / (flocculants) for assisted sedimentation.
These products are mostly so effective that only very little amounts of them need to be used. They are
effective in a wide pH variety of the raw water, and they form big flocks that can settle down rapidly. Due
to the formation of big flocks, these products are less suited for direct rapid sand filtration because they
might clog up the filtration medium.
■ As it is often difficult to make a mother solution with polymers, they have to be mixed directly with the raw
water under a pure form. This can render the fine tuning of the assisted sedimentation process quite difficult
and a jar test nearly impossible. An insulin syringe (1 ml) could be used to attempt a jar test with 1 litre
beakers, as only a few drops of pure liquid polymer are needed. As such, the jar test will stay an
approximation, but still precise enough to start the emergency water treatment.
■ An alternative for unknown raw water characteristics, is ferric chloride as it is also usable in a rather wide
pH range. This product can be used as well for assisted sedimentation as for direct rapid sand filtration.
With relatively short assisted sedimentation times in emergency treatment and/or when the dosage is
incorrect (this for both the assisted sedimentation and the filtration procedures), the water treated with
FeCl3 might turn (a little) yellowish. Although iron isn’t harmful for people’s health, the beneficiaries might
reject the treated water due to its colour and certainly when high residual concentrations render it
unpalatable. Anyway, it is recommended that the iron (residual) concentration stays within the approved
long-term standards, namely 0.2 mg/l.
■ Aluminium sulphate is interesting for assisted sedimentation and direct rapid sand filtration, certainly as it
can be found nearly everywhere in the world for reasonable prices. Ideally, the pH of the raw water should
be between 6.0 and 7.4, because beyond this pH range, the needed amounts of the product rise drastically.
It is recommended to buy aluminium sulphate directly under crystallized form because the breaking of
lumps into crystals to ease the preparation of the mother solution requires a lot of work and protective
clothing (e.g. gloves, mask, goggles).
■ There are some unconfirmed studies claiming that “high” aluminium concentrations (within drinking water)
might in the long run cause Alzheimer disease and neurological disorders. Potentially more worrying for
(emergency) aid-agencies is the unconfirmed concern that malnourished children consuming water with
high concentrations of (residual) aluminium might not pick up their weight again. Although that there are
still a lot of discussions on the potential adverse health effects of this product, it is important to measure
its residual concentration with an appropriate test kit after the water has been treated with a coagulant
containing aluminium. The residual aluminium concentration should always be kept as low as possible
(ideally less than 0.2 mg/l). In case any of the measurements are outside the normally used standards
(indicators), advice should be sought from your technical referent.
■ Strict quality control measures need to be respected when purchasing chemicals for potable water treatment
(e.g. coagulants, disinfectants). In case of local purchase, contact your technical referent in order to assure
that they are fit for human consumption.
■ Even though ferric chloride and aluminium sulphate don’t have an expiry date, they should always be
stored under correct conditions, meaning a cool dark place with low humidity.
■ Several products combining a coagulant, potentially some flocculants, and a disinfectant are available
under the form of tablets or sachets. These products are intended for individual households or small scale
(community) water treatment. A certain vigilance is required with these products because fixed doses of
different chemicals are added to a determined amount of raw water that can have any quality, without
performing a jar test (T.B. 2.15) or a Modified Horrocks test (T.B. 2.21). The Free Residual Chlorine
concentration (T.B. 2.22) of the treated water should at least be analysed, and preferably also its residual
aluminium or iron concentration (depending on the coagulant used in the product). In case any of the
measured values are outside the normally used standards (indicators), advice should be sought from your
technical referent. Besides the potential technical issues, a lot of attention should also go to the distribution
procedure of these products. It is also important to verify if the beneficiaries use the product properly.
Hence, a promotion and training campaign will be of utmost importance.
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T.B. 2.15 Jar test for coagulants

A jar test determines the quantity of a coagulant (mother) solution that is required to treat a certain volume
of turbid water. If the added coagulant dose is too low or way too high, no coagulation / flocculation will
occur. A small overdose will work, but it represents a spillage of resources and an increased residual
concentration.
Operation
Pre-tests
■ Measure the pH and the turbidity of the raw water. These analyses can be done with the pool tester (T.B.
2.22) and the turbidity tube (T.B. 2.13).
■ Perform additional analyses on the water’s conductivity and alkalinity (pH buffer effect), certainly when the
jar test isn’t successful over a wide range of coagulant dosages.
Jar test for aluminium sulphate / ferric chloride solutions
■ Prepare a 1% mother solution of the coagulant (T.B. 2.14).
■ Place at least 5 one litre transparent measuring beakers (jars) on a flat working space. The advantage of
transparent recipients is that the flocks will easily be detectable.
■ Rinse all the beakers three times with the raw water to be treated.
■ Fill the rinsed beakers to the 1 litre mark with the raw water to be treated.
■ Inject with a syringe (e.g. 10 ml capacity) a dose of 1% coagulant solution in every beaker, by increasing
gradually the amount (e.g. 0.5, 1, 3, 5 and 7 ml). Mark the injected doses on the beakers to avoid confusion
afterwards.
■ Stir the coagulant thoroughly in a circular movement during about a minute, immediately after the dose has
been injected. The stirring can be done with the syringe itself.
■ Detect if flocks start to appear in one or more recipients after some time. This process should normally
appear before the water stops turning in the beaker. If this is not the case, there is only a small chance that
flocks will still form.
➞ When no flocks have formed in any of the beakers before the water stopped turning, the jar test will have
to be repeated completely with higher dosages, although there might be other reasons for the raw water
not to flocculate (e.g. unfavourable conductivity and/or pH buffer effect).
➞ When flocks have formed in the beaker with high dosage but not in the jars with lower dosages, the highest
dose (e.g. 7 ml) can be added to each of the latter jars (e.g. going to 7.5, 8,10, and 12 ml).
➞ When no flocks have formed for the high dosages only, the “ideal“ dose might be passed already.
■ Wait about 30 minutes after the end of the mixing process for the flocks to settle down.
■ Compare visually the results in the different beakers (turbidity, size of the flocks, velocity of settling down).
The jar with the best results indicates how much coagulant should be added per given amount of raw
water. If there is hesitation in between two recipients, the “ideal” dose might probably be in between both
of them.
■ Fine-tune the dosing around the most favourable values by repeating the jar test completely in the same
way as described above. For instance, if the beakers in which 3 and 5 ml of coagulant were injected gave
the best preliminary results, the jar test can be repeated with dosages in between these values (3 ml, 3.5
ml, 4 ml, 4.5 ml and 5 ml).
■ Wait about 30 minutes after the end of the mixing process for the flocks to settle down.
■ Compare visually the results in the different beakers (turbidity, size of the flocks, velocity of settling down).
It can be tried to pour the supernatant gently in a turbidity tube, without having flocks coming along or
breaking up. If it is still difficult to determine the best result because the turbidity of several jars is the same,
choose the one where the least coagulant solution was injected. Note that the (field) jar test is only an
indicator of how much coagulant solution needs to be added in reality.
■ Extrapolate how much coagulant is required for the production of a big amount of water (e.g. 30 m³), based
on the “ideal” dose that has been determined by the jar test.
Example for aluminium sulphate:
Jar test indicates 3 ml of 1% Al2(SO4)3 solution per litre of raw water, extrapolated for a 30.000 l tank
➞ 3 ml/l x 30.000 l = 90.000 ml/tank = 90 l of 1% mother solution per batch of 30.000 l.
Based on the active ingredient of Al2(SO4)3, 5 kg will be needed for the 90 l (55.6g/l x 90l; T.B. 2.14).
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Key Input
1. Recipients (1l) with raw water - 1 l transparent beakers (or similar:
2. Syringe with coagulant solution glasses, glass jars, plastic buckets)
- Syringe (10 ml)
- Coagulant (solution)
- Watch
- Turbidity tube
- Pool tester
- (Conductivity meter)
- (Alkalinity test)
Polymers
■ As it is often impossible to make mother solutions with polymers (they might start to flocculate already with
the water of the solution), these coagulants have to be used under their pure form. This means that the
realisation and interpretation of a jar test are extremely difficult due to the very low volumes of these
products required to treat turbid water (in the order of 0.01 to 0.15 ml/l of raw water). An insulin syringe (1
ml) could be used to attempt a jar test with 1 litre beakers. As such, the jar test will stay an approximation,
but precise enough to start the emergency water treatment.
■ Therefore is the jar test for polymers often skipped in emergency situations. Hence, the tests are
immediately done in situ, on large scale. Anyway, polymers are mostly less critical in their dosing in
comparison with coagulants like aluminium sulphate or ferric chloride. Nevertheless, regular residual
aluminium / iron analyses should be done on the treated water, even when polymers are used.
■ In practice, foresee about 0.5 to 3 l of liquid polymers per reservoir of 30 m³. Be aware that these values
are only an indication in which range large scale tests should be made.
Post-tests
■ Measure the pH and the turbidity of the treated water by means of the pool tester (T.B. 2.22) and the
turbidity tube (T.B. 2.13). These tests are actually the pre-tests for chlorination (Modified Horrocks test) (T.B.
2.21 and 2.22).
■ Analyse the residual metal concentration, depending on the coagulant being used (iron or aluminium).
Their concentration should normally be lower than 0.2 mg/l. Be aware that the concentrations after a field
jar test and emergency assisted sedimentation are often up to 10 times higher.
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Remarks
■ If transparent beakers aren’t available, big glasses (e.g. pints), glass jars or even plastic buckets with all
the same and known volume can be used as well. During the jar test, the injected doses of coagulant will
have to be adapted according to the volume of the recipients.
■ The thorough stirring immediately after the coagulant has been injected in the raw water is important to have
a homogeneous mixture. This avoids over- and under-dosing at different places in the recipient. Under
laboratory conditions, once the thorough stirring is done, a slow mixing at specific speeds will continue by
an electric apparatus for 20 minutes. As this is very difficult to achieve manually on the field, the slow
mixing is limited until the swirl after the thorough stirring stops. This isn’t ideal, but it still gives a good
indication of the required coagulant dosage.
■ When the alkalinity (pH buffer effect) of the raw water is low, its pH can drop significantly when coagulants
are added, as most of them are acid. This can have a serious influence on the quantity of coagulant needed,
certainly when aluminium sulphate is used. A low pH buffer effect could even hamper the coagulation /
flocculation process. The pH of the raw water can be adapted (made higher or lower) with certain products
(e.g. respectively lime or sulphuric acid), but due to its specific difficulties (e.g. dosing, safety), advice from
your technical referent should be sought.
■ A very low concentration of ions (low conductivity) in the raw water can cause problems as well with the
coagulation / flocculation process. Rendering the conductivity a little higher by adding some kitchen salt
might solve the problem, but it is recommended to contact your technical referent for further information.
■ The presence of high quantities of algae or other organic material that can be found in swamps for example,
might require the use of a lot more coagulant.
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T.B. 2.16 Assisted batch sedimentation

Natural sedimentation takes a very long time, which can drastically be reduced by adding a coagulant (and
flocculants) to the raw water. This process is called assisted sedimentation. Coagulants (and flocculants)
will enhance the aggregation of the very small particles in suspension in order to make them bigger and
heavier (higher density). They will then settle down faster, thus lowering the turbidity of the water within
a more reasonable time span.
Operation
■ Install the sedimentation reservoir preferably at a spot nearby the raw water source, but far enough to
avoid that is gets flooded when the water level would (suddenly) rise. Make sure that the reservoirs are
installed on a solid and horizontal “platform” for security reasons.
➞ In emergency situations, onion tanks or big (circular) tanks with a metallic frame and plastic lining are the
easiest and fastest to install (T.B. 2.35; 2.36). These reservoirs should have a useful height of at least 1 m.
➞ Reservoirs with metal sheeting as a support can be used as well, but it takes longer to install them (T.B.
2.35).
■ Install a motor pump with its needed accessories (e.g. strainer, suction and delivery pipes; T.B. 2.28).
■ Add the coagulant (solution) in proportional quantities (as determined by the jar test; T.B. 2.15) during the
time the tank is filled with raw water,. The coagulant can be added to the raw water in various ways:
➞ Simple drop-drop system (for all kinds of coagulant solutions / liquid polymers):
• The principle of this system is that the coagulant gets mixed by simply being dropped into the raw water
sprouting out of the pump’s delivery pipe (as per figure A). The advantage is that only a plastic recipient
with a tap to regulate the coagulants flow is required. The recipient should be installed on some kind of
platform, together with the delivery pipe. The delivery pipe should be oriented tangential to the reservoir
in order to create an internal circular movement of the coagulated water, which will improve the flocculation
process. However, the water falling into the reservoir might break the flocks already forming in the rotating
water (certainly when the reservoir is still rather empty).
• When liquid polymers are used as coagulant, a 20 l jerrycan with tap can be sufficient as recipient. Its
dosing can be fine-tuned to some extent by adding an infusion set if available.
• Rather big quantities of aluminium sulphate or ferric chloride solutions will be required, thus a bigger
recipient (e.g. 120 l jar for cholera interventions) or several jerrycans will be needed.
➞ Suction Side Dosing (SSD) system (only for coagulant solutions, not for liquid polymers):
• This device, equipped with a regulation valve and a small flow meter, is installed at the entrance of the
pump (as per figure B), so the coagulant solution can be “sucked” up proportionally to the raw water flow.
The “flash” mixing of both liquids by the impellor of the pump enhances the coagulation process. The 90°
elbow (as per figure C) allows the raw water - coagulant mixture to arrive in a circular movement at the
bottom of the reservoir, which will improve the flocculation process, but without breaking the already
existing flocks. All these factors result in an enhanced reduction of the turbidity.
• The flow of coagulant solution that needs to be injected is determined by the jar test:
e.g. The jar test indicates a need of 4 ml of coagulant solution per litre of raw water:
-The pumping rate of the raw water is 25.000 l/h.
-The injection rate of the coagulant solution is: 4 ml/l x 25.000 l/h = 100.000 ml/h = 100 l/h.
-Turn the regulation valve of the SSD system in such a position that its flow is set at 100 l/h (indicated by
the SSD flow meter).
■ Allow the flocks to settle down at the bottom of the tank, once the reservoir is completely filled. This might
take several hours.
■ Retrieve the clarified water with great care. Settled flocks can be pumped up when the flow rate is too high
or when the entrance of the retrieval pipe comes too close to the sludge at the bottom of the reservoir.
Sometimes, the flocks might float on the water surface. In this case, the clarified water has to be retrieved
from underneath them. To deal with these problems, a retrieval pipe with floater can be connected to an
outlet at the inside of the reservoir (as per figure C). This also allows the removal of the treated water by
gravity in a safe way. This principle is strongly recommended if an onion tank is used for sedimentation.
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Key Input
A. Drop-drop system and retrieval from open rigid reservoir
B. Suction Side Dosing (SSD) system
C. Water delivery to (for SSD system) and retrieval from open reservoir
1. Reservoir filling with water - Reservoir (pool or onion type)
2. Coagulants recipient - Plastic 20 l jerrycans or 125 l jar
3. Valve / tap of coagulants recipient - Construction materials / tools for the platform
4. Delivery pipe - Suction Side Dosing system
5. Suction Side Dosing (regulation valve / flow meter) - Pipes, T-pieces and valves
6. Connection Suction Side Dosing system to pump - Coagulant (solution)
7. Retrieval pipe for the treated water - Motorised surface pump and accessories (kit)
8. 90° elbow - Floater
9. Strainer on retrieval pipe - Sticks and some rope to prepare the
10. Floater cross that avoids that the retrieval pipe
11. Motor pump descents too deep
12. Suction hose with strainer
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Remarks
■ Assisted batch sedimentation is an appropriate treatment method in the first phase of an emergency or as
pre-treatment before filtering, because it requires a limited amount of material. However, depending on the
settling time of the flocks, several reservoirs in parallel might be needed to come to the required water
production rate.
■ Bladder tanks should not be used for (assisted) sedimentation because their shape doesn’t allow a circular
movement of the coagulated water and it would be difficult to retrieve the treated water without having flocks
coming along. Because they are completely closed, it would also be difficult to remove the sediments
afterwards.
■ Besides the described batch procedure, the assisted sedimentation can also be done continuously by inclined
plate sedimentation or up-flow clarification for instance.
■ Polymers have better performances for assisted sedimentation in comparison with the other coagulants used
on the field. But as they are used undiluted (related to the difficulties to make a mother solution), polymers are
more difficult to dose. Coagulants such as aluminium sulphate and ferric chloride are introduced in the raw water
as a diluted solution (mostly 1 % mother solution), thus their dosing is less difficult (T.B. 2.14).
■ A further treatment method, at least a disinfection of the water, must follow the assisted sedimentation process.
Be aware that assisted sedimentation will not eliminate all cysts nor all helminths eggs, neither will chlorine.
Hence, it is also recommended to filter the water before chlorination, certainly where very low turbid water is
required (e.g. health structures).
■ With the rather short sedimentation times available during emergencies, the treated water often has high
residual concentrations of metal coagulants (the standard is 0.2 mg/l, but in reality it is often up to 10 times
higher). Field test kits for measuring the aluminium / iron residual concentration should be available to do a
regular follow up of the treated water.
■ These high residual metal concentrations due to the coagulants might have a negative impact on the health of
vulnerable people (e.g. severely malnourished children) or on the consumers’ acceptability of the water (colour,
taste). These residual metal concentrations can be reduced by (rapid sand) filtration.
■ The sludge doesn’t have to be removed after every cycle as it helps to form flocks during the next batch
(certainly if the turbidity of the raw water is rather low). However, as the sludge layer thickens, the water
production per cycle reduces. Therefore is it necessary to clean the reservoir at regular intervals. This can be
done manually by putting the flocks in suspension (e.g. with soft brooms) during the draining of the reservoir
or by means of a motor or even better a dewatering pump (T.B. 2.25).
■ To preserve the environment, a sedimentation hole should be dug for the drained water to pass through. If the
retention time in the hole is long enough, the flocks can settle down. Initially, it’s possible that the drained water
will even infiltrate in the underground, but after a while the soil will certainly be saturated. The “overflowing” water
should be drained back to the surface water, but down-flow of the intake of the raw water pump.
■ The Suction Side Dosing system cannot be used for liquid polymers, as its regulation isn’t fine enough for the
undiluted product. There is also the risk that the aggressiveness of certain polymers would destroy the seal of
the pump axle.
■ Several products combining a coagulant, potentially some flocculants, and a disinfectant are available under
the form of tablets or sachets. These products are intended for individual households or small scale (community)
water treatment. A certain vigilance is required with these products because fixed doses of different chemicals
are added to a determined amount of raw water that can have any quality, without performing a jar test (T.B.
2.15) or a Modified Horrocks test (T.B. 2.21). The Free Residual Chlorine concentration (T.B. 2.22) of the
treated water should at least be analysed, and preferably also its residual aluminium or iron concentration
(depending on the coagulant used in the product). In case any of the measured values are outside the normally
used standards (indicators), advice should be sought from your technical referent. Besides the potential
technical issues, a lot of attention should also go to the distribution procedure of these products. It is also
important to verify if the beneficiaries use the product properly. Hence, a promotion and training campaign will
be of utmost importance.
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T.B. 2.17 Filtration methods

To obtain high quality potable water, filtration is often necessary. Filtration uses a porous environment to
separate the solids from the water. The porous environment lets the liquid pass while the solids are
stopped. Most of the systems used on the field function with a support / surface filtration or with a granular
bed filtration. Examples of processes often used on the field are presented hereunder.
Support / surface filtration
All systems based on support / surface filtration function in a similar way: the water has to pass through a
surface with very fine pores, which will retain the particles that are bigger than the pores. These filters are
efficient but do clog rapidly when the turbidity of the water is high. Thus they need to be cleaned regularly,
and some systems even need a frequent replacement of the filters. Typical examples of surface filtration are
cartridge and membrane filters.
Cartridge (candle) filtration
The raw water passes through cartridges, made of metals, fibres or ceramic material, with a fine porosity.
Particles in suspension, cysts, helminth (eggs), most bacteria and a certain range of viruses will be retained.
Therefore, the treated water is of good quality. However, turbid water will clog the filters rather rapidly as the
particles settle down on their surface (the higher the turbidity, the faster the clogging). Even with a low
turbidity, the cartridges have to be cleaned frequently, certainly when they are pressurised.
Ceramic candles (T.B. 2.18) are most often used for individual and household water treatment, due to their
low production rate. They are mainly found in survival kits, in expatriates’ houses and sometimes in (small)
health structures. Under certain circumstances however, they might also be the preferred choice for a
population to do their own household water treatment. As the abrasive cleaning of the candles with a brush
or a rough sponge has to be done rather often, they need to be replaced frequently (ideally every 6 months
and at least once a year).
Membrane filtration
This filtration method consists of permeable membranes, often rolled up in tubes which are stored in
cylindrical containers. The kind of filtration (micro-, ultra- or nano-filtration) is determined by the size of the
membrane pores. As the pores are extremely fine, suspensible particles, cysts, helminth eggs and bacteria
can be retained, even viruses when ultra- or nano-filtration membranes are used. However effective this
kind of filtration is, post-chlorination is still strongly recommended to have a remnant protection effect. As
these kinds of systems function on the surface filtration principle, they have a tendency to clog rather rapidly,
certainly with a high turbidity. So (very) regular backwashes with clean water are necessary, but these are
often managed automatically. Producing very high quality water without the need of chemicals (except for the
recommended post-chlorination and some acids / alkalis for cleaning once in a while), these filtration systems
are unfortunately also very expensive and the membranes are still rather fragile.
Reverse osmosis is also associated to the membrane technology. In this case, (extreme) high pressures
are used to remove even dissolved elements like salt out of the water. These systems are not at all adapted
for turbid water. Small scale forward osmosis filters are also available. Their driving force to filter the water
does not come from hydraulic pressure (pump, gravity), but from osmotic pressure.
Granular bed filtration
In this process, the suspensible material is stopped in the inter-granular spaces of the filtering material (often
sand). In general, two treatment methods on a granular bed principle are commonly used: slow and rapid
sand filtration. Slow sand filtration is a mechanical and microbiological process. Rapid sand filtration is only
a mechanical process, which is also based on sieving but mainly on the principle of adsorption.
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Slow Sand Filtration

The mechanical filtering action of the granular sand bed together which the biological membrane that will
develop on top after some time (named Schmutzdecke) can remove cysts, helminth eggs, a large part of the
bacteria and even some viruses from the water. It gives also good results in clarifying the raw water, as long
as it doesn’t contain too many particles in suspension. Slow sand filtration isn’t suited to deal with turbidities
above 30 NTU. In case the turbidity is above this level, the raw water should pass through roughing filters,
which is actually a system of natural sedimentation. A post-chlorination of the water leaving the slow sand
filters is always recommended to obtain a remnant effect.
However simple the process seems, there are quiet some limits. As the velocity is low (0.1 - 0.3 m/h), the
head losses stay low, so that the filtration can be done by gravity. On the other hand, big filters are required
to obtain a sufficient water production for a large population (e.g. a surface of 20 m² will produce a flow of 2
to 6 m³/h). The system has to run 24 hours a day to guarantee the water quality. After maintenance work is
done, it will take at least several days for the Schmutzdecke to reform itself, and the pathogens won’t be
removed over that period. To overcome this problem, two parallel slow sand filters need to be installed and
maintained alternately. Another option is to build a big storage reservoir, which can only be filled if the daily
production of the slow sand filter is (a lot) higher than the required daily demand.
As the production capacity is rather low, slow sand filtration isn’t often used in emergencies. Contact your
technical referent before taking the decision to implement such a filtration system.
Rapid sand filtration
A rapid sand filter operates on two principles; some mechanical straining and mainly physical adsorption on
the surface of the sand grains. Rapid sand filtration can be installed after an assisted sedimentation process,
to remove the flocks (including the bacteria and viruses trapped inside), cysts and helminth eggs that would
have escaped otherwise. The rapid sand filter will also be able to remove the coagulation residuals (e.g. iron
or aluminium). This gives good quality water, but needs three different steps with the post-chlorination
included.
Direct assisted rapid sand filtration is possible as well; a coagulant will be added and the flocks will be filtered
out directly without sedimentation in a reservoir first. This process will remove the coagulants’ residuals to
acceptable concentrations (possibly even less than 0.2 mg/l, which is the maximum standard), reduce very
efficiently the turbidity of the raw water (< 5 NTU) and retain most helminth eggs and cysts. However, the
turbidity of the raw water should not exceed 300 NTU, because the filtration periods will become too short
and backwashing will be needed too often. In such situations, it is recommended to add assisted
sedimentation (in batch or continuous) prior to the filtration step.
According to the application, rapid sand filtration is done with velocities going from 4 up to 50 m/h, thus a
(relatively) high water production is possible with small filters. Several filters with filtration beds of different
granulometry can be put in series to obtain a better reduction of the turbidity over longer filtration periods.
The backwashes of the filters are done with pre-filtered or completely treated water, but compressed air, as
used in big water treatment plants, is often abandoned for small field treatment units because of the
complexity and extra expenses.
As the contact time in between the water and the sand is short, it’s impossible to have the biological action
that appears in slow sand filtration. Thus the free bacteria and viruses that aren’t trapped in the flocks won’t
be eliminated by rapid sand filtration, and post chlorination becomes obligatory.
Direct rapid sand filtration is a frequently used principle for field water treatment kits. This is due to the
production of potentially large quantities of high quality water (in combination with post-chlorination and
possibly pre-sedimentation) for rather low purchase costs and low operation and maintenance expenses.
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T.B. 2.18 Ceramic candle filters

Water is passed through micro-porous ceramic walls with a pore diameter of about 0.45 m (depending
on the quality of the filter), retaining all particles with a bigger size at the surface of the candle filter.
Ceramic candle filters can therefore remove practically all suspensible material from water, including
protozoa, helminth eggs, most bacteria and some viruses. This technique is nevertheless not effective for
dissolved substances like salts and chemical pollutants. Some types of ceramic candle filters contain
silver salts that are bactericide and that will prevent the development of a bio-film inside the candles.
According to the models, activated carbon can also be present inside the candles for adsorbing some
dissolved substances, thus reducing the risk of possible taste, odour or colour of the water.
Principle
■ Gravity filter: One recipient containing several candles stacks on the top of another, which is collecting the
treated water. By filling the upper recipient, the water will pass drop-by-drop through the candles (provided
they are not clogged) into the lower container. The filtered water can immediately be taken from the tap at
the lower recipient.
■ Pump filter: In this case, the water is forced under pressure through the filter by means of a small integrated
hand pump, thus increasing the flow. The strainer of its plastic “suction” pipe should be put into the raw
water before the pumping starts.
■ Assemble the candles of the gravity filter correctly with their rubber washers placed in between the candle
and the internal base of the upper container and their nuts properly tightened to ensure that no water can
pass without being filtered.
■ Keep the container where the filtered water is collected and preserved closed. It should be cleaned at least
once a week with a 0.05% chlorine solution (see T.B. 2.20) and rinsed afterwards with filtered water, without
touching the inside of the container.
■ Brush the candles under clean running water when their flow becomes too weak, rinse them and
reassemble the filter (see manufacturer’s instructions). A specific brush or rough sponge should be included
in the kit, but in case this specific cleaning material isn’t available, a semi-hard non-metallic brush specially
dedicated for this use can be utilized as well. As the candles are fragile, handle them with care.
■ Clean and air-dry the (pump) filters completely when they won’t be used over prolonged periods (e.g.
weeks to months). This avoids fungus and bacteria growth inside, which could lead to illness when the filter
is put back into service.
Remarks
■ Teams in the field should always drink filtered water because they can never be sure of the quality of local
water supplies. Candle filters can also be useful in (small) health centres, certainly in the starting up phase.
If proper promotion is done, these filters can also be considered as a household water treatment method
for populations.
■ It is recommended to purchase ceramic candle filters of renowned brands to be assured of good quality
water afterwards.
■ Always follow carefully the installation, operation and maintenance instructions included in the packaging.
■ Never consume the filtered water immediately after the system has been set up, because it may contain
ceramic particles and/or a high concentration of colloidal silver.
■ Avoid contact between boiling water and the candles as there is a risk that (small) cracks will be formed in
the ceramic material, undermining thus the filtration efficacy.
■ While cleaning the candles, care should be taken that dirty water can’t enter via their outlet. This would
contaminate the inside of the filter, rendering it useless.
■ In continuous utilisation, the candles should ideally be replaced every 6 months, and certainly after a year.
As a consequence, it is important to mark, preferably on the filter, the installation date of the candles. Some
manufacturers (certainly of pump filters) provide a measuring gauge allowing to verify the diameter of the
candle; it should be changed as soon as the gauge can pass freely around it (see the manufacturer’s
instructions).
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Key Input
A. Gravity filter
B. Pump filter
1. Ceramic candles Gravity filter: containing
2. Container collecting filtered water - 2 containers (metal or plastic)
3. Container of water to be filtered - lid
4. Candle fastening with rubber washer - ceramic candles (2 to 4) with
5. Tap rubber washers and (wing) nuts
6. Cover - tap
7. Outlet for filtered water
8. Hand pump mechanism Pump filter: containing
9. Fastening collars - 1 pump filter with flexible tube attached
10.Flexible tube (for raw water) - 1 brush / rough sponge to clean
11.Strainer (to pre-filter raw water) the ceramic candle
- 1 gauge to measure the diameter of the candle
(indicating the thickness of the ceramic material)
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T.B. 2.19 Chlorine-generating products

Chlorine is a chemical agent whose strong oxidizing properties are used for disinfection and
decontamination. Other than its natural gaseous form, which is complicated to use and to transport,
chlorine is found under the form of “chlorine-generating products”. Each product is characterised by its
chlorine content (active ingredient).
Chlorine-generating products
Chlorine content
The chlorine content should be labelled on the product’s packaging and is expressed in:
■ % of active chlorine
■ chlorometric degrees (ochl)
■ parts per million (ppm) or mg of active chlorine per litre.
(1ochl = about 0.3% active chlorine; 1ppm = 1 mg/l = 0.0001% active chlorine)
* For newly manufactured products
Product Chlorine content*

Sodium hypochlorite solution (bleach) 12°chl about 4% active chlorine
Sodium hypochlorite solution (bleach) 15°chl about 5% active chlorine
Sodium hypochlorite concentrate 48°chl about 15% active chlorine
Chlorinated lime (bleaching powder) about 30% active chlorine
Calcium hypochlorite /
High Test Hypochlorite (often called HTH®)
most often found as granules (also existing as powder or tablets) 65 to 70% active chlorine
Sodium DiChloro-isoCyanurate or NaDCC :
• tablets about 60% active chlorine
• granules about 55% active chlorine
Storage
■ Store chlorine-generating products in their original packaging which should be airtight, non-metallic or
properly painted / enamelled recipients. Shelter these products from heat, light and humidity, and store them
in a restricted access area (chlorine is dangerous especially for children). Never store chlorine-generating
products together with organic matter, nor with combustibles because of the high risk of fire or explosion.
For quantities larger than 10 kg, look for a separate storage place, away from equipment that could be
damaged by corrosion.
■ All chlorine-generating products have a loss in their chlorine content over time, and they generate toxic and
corrosive chlorine gas, which is heavier than air. Thus storage places for chlorine (generating products)
should be equipped with ventilations at ground level. Never store chlorine (generating products) in cellars.
■ All chlorine-generating products are very sensible to storage conditions:
➞ Particularly chlorinated lime and all forms of sodium hypochlorite are unstable. Sodium hypochlorite
solutions should not be used if they have been stored for more than 3 months after being manufactured.
➞ Calcium hypochlorite stores better with an active ingredient loss of about 2 – 5 % per year under
appropriate storage conditions. But under tropical conditions, the loss is usually much higher and the
recommended shelf life is limited to 2 years.
➞ NaDCC is by far the most stable product. Manufacturers guarantee a stable chlorine content (expiry date)
of 2 years for granules, 3 years for tablets in unopened tubs and 5 years for strips, under appropriate
storage conditions.
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Safety, care and handling

■ Any chlorine-generating product may be fatal if inhaled or swallowed. It is harmful if absorbed through the
skin as it causes severe irritation. High chlorine concentrations are extremely destructive to the mucous
membrane tissues, upper respiratory tract, eyes and skin. In case of contact with the eyes, rinse
immediately with plenty of running clean water and seek medical advice.
■ When handling any chlorine (-generating) product (e.g. opening drums, preparing and/or manipulating
solutions), use a sheltered but well ventilated location and wear suitable protective gear such as rubber
gloves, a plastic apron and eye / face protection.
■ Never mix calcium hypochlorite with anything but water.
■ Never mix calcium hypochlorite with NaDCC because toxic and explosive tri-chloramine gas may be
generated.
■ When purchased locally and in large quantities, calcium hypochlorite often comes in 40 - 50 kg drum
containers. All containers should always be stored in the upright position. They should not be dropped,
rolled or skidded in any case due to the risk of fire and explosion.
■ When measuring calcium hypochlorite or NaDCC granules, only use a plastic, glass or enamelled
measuring device which is completely clean, dry and free from any foreign matter, because of the risk of
fire and explosion.
■ Chlorine-generating products should not be brought into contact with acids, vinegar, toilet bowls cleaning
agents or any other cleaning agents (e.g. detergents) due to the risk of releasing toxic chlorine fumes.
Contact should also be avoided with beverages or any combustible material including paper, rags, tobacco,
oil based products and any form of heat like matches, flames, lighted cigarettes because of the risk of fire
and explosion.
■ When chlorine-generating products are spilled, wash them thoroughly down with water and do not allow
them to remain in contact with any organic or combustible matter like cloth, paper, oil.
Remarks
■ In case chlorine-generating products are bought locally, it’s important to ask for a certificate of their
composition because all products aren’t suited for drinking water. Also verify the UN transport code as it
can give an indication on the kind of chlorine-generating product that is purchased (calcium hypochlorite
suited for drinking water has the codes UN 1748 or UN 2880). It is important as well to buy these products
in closed and sealed containers from reliable suppliers or manufacturers.
■ Calcium hypochlorite (HTH®) and Sodium DiChloro-isoCyanurate (NaDCC) are recommended as
chlorine-generating products because of their good stability and high chlorine content.
■ NaDCC dissolves quickly and completely into a clear solution as it is effervescent, while the insoluble
chalk of calcium hypochlorite gives a cloudy solution and leaves a deposit that can lead to scaling. The
calcium can potentially provoke a bad taste of the treated water.
■ Calcium hypochlorite is more corrosive than NaDCC and the risk of fire is higher (fires of spontaneous
origin have already been reported). As calcium hypochlorite is less safe than NaDCC, its international (air)
transport regulations are more strict.
■ If large quantities of potable water have to be treated with NaDCC, it is recommended to use the granular
form (T.B. 2.20 and 2.21). For individual or household treatment, NaDCC tablets can be used, as they
exist for different quantities of water (e.g. 1 / 2 / 5 / 10 / 20-25 l). As these tablets contain a fixed amount
of active chlorine to treat waters with varying chlorine demand, it’s important to verify the Free Residual
Chlorine concentration prior to distribution / consumption (T.B. 2.21) and adapt the dosage accordingly.
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T.B. 2.20 Preparation and use of chlorine solutions for disinfection

Chlorine-generating products under granular or tablet form often need to be dissolved in clean water to
obtain a certain required solution concentration. Sodium hypochlorite solutions need to be diluted because
their chlorine concentration is most often too high. Once dissolved or diluted correctly, the different
chlorine-generating products will result in chlorine solutions with similar disinfection properties, but their
effectiveness might still vary a bit. The different chlorine concentrations that are often used by aid-agencies
have all their own respective purposes.
Preparation
From powder or granular product: HTH®, NaDCC, chlorinated lime
■ Check the concentration of the chlorine-generating product (% of active chlorine).
■ Determine the weight of the chlorine-generating product that is required to make 1 l of solution, using the
following formula:
X = Y x N x (100/C)
With X = grams of product to be added per litre of water to reach the desired solution concentration (g/l)
Y = desired solution concentration (%)
N = 10 g/l, equal to the amount of pure chlorine (active ingredient 100 %) needed
to make 1 litre of 1 % mother solution
(calculation: 1 l of water weighs 1000g; 1 % of 1000g = 10g, thus 1% solution = 10 g/l)
C = concentration of the product’s active chlorine, as mentioned on the packaging (%)
■ Pour the required weight of chlorine generating product in the determined amount of clean water. The
opposite (water on chlorine) is not allowed as this can induce violent chemical reactions.
Example 1:
Make 1 litre of 1 % mother solution with calcium hypochlorite (HTH®) containing 65% active chlorine
X = 1 x 10 x (100/65) = 15.4 g/l
which is about 15 gram of HTH® per litre of water or 1 level scoop/l (or 1 soupspoon/l)
Example 2:
Make 1 litre of 1 % mother solution with Sodium DiChloro-isoCyanurate (NaDCC) granules containing 55%
active chlorine
X = 1 x 10 x (100/55) = 18.2 g/l
which is about 18 gram of NaDCC per litre of water
From liquid chlorine-releasing compounds: sodium hypochlorite (bleach) having 4 or 5% active chlorine,
sodium hypochlorite concentrate having 15% active chlorine
■ Check the concentration of the sodium hypochlorite (% active chlorine).
■ Determine the total parts of water that are required in which the sodium hypochlorite needs to be dissolved,
according to the following formula:
TP= (M/N) –1
With TP = total parts of water required
M = concentration of the sodium hypochlorite active chlorine,
as mentioned on the packaging (%)
N = required solution concentration (%)
■ Add one part of sodium hypochlorite to the amount of water required.
Example 3:
Make 1 litre of 1 % mother solution with sodium hypochlorite (bleach) containing 5% active chlorine
TP = (5/1) - 1 = 5 - 1 = 4
Take one part sodium hypochlorite (5%) and add to 4 parts of water. In this case,
add 0.2 l of concentrated solution to 0.8 l of water (1 l of solution/5 parts = 0.2 l of bleach;
thus 0.2 l of bleach x 4 parts of water = 0.8 l of water)
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Example 4:
Make 1 litre of 0.2 % solution with sodium hypochlorite concentrate containing 15% active chlorine
TP = (15/0.2) - 1 = 75 – 1 = 74
Take one part concentrated solution and add to 74 parts of water. In this case,
add 13 ml of concentrated solution to 987 ml of water
(1000 ml of solution/75parts = 13.3333 ml of concentrate;
thus 13.3333 ml of concentrate x 74 parts of water = 987 ml of water).
Use
Disinfection of water
For chlorinating drinking water, a 1% chlorine mother solution (also called stock solution) is prepared first,
whichever chlorine-generating product is used. The tables hereunder present the procedures to prepare a
1% mother solution starting from different chlorine-generating products. The quantity of 1% mother solution
that needs to be added to disinfect a measured volume of water is then determined by the modified Horrocks
test (T.B. 2.21).
With recommended chlorine-generating products:
Starting with Preparation Remarks

Calcium hypochlorite (HTH®) 15 g per l of water Let the calcium deposit settle
with 65 - 70% active chlorine or and use only the supernatant
1 level scoop/l (1 soupspoon/l)
Sodium DiChloro-isoCyanurate 10 tablets per l of water Ensure that the excipients in the
(NaDCC) with 1 g active tablets are non-toxic
chlorine per tablet
Sodium DiChloro-isoCyanurate 18 g per l of water

NaDCC) granules with 55%
active chlorine.
When none of the above chlorine-generating products are available:
Chlorinated lime with 30% 33 g per l of water Let the lime deposit settle
active chlorine or 2 level soupspoons/l and use only the supernatant
Sodium hypochlorite (bleach) 200 ml per l of solution

with 5% active chlorine or 1 volume of bleach for
4 volumes of water
Sodium hypochlorite (bleach) 250 ml per l of solution Only if manufactured

with 4% active chlorine or 1 volume of bleach for very recently (<3 months) and only if
3 volumes of water stored under proper conditions.
Sodium hypochlorite concentrate 67 ml per l of solution

with 15% active chlorine or 1 volume of concentrate for
14 volumes of water
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Disinfection in a health structure

Different solutions with different chlorine concentrations are used in health structures. The chlorine
concentration in the solution depends on the usage of the disinfecting solution. These solutions are essential
to maintain a hygienic and safe environment within a health structure and even more during outbreaks of
infectious diseases like cholera, shigellosis, Ebola or Marburg. An in-depth description of how to use these
solutions properly for these highly infectious diseases can be found in the respective guidelines (see section
8.5 Further reading).
The 6 main chlorine solutions are: 2%, 1%, 0.5%, 0.2%, 0.1%, 0.05%. They can be prepared by using the
formulas presented above. In the context of these guidelines:
2% • Disinfection of corpses in case of a cholera outbreak T.B. 8.01

• Disinfection of stools and vomit in case of a cholera outbreak
1% Used as a mother solution to be diluted for:

• disinfecting drinking water T.B. 2.21; T.B. 2.23
• other purposes like cleaning and disinfection of a:
- well T.B. 2.03
- flexible reservoir T.B. 2.37
0.5% • Disinfection of corpses in case of Viral Haemorrhagic Fevers T.B. 8.01

(e.g. Ebola, Marburg) or Sars outbreaks
• Disinfection of stools, vomit, urine, body fluid spills, gloved hands in
case of Viral Haemorrhagic Fever outbreaks
0.2% • Disinfection of floors, walls, surfaces, beds, objects, latrines in case

of a cholera outbreak
• Disinfection and cleaning of:
- floors in case of rodents associated diseases or in case
of an outbreak of lice-associated diseases T.B. 1.08
0.1% • Disinfection and cleaning of:

- Tankers, pipes, pumps T.B. 2.34
- showers T.B. 4.01
- washing facilities T.B. 4.02
- collective dustbins and drainage holes T.B. 5.01
- reusable sharps containers T.B. 6.01
- drop pipe, slab and surroundings of a sharps pit T.B. 6.02; T.B. 6.03
- soft waste bins T.B. 6.05; T.B. 6.06
- organic waste bins T.B. 6.08
0.05% • Scrubbing the walls of a well T.B. 2.03

• Disinfection and cleaning of:
- recipients of ceramic candle filters T.B. 2.18
- open tanks T.B. 2.37
- Lorries / carts (waste transportation) T.B. 5.03
• Disinfection of hands, skin, clothing, bedding, washing up
in case of a cholera outbreak
• Disinfection of household gloves, aprons, goggles, clothing, bedding
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Remarks
■ Chlorine reacts with metals, leading to a high chlorine consumption and a strong oxidation of the metals. Hence,
never prepare chlorine solutions in metallic containers (unless properly enamelled).
■ Chlorine must always be poured in the water, but the opposite (water on chlorine) is prohibited due to the risk
of violent exothermic reactions that could lead to serious injuries.
■ The use of chlorinated lime, sodium hypochlorite containing 4 - 5% active chlorine or sodium hypochlorite
concentrate containing 15% active chlorine is only recommended if NaDCC and HTH® are not available.
■ A 2% chlorine solution should only be used for restricted purposes and should never be sprayed in enclosed
facilities because of its high concentration and the risks associated with the release of toxic chlorine gas in
contact with the air or organic matter.
■ Chlorine solutions should not be poured into a toilet or a latrine as it will stop the natural decomposition in the
septic tank or pit, filling them up more rapidly and generating extremely bad odours. However, in isolation units
during epidemics of cholera, shighela, Ebola or Marburg, it is recommended to use chlorine solutions to disinfect
all the patients’ excreta (see section 8.5 Further reading).
■ Calcium hypochlorite (HTH®) and chlorinated lime leave a deposit, thus only the supernatant should be used
and the deposit disposed of in a shallow pit.
■ Less corrosive products exist to disinfect medical equipment or surfaces in long-term health structures.
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T.B. 2.21 Batch chlorination of drinking water

Chlorination is one of the best methods for disinfecting drinking water because it is relatively simple,
effective, easy to monitor and it has a remnant protective effect. Only the chlorination of a known water
volume in a reservoir is presented here, known as batch chlorination. The principle is to add enough
chlorine to eliminate pathogens contained in the water (mainly bacteria and chlorine sensitive viruses),
and to leave a small fraction of chlorine available for dealing with possible recontamination. Chlorination
requires staff being trained in the dosage technique and in its monitoring.
Operation
To determine how much 1% chlorine mother solution that needs to be added to a measured volume of water,
use the modified Horrocks test:
■ Prepare 1 litre of 1% chlorine mother solution (T.B. 2.20).
■ Measure the pH of the water to be treated in order to determine the needed contact time (T.B. 2.22).
■ Take at least 4 non-metallic containers of known volume (preferably 20 l plastic buckets or jerrycans), all
having a cover.
■ Clean the containers and their cover 3 times with the water to be treated. When the containers are soiled
inside, the dirt can be removed the first time by a clean brush (or clean hands when they fit inside) and
water, the remaining times only rinse with the water.
■ Fill all the containers with the same amount of water to be treated (e.g. 20 l), put their cover on and label
them (1 to 4).
■ Add to each bucket a progressively increasing dosage of 1% chlorine mother solution with a graduated
sterile syringe :
➞ Container 1: 1.0 ml
■ Put the covers back on and wait for the chlorine to react during the minimum required contact time:
➞ For a pH < 8, minimum 30 min
➞ For a pH > 8 and/or a water temperature < 10 °C, minimum 60 min. (T.B. 2.22).
■ Measure the Free Residual Chlorine (FRC) concentration in each container (T.B. 2.22).
➞ If the pH < 8, choose as reference the container where the Free Residual Chlorine concentration is
between 0.2 and 0.5 mg per litre. In case two following containers would have a FRC in between 0.2 and
0.5 mg/l, opt for the one with the highest concentration.
➞ If the pH > 8, choose as reference the container where the FRC concentration is between 0.4 and 1.0 mg
per litre. In case two following containers would have a FRC in between 0.4 and 1.0 mg/l, opt for the one
with the highest concentration.
■ Repeat the Modified Horrocks test with higher 1% mother solution dosages if none of the FRC
measurements are in between 0.2 – 0.5 mg/l (0.4 – 1.0 mg/l; depending on the pH).
■ Extrapolate the determined dose of 1% mother solution to the volume of the water reservoir that will be
used.
■ Pour the solution in the reservoir, ideally while filling it up to obtain a homogenous repartition of the solution
in the water and mix well (if still needed).
■ Wait for the required contact time (depending on the pH and temperature of the water).
■ Control the FRC at the level of the taps before the water is distributed to the beneficiaries. Slightly adjust
the reservoir’s mother solution dosage if needed.
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Example
Chlorination of a 2000 l water reservoir
■ Follow the steps of the modified Horrocks test as described above for 20 l recipients.
■ The pH is measured to be 7.2 and the water temperature is at 20 °C. The FRC levels of the water in the
containers are measured after the required 30 minutes contact time, and are respectively as follows:
Container Added 1% mother solution Measured FRC concentration

1 1.0 ml 0.0 mg/l
2 1.5 ml 0.1 mg/1
3 2.0 ml 0.4 mg/l
4 2.5 ml 1.0 mg/l
■ The chosen reference dose will therefore be the one of recipient number 3, because its obtained FRC
concentration of 0.4 mg/l is between 0.2 - 0.5 mg/l.
■ If 2 ml of 1% chlorine solution is needed to chlorinate 20 l of water at the correct dosage, then 100 times
as much 1% mother solution will be required to chlorinate 2000 l of the same water quality, thus 100 x 2ml
= 200 ml of 1% mother solution.
■ The doses of 1% mother solution given in this example are only an indication. It may happen that the
chlorine amount needed to treat the water in the field is very different from this example.
Key Input
1. Beaker with 1% chlorine mother solution - Several containers of the same known volume, with lid
2. Recipients with water to be treated - Syringe (5 – 10 ml)
3. Lid of the recipients -1 % chlorine mother solution
4. Syringe with 1% chlorine mother solution - Pool tester with cover
- DPD 1, (DPD 3) and Phenol Red tablets
- Watch (to measure the contact time)
- Protective gear (gloves, apron, goggles/face shield)
- (Turbidity tube)
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Remarks
■ Chlorination is effective against most bacteria and plenty but not all viruses (e.g. Hepatitis E). At the doses
normally used for potable water treatment, chlorine isn’t really effective against protozoan cysts and
helminth eggs.
■ The most practical way to guaranty chlorine’s best effectiveness is to monitor the pH, the turbidity and the
Free Residual Chlorine concentration after the optimum contact time. Note that the chlorine demand may
vary over time with (unexpected) changes in the amount of organic matter in the water. It is thus important
to monitor the FRC concentration, the pH and the turbidity frequently in order to be able to adjust the water
treatment accordingly.
■ Particles in suspension (turbidity) can protect micro-organisms from chlorine disinfection. Even with a
correct Free Residual Chlorine concentration, many harmful micro-organisms may survive. Water to be
chlorinated must contain as little visible suspensible material as possible and when measured (e.g. with a
turbidity tube; T.B. 2.13), it should be less than 5 (N)TU (less than 20 (N)TU in acute emergencies). If the
turbidity exceeds the recommended values, a pre-treatment such as sedimentation (natural or assisted;
T.B. 2.14; 2.15; 2.16) or filtration (T.B. 2.17) should be done before the chlorination process.
■ Chlorination is less effective if the pH of the water is above 8 (see T.B. 2.22), therefore a doubling in contact
time (60 minutes) and FRC (0.4-1.0 mg/l) is required. If the temperature is below 10°C, the contact time
should also be doubled (60 minutes), but the Free Residual Chlorine concentration should still be between
0.2 and 0.5 mg/l if the pH is lower than 8.
■ If recipients with a tap are used, do not use the tap to fill the pool tester, as it might be contaminated and
lead to false results.
■ The taste or odour of chlorine in water is not a proof of the presence of Free Residual Chlorine (FRC). It
could be due to the presence of Combined Residual Chlorine (CRC), which has a less disinfecting capacity
and which cannot be measured with DPD 1 tablets. The CRC can be determined as follows:
➞ Add an additional DPD 3 tablet in the compartment in which a DPD 1 tablet has already been dissolved
to determine the FRC.
➞ Read the Total Residual Chlorine (TRC) concentration as soon as the DPD 3 tablet has dissolved.
➞ Determine the CRC by subtracting the FRC from the TRC.
■ A verification of the TRC and CRC once in a while is recommended, certainly if NaDCC is used as
chlorine-generating product (T.B. 2.19).
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T.B. 2.22 Monitoring chlorination

The simplest and surest way to monitor the effectiveness of chlorination is to measure the Free Residual
Chlorine (FRC) concentration in the drinking water. The presence of FRC in the treated water (after 30
or 60 minutes contact time, depending on its pH and temperature) indicates that enough chlorine has been
added to satisfy the chlorine demand and to create Combined Residual Chlorine (CRC), whilst still leaving
an excess of available free chlorine. The remaining FRC is available to deal with possible recontamination
in the distribution system or during handling.
Operation
The measurement of Free Residual Chlorine (FRC) concentration and pH is most easily done using a
comparator, commonly called a “pool tester”.
■ Remove the lid of the pool tester.
■ Rinse the inside of the pool tester, including its lid, 3 times with the water to be tested. This is to be sure
that all remaining residues of previous tests are removed.
■ Fill the 3 compartments to the top with the water to be tested, without dipping it in its recipient.
■ Tear the foil strip open and put one Phenol Red tablet in the small left hand compartment without touching
it. This is to measure the pH.
■ Tear the foil strip open and put one DPD 1 tablet in the small right hand compartment without touching it.
This is to measure the Free Residual Chlorine.
■ Replace the lid tightly with the arrows pointing towards the coloured reference scale. It is normal that some
liquid is pressed out of the pool tester.
■ Shake gently until the tablets are completely dissolved. This may take about 20 seconds, depending on the
water temperature.
■ Read the results immediately in natural day light, comparing the colours in the outer compartments
(containing the water samples with the dissolved tablets) with the colour scale of the central compartment
(reference).
■ Empty the pool tester and rinse it again with clean disinfected water to remove the residues of the analysis,
in order to prevent inaccurate results at the next measurement.
Results
■ Measuring the pH is necessary to interpret the FRC concentration correctly.
■ Measuring a Free Residual Chlorine concentration after the required contact time is a good indicator that
the chlorination is complete:
➞ The added chlorine has been reacting with the organic matter present in the water, including
micro-organisms (e.g. bacteria) and is therefore partly consumed (chlorine demand).
➞ A part of the added chlorine has combined with certain elements in the water (mainly nitrogen) and forms
the Combined Residual Chlorine (CRC), which isn’t effective to react rapidly against a post-contamination.
➞ The remaining residual chlorine is free in the water (FRC) and will immediately react to a
post-contamination (remnant effect). The following results should be obtained in low-income countries.
Water characteristics Contact time FRC

pH< 8 30 min 0.2 - 0.5 mg/l
PH > 8 60 min 0.4 - 1.0 mg/l
Temperature< 10oC (pH <8 ) 60 min 0.2 - 0.5 mg/l
The required contact time is needed to allow the completion of the disinfection process. The FRC concentration
shouldn’t be too low in order to provide a good protection against post-contamination. It shouldn’t be too high either
as this might induce the refusal of the beneficiaries to consume the water (not used to the odour or taste of
chlorinated water, although they can also be caused by the CRC).
WARNING: a Free Residual Chlorine concentration above 10 mg/l can cause bleaching of the DPD colour
(no colour to be observed), wrongly indicating zero residual chlorine.
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Key Input
A. Chlorine decomposition in water
B. Pool tester
1. Chlorine added -1 Pool tester with lid
2. Chlorine consumed - Phenol Red tablets (Phenol Red must be marked
3. Combined Residual Chlorine (CRC) in green on the packaging)
4. Free Residual Chlorine (FRC) - DPD 1 tablets (DPD 1 must be marked in green
5. Cover on the packaging)
6. Central compartment - Optional DPD 3 tablets (DPD 3 must be marked
7. pH compartment (Phenol Red tablet) in green on the packaging)
8. FRC compartment (DPD 1 tablet) - Water to be tested
9. pH reading scale
10. pH reference scale
11. FRC reference scale
12. FRC reading scale
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Remarks
■ The pool tester can be used as well to perform the modified Horrocks test (T.B. 2.21), as for monitoring the
Free Residual Chlorine (FRC) concentration of an operational water supply system.
■ The monitoring of FRC for a water supply system should be done on a regular basis (at least daily). It is
recommended to let the water flow for a few moments (e.g. 30 seconds) before taking it from a tap. If this
monitoring shows a constant discrepancy between the actual results and the expected range, another
modified Horrocks test must be undertaken.
■ It’s important that the quality of the water to be tested doesn’t change during the rinsing and filling steps of
the modified Horrocks test (T.B. 2.21), as this might result in false measurements.
➞ The water can be taken from the recipient and introduced to the pool tester by means of a sterile syringe
(e.g. 50 ml). The Free Residual Chlorine would react immediately with a contaminated syringe, thus
indicating a lower FRC concentration than is actually present in the treated water. It is therefore of utmost
importance not to touch the outside of the syringe that comes in contact with the treated water, nor to
place it on a contaminated surface (put it carefully back in its packaging).
➞ An alternative to the sterile syringe is to gush the water from the water container directly into the pool tester.
This is a rapid manner, but a lot of water will be spilled, meaning the whole procedure, including the rinsing
and filling of the containers, will have to be repeated if the first round of the modified Horrocks test doesn’t
provide acceptable results.
➞ Never put the pool tester into the water container as its outside is contaminated.
➞ If recipients with a tap are used, do not use the tap to fill the pool tester, as it might be contaminated and
lead to false results.
■ For the same reason should the tablets, the inside of the pool tester or the inside part of its cover never be
touched. Never use tablets that have fallen on the ground.
■ The printing “DPD 1” / “Phenol Red” on the foil strips must be in green, meaning that the tablets are rapid
dissolving. Tablets of foil strips with black printing should never be employed with the standard pool tester
that is used on the field for monitoring chlorination.
■ The tablets normally have a shelf life of minimum 5 years. The expiry date should be printed on the outside
of their outer (cardboard) packaging, and for some brands on the foil strips. Other brands have the
manufacturing date indicated on the foil strips under the form of a code: “A” is the year 2003, “B” is 2004.
The two numbers after the capital letter indicate the manufacturing month.
■ Only whole tablets must be used. Do not use broken tablets (bad storage or while opening packaging).
■ Do not use tablets that disintegrate on opening or have lost their colour (dull grey / brown instead of bright
white for DPD 1, and dull brown instead of bright orange for Phenol Red).
■ Expired or damaged tablets can be disposed of with normal waste.
■ Read the results within 60 seconds once the tablets have dissolved to be sure of a reliable measurement.
The results are not guaranteed after this limited period.
■ Read the results under good illumination conditions, meaning natural day light. Sun glasses must be taken
off. Ideally, the reading should be made on a white surface (e.g. a tent wall), but pointing the pool tester
towards the sky, away from the sun, can do as well.
■ The pH must systematically be measured before starting chlorination, as a pH > 8 requires a higher contact
time and a higher FRC concentration (see above). The pH of (surface) water may vary significantly over
time, so it needs to be controlled frequently.
■ Comments on the pH of water:
➞ pH = 7: neutral; pH < 7: acidic; pH > 7: alkaline (or basic).
➞ pH values under 6.8 will always cause a yellow colouration, whereas pH values above 8.2 will cause a
red colouration with the Phenol Red method of the standard pool tester used on the field.
■ The taste or odour of chlorine in water is not a proof of the presence of Free Residual Chlorine (FRC). It
could be due to the presence of Combined Residual Chlorine (CRC), which has a less disinfecting capacity
and which cannot be measured with DPD 1 tablets. The CRC can be determined as follows:
➞ Add an additional DPD 3 tablet in the compartment in which a DPD 1 tablet has already been dissolved
to determine the FRC.
➞ Read the Total Residual Chlorine (TRC) concentration as soon as the DPD 3 tablet has dissolved.
➞ Determine the CRC by subtracting the FRC from the TRC.
■ A verification of the TRC and CRC once in a while is recommended, certainly if NaDCC is used as
chlorine-generating product (T.B. 2.19).
■ Colour-blind people might have problems reading the FRC, TRC and/or pH with the pool tester.
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T.B. 2.23 Controlled bucket chlorination

Water that is collected by individuals from an unprotected and/or contaminated source (e.g. open well,
lake, river, flooded borehole) is disinfected directly in their own recipient. It is an effective method as long
as the water isn’t too turbid. As controlled bucket chlorination is labour intensive, it should be restricted
to short-term emergency use only. In closed settings, bucket chlorination should be replaced rapidly by
a batch chlorination system in reservoirs that are connected to tapstands, whereas in open (rural) settings,
protected water sources are the preferred option.
Preparation
Set up the bucket chlorination system by training several chlorinators and their supervisors. Typically one
supervisor can manage a maximum of 30 chlorinators, although this will vary according to the situation. In
practice, one chlorinator should be able to treat at least 2 buckets of water per minute.
Chlorinator tasks Supervisor tasks

■ Preparation of the 1% chlorine solution ■ Perform turbidity, pH and chlorine jar tests
■ Evaluating the volume of the people’s water (modified Horrocks test)
recipient ■ Monitoring the performance of the chlorinators;
■ Adding the corresponding volume of 1% chlorine checking of the chlorinators’ records and
solution to the people’s recipient (randomly) spot checking the chlorinated water
■ Recording the details of the dosage inside the users’ recipients through Free Residual
■ Providing basic information on chlorination to the Chlorine measurements
beneficiaries; ■ Monitoring the water source for any changes in
e.g. the need to wait for 30 minutes before using the turbidity, pH or chlorine demand
water (if pH < 8). ■ Locate the chlorinators next to areas where people
■ Responsible for the chlorination teams and for the collect drinking water. In areas where there are
promoting team (promotion of the chlorination many water points, try to organise with the
system to the beneficiaries) community a smaller number of focal water points
that are accessible to all and that can provide
enough water to cover the demand.
■ Launch within the community an information
campaign to promote this chlorination method.
Operation
■ Measure the turbidity (T.B. 2.12) and pH of each individual water source (T.B. 2.22) to determine the
relevance of chlorination and the appropriate contact time. When the turbidity of the water to be treated is
high, chlorination isn’t effective. The recommended turbidity value for efficient chlorination is set at 5 (N)TU,
although turbidities up to 20 (N)TU are acceptable during the acute phase of an emergency. In case these
values are exceeded, the amount of suspensible particles in the water has to be reduced by natural or
assisted sedimentation (T.B. 2.16) and/or filtration (T.B. 2.17).
■ Prepare a 1% chlorine solution (T.B. 2.20), preferably on a daily basis because correct storage conditions
will most probably be lacking. Use non-metallic containers because metal consumes chlorine and will
corrode rapidly.
■ Carry out the chlorine jar test (modified Horrocks test; T.B. 2.21) for each individual water source.
■ Determine the volume of the different water-collecting recipients from the beneficiaries. In case it proves
to be difficult to estimate the volume of their recipients, a weighing scale can be used (1 kg = 1 litre of water).
■ Inject with a syringe the appropriate amount of 1% mother solution, related to the volume of each individual
recipient and based on the results of the modified Horrocks test.
■ Do random tests on several containers to verify if a correct Free Residual Chlorine concentration (FRC) is
reached:
➞ if pH < 8, FRC of 0.2 - 0.5 mg/l after a minimum contact time of 30 minutes.
➞ if pH > 8, FRC of 0.4 - 1.0 mg/l after a minimum contact time of 60 minutes because chlorination is less
effective if the pH is above 8.
Insufficient FRC concentrations of the collected water can be due to dirty containers, thus resulting in a
higher chlorine consumption (higher chlorine demand; T.B. 2.22).
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Key
1. 1 % chlorine solution
2. Syringe with 1% chlorine solution
3. Recipient of a beneficiary
Input
- Chlorine-generating product
- Protective clothing: gloves, aprons, goggles
or face shield and boots
- Measuring cylinder 1l
- 20l jerrycans for 1% solution storage
- 20l buckets for the Modified Horrocks test
(chlorine jar test)
- Pool testers with DPD 1 and Phenol Red tablets
- Range of syringes (e.g. 5, 10 ml)
- Turbidity tube
Remarks
■ Keep chlorine-generating products in their original packaging which should be airtight, non-metallic or
properly painted / enamelled containers. Shelter these products from heat, light and humidity, and store
them in a restricted access area (chlorine is a dangerous product). Never store chlorine-generating products
together with organic matter (e.g. food), nor with combustibles because of the risk of fire or explosion. For
quantities larger than 10 kg, look for a separate storage place, away from equipment that could be damaged
by corrosion (chlorine is a strong oxidant).
■ It is recommended to provide to each chlorinator a table indicating the amount of 1 % chlorine solution that
needs to be injected per volume of recipient (based on the modified Horrocks test); e.g. 2ml of 1 % chlorine
solution for a recipient of 8 litres, 2.5 ml per 10 l, 3 ml per 12 l, 4 ml per 16 l, 5 ml per 20 l.
■ The syringes for chlorine dosing are susceptible to wear, so sufficient supplies should be stored.
■ The transport between the water point and a person’s home can be sufficient for both the mixing and the
required contact time. Where this is not the case, a strategy will have to be implemented that insures the
appropriate contact time.
■ A distribution of clean recipients, in plastic material, such as jerrycans may be necessary to ensure that the
population has proper and clean transportation and storage means. Moreover, as the recipients will all be
of the same capacity, the chlorination will be easier. In case it isn’t possible to provide clean recipients, the
cleaning of the beneficiaries’ containers should be envisaged.
■ In situations where water is sold, it may be advisable that the water sellers are involved in the chlorination
process, to ensure that the sold water is disinfected.
■ Key users can be enabled to give feedback on water quality, if they are equipped with a pool tester (T.B.
2.22) and trained for checking the FRC concentration.
■ Several products combining a coagulant, potentially some flocculants, and a disinfectant are available
under the form of tablets or sachets. These products are intended for individual households or small scale
(community) water treatment. A certain vigilance is required with these products because fixed doses of
different chemicals are added to a determined amount of raw water that can have any quality, without
performing a jar test (T.B. 2.15) or a Modified Horrocks test (T.B. 2.21). The Free Residual Chlorine
concentration (T.B. 2.22) of the treated water should at least be analysed, and preferably also its residual
aluminium or iron concentration (depending on the coagulant used in the product). In case any of the
measured values are outside the normally used standards (indicators), advice should be sought from your
technical referent. Besides the potential technical issues, a lot of attention should also go to the distribution
procedure of these products. It is also important to verify if the beneficiaries use the product properly.
Hence, a promotion and training campaign will be of utmost importance.
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T.B. 2.24 Basic topographic survey

In order to design a water supply system, it is necessary to conduct a survey identifying the topography
of the proposed route. This will permit to calculate the characteristics of a water pipeline that will be
gravity-fed or pressurised by a pump. The length is preferably measured by means of a long measuring
tape, while the height difference can be calculated based on the length and the vertical angle in between
the two extremities of the water supply system. The topographic surveys described hereafter are for
simple and rather short water supply systems.
Procedure
A. Calculating the height difference on a hill with a single and rather constant slope
■ Measure the eyesight height of the surveyor.
■ Determine by means of a long measuring tape (e.g. 50 m) the distance in between the two extremities of
the water supply system, namely the water source and the utility point. If still needed, it should be verified
if the proposed route will permit the excavation for a potential underground installation of the pipe.
■ Stand at the lower extremity of the water supply system (e.g. river), hold the Abney level to the eye and sight
the other extremity of the water supply system (e.g. reservoir) by centring the cross-hair against the target.
■ Adjust the index arm until the bubble (visible in half of the field-of-view) is centred against the cross-hair
and block the index arm with its fixing screw.
■ Read the vertical angle on the arc in degrees
■ Transfer the angle measured in degrees into radians: degrees x π /180 = radians and π = 3,14159
■ Calculate the height difference in between the extremities of the water supply system by using the following
formula:
H = L x sin (α) + h
With H = height difference in between the extremities of the water supply system
L = distance in between the two extremities of the water supply system
α = angle in radians between the horizontal level (measured at the eyesight
of the observerstanding at the lower extremity) and the upper extremity of the water supply system
h = eyesight height of the surveyor
Example:
L= distance measured in between the river and the reservoir up the hill = 300 m
α= measured angle between the river and the outlet of the reservoir up the hill = 5°
h= eyesight height of the surveyor = 1.71 m
H = 300 m x sin (5° x π /180) + 1.71 m = 27.86 m
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Key Input
1. Abney level - Abney level
2. Cross-hair - Long measuring tape (e.g. 50 m)
3. Index arm - Notebook and pen / pencil
4. Fixing screw - Calculator
5. Air bubble centred against cross-hair
6. Arc
7. Ocular
8. Outlet of reservoir
9. Topography of the area
10. Tapstand
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B. Calculating the height difference when a short water supply system passes through a
“small” valley
■ In this case, measurements must be taken from the bottom of the valley, first in the direction of one extremity
(a) of the water supply system and secondly in the direction of the other extremity. The same procedure
as described in A must then be followed twice. The height difference between the two extremities is then
represented by the difference (H) between H(a) and H(b).
Example:
L(a) = distance in between the bottom of the valley and the extremity (a) (e.g. outlet of a reservoir) = 250 m
α(a) = angle measured in between the bottom of the valley and extremity (a) = 7.2°
L(b) = distance in between the bottom of the valley and the extremity (b) (e.g. a tapstand) = 150 m
α(b) = angle measured in between the bottom of the valley and extremity (b) = 7.8°
h = eyesight height of the surveyor = 1.71 m
H(a) = 250 m x sin (7.2° x π /180) + 1.71 m = 33 m
H(b) = 150 m x sin (7.8° x π /180) + 1.71 m = 22 m
H = 33m - 22m = 11 m
C. Calculating the height of a water tower
■ Measure the eyesight height of the surveyor.
■ Choose a reference point on a flat surface nearby the water tower from which all measurements will be taken.
■ Determine the horizontal distance in between the reference point and the water tower by means of a measuring
tape.
■ Stand at the reference point, hold the Abney level to the eye and sight the highest part of the water tower by
centring the cross-hair against the target.
■ Adjust the index arm until the bubble (visible in half of the field-of-view) is centred against the cross-hair and
block the index arm with its fixing screw.
■ Read the vertical angle on the arc in degrees.
■ Transfer the angle measured in degrees into radians: degrees x π /180 = radians and π = 3,14159
■ Calculate the height of the water tower by using the following formula:
H = L x tangent (α) + h
With H = height of the water tower
L = horizontal distance in between the reference point and the water tower
α = angle in radians between the horizontal level (measured at the eyesight of the observer
standing at the reference point) and the upper point of the water tower
h = eyesight height of the surveyor
Example:
L = horizontal distance in between the reference point and the water tower = 40 m
α = angle measured in between the reference point and the water tower = 24.5°
h = eyesight height of the surveyor = 1.71 m
H = 40 m x tan (24.5° x π /180) + 1.71 m = 20 m
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Remarks
■ Long complicated water supply systems passing several hills fall out of the scope of these guidelines (see
section 2.5 Further reading).
■ When making a topographic survey of a single slope for a gravity-fed system, the available height difference
(pressure) to overcome the linear and local head losses (T.B. 2.31) should be measured in between the
tap height and the outlet of the reservoir. This means that standing at the tap site, the outlet of the reservoir
should be targeted with the Abney level. The height of the tap should be deducted from the calculated
height based on the Abney level measurement (as described above).
■ To determine the maximum pressure in a gravity-fed pipeline, the maximum height difference between the
lowest point in the system and the maximum water level (in the reservoir) should be measured. This
maximum height difference is important to verify the pressure the pipe has to resist when all the taps are
closed. When the maximum water level in the reservoir can’t be determined, its maximum height can be
used as a reference.
■ To be able to determine the pressure that a pump has to deliver pumping water uphill, the height difference
should be measured in between the (dynamic) water level of the source and the maximum water level in
the system (e.g. completely filled reservoir, highest point within the pipeline). To this pressure related to the
height difference, the needed pressure to overcome the head losses (linear and local) should be added to
determine the required pump capacity.
■ In case the total height of a water tower has to be determined, the upper part of the reservoir should be
sighted with the Abney level. However, in order to know the minimum pressure that the water tower will be
able to provide, the lower part (outlet) of the reservoir should be sighted.
■ The distance and the height difference can also be measured with a GPS, but be aware that the majority
of these instruments only give an horizontal precision equal to 10 m and the vertical precision is even
lower. So normal GPS systems aren’t that suited for topographic surveys.
■ The clinometer is similar to the Abney level. It has a simpler concept and is cheaper, but as the sighting is
more difficult to do, the precision is less accurate than with an Abney level.
■ The altimeter functions by measuring the barometric pressure differences at different altitudes (lesser
atmospheric pressure at higher altitude). As varying weather can change the barometric pressure as well,
the measures should be taken in a short period. An alternative is to have one mobile and one or two fixed
altimeters at the extremities of the topographic area under study. By measuring at regular intervals the
pressure differences at the fixed altimeters, it will be possible to add a correcting factor to the measurements
of the mobile altimeter. The altimeters precision of 1 to 5 m is often not sufficient.
■ The theodolite and laser are both high-precision instruments that are expensive and might require special
training. The accuracy obtained with these instruments (within centimetres) is usually not needed for
topographic surveys.
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T.B. 2.25 Centrifugal pumps

Most motorized (combustion engine or electric) water pumps used by aid-agencies are centrifugal types.
The principle of a centrifugal pump is that its spinning impellor (rotor) throws the water outwards and the
empty space that is created at the centre of the impellor is filled via the “suction pipe” by new water, which
is actually pushed in by the atmospheric air pressure. This new water will be thrown outwards again by
the impellor, creating again an empty space at its centre and so on continuously until the pump is stopped.
The velocity of the water thrown out of the impeller is partly transformed within the pump’s snail house
(stator with a specific form) into pressure, thus the water can be transported at a certain flow over a
certain height.
Types of centrifugal pumps mainly used by aid-agencies

Surface pumps
They will most of the time be situated above the water surface and will “suck up” the water to deliver it at
higher grounds. Whatever the kind or the power of the motor driving the pump, its maximum suction height
(head) is about 7 m at sea level, and decreases as the altitude rises.
■ Low pressure motor pumps (e.g. maximum pressure of about 300 kPa or 3 bar), driven by a petrol or diesel
engine, are often used in emergencies. As motor pumps are designed to work at construction sites, they
can deal with very turbid water that contains small solid particles.
■ Most high pressure pumps (e.g. > 600 kPa or 6 bar) aren’t conceived to pump turbid water.
■ Trash pumps (T.B. 3.13) are able to pump turbid water containing solids up to 20 – 30 mm (e.g. small
debris, faeces) without clogging. Their impellor blades often have sharp edges to shred soft particles.
Submersible pumps
They need to be completely submerged in the water, otherwise they stop or even break down after a short
period of use. As they are completely submerged, these pumps don’t “suck up” the water, they only have to
deliver (push) it. They are specifically interesting for (tube) wells that have their water level (a lot) deeper than
7 m under the surface. The flow and pressure that can be delivered, depend on the size of the pump and on
the power of its electric motor (most often combined in one piece of equipment). Submersible pumps are
designed to lift non-turbid water, thus solid particles in suspension will damage their impellers and pump
house.
Dewatering pumps
They combine to a certain extent features of the commonly used motor pumps and the submersible pumps.
Dewatering pumps that are driven by electric motors, can be completely submerged or nearly completely out
of the water (as long as the impeller part stays submerged). Some high quality models exist that have their
electric motor cooled by the pumped water, so the motor part can stay out of the water for prolonged periods.
As their inlet has to be under the water level, dewatering pumps can only deliver water, but at (relatively) high
flow rates. As these pumps are designed for (very) dirty water, their delivery height is rather limited (certainly
in comparison to submersible pumps in the same electric power range). Aid-agencies use them mainly to
dewater hand dug wells rapidly, before the works within can start. They can also be used during well cleaning
(T.B. 2.03) or to remove the sludge from assisted sedimentation reservoirs (T.B. 2.16). They can also be
employed to deliver potable water from hand dug wells that are more than 7 m deep.
Pump characteristics
Identification plate
Every centrifugal pump should have an identification plate indicating at least two working points:
■ The maximum Total Manometric Head (TMH) it can reach (at zero flow); expressed in kPa, bar, meter
Water Column (mWC).
■ The maximum flow it can reach (theoretical working point at TMH zero); expressed in l/s, l/min, m³/h.
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Key
A. Motor pump
B. Submersible pump
C. Dewatering pump
D. Pump graphs (centrifugal pumps)
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Characteristics curves (graphs)

■ pQ (upper part of the graph): The pQ curve of a centrifugal pump is the relationship between the pressure
(p) and the flow (Q) it delivers (for a motor pump at the maximum regulated speed of the combustion
engine). The curve determines the capacity of the pump over its working range. Note that at maximum
pressure, the flow is zero. Often, a part of the curve is printed in bold. This is the range at which the pump
should function to have a high efficiency. The actual working point (the specific pressure and flow at which
the pump will function) is determined by the height difference and the head losses in the pipe system that
the pump has to overcome (T.B. 2.31; 2.32).
■ Pump efficiency and power requirements (lower part of the graph): Some manufacturers of (electric)
centrifugal pumps also provide curves indicating the efficiency (Eta) and the power requirement (P2) of a
specific pump. The efficiency is the relation between the power transmitted to the water and the power
delivered by the motor. Every pump has its own efficiency curve, which will vary according its flow. The
maximum efficiency is where most of the power of the motor is transferred to the water as shown on the
curve. The power curve also shows that a centrifugal pump needs the least power when the flow is zero.
So if a generator has difficulties to deliver the starting current of an electric centrifugal pump, it’s
recommended to start it with its gate valve closed (Q = 0, p = max.), because this requires the least power,
thus also the least starting current.
Remarks
■ Always read the owner’s manual before using a pump.
■ Motor pumps and generators should never be lowered inside or put directly next to a well to avoid their toxic
exhaust gasses accumulating within.
■ Dewatering pumps should be stopped and disconnected from their electricity source before people enter
the well.
■ When a generator is used to supply power to an electric pump, make sure it is earthed.
■ Not all surface centrifugal pumps are self-priming; thus not only their pump house has to be filled completely
with water before the pump is started, but also their “suction” pipe. In case of doubt if a pump is self-priming,
always fill its “suction” pipe with water.
■ Some high capacity surface pumps can’t “suck up” the water and need to have the water level at the same
height as the pump axis, or even above (check the owner’s manual).
■ Not all centrifugal pumps are capable of pumping turbid water. The possible presence of large quantities
of sand or other solid particles in the water may damage the moving parts of the pump.
■ The installation of a strainer is compulsory, even for pumps which are specifically manufactured to deal with
water that contains solid particles.
■ The presence of salty or brackish water may corrode the pump rapidly.
■ Some electric pumps have electronic features that start their motor slowly and thus require a lower starting
current (consequently also less starting power). It is therefore not necessary to start this kind of pumps with
a closed gate valve.
■ Be aware that 10 meter Water Column (mWC) is about equal to 100 kPa or 1 bar (with bar and mWC being
the unities most commonly used by technicians).
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T.B. 2.26 Information required to identify a centrifugal pump

It is very important to determine the correct pump for every situation. In emergencies, the choice will often
be restricted because of the limited variety of pump kits. Nevertheless, within the existing range of kits,
the pump (characteristics) should correspond as close as possible to the needs. Within chronic
emergencies and stabilized situations, a specific pump outside the kit range might have to be chosen
according to the design of the water supply system.
Procedure
■ Determine the water demand for a certain population and/or a health structure.
■ Calculate the desired pump flow (l/s, m³/h) and the number of times it has to start, based on:
➞ the daily water demand,
➞ the available storage capacity of the reservoirs,
➞ and the time available to fill the reservoirs, which is depending on the moment of the day when the
population is collecting the water (mainly in the morning and early evening) and/or on the space of time
a potential generator is functioning (for electric pumps).
■ Collect physical information related to the site: check the diameter and the depth of the hand dug well or
borehole, make a sketch with the dimensions of the river bank, the water’s edge of the lake or canal (for
the determination of the place availability to install a pumping station), verify the altitude (height above the
sea level).
■ Determine if the yield of the water source can cope with the desired pump flow. If information on the
maximum yield of a (tube) well is not available, a pumping test should be performed (T.B. 2.27).
■ Collect information on the water characteristics: pH, turbidity, salinity.
■ Specify the purpose of the pump: e.g. the pump will be used for water treatment using chemicals as
aluminium sulphate or ferric chloride.
■ Determine the energy source for pumping: diesel, petrol, electricity, solar.
■ Investigate the local knowledge to maintain and repair pumps.
■ Determine the exact locations of the water source, the pumping station and the reservoirs, and make a
topographic plan that:
➞ indicates the vertical distance in meters between the lowest water level and the highest level to which the
water has to be pumped, or in other words the Total Geometric Head (TGH) (T.B. 2.24). Note that the
highest point is not necessarily the storage reservoir. Take also the possible seasonal variations of the
water source levels into consideration.
➞ gives the total length of the pipe in order to calculate the Total Head Losses (THL). The head losses
include the linear head losses (friction of the water passing through the pipe) and the local head losses
(e.g. friction of the water passing through valves, bends, strainer) (T.B. 2.31).
■ Calculate the Total Manometric Head (TMH) (see hereunder).
Total Manometric Head (TMH): total pressure the pump has to deliver
(expressed in mWC, kPa or bar)
Total Manometric Head (TMH) = Total Geometric Head (TGH) + Total Head Losses (THL)
Total Geometric Head (TGH) = Geometric Suction Head (GSH) + Geometric Delivery Head (GDH)
Geometric Suction Head (GSH):
from the water resource level to the centre (axle) / inlet of the pump.
Remark: Be aware that for (tube) wells the dynamic water level at the desired flow should be used.
Geometric Delivery Head (GDH): from the pump axle/impellors to the highest point in the delivery system.
Remark: Once the water is pumped over the highest point in the delivery system, siphoning can occur if
the actual outlet is at a lower level, which will reduce the Geometric Delivery Head. Still, it is recommended
to use the initial GDH to determine the pump in order to be sure that the system will work (assuring that
the pump is capable of pushing the water over the highest point). The final result can then only be that
the obtained flow is somewhat higher than initially expected.
Total Head Losses (THL) = Suction Head Losses (SHL) + Delivery Head losses (DHL)
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Key Input
A. Surface pump
B. Submersed pump
1. Geometric suction head - Measuring equipment (tape measure, level, etc.)
2. Geometric delivery head - Sketch and description of the site
3. Level of the pump impellor (axis) - Technical information on pump (characteristics),
4. Lowest water level of the source (dynamic) pipe type (e.g. Heliflex, PE, GI), pipe diameter,
5. Highest water level (static) couplings, valves, bends, etc.
6. Internal diameter of the suction pipe
7. Internal diameter of the delivery pipe
8. Length of the suction pipe
9. Length of the delivery pipe
10. Atmospheric pressure
11. Pump
12. Non return valve (optional)
13. Suction strainer with foot valve
14. Storage reservoir
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Remarks
■ The ease of maintenance and the robustness of the pump; the number of hours the pump has to run or
the number of times it has to start per hour; the availability of fuel (what type of fuel) or electricity; the
availability of tools, spare parts and maintenance skills; the purchase, running, maintenance and repair
costs; these are all factors that should not be underestimated in the choice of a pump (and certainly not
for long-term use).
■ Electric motors require a higher current (thus more power) to start than to run normally. This should be taken
into consideration for the choice of a generator. The required starting current can be reduced for a
centrifugal pump by starting it with a closed gate valve at the delivery side. However, this valve has to be
opened as soon as the pump has reached its normal regime (only some seconds). Some electric pumps
have electronic features that start their motor slowly and thus require a lower starting current (consequently
also less starting power). It is therefore not necessary to start this kind of pumps with a closed gate valve.
■ Water hammering is a phenomenon that happens when water flowing in a pipe is suddenly stopped (e.g.
by quickly closing a ball or a butterfly valve), which results in pressure building up rapidly and the water
shooting back in the opposite direction. This leads to several (high) pressure peaks (hammering), and
which can end in a damaged water supply system. Only gate valves should be used in pumping systems
because their closing time is slow, thus the risk of water hammering reduces drastically (ball and butterfly
valves should not be used).
■ The suction ability of a surface pump is limited to maximum 7 m at sea level, whatever its motor power.
Therefore should the suction height (head) be as small as possible and the length of the suction pipe as
short as possible. The suction ability diminishes as the altitude increases (see table hereunder).
Altitude (m) Loss of suction head (m)
0 0
500 0.60
1000 1.20
1500 1.70
2000 2.20
2500 2.70
3000 3.20
3500 3.60
Motor pumps should never be lowered inside or put directly next to a well to reduce the length of the suction
pipe.
■ Not all surface centrifugal pumps are self-priming, thus not only their pump house has to be filled completely
with water before the pump is started, but also their “suction” pipe. In case of doubt if the pump is
self-priming, always fill the suction pipe with water.
■ Some high capacity surface pumps can’t even “suck up” the water and need to have the water level at the
same height as the pump axis, or even above (check the owner’s manual). They can only deliver water up
to a certain height at a certain flow, which depends on the power and the rotation speed of the motor.
■ Not all centrifugal pumps are capable of pumping turbid water. The possible presence of large quantities
of sand or other solid particles in the water may damage the moving parts of the pump.
■ The presence of salty or brackish water may require a special pump that is less vulnerable to corrosion.
■ The height of the water column in a well creates a pressure at the entrance of the submerged pump, thus
the Geometric Suction Head (GSH) is negative and needs to be subtracted from the Geometric Delivery
Head. This means in practice for submersible and de-watering pumps that the Total Geometric Head can
be counted from the dynamic water level until the highest point in the pipe system. Be aware however that
some pumps will have a maximum pressure (depth) to which they can be submitted. Take also into account
that the deeper the pump is lowered inside a well, the longer the delivery pipe has to become, thus the
higher the delivery head losses will be.
■ The suction head losses for submersible and de-watering pumps are very low because there aren’t any inlet
pipes causing friction. However, the friction of the water with the gravel pack and slotted casing of a
borehole cannot be neglected (T.B. 2.27).
■ Be aware that 10 meter Water Column (mWC) is about equal to 100 kPa or 1 bar (with bar and mWC being
the unities most commonly used by technicians).
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T.B. 2.27 Determination of the maximum pumping rate of a well

In order to verify if a hand dug well or a tube well (borehole) can cover the water demand, it’s important
to determine its maximum pumping rate via a pumping test. The maximum pumping rate is also important
to identify an appropriate pump for the well. The pumping test consists of recording the evolution of the
water drawdown inside the well at increasing flow rates. The dynamic water level related to the maximum
pumping rate, together with the depth at which the slotted tube well casing starts also determine at what
depth the pump should be installed.
Procedure
■ Check the well’s logbook for following information: total depth, static water level, dynamic water level at
maximum pumping rate and depth where the slotted part of the tube well starts. If the logbook isn’t
available, all the above mentioned data have to be determined before a pump can be chosen and/or
installed. Neighbouring wells can provide an estimation of the well depth and the static water level in the
area.
■ Determine the total depth of the well. This can be done by introducing a disinfected heavy weight (e.g. a
stone) on a long rope into the well. Once the weight can’t be felt anymore, the bottom is reached. The
length of the inserted rope, starting from the ground surface (e.g. the edge of the wellhead / the casing
aboveground) until the bottom can be measured, and therefore indicates the total depth of the well.
■ Determine the static water level of the well by means of a dipper. A dipper is a probe connected to a long
measuring tape that will give a light and/or sound signal when it comes in contact with water. To obtain
correct data, the static water level measurement should only be done when the well hasn’t been used for
at least 24 hours.
■ Estimate, in case of a borehole, the depth where the slotted casing starts based on its total depth and the
static water level. A properly designed borehole often has 1 to 3 lengths of slotted casing of 4 to 6 m length
each, depending on the extent (thickness) of the underground aquifer. It’s important to consider that a
correctly designed borehole can never have its static water level lower than the slotted part of the casing.
■ Install a motorized centrifugal pump (T.B. 2.25). For shallow wells (static water level less than 6 m deep at
sea level), a motor pump can be used. For hand dug wells with a deeper static water level, a dewatering
or a submersible pump will have to be used. For deep tube wells a submersible pump will need to be
installed, at least 1 m above the slotted casing (T.B. 2.29). A gate valve should be foreseen on the delivery
pipe to regulate the pumps flow accurately.
■ Start the pump with the gate valve closed, open it slowly and regulate the flow “Q” at 0.5 m³/h by means
of the valve. The flow can be determined by measuring the time needed to fill a recipient of known volume
(e.g. 20 - 30 l), or a lot easier by an instant flow meter.
■ Measure the drawdown “s” (in meter) with the dipper, and follow up until the dynamic water level has
stabilized (drawdown < 1 cm/minute) at this specific flow rate. Often a stabilization period of 2 hours is
taken, but in acute emergencies,it can be tried to reduce this period.
■ Plot the measured figures on a flow (abscissa) / drawdown (ordinate) graph to indicate the working point.
A straight line can also be drawn from the graphs zero point (flow = 0, drawdown = 0) across the first flow
(Q = 0.5 m³/h) / drawdown (s) working point, representing more or less the linear head losses within the
aquifer (as the non-linear head losses will mostly still be low for such a low flow).
■ Measure also the turbidity of the well water by means of a turbidity tube (T.B. 2.13). The turbidity should
preferably be less than 5 NTU, and certainly not above 20 NTU.
■ Increase the flow to 1 m³/h by opening the gate valve a little more, and whilst monitoring the turbidity. follow
the drawdown over the same period as for the flow of 0.5 m³/h.
■ Plot the new working point on the graph and interconnect the different working points to form the well curve,
representing the linear and non-linear head losses during pumping (as per figure C).
■ Keep adding a step of 1 m³/h to the flow rate while measuring the drawdown, and keep on plotting the
results on the graph, until the non-linear head losses have become equal to the linear head losses, or until
the well curve bends significantly away from the linear head losses line. These phenomena indicate that
the critical flow is reached. The critical flow is also reached when the turbidity of the pumped up water
starts to rise drastically. In case these phenomena don’t occur, the flow rate can be increased until the
maximum possible drawdown is reached, meaning that the dynamic water level is still at least 1 m above
the pump (or the strainer if a surface pump is used).
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Key Input
A. Dipper - Logbook
B. Instant flow meter with gate valve - Rope and disinfected weight (e.g. spanner)
C. Flow (Q) – drawdown (s) graph - Dipper
- Recipient and watch or instant flow meter
1. Gate valve - Gate valve
2. Instant flow meter - Pump kit (motor, dewatering or submersible)
3. Linear head-losses - Turbidity tube
4. Non-linear head-losses (turbulence) - Squared / graph paper, ruler and pen
5. Critical flow
6. Maximum pumping rate
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Interpretation of the results

■ When a well is being over-pumped beyond its critical flow, it can result in the well curve bending significantly
away from the linear head losses line. This is caused by:
➞ important turbulence and thus heavy non-linear head losses within the gravel pack and the slotted casing
of a tube well, or
➞ the dewatering of a particular productive aquifer.
In any case, over-pumping should be avoided. This means that the maximum pumping rate should be
below the critical flow. In practice, and to play on the safe side, the pump flow rate of the last test before
the critical flow is reached, can be considered as the practical maximum pumping rate.
■ A serious increase of the turbidity also indicates that the (tube) well is over-pumped. The maximum pumping
rate should then be regulated at the flow delivering water with a turbidity of less than 5 NTU (maximum 20
NTU during acute emergencies).
■ In case the critical flow isn’t reached, nor the turbidity has risen, the maximum pumping rate should be set
at the flow at which the dynamic water level in the well is at least 1 m above the pump.
■ Based on all the results, a logbook with all the available information should be made and archived for future use.
Remarks
■ This simplified pumping test provides the possibility to determine rapidly an approximation of the most
essential parameters that are needed to exploit safely an existing well. However, the approximations made
above do not guarantee any long-term results for the tested well. Other more sophisticated methods exist
(e.g. Porchet) and can be found in specific literature (see section 2.5 Further reading).
■ The following data are important factors for the exploitation of a well:
➞ Total depth: in practice the depth from the edge of the wellhead or from the casing aboveground, until the
bottom of the well.
➞ Static water level: water level before pumping starts (not having been pumped for at least 24 hours).
➞ Dynamic water level: water level at a certain pumping rate, preferably at the well’s maximum pumping rate
(but certainly not above).
➞ Maximum pumping rate: the maximum water flow that the well can deliver without having important
non-linear head losses, too high turbidity of the water or being sucked dry.
➞ Depth where the slotted part of the casing starts: the part where the water enters the tube well.
■ Even if the logbook of the well is available, it can be interesting to verify all its data, at least if time permits.
■ When determining the total depth of the (tube) well, make sure there aren’t any obstacles blocking the free
passage of the weight and rope (e.g. a pump).
■ An appropriate submersible pump should be installed with its bottom at least 1 m above the slotted casing
of the tube well, in order to avoid:
➞ erosion of the soil at the level of the pump inlet, and
➞ an insufficient cooling of the pump motor (T.B. 2.29).
■ A dewatering pump or the strainer of a motor pump’s “suction” pipe should never be less than 0.5 m away
from the bottom of a hand dug well. This is to avoid that settled dirt particles would be pumped up, which
would increase the turbidity drastically from the start.
■ If the turbidity of the well water is already high before the pumping test starts, it can be an indicator that
the well hasn’t been designed correctly (e.g. no lining for a hand dug well) and/or developed properly (no
slow pumping during prolonged periods). Another possibility is that the well has been over-pumped
previously.
■ Where water is scarce, avoid wastage during the pumping test by collecting the water in a reservoir.
■ The distance in between the well curve and the linear head losses line indicates the non-linear head losses,
created by the turbulent flow inside the gravel pack and the slotted casing of the tube well.
■ If time is available, it is preferable to increase the flow in steps of 0.5 m³/h, instead of 1 m³/h.
■ It is also possible to do a pumping test with a flow in between the two measures where the critical flow
appeared, in order to determine the maximum pumping rate more precisely. This is recommended if the
“initially obtained” maximum pumping rate is too low in comparison with the desired flow (and thus not
covering the water demand).
■ After the maximum pumping rate has been determined, it’s recommended to pump at this rate for 24 hours,
in order to verify the capacity and the stability of the well.
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T.B. 2.28 Motor pump kit installation

The petrol and diesel motor pump kits are packages designed to provide water in emergency situations.
They permit water to be pumped from a water source (e.g. shallow well, river), from or to a water truck
or a reservoir. They can also be used for direct water distribution.
Installation and operation

■ Choose the pumping site: it should be easily accessible in all seasons and not liable to flooding, particularly
where the pump is to be used for filling water trucks.
■ Prepare the site so as to install the pump as close to the source as possible, in order to reduce the suction
head, but keeping in mind the potential sudden water level differences. Motor pumps should never be
lowered inside or put directly next to a well, to avoid their toxic exhaust gasses accumulating within.
■ Fit the strainer with foot valve at the lower end of the suction pipe. Attach a float so as to hold the strainer
about 0.3 m below the water surface to avoid creating eddies and thus sucking in air and/or floating
vegetation, and preferably 0.5 m (at least 0.3 m) above the bottom to avoid sucking in mud.
■ Lay the suction pipe on a rising slope (avoid dips if possible), making sure that all the connections are well
tightened. An air leak through the connections or a hole in the suction pipe could mean losing the priming
of the pump. The total suction head should be limited to 7 m (at sea level). If possible, restrain to one
suction pipe as this limits the risk of air leaks and reduces the suction head due to friction losses.
■ Lay the delivery pipe up the slope towards the reservoir / tanker filling point and make the connections.
■ Check always the oil level of the pump engine before starting. Be aware that new motor pumps are most
often delivered without oil in the engine.
■ Fill up with fuel. For safety reasons, refuelling should only be done when the engine has cooled down.
■ Check regularly the general condition of the motor pump (e.g. the air filter, the spark plug), according to
the manufacturers’ instructions.
■ Fill the pump body with water. Most motor pumps provided under kit form are self-priming, so filling the
suction pipe to encourage priming isn’t essential. However, for some (high pressure) pumps and older
self-priming pumps, and/or when the suction head is high (e.g. nearly 7 m at sea level), it is required to
prime the suction pipe as well. In case of doubt, it is always best to fill the suction pipe.
■ Start up the pump, following the instructions of the user’s manual. Make sure to know how to stop the
pump before starting it, to be ready in case something would go wrong.
■ Record the pumping periods in the maintenance book to keep a count of the hours the pump has been
running, and to plan the engine’s maintenance schedule.
Remarks
■ Small petrol motor pumps are light, and are therefore also suitable for mobile use (e.g. on a pick-up or a water
truck). They are mainly suited for limited pumping times. Small motor pumps are mounted in a frame and are
portable by one to two persons. Some models have their 4-stroke engine fitted with a low-oil security system.
■ Diesel motor pumps are mainly suitable for fixed installations as they are heavier, which means they have to
be carried by at least two persons. They’re more suited for long pumping periods.
■ The risk of transporting petrol, especially in conflict areas, and the (generally) better availability of diesel should
also be taken into account when a choice has to be made between a diesel or a petrol motor pump.
■ Some high capacity surface pumps can’t even “suck up” the water and need to have the water level at the same
height as the pump axis, or even above (check the owner’s manual).
■ Most motor pump kits are supplied with some lengths of Heliflex pipe, a strainer with non-return valve, a 20 l
jerrycan for fuel, engine oil, a funnel, a tool kit with spare parts for normal services, a user’s manual and a
maintenance logbook. The components of the kit should not be separated. The whole kit should be repacked
in its original case if it is to be stored again or sent elsewhere.
■ Where the motor pump is to be used for long periods in a fixed position, shelter it from the weather.
■ A strainer with non-return foot valve should be installed to exclude large impurities and to keep the suction pipe
full of water when the pump is stopped.
■ Do not use flat hoses for suction.
■ A non-return valve can be installed on the outlet of the pump to protect it against water hammering.
■ The recommended conditions for operation and maintenance (e.g. pumping hours, the frequency of oil changes)
should be followed to avoid breakdowns, which might interrupt an emergency water supply.
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Key Input
1. Float - Shovels and picks for preparing the site
2. Strainer with non-return foot valve - Fuel (petrol or diesel)
3. Water source (e.g. river, well) - Complete motor pump kit
4. Heliflex suction pipe - Float and rope
5. Petrol or diesel motor pump - Reservoirs or water tankers for filling
6. Non-return valve (optional)
7. Delivery pipe (Heliflex or flat hose)
8. Geometric suction head
9. Geometric delivery head
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T.B. 2.29 Submersible pump installation

Submersible pumps are mainly designed to provide water from tube wells (boreholes). With some small
modifications, they can also be used in hand dug wells. Although it is also possible with submersible
pumps, there are better and cheaper options to pump water from rivers and reservoirs. Submersible
pumps should not be used for water containing a lot of particles in suspension (< 50 g/m³).
Installation
■ Verify the borehole’s static water level, the level where the slotted casing starts, its maximum pumping rate and
the corresponding dynamic water level. This can be verified by looking in the borehole’s logbook and/or by doing
a pumping test (T.B. 2.27).
■ Determine the water demand / consumption.
■ Choose a submersible pump corresponding to the water demand, the amount of time the pump has to run, the
electricity supply, the delivery height of the water, while keeping in mind the maximum pumping rate of the
borehole (T.B. 2.26).
■ Disinfect the borehole with a 1% chlorine mother solution (T.B. 2.03).
■ Verify if the wellhead is complete with an elbow, a gate valve and a (fast-)coupling on the outside, and a hook
for the security rope on the inside. It should also have a closable opening to introduce a dipper (T.B. 2.27), and
a “sealable” opening for the electrical power cable.
■ Lay the submersible pump next to the existing borehole on a piece of plastic sheeting and roll off its electrical
power cable in a straight line.
■ Roll off the raising main next to the electrical power cable, starting from the pump side. The raising main can
be a special flat hose or a PE pipe, as long as it has the correct diameter.
■ Cut the raising main to the correct length; the pump should be at least 1 m under the dynamic water level at
maximum pumping rate, and at least 1 m above the slotted part of the casing. When determining the raising
main’s length, keep in mind that there might be variations in the water level according to the seasons. As the
pump should be hanging directly on the pipe, be also aware that the raising main itself might stretch for up to
3% once it’s filled with water.
■ Put the appropriate couplings on both extremities of the raising main and tighten them firmly.
■ Connect the raising main couplings tightly with Teflon tape to the submersible pump on one side, and to the
wellhead on the opposite side.
■ Put short lengths of PVC or PE pipe around the electrical power cable at the level of the couplings to avoid it
getting damaged by friction.
■ Fit the electrical power cable with the provided cable straps (or PVC tape) to (the loops of) the raising main,
allowing a little slack (5% by snaking the cable). The electrical power cable should be fixed at every meter of
raising main.
■ Pass the power cable through the foreseen hole in the wellhead before installing the electrical plug.
■ Lay out a rope next to the raising main and electrical power cable. A polypropylene (PP) rope with a minimum
diameter of 5 mm is recommended for use in boreholes because it won’t rot in this humid environment.
■ Cut the rope to the correct length. As the pump won’t be hanging on this rope (it’s only there as a security in case
something would go wrong), it has to be at least 3 % longer than the raising main in order for the latter not to kink
which would cause serious local head losses; e.g. for 50 m of pipe, the rope should be at least 51.5 m.
■ Fix the extremities of the rope to the pump and the wellhead.
■ Make sure that the aboveground edge of the casing is cut horizontally because it will be the support of the
wellhead.
■ Lower the pump with its raising main, cable and rope into the casing whilst cleaning them with water and a cloth
soaked in a 0.05% chlorine solution. Take care not to damage any of them. Be aware that the weight will
accumulate as the pump with its electrical power cable and the raising main (e.g. 0.5 kg/m) is lowered deeper
and deeper in the casing.
■ Position the wellhead on top of the casing.
■ Connect the water outlet of the wellhead to a reservoir.
■ Connect the electrical plug to a power supply and the submersible pump is operational.
■ Verify the drawdown when pumping for the first time to avoid that the pump would run dry, and check the
turbidity (T.B. 2.13) of the pumped up water (a higher turbidity could indicate that there is over-pumping of the
borehole). Adjust the pump’s yield with the wellhead’s gate valve, if necessary.
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Key
1 Closed casing
2. Closed casing with stopper at bottom
3. Slotted casing
4. Backfill
5. Cement grouting
6. Clay (Bentonit) balls
7. Gravel pack
8. Submersible pump
9. Couplings
10. Raising main (pipe)
11. Electrical power cable
12. Cable straps
13. Rope (optional)
14. Wellhead with accessories
15. Static water level
16. Dynamic water level (cone)
Input
- Submersible pump with electrical cable
- Wellhead assembly
- Raising main (special flat hose or PE pipe)
- 2 special couplings.
- Cable straps / PVC tape
- Short lengths of PE or PVC hose
- Heavy duty gloves
- Teflon tape
- Knife or hacksaw
- Small screwdriver
- Cloth and 0.05% chlorine solution
- Clean water
Optional
- 2 sets of installation clamps*
- Tripod or rolling wheel (with a car)*
*Items also useful for pump retrieval.
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Remarks
■ The relatively easy installation procedures described here are only valid for submersible pumps that have
all their protection facilities (e.g. dry run, over- and under voltage, overloading) integrated in the pump itself,
thus not needing an external control panel.
■ Submersible pumps should preferably be ordered with the electrical power cable already installed, because
a faulty installation (e.g. leakages in the electrical isolation) can lead to serious damages and electrocution
if a metallic raising main would be used.
■ Some aid-agencies provide submersible pumps with all the needed accessories under kit form in order to
equip existing boreholes rapidly during acute emergencies. These pumps can be powered with portable
generators. Although it is tried to cover a wide flow range, the available variety of submersible pumps in these
emergency kits is limited. So for chronic emergencies and stabilized situations, it is strongly recommended
to purchase submersible pumps with their accessories (e.g. rising main, wellhead, rope), fully adapted to the
delivery height, the desired flow and the corresponding head losses. Remember that the desired flow should
not be above the maximum pumping rate of the borehole.
■ It is possible to install a small submersible pump with a limited length of flexible raising main manually, but
the weight, accumulating as the system is lowered deeper and deeper in the borehole, should not be
underestimated. In any case, a minimum of two persons should be located directly at the borehole to lower
the pump inside the casing, without the cleaned and disinfected raising main, electrical power cable or rope
dragging over its edge. At least a third person should bring the wellhead closer to the borehole as the pump,
raising main, electrical power cable and rope are lowering. Other options are to lower the submersible pump
and its accessories by means of a car and a rolling wheel, or a tripod.
■ The pump should be lowered or hoisted by the pipe, and the rope and electrical power cable guided. Never
pull on the electrical power cable.
■ Although often used as raising main, metal pipes are rigid and heavy, and thus more difficult to transport, to
install and to retrieve. For the installation and retrieval of such a pump system (e.g. for maintenance or
repair purposes), a tripod with pulley-block will be needed. These pipes are also vulnerable to corrosion (at
their connections), even if they are made of galvanised iron or epoxy coated steel. Nevertheless, their
availability on the spot can be higher than for other materials and they allow the construction of very solid
systems.
■ Once the submersible pump is installed in the borehole, it’s recommended to verify its correct functioning
and if its yield doesn’t exceed the maximum pumping rate of the tube well. This can be verified trough a
pumping test (T.B. 2 27), with the help of an instant flow meter and a special device to measure the water
level, often called a dipper. In case the maximum pumping rate would be exceeded, the flow of the pump
can be reduced by closing the gate valve on top of the wellhead a little.
■ For installation in a hand dug well, the submersible pump often needs to be positioned horizontally to stay
1 m under the water surface (dynamic water level) and at least 0.5 m above the bottom of the well. These
distances should be respected to avoid the submersible pump respectively going too often into dry-run
protection, or “sucking up“ settled particles. To avoid suspensible particles to settle on the horizontally
positioned pump and therefore reducing its cooling, it needs to be installed within a cooling mantle that is
hanging on ropes or standing on long legs.
■ Electrical dewatering pumps can also be used within hand dug wells to retrieve potable water, just by being
hung up at least 0.5 m above the bottom of the well (similar to figure B in T.B. 2.03). However, attention
should be paid not to over-pump the well because dewatering pumps can have a big yield.
■ During the first step of hand dug well cleaning, a dewatering pump can be put on the bottom of the well to
remove as much sludge as possible (these pumps are capable of dealing with reasonable amounts of turbid
water). Afterwards, the pump should be hung at least 0.5 m above the bottom of the well to dewater the
hyper-chlorinated water of the disinfection process (T.B. 2.03). During human activities inside the well, the
dewatering pump should be stopped and disconnected from the electricity supply to avoid electrocution.
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T.B. 2.30 Pipes for potable water supply

There are several types of pipes on the market, all with different advantages and inconveniences. The
lay-flat (fireman’s) hoses and the spiralled (Heliflex) pipes are often used by aid-agencies, because they
are part of the emergency kits. Other common pipe types are made of polyethylene, PVC and galvanised
iron.
Classification of pipes
Lay-flat hoses
Lay-flat hoses (fireman’s hoses) are commonly available in emergency kits in rolls of up to 50 m and diameters
of 2 or 3” (Nominal Diameter ND 50 or ND 80). Being collapsible when not in use, lay-flat hoses can be rolled up
in relatively small volumes, which eases their transportation. However, lay-flat hoses cannot be used at the
suction side of a pump, they cannot be buried as such in the ground and they tend to kink when changing
direction, causing a lot of local head losses (T.B. 2.31). The connections to pumps, tanks or to each other are
often made with fast couplings. They usually have a pressure resistance equal or higher than spiralled pipes.
Spiralled pipes
Spiralled pipes (Heliflex pipes) can be used at the suction and the delivery sides of a pump. Spiralled pipes that
are usually found in emergency kits have a diameter of 2 or 3“; (ND 50 or ND 80). They usually have a pressure
resistance of up to 6 bar. Because they are flexible, some coils of spiralled pipes are often delivered with
emergency water tanks and pumps kits, permitting the rapid installation of short pipelines. Because of the used
couplings and the corresponding high local head losses, Heliflex pipes are often only installed on short distances.
Due to their spiral reinforcement, these pipes can also be buried.
Polyethylene (PE) pipe
Especially the smaller diameter PE pipes are flexible. At diameters of up to 75mm, PE pipes are often sold in coils
of tens of meters. PE pipes are easy and fast to install, which explains why they are more and more used in
emergencies. The common method for joining PE pipes is through welding, but mechanical couplings are often
used as well for small diameter pipes. There are several commercial welding techniques available, from which
butt and electro fusion are probably the most common. Both techniques will require a generator. The butt fusion
technique uses a welding machine that melts both pipe butts, usually by a hot plate, and than pushes them
together to form a watertight joint. The electro fusion technique is probably more easy to use, especially for
repairs. It involves a sleeve into which the two pipe ends slide and fuse together once the fitting is connected to
the generator. Fusion indicators are commonly designed into the fittings. When sufficient melt pressure has been
generated, the indicator will protrude. A welding machine is only worth obtaining if several kilometres of PE pipes
have to be installed. Although it is strongly recommended to bury PE pipes, they have already been installed
aboveground for relatively long periods during emergencies.
Poly Vinyl Chloride (PVC) pipes
PVC pipes are far less flexible than PE pipes. PVC pipes are commonly available in lengths of 4 to 6 m with push
fit insertion joints (collars) or joints that require solvent cement (PVC glue). After both pipe ends have been
degreased, the PVC glue can be applied in a longitudinal way on both joints to form a watertight seal once the
pipes are pushed into each other. Both glue and degreaser are IATA regulated and cannot be air transported
without special authorisations and precautions. Note that not all PVC glue can resist the high pressures that are
sometimes reached in potable water supply systems. This should be taken into account when this product is
bought locally. Therefore is it recommended to only use push fit joints during emergencies. PVC pipes should
always be protected against direct sunlight.
Galvanised Iron (GI) pipes
Galvanised iron pipes are commonly available in lengths of 4 to 6 m and diameters of up to 4” (100 mm). It is
advised to use GI pipes only in special occasions because they are heavy and often expensive. GI pipes can be
used for area’s where the pipeline:
■ cannot be buried,
■ is exposed to damage risks (like at rocky area’s or at tapstands),
■ passes sections with very high pressures (> 16 bar),
■ crosses a stream or a road, or is installed inside buildings.
GI pipes are screwed together through a socket or unions. When sockets are used, one has to make the joint
watertight by wrapping PTFE (Teflon) tape or hemp with paste around the thread in a clockwise direction before
screwing the pipe together. In most countries, pipe-threading sets can be found on the local market (feasible to
thread diameters up to 1.5” manually).
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Remarks
■ To choose the right pipe type, one has to take several factors into consideration such as; the context
(emergency or stabilized situation), the volume for storage and transport purposes, the local availability, the
quality, the purchase and transport costs, the soil or environmental conditions, the nominal pressure that
might occur in the pipes, the easiness to install and to dismantle, the head losses (T.B. 2.31), the available
diameters. For long-term systems it can be worthwhile to test the quality of plastic pipes (PE and PVC).
Contact your technical referent if you want to perform a test in Europe to verify if the plastic pipe complies with
the standards for food quality, pressure resistance and aging.
■ All pipes do have a pressure rating, often expressed in PN (Pression Nominale / Nominal Pressure). The
maximum nominal pressure should normally be mentioned on the plastic pipes. A rating PN 6 means that the
pipe can resist a nominal pressure of up to 6 bar, and should not be exposed to higher pressures as it risks
to burst (certainly over time). The pressures will need to be calculated in order to choose the right kind of pipe
(T.B. 2.31; 2.32).
■ The sizes of PE and PVC pipes are specified in terms of nominal outside diameter (OD), not by the internal
diameter. The inner diameter of plastic pipes depends on the nominal pressure they can sustain: the higher
the pressure, the thicker the pipe wall, the smaller the inner diameter. Typical pressure ratings for plastic
pipes are PN 4, PN 6, PN 10 and PN 16. In case pressures above 16 bar can occur inside the pipe, other
materials like GI will be required.
■ To cover longer distances in (acute) emergencies, lay-flat hoses or sometimes PE pipes are installed
aboveground because they exist in rolls of tens of meters, which reduces the installation time drastically. In
a later stage with correct underground installation (T.B. 2.33), PE is the preferred option over PVC, although
they are often more expensive to purchase. PE pipes are faster and easier to install and when there is a
rupture of the tube, it will stay localised, whereas the PVC pipe can burst over its entire length.
■ In order to keep the pipes safe from damages or deformation, it is important to store, handle and transport
them with care.
➞ Pipes should never be stored in a pile higher than 1.5 m, in order to avoid accidents and/or damages to the
material.
➞ PVC pipes with push fit insertion joints (collars) should be stacked in an alternating manner to avoid
deformation of the tubes and they must also be stored on a flat surface.
➞ In case the pipes are exposed to sunlight, they should be covered completely. Plastic will become brittle
over time, even when they have been treated to resist UV-radiation.
➞ In cold temperatures, plastic pipes get more brittle and therefore break easier. Specific precaution is needed
during handling and transport.
➞ Contact with hard surfaces like stones, concrete or metal could damage the plastic and even the threads of
GI pipe. It is therefore also important to carry the pipes, and not to drag them along, nor to drop them on the
ground.
■ Besides the PVC pipes for potable water supply, there are also PVC pipes for rainwater and wastewater
drainage. The drainage pipes are not capable to withstand the pressures that are often obtained in potable
water supply systems, thus they should never be used for that purpose. On top of that, their plastic often
doesn’t comply with food quality standards.
■ An alternative to welding machines is to weld PE pipes together manually. A metal plate is heated by means
of a gas or kerosene torch, to which both PE pipe butts are melted before being pushed manually against each
other. The right welding temperature of the metal plate can be verified by means of heat indicating crayons.
■ If a lay-flat hose is put horizontally along a slope, the hose might roll towards the bottom of the slope once it
is filled. This can be avoided by putting the hose in a shallow (open) trench. If a lay-flat hose is put vertically
on a slope, the filled hose might snake into a zigzag shape.
■ Special lay-flat hoses exist to install submersible pumps into boreholes (T.B. 2.29). Their extreme high tension
strength and special couplings resist the heavy weight of the water column and pump hanging directly on the
hose. Such an installation should never be made with the normal fireman’s hoses that can be found in the
emergency kits.
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T.B. 2.31 Head losses

When water flows through a pipe, it will encounter a certain resistance due to friction in between the water
molecules themselves, and with the pipe wall. When a pipe, lying on a single slope and closed at its lower
end is completely filled with water, an increasing pressure can be measured in the pipe towards its lowest
part. When the water is allowed to flow, the pressure within the pipe will accumulatively diminish towards
its lower part. These pressure losses, due to accumulative friction losses inside the pipe, are called head
losses. For simple and rather straight pipelines (e.g. a short connection from a spring catchment, a
tap-stand connected to a reservoir), the head losses can be determined with flow nomographs or tables.
Principle
On a pipeline, two types of head losses are to be found:
■ The linear head losses, due to the friction of water passing in the pipe.
■ The local head losses, caused by the friction of water passing through accessories such as valves (even
when completely open), bends, Tee-pieces, connections.
The head losses are most often expressed in meter Water Column (mWC) per 100 m of pipe length or
percentage; a head loss of 1% corresponds to 1 mWC (0.1 bar) per 100 m of pipe length.
Linear head losses
The linear head losses (H) depend on several factors (represented on the nomograph),
which are all interrelated:
■ The inner diameter (d) of the pipe (mm)
■ The flow (Q) through the pipe (l/s)
■ The velocity (v) of the water within the pipe (m/s): it depends on the flow and the inner pipe diameter
■ The roughness of the pipe: it depends on the material; e.g. PE, PVC, GI
■ The length of the pipe
The interrelationship is as follows:

■ For a constant flow, same length and roughness of the pipe, the smaller the diameter, the higher the velocity
in the pipe and thus the higher the head losses will be (as per figure A).
■ For a same diameter, length and roughness of the pipe, the more the flow increases, the higher the velocity
in the pipe and thus the higher the head losses will be (as per figure A).
■ For a constant flow, same diameter and length, the rougher the pipe, the higher the head losses will be.
■ For a constant flow, same diameter and roughness, the longer the pipe, the higher the accumulated head
losses will be.
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Key
A. Flow (Q) - head loss (H) graph
B. Nomograph (adapted from T.D. Jordan)
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Use of the Nomograph

When the information of two factors is known, their figures can be plotted on their respective column on the
nomograph. By connecting these plotted figures by a straight line over the whole width of the nomograph,
the other factors can be directly read or simply calculated.
Some examples:
■ If the inner diameter of the pipe and the desired flow are known, the velocity of the water in the pipe and
the linear head losses per 100 m pipe length (depending on the material of the pipe) can directly be read.
To know the real linear head losses, its figure just has to be multiplied by the real pipe length (taking into
account the multiplying factor 100).
■ If the maximal potential linear head losses are calculated (depending on the available height difference; T.B.
2.24) and the inner pipe diameter is known, it’s possible to read the maximal potential flow passing through
the pipe (taking into account the complete pipe length).
■ If the desired flow is known and the maximal potential linear head losses are calculated, it’s possible to read
immediately the needed minimum inner pipe diameter.
Local head losses
To calculate the local head losses, tables exist which indicate for all kinds of accessories the frictional head
loss factor to be used in the calculations. However, for simple pipelines with a reasonable length (e.g. some
hundreds of meters) and few accessories, the local head losses are often estimated as 15 % of the linear
head losses. This estimation isn’t valid of course for (rather) complicated pipelines and networks; for instance
inside buildings where there are a lot of bends, valves and T-pieces. In case of doubt, contact your technical
referent for more information.
Total head losses
Total head losses = linear head losses + all local head losses
Often simplified: Total head losses = linear head losses x 1.15
Remarks
■ The factors influencing the linear head losses will be determined themselves by other aspects:
➞ Inner pipe diameter: its choice is restricted by the limited availability of different pipe diameters.
➞ Flow: depends on the water demand and the time wanted / available to get it to the beneficiaries
➞ Roughness: depends on the material of the available pipes
➞ Pipe length: depends on local topography
■ The diameter mentioned on the nomograph is the inner diameter. Take this certainly into account for plastic
pipes because their outer diameter is standardised in size, whilst their resistance to pressure depends on
their wall thickness, and therefore has an influence on their inner diameter. For instance, the inner diameter
of a PN 16 pipe is smaller than the inner diameter of a PN 6 pipe of the same external diameter (T.B. 2.30).
■ The water velocity is important:
➞ A velocity less than 0.7 m/s might result in particles settling inside the pipe, eventually clogging it.
➞ A velocity higher than 3.0 m/s might result in particles eroding the pipe, and the risk of serious water
hammering increases (T.B. 2.26).
■ The linear head losses for PVC and PE pipes are similar.
■ For a gravity flow system, the total head losses, expressed in mWC, can never be higher than the height
difference in between the water source and the outlet.
■ Similar head losses are present when water is moved upwards by means of a pump. When a pump is to
be chosen (T.B. 2.25; 2.26; 2.28), these head losses expressed in mWC have to be added to the real
height difference that the pump has to overcome (initially the height in between the water surface and the
highest point in the water system).
■ It is very difficult, if not impossible to estimate the head losses for Heliflex pipes and lay-flat hoses. Some
Heliflex pipes have a high “roughness” due to the spiral that is also noticeable on its inside. When several
Heliflex pipes are connected to each other, their double fast-couplings present every so many meters (e.g.
6 – 8 m) will create a lot of local head losses as well. Lay-flat hoses might be quite rough on the inside as
well, and they kink very easily (already at the slightest change of direction), thus creating a lot of
unpredictable local head losses.
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T.B. 2.32 Calculation of a simple pipeline

The calculation of big water supply systems can be very complicated and should be left to specialists, who
are often using specific computer software. However, it is possible with simple means to calculate
uncomplicated and relatively short pipelines (maximum a couple of kilometres). This kind of calculation
requires a proper topographic survey, knowledge about head losses and the use of a nomograph. It is
always recommended to have a (specialised) colleague verifying the obtained results.
Procedure
■ Perform a basic topographic survey (T.B. 2.24).
➞ Determine the total length of the (future) pipeline.
➞ Determine the height difference between the outlet of the spring / reservoir and the end tap(stand) / valve
(indicated as H2 in the figure).
➞ Determine the maximum pressure that potentially will be applied on the pipes. This maximum pressure is
exercised at the lowest point of the gravity flow system when the water isn’t moving (all taps / valves closed).
Be aware that the lowest point of the system does not necessarily mean the end tap / valve. Thus the maximum
pressure in the system is determined by the height difference in between the outlet of the spring or the highest
water level in the reservoir and the lowest point of the pipeline (indicated as H1 in the figure). So the maximum
pressure in the pipeline is expressed in meter Water Column (mWC), or bar (if divided by 10).
■ Shortlist amongst all the available pipes the types that will resist the maximum pressure (e.g. PE, PVC, GI; T.B.
2.31).
■ Choose a specific pipe within this shortlist, and measure its inner diameter (mm). The choice should be based
on aspects like costs, availability, transport problems, roughness, food grade quality.
■ Determine the flow that needs to pass through the pipeline (converted into l/s), depending on the amount of
water (water demand) that needs to be transported over a desired or available time frame.
■ Plot both the inner diameter and the flow figures on the nomograph (T.B. 2.30). It’s recommended to do this on
a copy of the nomograph.
■ Interconnect both plotted points with a ruler and draw the line over the whole width of the nomograph.
■ Read the velocity of the water. The velocity should preferably be in between 0.7 and 3 m/s.
■ Read the head loss in mWC per 100 m of pipe length, depending on the pipe’s material (related to the roughness
of PVC / PE or GI).
■ Calculate the total linear head losses according to the total length of the pipe and add the estimated 15 %
of local head losses to obtain finally the total head losses in mWC.
■ Compare the total head losses in mWC with the total available pressure at the outlet (height difference H2 in
between the water outlet of the spring / reservoir and the tap / valve). When the total head losses are deducted
from the total available pressure, there still should be a positive pressure to overcome the local head losses
of the tap / valve (minimum 1.2 m and up to 7 m for some tap models).
■ Restart the exercise using a decreased flow and/or an increased pipe diameter in case the above mentioned
positive pressure isn’t reached (or even be negative). The exercise on the determination of the head losses
will have to be repeated until an acceptable result is found.
Example
The design of this simple gravity flow water supply system has its reservoir centralised nearby the source,
but the distribution takes place at a certain distance. The shortest distance between both is through a small
valley. The water demand can be satisfied with one tapstand.
■ Thetopographic survey has been done and provides following information:
➞ Length in between the source and the taps, following the valley (total pipe length): L = 400 m
➞ Height difference between highest reservoir level and lowest point in the valley: H1 = 35 m
➞ Height difference between outlet of reservoir and taps: H2 = 6 m (available pressure of 6 mWC)
■ Technicalinformation regarding the available material:
➞ Available PE pipe: PN 6
➞ Inner diameter of the PE pipe PN 6: 50 mm
➞ Head loss in the taps of the available tapstand is 1.6 m at ideal flow of 0.225 l/s per tap
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■ Results of the calculation

PN6 pipe (max. 6 bar or 60m pressure) will withstand the maximum pressure (35m height or 3.5 bar) at the
bottom of the system when all the taps are closed, so it can be used.
Desired ideal flow: 0.225 l/s per tap. For the available tapstand with six taps:
0.225 x 6 = 1.35 l/s when all the taps are open at the same time.
➞ The nomograph indicates a head loss of about 1 mWC per 100 m pipe length and the velocity is just at
the limit to avoid sedimentation in the pipe (0.7 m/s).
➞ For the total pipe length of 400 m, the total linear head loss equals 4 m (1 mWC/100 m x 400 m)
Total head losses = 4 m + 15 % local head losses = 4.6 m
➞ 6m available pressure - 4.6 m head losses = 1.4 m pressure left over to overcome the tap head losses
1.4 m pressure left over - 1.6 m pressure used to overcome tap head losses at this flow = -0.2 m
the residual head at the outlet of the taps can never be lower than 0 m
■ Conclusion: the system will work, but at a slightly lower flow than was expected (about 10 l/min per tap).
The velocity in the pipe will also drop below 0.7 m, thus there is a risk of sedimentation within the tube. In
case the wanted flow of 1.35 l/s is essential, the simplest solution would be to lower the tapstand by
minimum 0.2 m (if the recipients of the beneficiaries would still fit underneath).
Key Input
1. Reservoir -Topographic study
2. Highest water level in the reservoir -Nomograph
3. Outlet of the reservoir -Calculator
4. Pipeline -Ruler
5. Topography of the area -Pen
6. Tapstand
H1: height difference in between the highest level in the reservoir and the lowest point in the valley
H2: Height difference in between the outlet of the reservoir and the taps
L: Total length of the pipeline
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Remarks
■ The above mentioned maximum pressure in the pipe is not considering potential water hammering (T.B.
2.26), which is caused when the water flow is suddenly stopped by closing a ball valve for instance or by
an accidental immediate blockage of the pipe. Water hammering, which are enormous pressure shocks,
can cause serious damages to the system and even personal injuries, thus one should try to avoid it at all
times.
■ For plastic pipes, the maximum admissible nominal pressure is often mentioned on the pipe itself; e.g. PN
6 means it can resist to a maximal nominal pressure of 6 bar (T.B. 2.30).
■ The choice in pipe diameters is often determined by the availability on the market.
■ The diameter mentioned on the nomograph is the inner diameter. Take this certainly into account for plastic
pipes because their outer diameter is standardised in size, whilst their wall thickness depends on their
resistance to pressure, and therefore has an influence on their inner diameter. For instance, the inner
diameter of a PN 16 pipe is smaller than the inner diameter of a PN 6 pipe of the same external diameter
(T.B. 2.30).
■ The water velocity is important:
➞ A velocity less than 0.7 m/s might result in particles settling inside the pipe, eventually clogging it.
➞ A velocity higher than 3.0 m/s might result in the particles eroding the pipe, and the risk of serious water
hammering increases.
■ The height difference H2 to determine the available pressure at the end tap, should normally be measured
in between the water level of the spring / reservoir and the tap. As the water level of a reservoir can vary
over time (getting empty, being refilled), it’s careful to keep the tank’s outlet as a reference because this
doesn’t (really) change in height and it reflects the minimum pressure available.
■ For gravity flow systems, the total head losses in mWC can never be higher than the height difference H2
in between the water source and the final outlet (e.g. tap). In case the calculated total head losses (in
mWC) are higher than the available height difference (in m), the water supply system will regulate
automatically its velocity, and therefore the flow will be lower than expected.
■ Similar head losses are present when water is moved upwards by means of a pump. When a pump is to
be chosen (T.B. 2.25; 2.26; 2.28), these head losses expressed in mWC have to be added to the real
height difference that the pump has to overcome (initially the height in between the water surface and the
highest point in the water system).
■ The maximum pressure resistance of pipes for motorised pump systems should be more than the maximum
pressure the pump can deliver (as such the pipes can’t burst, even with the pipe system closed / blocked
and the pump at maximum pressure).
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T.B. 2.33 Pipe installation

Water is often transported from one place to another through pipes. In acute emergencies, certain pipe
types can be installed aboveground to gain time. But to protect the pipes from the environment, the climate
and abuse, they should be buried as soon as possible.
Pipe laying
■ Mark the future pipeline path clearly with pegs (and strings) to ensure straight lines. For long pipelines, this
should normally have been done during or just after the topographic survey (T.B. 2.24). The pipeline should
be kept as far away as possible from points where erosion can occur, like landslide areas, gullies and
riverbanks.
■ Dig the trench with its walls slightly inclined because complete vertical walls tend to collapse easier. The
angle will depend on the type of soil. The dug out soil should be put a little away from the trench in order
to avoid it would slide back into the ditch. The width at the bottom of the trench should be such that it
permits the easy installation of the pipeline. Ideally, a distance of 0.3 m should be foreseen on both sides
of the pipe. The strict minimum depth at which a pipe should be buried is 0.5 m, although that the ideal
minimum depth is often considered to be around 0.8 m. In reality, the depth of the trench has to be chosen
with the aim of protecting the pipeline against:
➞ a farm plough in agricultural land: check the depth it might reach.
➞ sharp hooves and the weight of heavy animals walking over it.
➞ the weight of vehicles at motor road crossings: should be a trench dug of 1.5 m depth or the pipeline
protected otherwise.
➞ extreme temperatures: pipes can be protected from freezing or heat by laying them deeper in the ground.
➞ erosion: the topsoil can erode over the years and the pipes might become exposed.
Don’t open the trench too far ahead in advance as it can get damaged by erosion, and collect rainwater.
■ Remove all rocks and stones from the inclined walls and bottom of the trench, certainly when plastic pipes
will be installed because they might get damaged by them.
■ Place preferably a sand bed layer of 0.05 m to 0.1 m (recommended) thick at the bottom of the trench, on
which the pipeline can rest without any strain. In case the trench is situated in a very humid zone, the bed
layer can be made with round pebbles (diameter of 5 to 30 mm) instead of fine sand, in order to drain the
groundwater away underneath the pipeline.
■ Lay the pipes in a slightly zigzagged manner inside the trench, together with their fittings and accessories
(e.g. bends, valves), and connect them in the most appropriate way (T.B. 2.30).
■ Do not leave a pipe end open or exposed so as to prevent it from dirt or animals like snakes getting inside.
If nothing better is available, simple plugs made of tree branches can be used.
■ Anchor all pipes to concrete blocks (thrust blocks) at bends, branch points, valves and at passages of
steep slopes, to avoid that the joints would become loose due to the lateral forces where the flowing water
changes direction.
Backfilling
■ Backfill the trench as soon as possible to protect the pipe from the sun and vandalism. The backfill material
should not contain organic material (such as sticks and bushes). The backfill material should ideally be
slightly compacted at every layer of 0.1 m.
■ Prevent rocks and stones to be dumped on the pipes. Only after the pipe has been covered by around 0.5
m of soil, stones and rocks can be used to backfill.
■ Don’t cover the joint sections with soil until the pipe has been operated at full pressure and it has been
inspected for leaking joints. If the joints are exposed to direct sunlight before they can be inspected, it will
be good practice to temporarily cover them (with plastic sheeting for instance). After inspection the joints
should be covered.
■ Put markers (e.g. piles of stones cemented together) along the pipe line at regular intervals and all important
points (e.g. the points were the pipe diameter changes, at direction changes or branch points). Identify the
markers by using codes or numbers. If possible, make a sketch of the system, presenting all the information
available.
■ Plant short rooted vegetation (e.g. grass) on the backfilled trench to stabilise the soil and to protect it against
erosion.
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Key
A. Birds view of a pipeline
B. Cross section
1. Pipes (zigzagged)
2. Elbow
3. Thrust block (anchor)
4. Sand bed layer
5. Compacted backfill layers
6. Rough backfill layer
7. Joint section (still uncovered)
8. Marker (e.g. pile of stones cemented together)
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Remarks
■ Prior to the trench excavation and the installation of the pipes, issues related to land and/or water ownership
must be taken into consideration and solved (T.B.1.04).
■ A flat and levelled storage facility should be prepared nearby the construction area before the pipes arrive on
site. The facility should have enough space in order that the piles of pipes don’t have to exceed 1.5 m in height.
The moment the pipes arrive on site, they should be protected from direct sunlight. If the storage facility isn’t
a closed shelter, the pipes should be covered. PVC pipes with push fit insertion joints (collars) should be
stacked in an alternating manner to avoid deformation of the tubes and they must also be stored on a flat
surface. It should also be avoided that the pipes have to stay too long on the site without being installed. The
ends of the pipes should be closed to avoid dirt or animals getting in. The plugs have to be removed just before
the pipes are installed.
■ Care should be taken not to damage the pipes during handling, transport and storage on site. Contact with hard
surfaces like stones, concrete or metal could damage the plastic and even the threads of GI pipes. It is therefore
important to carry the pipes and not to drag them along, nor to drop them.
■ In cold temperatures, plastic pipes get more brittle and therefore break easier. Specific precaution is needed
during handling and transport.
■ When the pipeline path follows a slope, it is better to start the work downhill and to progress uphill in order that
runoff water can evacuate freely and the trench doesn’t get flooded.
■ In some areas it will be impossible to bury the pipes due to the rocky underground. In these situations, it is
preferred to install pipes that can endure shocks and harsh climatic conditions, like GI tubes. All aboveground
pipes should be protected at places where heavy animals pass and at vehicle crossings.
■ When the trench is less than 1-1.5 m deep at motor road crossings, the pipe without any joints should be
embedded and covered by 0.2 m of sand. On this sand layer, a reinforced concrete slab of around 0.1 m thick
should be poured. Above this concrete slab, the trench can be backfilled normally.
■ In some circumstances (road or river crossings), it will be required to install the plastic pipes inside metal (e.g.
GI) pipes with a bigger diameter. However, if a leak occurs in the PVC pipes, it will be difficult to localize it. It
should also be avoided that dirt, stones or small animals can enter in the openings between the inner and
outer pipes. This can be done by wrapping them in plastic sheeting.
■ Pipes that are left in the sun, even when already installed, will heat up and expand, but they will contract again
when they get buried or when cool water flows through them. To avoid that the contraction might pull the plastic
pipes out of their sockets or fittings, they should be installed in a zigzagged manner. The UV-radiation of the
sun makes the plastic pipes also brittle over time.
■ Anchors and thrust blocks can be made out of simple cement blocks. The pipes and accessories (e.g. bends)
can be anchored to the blocks by means of reinforcement iron bars.
■ If the length of the path is important, dig the trench over 500 m, install the pipes and backfill the trench before
doing the same on the next 500 m. Doing all the procedures over the whole length at once might lead to several
problems: e.g. trenches collapsing, damages to uncovered pipes, theft.
■ For pipelines of several kilometres in length, it is important to install sludge- and air valves. Sludge valves will
need to be opened once in a while to avoid blockages from accumulated dirt / mud particles. Air valves might
show their usefulness already from the beginning by removing air-locks when the pipeline is filled for the first
time. An air-lock is an air bubble trapped in the pipeline, whose size is such that it interferes with the water flow
through the section. They are formed when the pipeline is first constructed or when subsequently drained for
maintenance purposes. Anyway, the design and installation of such long pipelines should be left to specialists.
■ Before a pipeline can be put into operation, it should be rinsed and disinfected first:
➞ Run potable water through the system until no visual dirt comes out anymore, and drain completely.
➞ Prepare 10 l of a 1 % chlorine mother solution per m³ of pipeline volume (over its whole length).
➞ Add all this prepared 1 % chlorine solution to a reservoir containing an amount of clean water equal to the
pipeline volume and mix well to obtain hyper-chlorinated water.
➞ Fill the pipeline completely with this hyper-chlorinated water. The process should be done slowly for the air to
be able to escape, and with the end valves closed.
➞ Drain the pipeline completely once the contact time of at least 24 hours is passed, and rinse with potable
water.
■ During an emergency, small air leaks on the suction side of a pump or other small leaks at the distribution
pipes can be temporarily repaired with a 1 meter long (x 25mm) inner tube wrapped tightly around the leak.
The leaking pipe or joint should be properly repaired or replaced as soon as possible.
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T.B. 2.34 Water trucking

In a large number of emergencies, water trucking is used as a temporary measure to provide water to the
beneficiaries. The installation of more sustainable solutions can be time consuming and an urgent need
for water often necessitates trucking in the initial stages. However, water trucking is expensive, often
difficult to organise and to maintain, thus it should be avoided if feasible or replaced as soon as possible.
In most settings, the development of an alternative water supply system will be cheaper in the long run.
Procedure
Water requirements
■ Determine the volume of water to be supplied (see example hereunder) and preferably add 10-20% to
allow for losses and new arrivals. Losses will vary according to different factors like the quality of equipment
(e.g. leaking taps / tankers), the mode of water collection (e.g. jerrycans with cap versus open buckets
without lid), the type of delivery point.
■ Synchronise where possible the water delivery with the peak demands of the beneficiaries (e.g. early
morning and early evening).
Water source
■ Select a water source taking into account its yield, its proximity to the delivery point, its access for trucks
and its water quality. The loading site of the water source should have enough space to allow easy filling
of the trucks and if needed, the installation of a treatment system (e.g. assisted sedimentation; T.B. 2.16)
or of a storage infrastructure (e.g. for a low yielding source).
Transport means
■ Select the size and type of vehicle, taking into consideration the road conditions (e.g. the load-bearing limit
of the road surface, slippery surfaces, steep slopes, tight corners, narrow tracks). Bladders fitted on flatbed
trucks or mounted on tractor pulled trailers are a good alternative to water trucks. Solid plastic tanks can
also be used but special attention has to be given to the fact that they will modify the centre of gravity of
the truck. Generally the greater the capacity of the trucks the more efficient the process is, as long as the
road conditions permit the use of big vehicles.
■ Calculate the size of the fleet needed by following the steps of the example hereunder. Incorporate a safety
factor in the design if the transport fleet is not that reliable, like a back-up vehicle or additional storage
capacity at the delivery point.
■ Inspect, clean and disinfect with a 0.1% chlorine solution (T.B. 2.20) all the tankers and any associated
piping or pumps before use. Rinse them well afterwards with clean disinfected drinking water to remove
the chlorine residuals. Avoid tankers that have previously been used to transport oil, fuel or chemicals and
opt instead for dairy or brewery type tankers.
Contracting of trucks / drivers
■ Hire lorries for water trucking on the basis of either a set time frame (e.g. per month), or on the quantity of
water delivered (e.g. per trip of a tanker of known volume). Hiring per quantity of water delivered requires
greater monitoring but motivates the contractor to meet the agreed targets.
■ Make contracts and sign them (prior to the start-up of the work), clearly stating the responsibilities of both
parties in terms of insurance (in case of accident), vehicle maintenance, fuel and lubricant costs, labour
(driver and his helper). In terms of management, it is recommended that the contractor takes on all these
responsibilities for a reasonable premium.
■ Make sure that the drivers follow the organisational rules and that the vehicles correspond to the regulations
of the specific country.
Budget
■ Ensure adequate funding for the specified time frame, on the basis of a detailed budget because the running
costs of trucking operations are often high.
■ Include also more hidden costs like maintenance of loading and delivery points, installation and running
costs of storage and treatment facilities, and salaries of watchmen, fleet managers, chlorinators.
Monitoring
■ Monitor the quantities delivered and to which water points. A centralised monitoring system will be required
in large operations, particularly in situations where different partners are involved.
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Example of a Tanker Schedule
Facts
Population 12,000
Min. amount of water needed 15 l/person day
Calculation of daily requirements

Population x amount/person day 12,000 x 15 = 180,000 l/day
Estimated wastage 10% +18,000 l/day
Total 198,000 l/day
Calculation of turn-around time

Time to fill tanker (5m3 at 20 000 l/h) 15 min
Journey time from filling till delivery points
(17.5 km at 30km/h on average) 35 min
Time for emptying truck (5m3 at 25 000l/h)* 12 min
Return journey time (17.5 km at 30km/h) 35 min
97 min
Add 20% for contingencies (e.g. breaks) 19 min
Gross turn-around time 116 min = about 2 hours
The number of tankers can now be determined

Number of deliveries = working hours per day = 12 = 6 rotations
per tanker in a day gross turnaround time 2
Total number of = daily tanked water = 198,000 = 39.6

deliveries in a day volume per tanker 5,000
➞ about 40 deliveries/day
Number of tankers = 40/ 6 = 6.6 ➞ 7 tankers
Summary: A total of 7 trucks with a carrying capacity of 5,000 litres each will be required to make 6 trips per
day to supply 15 l/person day to 12,000 people. The selection of 8 tankers, rather than 7, adds a degree of
security in case of a breakdown of one of the other tankers.
* Using a pump to offload water from the tanker at the delivery point reduces the turn-around time.
Remarks
■ Chlorination within the water truck can save a lot of time because the contact time needed for the disinfectant
(T.B. 2.21) can start already during the transport.
■ If chlorination of the water has to be done in the trucks, a 1% chlorine mother solution (T.B. 2.20) has to be
prepared (only add the supernatant, not the potential calcium deposits). The quantity of chlorine that has to be
added per truck should be evaluated by a chlorine jar (modified Horrocks) test (T.B. 2.21). If tankers are metallic,
the Free Residual Chlorine (FRC) concentration should be verified at the destination and the chlorine
concentration adapted accordingly if needed.
■ The selection of water distribution points should be made on the basis that water will be supplied by tankers:
ease of tanker access will be the main consideration. Avoid time-consuming offloading procedures like pumping
water from tanker to storage tank over extended distances.
■ Offloading must be done from the truck to the reservoirs and not directly to the beneficiaries because the latter
wastes too much time. It’s better that the water truck can leave as soon as possible to fetch another batch of
water.
■ Efficiency is often an area of weakness in water trucking operations. Attention should be given to reduce the
turn-around time and water losses, and to avoid bottlenecks. For example, pumps can be used to reduce the
time needed to offload tankers. Having a pump as well as telecommunication means in every truck can thus
be considered as an advantage.
■ If security permits, the trucking should start and stop well beyond the times people collect the water, in order
to comply with the peak demands (so potentially have two periods of water trucking of about 6 hours each,
around the peak demand periods).
■ Given the high costs of water trucking over an extended period, a firm commitment to develop more appropriate
water supply solutions for the medium and long-term must be taken. It may involve the development of new
water sources and/or transport means (e.g. installation of a pipeline), or the improvement of existing ones.
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T.B. 2.35 Emergency water tanks

During acute and chronic emergencies, several types of water tanks can be used. Apart from storage,
certain tanks can also be used for other purposes like transport or water treatment (e.g. assisted
sedimentation). Before ordering a certain type of water tank, one has to consider the most likely use, the
size of the tank needed, the time and easiness to set it up.
Most commonly used tanks in emergencies
Type Capacity m3 Set up Use Remarks
Bladder 0.85 -Very easy and - Storage - Static or mobile

(pillow tank) 2 fast to set up - Chlorination - Difficult to clean
Closed tank 5 - Mountable on - Transport
a flatbed truck
Bladder 15 - Very easy and - Storage - Static

(pillow tank) fast to set up - Chlorination - Difficult to clean
Closed tank
Onion tank 30 -Very easy and - Storage - Static
Self sustaining fast to set up - Chlorination - Relatively
open tank with roof - (Assisted) difficult to clean
sedimentation
Liner tank 30 - Easy and - Storage - Static

supported by 60 relatively fast to - Chlorination - Easy to clean
metal frame set up - (Assisted) when mounted
Open with roof sedimentation
Corrugated iron 11 - Least easy to set - Storage - Static

sheet tank with a 45 up - Chlorination - Easy to clean
separate lining 70 - Bulky transport - (Assisted) when mounted
Open with roof 95 because of sedimentation - Less suited for
corrugated acute emergency
sheeting - Longer life
expectancy
Remarks
■ The permanent available volume of water that needs to be stored to avoid shortages is situation dependent:
➞ For a health centre, a storage capacity of 2 days water supply is considered as a minimum.
➞ For a refugee or an Internally Displaced Persons camp, a general storage capacity of 5 l/person is
recommended as a strict minimum.
■ Besides the above mentioned factors, the choice of the type of tank can also depend on other issues like:
➞ Expected use and local conditions (e.g. climate, security)
➞ Purchase price
■ Storage tanks must be placed upon a sound foundation. When the water tanks are full, considerable pressure
is exerted on the ground. If the construction is not adequately designed and the soil at the tank’s base becomes
saturated with water, there is risk of collapse.
■ For the water to be distributed by gravity, the tanks will have to be higher than the taps. This height difference
can be reached by using a natural slope or by building platforms. When a natural slope isn’t available or there
isn’t time or material to build a platform rapidly, a hand or motor pump can be connected to the reservoir to
assure the water distribution (T.B. 2.36).
■ The area around the storage tanks must be fenced and may have to be guarded to prevent abuse and
vandalism.
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Key
A. Bladder tank
B. Onion tank with cover
C. Plastic liner tank supported by open metal frame with cover
D. Corrugated iron sheet tank with a separate lining and cover
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T.B. 2.36 Installation of flexible reservoirs

Flexible reservoir kits are designed to supply water rapidly during emergencies. Once the base prepared
(e.g. raised platform), the reservoir can be very quickly operational: from a few minutes for a bladder or
an onion tank till some hours for a reservoir with a frame.
Installation
■ Choose a site for the installation, ensuring that the reservoir will be accessible under all circumstances and
at all times to be able to fill it (e.g. by water trucking). A reservoir filled with water is heavy (e.g. about 15
ton for a full 15 m3 bladder) and needs to be installed at a safe location where it can’t cause accidents (e.g.
a filled reservoir rolling down a slope, or a bladder on top of a non-reinforced flat roof). Discussions with
the different stakeholders must also be undertaken when choosing the site.
■ Prepare a base to install the tank by:
➞ using the natural slope of the terrain or a safe existing construction. This method allows a relatively rapid
installation of the reservoir. But the slope should not be too steep and might need to be excavated to have
a flat base. The existing construction on the other hand should be strong enough not to collapse under
the heavy weight of the filled reservoir.
➞ constructing a platform strong enough to withstand the heavy weight of the filled reservoir. All kinds of
material can be used to construct a platform: e.g. compacted earth with sloped embankment, oil drums
(the drum at the perimeter filled with stones or soil for stability), sand bags, wooden beams and planks,
(cemented) boulders, gabions. In case such material would only be available in limited amounts or that it
would become too expensive, it’s possible to use it only for the outer hull of the platform and fill the inside
with stones and/or earth.
➞ putting the reservoir straight on the ground without a height difference and supply the tapstands with water
by means of a hand pump or a motor pump. This system has the advantage that it can be installed very
quickly with a minimum of preparation. When a motor pump is used, the distribution system can easily be
extended, but it consumes fuel.
The base for the reservoir should be flat and larger than the surface of the empty tank (a minimum free
space of 0.3 m all around the tank should be foreseen). The base should be cleared of all objects that could
puncture the tank (e.g. stones, sticks, nails) and if possible, covered with a layer of sand.
■ Spread the groundsheet out on the base.
■ Put the tank (the liner and the potential frame) on the groundsheet, taking into consideration the direction
of its outlet(s). In case of a frame, assemble it and connect the flexible tank liner according to the
manufacturer’s instructions.
■ Verify if the outlet valves of the reservoir are well tightened and adjust if needed (the manufacturers don’t
always tighten them very well, or haven’t even installed them at all). Teflon tape can be used to avoid leaks
at this level.
■ Organise the distribution point(s) by installing the tapstands (T.B. 2.39). An alternative for very short term
distribution is to use the ball valves that are supplied in certain kits.
■ Connect the pipe(s) between the tank and the distribution point(s), potentially via a pump.
■ Install a drainage system around the reservoir’s base and around the distribution point(s) to avoid rapid
deterioration of the sites.
■ Install a shadow net, or a roof made of local vegetation (e.g. banana leaves) or plastic sheeting over the
reservoir to protect it at least against direct sunlight. This helps to avoid that the water in the tank gets warm.
It will also protect the plastic liner against UV-irradiation, which renders the material brittle over a prolonged
period. For very harsh weather conditions (e.g. freezing temperatures), special protective measures have
to be taken. In such cases, contact your technical referent.
■ Build a fence to avoid kids playing with or on the (flexible) reservoir. It is also strongly recommended to have
an attendant at the reservoir for safety, operation and maintenance.
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Key Input
A. Installation on a raised platform
B. Reservoir on the ground with the supply via a motor pump
1. Platform (e.g. earth, drums, timber, natural slope) - Excavation equipment
2. Groundsheet - Material to make platform
3. Reservoir - Fence material
4. Drainage channel - Reservoir kit with accessories
5. Fence - Motor pump kit (water supply)
6. (Raised) lorry access - Hand pump to supply tap-stand
7. Pipeline towards the tapstands - Tapstands kit
8. Motor pomp - (Water truck to fill the tank)
9. Tee-piece
10. Recirculation pipe back towards the reservoir
11. Gate valve
12. Roof (e.g. shadow netting)
13. Suction pipe
Remarks
■ In order to avoid abuse of the (flexible) reservoir, it is recommended not to have it too close to the distribution
point(s). However, the longer the distance, the higher the head losses in the delivery pipe(s) and the lower
the flow (T.B. 2.31) will be. This is certainly important when a platform needs to be build because the higher
the head losses, the higher the reservoir needs to be. Also when the water is delivered from the reservoir
to the tapstand via a hand pump, the distance should be restricted.
■ Bladders can be filled via the central opening or via one of the side connections. In the latter case, the cap
of the central opening must be unscrewed and put loosely on top, allowing the air that is trapped inside
the reservoir to escape, but without dirt entering. Do not overfill the tank: when water is overflowing via the
central opening, the reservoir is full.
■ When water is pumped from the reservoir to a tapstand by means of a motor pump, a recirculation system
from the pump directly back to the reservoir must be installed (as per figure B). This is to avoid that the
pump and the water inside would heat up when all the taps are closed. Failing to have a recirculation
system can potentially lead to personal injury (burns) and will eventually break the pump. In cold weather,
this recirculation system also reduces the risk of the water starting to freeze in the reservoir and the pipes.
■ Do not loose the hook spanner. If it gets lost, there are some in the water tool kit.
■ When rationing the water, the gate valve(s) of the reservoir can be closed and the knob removed. Be careful
not to loose the knob.
■ After use, it is essential to clean, disinfect and dry the tank completely before repacking it (T.B. 2.37). Do
not fold the tank until it is completely dry (takes 2 - 3 days of drying at least).
■ To repair the reservoir, use the repair module that is included in the kit and follow the instructions carefully.
■ Metal construction scaffolding can be used to construct a water tower, permitting the relatively rapid
installation of reservoirs on rather high elevations (e.g. 3 m). Only professional scaffolding should be
installed on a solid underground (preferably concrete foundation) to avoid the risk of collapse once the
reservoir is filled. This solution could be particularly interesting where a centralised water supply system
is required (e.g. in a health structure).
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T.B. 2.37 Cleaning of flexible reservoirs

Reservoirs should regularly be cleaned to remove the bacterial layer (bio-film) and/or the particles that
have accumulated inside the tank. Both will lead to a higher chlorine demand and a faster reduction of
the Free Residual Chlorine (FRC) concentration. Also when flexible water reservoirs aren’t needed
anymore, due to the reduction of the activities or due to the replacement by more solid tanks, it is strongly
recommended to recuperate them for later use. Of course, the flexible reservoirs should be checked,
cleaned, disinfected and dried before they are stored in the warehouse.
Operation
External cleaning of all kinds of flexible reservoirs
■ Check the reservoir for leakages or other damages (e.g. faulty connections). Repair them when needed
and if it is still possible. The check up for leaks is easiest by filling the reservoir completely with water. In
case of holes, fix them with the repair material included in the kit, according to the manufacturer’s
instructions.
■ Put the groundsheet of the reservoir on a big, clean, flat but slightly sloped surface (e.g. tarmac, concrete).
Make sure that the sloped surface has a drainage system at its bottom.
■ Wet the groundsheet with clean, non-salty water, clean it on both sides with water and liquid soap by means
of a soft brush and rinse it to remove all dirt and soap residues. It is possible that some force will have to
be used to remove all dirt.
■ Put the reservoir (liner) on the cleaned groundsheet.
■ Drain all the remaining water out of the reservoir.
■ Wet the reservoir with clean, non-salty water, clean it on all outer sides with water and liquid soap by means
of a soft brush and rinse it to remove all dirt and soap residues. Before flipping the reservoir over to clean
the bottom side in a similar way, it is recommended to rinse the groundsheet again in order to avoid that
dirt coming from the bottom of the tank would be transferred to its cleaned side.
■ Rinse the complete reservoir and groundsheet thoroughly again with clean, non-salty water.
Internal cleaning of bladder tanks

■ Move the bladder and its groundsheet to a big, clean and completely flat surface (e.g. tarmac, concrete).
■ Once installed and the side opening(s) closed, fill the bladder with some clean, non-salty water in order to
get an even thin water layer of 2 - 3 cm thick.
■ Rub the upper side of the bladder against its bottom side in order to loosen all the dirt inside. Special
attention should be given to the corners of the bladder.
■ Empty the bladder via a side opening by lifting the reservoir at the other side.
■ Keep repeating these actions until no dirty water comes out of the bladder anymore. When the inside of
the bladder would stay dirty (e.g. high presence of algae or a bio-film), a certain amount of 1% chlorine
mother solution can be added (e.g. 20 l for 2 m³ bladder, 40 l for 5 m³ bladder and 100 l for 15 m³ bladder;
T.B. 2.20) when a new thin layer of clean non-salty water is introduced. This high chlorine concentration
should help to remove the organic material.
■ Add some 1% chlorine mother solution inside the bladder (10 l for 2 m³ model, 20 l for 5 m³ model and 50
l for 15 m³ model) when a new thin layer of clean non-salty water is introduced, with the intention to disinfect
the reservoir. The solution can be drained from the reservoir after at least 30 minutes.
■ Rinse the reservoir inside and out for a last time with clean, non-salty and disinfected water, as well as its
groundsheet.
Internal cleaning of open tanks
■ Turn the reservoir (liner) inside out on its clean groundsheet. For a reservoir with a (corrugated sheet) frame, it’s
often easier to clean and disinfect the inside of the liner when it is still mounted.
■ Wet the inside of the reservoir with clean, non-salty water and clean it with water and liquid soap by means of a
soft brush.
■ Rinse the reservoir thoroughly with clean, non-salty water until all dirt and soap residues have disappeared.
■ Disinfect the inside of the cleaned open reservoirs by means of a clean cloth or sponge soaked in 0.05% chlorine
solution (T.B. 2.20). When a sprayer is available, it can be used as an easy alternative to disinfect the reservoirs.
■ Rinse the groundsheet and the reservoir (inside and outside) for a last time with clean, non-salty and disinfected
water.
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Re-packing of reservoirs
■ Dry the reservoir properly, preferably in a non-humid environment (e.g. inside a building to avoid that it gets
wet by the rain). The drying can be done by hanging the reservoir up without touching the ground, whilst
the different surfaces of the plastic liner (bottom and upper sides of a bladder, bottom and vertical sides of
an open tank) should stay well separated from each other. When possible, have all the openings open
and pointing downwards so the water can drip out easily. In case a compressor is available, blow
compressed air into the (bladder) reservoir to dry it.
■ Put some talc powder in and on the reservoir in order to absorb the last humidity, once the reservoir seems
completely dry.
■ Fold the reservoir properly and store it in a solid crate, together with all its accessories. The crate is
preferably made out of metal to protect the liner against rats biting holes in it. Make sure that the solid
elements of the reservoir can’t damage its plastic liner; e.g. the couplings should be covered with some
cardboard or with the plastic envelop that sometimes is issued by the manufacturer.
Key Input
Drying of a flexible reservoir by hanging it: - Big concrete / tarmac surface
A. on a metallic tube introduced via the central opening - Plenty of clean, non-salty water
B. over an external metallic tube - Liquid soap
C. on the corner reinforcements - Soft brushes (on long stick)
- Chlorine (Chlorination kit)
- Graduated buckets / jerrycans
- Protective clothing (gloves, boots,
overall, goggles or face shield)
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Remarks
■ Make sure that the cleaners wear their appropriate protective gear (an overall, rubber boots, rubber gloves,
goggles or a face shield), certainly when they are working with chlorine (as chlorine splatters might cause
injuries).
■ Salty water cannot be used because it could corrode the valves and leave salt residues on the reservoir
and groundsheet.
■ Make sure that all openings of the bladder tanks are well closed during its external cleaning to avoid soap
getting inside. If some residuals of the soap would stay behind in the bladder, it could give a bad taste to
the water when the reservoir would be put in use again.
■ The internal cleaning of the 15 m³ bladder can be started by pumping clean, non-salty water across the
reservoir. The water should enter via one side opening and leaving via the opposite opening. The flow rate
of the pump should be adapted to the evacuation rate at the opposite side (the reservoir should not start
to swell up). The pumped water will remove already the first dirt particles from the tank. The pump period
shouldn’t take too long and can be stopped when the first wave of really dirty water has been evacuated.
The same principle can be repeated once more in the opposite direction. The rest of the internal cleaning
should be done as described above.
■ A soft brush on a stick can sometimes also be helpful to clean the inside of the smaller bladder models.
However, a very flat surface is needed to be able to clean it with this method.
■ The easiest way of cleaning onion tanks is to clean the outside wall first, turn it upside-down and clean its
bottom, then turn it inside out and repeat the same procedure again (first the inside wall that has come on
the outside now, then the bottom). In between each step, the reservoir and groundsheet should be well
rinsed. This procedure ensures that no spots of the tank will be missed. This principle can also be used
for flexible reservoirs with a support frame in case they wouldn’t be installed any longer.
■ This kind of cleaning is not required after each cycle of assisted batch sedimentation (T.B. 2.16).
■ Some brands provide specific features to ease the hanging of the reservoir (e.g. special reinforcements at
the corners of bladders, as per figure C; a big internal central ring on some onion tanks). Bladders that don’t
have these features can be hung over a long smooth metal bar or a bamboo stick and lifted from the
ground by means of ropes (as per figure B). A better alternative is to use a smooth metal pipe (+/- 1 m long)
that is introduced inside the reservoir through its central opening and then hoisted from the ground (as per
figure A). The advantage of this system is that the upper and bottom sides of the reservoir can be separated
from each other for better drying. The edges of the pipe should be protected with a cloth to avoid punctures
of the liner.
■ Make sure that all accessories of the kit are present before starting to repack (e.g. hoses, valves, all the
bolts and nuts of reservoirs with a frame). If parts are missing, they should be replaced
■ Before taking the used and cleaned reservoirs in use again, rinse their inside with some clean and non-salty
water to remove all the talc powder.
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T.B. 2.38 Ferrocement tank

The construction of a ferrocement water tank may be considered when planning to make a long-term
storage system, like for rainwater harvesting. Its water tightness and strength are directly related to the
quality of materials used and the care taken in its construction. The round shape of the ferrocement tank
is created by using a removable mould to which wire mesh is attached that will be covered afterwards with
a cement coating. It is equally possible to build a framework of reinforcement bars which avoids having
to use a mould. The bars are embedded in the cement coating, thus reinforcing the structure.
Construction
Technique using wooden stakes (for a tank of 1,500 l)
■ Drive stakes vertically into the ground, forming a circle of 1.2 m in diameter. The centres of the stakes
should be spaced about 0.2 m from each other, leaving at least 1.5m of their length aboveground.
■ Wind three thicknesses of wire mesh around the circle of stakes. Stretch and flatten the layers of mesh well
against each other and fix them to the stakes and to each other with fine wire.
■ Reinforce the structure by winding round it three turns of thick wire: at the top, in the middle and at the
bottom.
■ Push a length of galvanised iron pipe with a valve attached through the mesh near the bottom (for draining),
and another one diagonally above with a valve or tap for the outlet. In case water is taken directly from the
tank, there should be high enough space in between the ground surface and the tap to be able to put
containers underneath. A third pipe for the overflow is fixed near the top of the tank.
■ Apply a 10 mm first coat of cement plaster (T.B. 2.05) to the outside. One person should be on the inside
to retain the mortar with a float as it is applied. Leave it to harden for 12 to 24 hours, keeping it damp.
■ Cut the wires that connect the mesh to the stakes. Cut also the wires that are sticking out.
■ Pull out the stakes and cut off the wires which stick out.
■ Apply a 10 mm coat of cement plaster to the inside so as to cover the mesh completely. Leave it to harden
for 12 to 24 hours, keeping it damp.
■ Apply a finishing coat (smooth cement plaster; T.B. 2.05) to the inside and the outside and smooth well.
■ Cover the bottom of the tank with wire mesh and curve it up at the corners where the walls meet the bottom.
■ Apply a 10 mm layer of cement plaster on the bottom, forming a slope towards the drainpipe.
■ Apply a second 10 mm cement plaster coat once the first one has dried, and smooth it well.
Remarks
■ The composition of cement plaster is described in T.B. 2.05. To simplify, it can also be composed of 1 part
cement to 2 parts of clean, sieved sand.
■ The final thickness of the tank walls should be 30 to 40 mm.
■ Once the coats have been applied, it is important to cover the tank with damp jute sacking or plastic sheeting
for at least one week for a good curing of the cement. This allows the cement to develop its high strength
and avoids the risk of appearing cracks (T.B. 2.05).
■ A metal cross piece should be connected to the pipes to anchor them in the mesh before plastering.
■ The overflow pipe should be foreseen with a screen or a siphon to avoid access to vectors.
■ To protect the stored water from getting contaminated, the tank should be foreseen with a cover:
➞ To make a closed cover on the tank, it is possible to include reinforcing bars within the wall mesh forming
a domed structure that is covered with mesh and plastered with cement plaster. An inspection hole with
a lid should be foreseen in the tank cover.
➞ Alternatives for the “ferrocement” cover are a reinforced concrete slab (attention for the weight) with
inspection hole, a plastic lining or a solid metallic, plastic or fibreglass lid.
■ Make sure there is a correct evacuation system for the overflow and the spilled water if collection is done
directly at the tank. It should be avoided that laundry or dishes will be washed directly at the tap of the
reservoir.
■ Plastic sheeting installed inside a frame of vertical wooden stakes interwoven with horizontal wooden sticks
can become a 1m³ reservoir for acute emergencies.
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Key Input
1. Wooden stakes - Sharpened wooden stakes (50 x 50 x 1.750 mm)
2. Wire mesh - Sledgehammer
3. Overflow pipe with screen and/or siphon - Fine wire mesh (1.5 mm wire, 12 mm mesh)
4. Outlet pipe with tap / valve - Rolls of fine wire (0.5 mm) and thick wire (2 - 2.5 mm)
5. Drainpipe with valve - Cement, building sand and clean non-salty water
6. Galvanised steel wire, 2-2.5 mm diameter - Metal cross pieces to anchor galvanised pipes
7. Exterior coat of cement mortar - Galvanised iron pipes (0.3 m long, ¾” for outlet
8. Interior coat of cement mortar if fitted with tap, otherwise 1” or better 1.5”
with gate valve as for drainpipe, 1” or 1.5”
for overflow, fitted with screen
- Mason’s tools
- Jute sacking or plastic sheeting
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T.B. 2.39 Distribution tapstand

Tap-stands are pre-assembled to be installed quickly and easily, allowing a rapid provision of water
distribution points in emergency situations. Tapstands are sturdy to allow constant use. There are different
models of tapstands available, but most of them do have 6 self-closing taps. With a maximum of 200 -
250 persons per tap, one tapstand can therefore be sufficient to provide water to 1200 - 1500 persons.
Even with the self-closing taps, spillage is inevitable. Therefore is a proper drainage essential as of the
beginning of the installation.
Installation
■ Choose the site to install the tapstand(s). The site should permit a good drainage for rain and spilled water, and
should be easily accessible for the users, specially for vulnerable groups.
■ Construct an apron with protective kerb at the chosen tapstand site, made with stones and covered with cement
plaster (T.B. 2.05), or preferably lean concrete (similar to T.B. 4.02). This apron should drain the spilled water
away and thus avoid mud and stagnant water near the water point. The spilled water should be disposed of
via a soak away pit (T.B. 4.06), an infiltration trench (T.B. 4.07) or an evapo-transpiration area (T.B. 4.08). If the
spilled water is not mixed with grey water (water coming from washing laundry or dishes on the apron), it
doesn’t need to pass via a grease trap, and it could also be used to irrigate a vegetable garden.
■ Assemble the tapstand in such a way that the distance in between the nozzle of the taps and the apron is
slightly higher than the biggest water recipient in use by the beneficiaries (often a gap of 0.5 m is sufficient).
This limited distance will reduce the amount of water falling next to the recipient, especially in windy places.
For people (e.g. children) who often come to collect water with small (e.g. 5 litres) jerrycans, a small stand can
be made under one or two taps.
■ Connect the tapstand to the reservoir. Ensure a correct pressure and flow at the taps by creating the right
height difference between the tapstand and the reservoir and/or by choosing the right type and proper diameter
of pipe (T.B. 2.36).
➞ A too high pressure can make it difficult (for children) to open the self-closing taps, and it can create a water
hammering (bounce) effect.
➞ A too low pressure might result in a flow rate below the desired yield, and it can increase the leaking of certain
self-closing taps.
An alternative is to provide an artificial pressure and flow by means of a hand pump or a motor pump.
Remarks
■ Make sure that water is freely accessible to all beneficiaries, specifically to vulnerable groups.
■ A distribution tapstand kit might have two tapstands.
■ In case the tapstand is connected to the reservoir with a non-collapsible pipe (e.g. Heliflex pipe), it is
strongly recommended to bury it, even in an acute emergency.
■ If several tapstands are to be installed at the same place, separate them enough to avoid beneficiaries
pushing and shoving at busy times. The bigger reservoirs have two outlets, so it is possible to install a
tapstand at each end to have two distinct distribution points. Also a tapstand supervisor can be appointed
to avoid problems.
■ To connect two tap-stands in series, undo the stopper from the Tee of the first tapstand and connect it with
a piece of (Heliflex) pipe to the inlet of the second one. To have a good flow at all taps, do not place more
than 2 tapstands in series.
■ To ensure a minimum flow of around 10 l/min from each single self-closing tap, a nearby reservoir should
be installed at least 1.2 - 1.5 m above the tapstand.
■ The height of certain tapstands can be determined by the angle and the position of its legs.
■ In case the water flow at the tapstand would be too high (risk of big splashes), it can artificially be reduced
by installing a partially closed gate valve at its inlet.
■ Check from time to time that the taps close properly. Solid particles in the water or objects inserted by
users may prevent closure and therefore will increase water losses.
■ When a soak away pit is chosen to dispose of the waste water, allow a minimum distance of 3 m away from
the tapstand.
■ During the first days of an acute emergency, the evacuation of the spilled water can be done via a gravel
pit, while constructing a correct apron.
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Key Input
1. Tapstand - Reservoir for water supply
2. Self closing taps - Tapstand kit(s)
3. Double connection (different models) - Delivery pipes
4. Stopper and chain - Material to make apron (T.B. 2.04)
5. Reservoir - Material to make roof (leaves, shadow net, 6 .
Reservoir outlet and tee plastic sheeting, poles, timber, rope, tools)
7. Delivery pipe towards the tapstand - Spanner to fix the tapstands’ legs
8. Fence - Hook spanners
9. Apron with a protective kerb
10. Drain towards the infiltration system / garden
11. Roof
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TECH-SAN-160_CH3 22/03/10 10:08 Page 1
Safe Excreta Disposal

Narrative
Technical briefs
T.B. 3.01 Defecation fields

T.B. 3.02 Trench latrines
T.B. 3.03 Improved trench latrines
T.B. 3.04 Simple pit latrines
T.B. 3.05 Latrine slab
T.B. 3.06 Children’s pit latrines
T.B. 3.07 Ventilated Improved Pit (V.I.P.) latrines
T.B. 3.08 V.I.P. latrine slab
T.B. 3.09 Twin pit latrine
T.B. 3.10 Pour-flush latrines
T.B. 3.11 Septic tank
T.B. 3.12 Raised pit latrines in problem soils
T.B. 3.13 Emptying latrines and/or septic tanks
Chapter 3
Safe Excreta Disposal - draft 3 1

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3 2
Safe Excreta Disposal - draft
TECH-SAN-160_CH3 22/03/10 10:08 Page 3
3.1 Why have excreta to be disposed of correctly?

Human excreta transmit many infectious diseases. The pathogens leave the body of the infected
person via the excreta and can then be transmitted to healthy individuals. This problem is particularly
acute in health care facilities due to the high number of sick people present and to the high level of
infectiousness of their excreta.
Five types of excreta-related diseases or transmission routes may be identified:
■ Faeco-oral transmission (bacterial and non-bacterial)
Pathogens are transmitted by direct contact (hands) and domestic contamination (water, food and
objects contaminated by excreta). Pathogens may be viruses, bacteria, protozoa and certain helminths.
The list of faeco-orally transmitted diseases includes notably amoebic dysentery, cholera, giardiasis,
hepatitis A and typhoid fever.
■ Helminths (worms) transmitted by the soil
Helminth eggs have a latent period between the moment they are excreted and the moment they
become potentially infectious. The transmission of these “geo-helminths” takes place through the
contamination of soil and/or crops. It mainly concerns ankylostoma, ascaris and strongyloides. Infection
by these helminths is very frequent and the prevalence may be higher than 90% in certain populations.
■ Beef and pork tapeworms (taenia)
Cattle and pigs are intermediate hosts of taenia. The transmission cycle involves the contamination of
soil and forage by human excreta, then the ingestion of undercooked meat by humans.
■ Water-based helminths
The excreted eggs of those helminths pass part of their life cycle in one or several intermediate aquatic
hosts (snails, crustacean, fish), before becoming infectious to humans. An example is schistosomiasis.
Its transmission cycle involves the contamination of surface water by human excreta, development
within a snail host and finally the penetration of the skin of a new human host when he enters the
water.
■ Excreta-related diseases transmitted by insect vectors
This includes all the diseases, which can be transmitted by “insects” like flies and mosquitoes, which
breed in environments containing excreta (e.g. Culex pipiens mosquito that transmits filariasis).
3.2 What does the term safe excreta disposal mean?

The term “excreta” includes urine and faeces. Urine is less dangerous than faeces, except in the case
of typhoid, paratyphoid, leptospirosis and one type of schistosomiasis (Schistosoma Haematobium).
The main objective of safe excreta disposal is to reduce the transmission of diseases due to
environmental contamination by faecal matter or the proliferation of vectors. This objective can mainly
be reached through excreta containment.
The health impact of excreta disposal activities is difficult to evaluate however. It is generally agreed
upon that a health impact will only be achieved if these activities are linked to improved water supplies,
and individual and collective hygiene. It might also be necessary to combine excreta disposal with
vector control methods (e.g. spraying).
For each of the five types of excreta-related diseases, following respective control measures can be
proposed (see table hereunder):

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Faeco-oral Helminths Beef and Water- Insect

Control measures transmis- transmitted pork based vectors
sion by soil tapeworms helminths
Safe excreta disposal X X X X X
(providing latrines / combined with
toilets) vector control
Improvement of water X - - - -
quantity and quality
(e.g. boiling of water)
Improvement of shelter X - - - -
conditions
Improvement of hygiene X - - - X
practices (e.g. hand
washing, covering food)
Health promotion X X X X X
Treatment of excreta X X X - -
before its use for
fertilizing crops
Inspection and thorough - - X - -
cooking of meat
Inspection and thorough X X X X X
cooking of fish and
aquatic plants
Control of intermediate - - - X -
hosts (e.g. snails in
irrigation canals)
Reduction of contact with - - - X -
potentially contaminated
water
3.3 Where / When should safe excreta disposal management

be implemented and by Who?
A distinction should be made between:
■ First phase (acute) emergencies
■ Chronic emergencies and stabilized situations
In the first phase of an emergency, where there is a large concentration of people (e.g. refugee camps,
collective centres), or where the normal sanitation structures are destroyed due to a (natural) disaster,
it is essential to provide simple defecation facilities immediately. These facilities are provisional and
need to be improved or replaced progressively over time by more suitable structures as the situation
develops into a chronic emergency. In chronic emergencies as in stabilized situations, factors like
local practices and socio-cultural issues should dictate the choice of the techniques used.
In the first phase of an emergency, the aid-agency will often have to implement and to maintain
(cleaning and repairing) the facilities. In chronic emergencies and certainly in stabilized situations,
community participation will be essential for correct excreta disposal management. In those cases, the
users should be included as much as possible in the choice, the implementation and the maintenance
of the excreta disposal facilities. The authorities can also have an impact on the choice of the excreta
disposal method, because standardised facilities are desired, for example.
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It should be verified if the users can provide their own anal cleansing material. If not, the aid-agencies
might have to supply appropriate material that doesn’t fill up the latrine pits too fast.
A gradual improvement of the excreta disposal facilities is also valid for health structures, even if those
facilities will have to be conform to the essential requirements (T.B. 1.08) already from the start (e.g.
upgrade from improved trench latrines to simple pit latrines). Appropriate material for anal cleansing
should be readily available.
Correct sanitary facilities are extremely important for female teenagers and adults, certainly during
their period. It might therefore be important to integrate washing basins and drying lines within female
sanitary blocks, for the ladies to be able to wash their reusable sanitary napkins. A waste bin in the
neighbourhood of the sanitary facilities is essential for the disposal of (single use) sanitary napkins.
3.4 How should safe excreta disposal be managed?

For correct planning and organisation of safe excreta disposal, it is necessary to follow all the different
steps described in chapter 1. Some specific points of the assessment phase directly related to excreta
disposal are gathered below.
As only simple and temporary excreta disposal solutions will be chosen for the first phase of the
emergency, the information needed before implementation is limited and can be collected during the
initial assessment. Some basic data on the physical nature of the site, the demography, the anal
cleansing habits of the population and the material available are sufficient to determine the first phase
of the strategy.
An in-depth assessment with the participation of the users will be needed to define a safe excreta
disposal strategy for chronic emergencies and stabilized situations. For facilities to be fully functional,
a lot of information needs to be collected and analysed. In general the choice of an excreta disposal
technique depends on:
■ Socio-political factors:
➞ Authorities that forbid or enforce a method of excreta disposal
■ Demography of the population (number of beneficiaries)
■ Socio-cultural and religious factors: particularly traditional and local attitudes and practices
concerning excreta disposal:
➞ Separation of the sexes
➞ The need for privacy
➞ Position (sitting or squatting)
➞ Method of anal cleansing (wipers or washers), material used, its disposal
➞ Menstruation (material used, its disposal or being washed and reused)
➞ Particular orientation of the latrines
➞ Taboo places and/or practices (e.g. defecating on top of each others excreta)
➞ The acceptability of emptying a latrine pit
■ The physical nature of the site:
➞ Available space: public, cluster or family type latrines; emptying or replacing when full
➞ Soil: type; available depth and ease to excavate; infiltration rate; stability; resistance against weight
(heavy superstructure).
➞ Water: availability in sufficient quantities (in case of anal cleansing with water and pour-flush latrines);
different resources and their proximity (risk of pollution); level of the water table and its seasonal
variations (risk of pollution); natural drainage of runoff water; risk of flooding
■ Climate:
➞ Precipitation patterns (e.g. rainy season)
➞ Temperature (important for vectors)
➞ Main wind direction (odour)

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■ Available resources:
➞ Financial (material and labour costs have an influence on the type and quantity of latrines)
➞ Materials and tools (if locally available, there will be an impact on the construction time and costs,
but also on the environment)
➞ Human (skills and experience to construct the facilities)
■ Time:
➞ Constraints (short time frame to build facilities in emergency situations)
➞ Lifespan (adapted to each situation but it has to be considered from the start)
■ Operation and Maintenance (taken in charge by the users or the aid-agency)
The system should be chosen with all this information in mind, whilst remaining simple, cheap and
above all easy to install and maintain (by the population / beneficiaries).
There are many excreta disposal techniques. In each situation the chosen technique should be
adapted to the context, the site conditions and the users (their culture and habits). If these issues are
ignored, the facilities will most probably become unused after a while and/or get damaged. The sanitary
facilities may even create a health risk by themselves.

In general, an excreta disposal technique may be considered acceptable when:
■ It isn’t harmful for public health:
➞ It contains the excreta in one place.
➞ It does not create an attraction for insects or any other animal.
➞ It is not a source of pollution for the water points and the surrounding environment.
■ It provides a certain comfort to the users:
➞ It is adapted to the local habits.
➞ It is accessible to the users (e.g. pathways).
➞ It is not a nuisance in terms of odour or sight.
■ It gives a minimum of privacy:
➞ Gender has to be taken into consideration (separate excreta facilities for men and women might
have to be constructed, certainly in public buildings like schools and health structures).
➞ Special facilities for menstruating women and girls might have to be considered (e.g. discrete
washing places for sanitary towels).
➞ There should always be a separation in between the excreta facilities of the staff and the patients /
visitors in health structures.
■ It is safe:
➞ Strong construction.
➞ Not too dark inside.
➞ Situated at such a place to prevent sexual violence (close enough to buildings / dwellings, lights
available during the night time).
■ It is adapted to specific population groups:
➞ Handicapped and physically impaired people may need specifically adapted excreta disposal
facilities in terms of distance, available space, equipment (e.g. handrails, seats). The design of
these facilities will mostly be done on a case-by-case basis.
➞ The distance that infected people (e.g. HIV / AIDS) can cover are limited, thus the excreta facilities
should be close by.
➞ Children should have latrines adapted to their size / physiognomy.
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■ It respects cultural requirements; besides the defecation position, the superstructure itself can have
an influence if a facility is used or not:
➞ Some cultures want it to be open, but most prefer to have privacy and thus a superstructure, with
or without a roof (also depending on the type of latrine and rainfall).
➞ Doors are not always available or affordable, so it should be checked if a spiral-shaped
superstructure without a door is acceptable.
➞ Local materials should be chosen as much as possible, as long as this doesn’t have a too negative
impact on the environment (e.g. deforestation).
For excreta disposal facilities to be more effective and to increase the public health benefits, they
should be maintained regularly, and hand-washing equipment (including soap or ashes, and water)
should be available.
3.4.3 Early stages of the emergency (acute phase)

To have an impact with safe excreta disposal, it’s important to rehabilitate the formerly used “wild
defecation areas” once better facilities are at hand.
Defecation fields (T.B. 3.01) may provide a very short term emergency solution, particularly in hot dry
climates and where there is enough space available.
Trench latrines (T.B. 3.02) may also be an adequate solution for acute emergency situations. The
advantages over a defecation field are that the faeces are already better contained and possibly
covered by the user with soil (located alongside the trench). The reduction of required space is another
advantage.
Improved trench latrines (T.B. 3.03) are simple and rapid to build, certainly when prefabricated
(plastic) slabs are available. Therefore, they can still be constructed during the first phase of an
emergency. The slabs reduce the risk of people falling into the trench and the accessibility for flies is
limited, at least if the lid is replaced on the slab. As the superstructure is divided in different
compartments, improved trench latrines offer already about the same privacy as simple pit latrines.
Combining some features of the trench latrines (simplicity and rapidity to construct) and the simple pit
latrines (privacy, already improved safety), the improved trench latrines are an interesting intermediate
solution. They are also the minimum option for health structures during acute emergencies.
If an auger or (hand) drilling equipment is available, a borehole latrine covered with a simple slab may
be installed rapidly. Be aware however that the faeces often stick to the sides of the upper bore part,
thus increasing the risk of attracting flies and augmenting the likelihood of blockages. Additionally,
borehole latrines can only be made in areas with a very low water table (even during the rainy season).
In some parts of the world, defecation in plastic bags is a common practice (e.g. in slums where no
latrines are available). In certain situations (e.g. lack of space in flooded areas, difficulties to dig in the
debris after an earthquake), and if it is socio-culturally acceptable, this practice might be the only
feasible solution during the first phase of an emergency. The bags should be biodegradable and
preferably specially designed for the purpose (e.g. adapted shape and capacity, containing a specific
product accelerating the biodegradation and/or absorbing the liquids). Obviously, the bags have to be
collected, transported and disposed of (burial) in a safe manner. As the bags should be closed after
use with a knot, the health risks are less compared to the collection of night soil in buckets, which
is another common but unsafe practice in some places.
Whatever the emergency solution chosen, it is important to take steps to ensure that the facilities work
well, are maintained properly and are utilised by the beneficiaries. Promotion campaigns and support
from the local leaders are therefore essential. Hand washing equipment nearby the excreta disposal
facilities should not be forgotten, even in acute emergencies.

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3.4.4 Chronic emergencies and stabilized situations

Where simple means are used in the first stages of an emergency, different disposal techniques may
be used in the later phases of an emergency and in stabilized situations. There is no formula to suit
all circumstances. But based on the collected information as described above, it should be possible
to choose the most appropriate solution that remains simple, cheap and above all, easy to install, to
use and to maintain (possibly by the population / beneficiaries).
Simple pit latrines (T.B. 3.04) are the most common excreta disposal facilities to be found in population
settings, because they are rather quick and easy to build. As these facilities are built to last for a longer
time span, more attention should go the pit and its lining, the slab (T.B. 3.05) and the superstructure. Often,
small children cannot use a normal simple pit latrine due to the size of the defecation hole and the position
of the foot rests. They are often also afraid to be enclosed inside the superstructure. Therefore is it important
to implement children’s pit latrines (T.B. 3.06) as well, specially in health structures where lots of children
are present (e.g. feeding centres, paediatrics ward).
Ventilated Improved Pit (VIP) latrines (T.B. 3.07; 3.08) are mainly interesting for long-term settings, such
as public buildings like schools and health structures. Their ventilation pipe with flytrap is a big advantage
as it reduces considerably odour and fly nuisances. However, VIP latrines are rarely the ideal option in
population settlements within chronic emergencies because they are rather difficult and expensive to build,
certainly by families themselves without any support. Children might also be afraid to use a VIP latrine
because of the semi-dark environment that has to be kept in its superstructure for proper functioning.
Twin pit latrines (T.B. 3.09) consist of two completely separated (VIP) latrines, of which only one is
operational at the time. Once the first (VIP) latrine pit is full, the second one can be opened for use. When
well designed, the full pit can be emptied manually, but only if a period of minimum two years has passed
since it was last used. This minimum period is for the excreta to become completely harmless. This has
the advantage that twin pit latrines can be used over and over again without any health risks. This can be
extremely interesting for health structures in stabilized situations. However, in many cultures there are
taboos related to the handling of excrement residues. It also requires a certain knowledge or training to
use them correctly. The initial investment is considerable and therefore are twin pit latrines rarely used at
family level. This kind of latrines can be used as / transformed into ecological sanitation facilities.
Dehydration sanitation (separation of urine and faeces) and aerobic composting latrines (adding
domestic organic waste and aerating) are ecological sanitation (Eco-San) systems which should shorten
the period before human waste can be handled safely. However, they are only to be implemented in areas
where they are already known and practiced, or when a complete long-term latrines project is started with
a serious integrated promotion campaign. They are mostly not appropriated for emergency situations.
Raised pit latrines (T.B. 3.12) above the ground level are one of the options to provide adequate sanitary
facilities in difficult circumstances (e.g. high water table, flooding, rocky underground). However, a raised
pit is often more difficult to build and costs are often higher. Simple pit latrines, VIP latrines and twin pit
latrines can all be raised.
Pour-flush latrines (T.B. 3.10) can be very interesting for populations that use water for anal cleansing,
certainly as the siphon forms a seal that reduces the odour and fly nuisances. If the design is well made,
it requires very little water to flush the latrine. However, enough water should be available in the direct
neighbourhood to consider this option, certainly in settings with a lot of people. It is recommended as well
to use the system only if the population is familiar with this technology, or when there are time and resources
enough to promote their correct use and maintenance. Pour-flush latrines should be completely avoided
when people are using solid materials (maize cobs, stones, leaves) to do their anal cleansing, as they will
block the siphon rapidly.
Septic tanks (T.B. 3.11) connected to pour-flush latrines or flush toilets will separate the solids (faeces)
from the liquids (mainly water). The faeces will decompose an-aerobically within the septic tank, whereas
the liquids need to be evacuated. As these liquids still contain a lot of pathogens, a decent infiltration or a
closed sewer system will be needed to avoid health risks. Some septic tanks are foreseen with a percolator
which treats the liquids to a certain extent, reducing the amount of pathogens before disposal.
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Complete sewage systems fall out of the scope of these guidelines.

Maintenance is a key element in the use of excreta disposal facilities. A dirty latrine will certainly not be
used. Hand washing facilities with soap (or ash) nearby the latrines are essential to reduce the hazard of
faecal-orally transmitted diseases.
3.4.5 Public versus family facilities

In the first phase of an emergency, public facilities are most often the only viable option for “safe”
excreta disposal, because they have to correspond rapidly to a minimum level of quantity and quality.
Also in chronic emergencies, this minimum level may only be obtained when public facilities are built
by aid-agencies. Linked to the specific physical nature of the site (e.g. limited availability of space,
high water table, rocky ground), it might be (technically) impossible for the people to construct their own
latrine. Non-precarious situations may also require public facilities, like:
■ Health structures: dispensaries, hospitals, feeding centres
■ Public places: markets, schools
However, when a public facility is adopted for a population or for a central service (e.g. a hospital), it
is indispensable to appoint a team that is responsible to ensure correct maintenance. This team will
probably have to be remunerated for this service. The main advantage of family latrines over public
facilities is the fact that they normally pose fewer maintenance problems. People normally take more
care of their own latrine and have fewer problems with cleaning the dirt of their family members than
of total strangers.
As family latrines are mostly closer to the dwellings, the chance of actually being used improves,
certainly when the people themselves have built them. The smaller distance increases also the safety,
certainly for women and girls as they may be victim of sexual violence when they go to the latrine (at
night). It might be easier to persuade people to dig their own individual family latrine if a good promotion
campaign is done and when construction material is (made) available.
If family latrines are not possible because of the population density or due to a lack of resources, an
alternative is to construct one latrine per lot of three or four dwellings (or about 20 people), called a
cluster latrine. The advantages are that the distances stay small and that the latrine is used by people
who know each other and therefore can make arrangements for the maintenance. Another alternative
to a high population density is to build centralized units at the edge of a living quarter or camp section
where each family or group of families has access to its own latrine (preferably closed with a padlock),
but this increases the distance in between the facilities and the dwellings.
The area allowed for latrines should also be big enough to dig new pits when the first ones are full.
Another possibility is to empty the full latrines. Special equipment is required however (T.B. 3.13) and
the dumping site for the excreta has to be well chosen to avoid health and environmental risks and
nuisances.
3.4.6 Calculation of the effective and total volumes of a latrine pit

The pit latrine is the most common system of excreta collection in the world. To calculate the effective
volume of a pit, proceed as follows:
Veff = (N x S x Y)
with: Veff = effective pit volume in m³,
N = number of users
S = solids accumulation rate in m3/person year
Y = lifetime of the latrine in years

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Use a solids accumulation rate of:

■ 0.04 m3 per person a year for human waste retained in water; e.g. wet latrines (not recommended).
■ 0.06 m3 per person a year for dry conditions; e.g. dry latrines.
Be aware that these figures are only indicators and can vary significantly:
■ The effective pit volume may be increased by 30 to 50% if bulky anal cleansing materials are used
(e.g. stones, maize cobs).
■ For pits that are intensively used and only have a lifetime of maximum a year, the solids accumulation
rates should be doubled.
■ Soils with low permeability, will have a low infiltration rate, thus filling up a lot faster than initially
expected, certainly when water is used for anal cleansing.
The effective volume represents the space available for excreta storage, but when calculating the total
required pit volume, a free space with a depth of 0.5 m has to be added to the effective volume. This
free space at the top of a full latrine is to avoid:
■ unpleasant sights during use
■ excreta splashing out of the pit during use,
■ odour and fly problems after backfilling.
Thus the total volume is represented by:

Veff = (N x S x Y)+0,5A
with: V = total required volume
A = pit base area
The bottom of the pit should be at least 1.5 m above the highest possible water table, because this
reduces the chance of microbiological contamination of the groundwater virtually to nil in homogeneous
soils. The required vertical distance for heterogeneous soils is difficult to predict however.
The suggested minimum lifetime of a simple family pit latrine that can’t be emptied is 5 years. Public
latrines for 20 users should last for about 2 years at least before they are full. Normal twin pit latrines
should have a capacity of at least 2 years per compartment in order to render the excreta completely
harmless before being emptied. Ecological sanitation systems can usually do with less time to render
the excreta completely harmless, if there are well operated and maintained.
Rectangular pits can cave in rather easily, whereas circular holes have a more natural resistance
against collapse because of the arching effect. Deep pits in soft sands and gravels, unconsolidated
soils, (back)filled land, compressed mudstones and shale should always be lined. Soils with a
significant amount of clay or high iron oxides content (e.g. laterite), or consolidated sedimentary rocks
are less at risk of collapse. Nevertheless, a lining is always recommendable (in chronic emergencies
and stabilized situations) for security reasons and to prolong the lifespan of a latrine.
Rocky bottoms in which it is difficult to excavate, flood prone areas or situations with a high water
table may require raised latrines (T.B. 3.12). Still, infiltration of the liquids will have to be foreseen in
the underground part of these structures. Sometimes the water table is that high that contamination
of the groundwater can’t be avoided. As such, it isn’t a problem to contaminate the groundwater
microbiologically, as long as it isn’t used for domestic or health purposes, and/or for drinking water. It
is also easier during emergencies to supply potable water than to evacuate excreta on a daily basis
(except maybe if the faeces are stored in sealed plastic bags).
It’s also important to drain runoff water away from the latrines to avoid erosion of the pit and the
surroundings.
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3.5 Further reading

Willey, 1993.
Intermediate Technology, RedR, 2002.
S. Esrey, J Gough, D. Rapaport, R. Sawyer, M. Simpson-Hébert, J. Vargas, U. Winblad
Ecological Sanitation
Swedish International Development Corporation Agency (SIDA), 1998.
D. Fokwa, D. Embogo
Le Guide du Tacheron
Cimencam, 1993
P. Harvey, S. Baghri, B. Reed
Emergency Sanitation
Water, Engineering & Development Centre (WEDC), 2002.
P. Harvey
Excreta Disposal in Emergencies: A field manual
An inter-agency publication
H. Jones, B. Reed
Water and Sanitation for Disabled People and Other Vulnerable Groups

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T.B. 3.01 Defecation fields

Defecation fields represent a basic disposal method to avoid excreta to be spread all over the camp.
They are only justified in the very early stages of emergency situations, particularly in hot dry
climates, where there is sufficient space for their implementation and when they are acceptable for
the beneficiaries. Safer and more permanent solutions should be implemented rapidly.
Installation
■ Choose a site away from fields where crops for human consumption are grown. It should be located
downwind and away from living areas (at least 30 m), avoiding watercourses and at a reasonable
distance (minimum 50 m) and preferably downstream from all water sources, storage and treatment
areas.
■ Prepare the site: remove all debris, determine the depth of the water table and bring in the needed
material and equipment.
■ Fence the area (for example with plastic sheeting), and put up a zigzag entrance in order to limit the
risk of animals straying and to keep as much privacy as possible (at least a strict gender separation).
Additional movable screens can be placed inside the area to improve the privacy and to indicate
where to defecate.
■ Dig drainage channels around the defecation field fence to prevent potential runoff water from
entering.
■ Put a water container with a tap and soap (or ash if soap isn’t available) in an obvious place (near
the exit) to allow hand washing after defecation. Make sure that an infiltration system, at least a
gravel pit or preferably a soak away pit (T.B. 4.06) is foreseen.
■ Provide anal cleansing material if needed, and a waste bin for sanitary napkins in the women’s
section.
■ Allocate two trained guards (mind the gender) who should manage the correct use of the defecation
field.
Key Input
1. Fence (e.g. plastic sheeting) - Stakes and ropes (fence and defecation zone)
2. Closed water container with tap / soap or ash - Sledgehammer
3. Infiltration system for wastewater - Non-transparent plastic sheeting
(e.g. gravel pit) (or local material)
4. Zigzag entrance - Hammer and nails
5. Trench (optional) - Shovels, hoes, picks to dig runoff drainage /
6. Soil for burying excreta (optional) gravel pit / trench
7. Defecation zone in use - Stones / gravel
8. Ropes and stakes indicating - Water container (e.g. at least a 200 l drum or
the defecation zone in use better a 2000 l bladder) with tap
9. Runoff drainage - Soap or ash
10. Excreta - Anal cleansing material (if required)
- Waste bin for sanitary napkins(if required)

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Remarks
■ Defecation fields are not really suited during the rainy season as runoff water risks to spread the
excreta, and thus the contamination over a big area. Defecation fields should also be protected
against floods.
■ The objective should be to replace the defecation fields as quickly as possible with a more hygienic
system; e.g. improved trench latrines (T.B. 3.03), simple pit latrines (T.B. 3.04).
■ Defecation fields should be clearly marked and provided with enough space; about 0.5 m²/person
day (pathways not included).
■ It is compulsory to build gender separated defecation fields. Simply dividing the male and female
sections with plastic sheeting and providing two separate entrances may not be acceptable by the
users.
■ Lighting at the defecation field is highly recommended for safety / security reasons.
■ It is strongly recommended that the defecation field is utilized according to a pattern in order to use
the available space most effectively. Some poles and ropes, which position has to be changed after
a while, will indicate the defecation zone in use (each row maximum 20 m long, about 1.5 m wide).
To encourage the full usage of a defecation zone, the guards can relocate a screen that provides
some additional privacy along the row as it fills up with excreta; from the outer side of the zone
towards the central alley. By using the row’s entrance also as an exit avoids that people have to
pass an area that is already covered with excreta.
■ When a bulldozer is available, it can be used to scrape off the ground surface at the end of the day,
to be able to reuse the defecation field again. The excreta can be pushed into a trench at the edge
of the field and covered with the excavated soil, to reduce the attraction of flies. In homogeneous
soils, the bottom of the potential trench should be at least 1.5 m above the highest groundwater
table. The required vertical distance for heterogeneous soils is difficult to predict. The water table
depth can be estimated by verifying the water level in nearby wells. Another option is to drive a metal
bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground, as deep as 1.5
m beneath the required trench depth. When pulled out, the rod or (the earth inside) the pipe should
be dry. If not, the trench depth should be adapted accordingly. Soil saturated with water after heavy
rainfall might give a false impression of the actual water table level.
■ It is recommended to add wood ash every day to the excreta (within the potential trench). This gives
a perceptible odour reduction. Active lime will also reduce the odours, but might slow down the
decomposition of the excreta.
■ If a simple infiltration system with stones and gravel is placed under the water container for hand
washing, follow closely if it doesn’t clog up too fast with soil and greasy soap residues. If so, an
emergency grease trap (T.B. 4.04) will have to be added.
■ People could also defecate on a small pile of sand, after which they have to scoop up their
excrements with a shovel and dispose of them in a drum or trench. This technique requires less
space but more supervision.

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T.B. 3.02 Trench latrines

Trench latrines represent a method of excreta disposal, which is simple and rapid to implement.
They are only justified in acute emergency situations, until more permanent solutions are
constructed. The assessment for more permanent solutions should start as soon as the trench
latrines are implemented.
Installation
■ Choose a site with stable soil, downwind from living areas. It should be at least 30 m away (more for
fissured underground and limestone) and downhill from all water sources, storage and treatment
facilities.
■ Prepare the site: remove all debris, implement a soil texture test (T.B. 4.05), determine the depth of
the water table and bring in all the needed material and equipment.
■ Fence the area (for example with plastic sheeting), and put up a zigzag entrance in order to limit the
risk of animals straying and to keep as much privacy as possible (at least strict gender separation).
■ Use string lines to lay out the trenches, 0.3 m wide (less for children) and at least 1.5 m apart from
each other. Allow about 3.5 m length per 100 users.
■ Dig trenches of about 0.9 m deep (1.5 m deep if a mechanical excavator is available). In unstable
soils, it might be necessary to dig trenches less than 0.9 m deep (but they will fill up faster). Place
the excavated soil near the side of each trench for the users to cover their excreta after each use,
as to reduce the odours and the attraction of flies. Make sure there is enough space in between the
trench and the excavated soil.
■ Lay planks along the two sides of the trench to ensure a good foothold and to limit erosion of its
edges. For safety reasons, interconnect the opposite planks with beams and anchor them to avoid
that they slide away.
■ Dig drainage channels around the trench latrines’ fence to prevent runoff water from entering.
■ Put a water container with a tap and soap (or ash if soap isn’t available) in an obvious place (near
the exit) to allow people to wash their hands after defecation. Make sure that an infiltration system,
at least a gravel pit or preferably a soak away pit is foreseen.
■ Provide anal cleansing material if needed, and a waste bin for sanitary napkins in the women’s
section.
■ Allocate two trained guards (mind the gender) who should manage the correct use of the trench
latrines.
Key Input
1. Fence (e.g. plastic sheeting) - Stakes, rope and sledgehammer (for the fence)
2. Closed water container with tap / soap or ash - Non-transparent plastic sheeting
3. Infiltration system for wastewater (e.g. gravel pit) (or local material)
4. Zigzag entrance - Hammer and nails
5. Planks - Tape measure, string lines, sticks
6. Trenches (0.3 m wide) - Picks, hoes, shovels (also to cover the excreta)
7. Soil for burying excreta - Planks (or wooden poles)
8. Band of plastic sheeting (optional), partly lying - Stones / gravel
underneath the planks, partly hanging in the trench - Empty cans (to handle soil for burying excreta)
9. Runoff drainage - Water container (e.g. at least a 200 l drum or
(useful for trench maintenance and against
erosion) better a 2000 l bladder) with tap
- Soap or ash
- Anal cleansing material (if required)
- Waste bin for sanitary napkins(if required)
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Remarks
■ Trench latrines should be clearly marked and protected against flooding.
■ In homogeneous soils, the bottom of the trenches should be at least 1.5 m above the highest possible
groundwater table. The required vertical distance for heterogeneous soils is difficult to predict however.
The depth of the water table can be estimated by verifying the water level in nearby wells. Another option
is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground,
as deep as 1.5 m beneath the required trench depth. When pulled out, the rod or (the earth inside) the
pipe should be dry. If not, the trench depth should be adapted accordingly. Soil saturated with water
after heavy rainfall might give a false impression of the actual water table level.
■ The planks may be replaced by wooden poles. To keep them from rolling away, dig the poles slightly in.
■ It is compulsory to build gender separated trench latrines areas. Simply separating the male and female
sections with plastic sheeting and providing two separate entrances may not be acceptable to the users.
■ Special latrines with facilities such as a seat and handrails should be built for physically impaired people,
as trench latrines can’t be used by some of them (incapable to squat). Potties are an alternative for
children.
■ Lighting the trench latrines at night is highly recommended for safety / security reasons.
■ To encourage full usage of the trenches, ropes or screens providing some privacy can indicate those in
use.
■ Try to make sure that the users cover their excreta with a layer of soil, located next to the trench.
■ If possible, add wood ash to the trenches at least once a day. This gives a perceptible odour reduction.
Active lime will also reduce the odours but might slow down the decomposition of the excreta.
■ If a simple infiltration system with stones and gravel is placed under the water container for hand washing,
follow closely if it doesn’t clog up too fast with soil and greasy soap residues. If so, an emergency grease
trap (T.B. 4.04) will have to be installed.
■ Once the trenches are nearly full (about 0.3 m from the surface), dismantle and backfill them. Don’t dig
at this place again for at least two years, but plant water-absorbing trees (e.g. mangos) to re-stabilize
the soil.
■ The objective should be to replace the trench latrines as quickly as possible with a safer and more
hygienic system; e.g. improved trench latrines (T.B. 3.03), simple pit latrines (T.B. 3.04).
■ If people want to build their own facilities immediately, a shallow family trench can be an option. Apart
from the size (e.g. 0.5 x 0.3 x 0.5 m deep), the principle is the same as for normal trench latrines.
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T.B. 3.03 Improved trench latrines

Improved trench latrines represent a method of excreta disposal, which combines the features of
normal trench latrines (simple and rapid to implement) and simple pit latrines (privacy and an
already improved safety). Although they are only justified in emergencies, they do offer an
interesting solution in between the normal trench latrines and the (family) simple pit latrines. They
are also the minimum option for health structures during acute emergencies.
Construction
■ Choose a site with stable soil, at least 30 m away (more for fissured underground and limestone) and
downhill from all water sources, storage and treatment facilities. The facilities must have an easy
access, not less than 5 m and not more than 50 m away from the dwellings (< 30 m from health
structure shelters).
■ Prepare the site for construction: remove all debris, put up a temporary fence, implement a soil
texture test (T.B. 4.05), determine the depth of the water table and bring in all the needed material
and equipment.
■ Lay out the trenches, using string lines. Allow per trench about 3 m length (4 slabs), for 80 - 100 users.
Their width depends on the prefabricated slabs size:
➞ For small (plastic) slabs of 0.8 x 0.6 m, foresee a trench of 0.3 m wide,
➞ For big (plastic) slabs of 1.2 x 0.8 m, foresee a trench of 0.9 m wide.
■ Dig the trenches at least 0.9 m and maximum 1.5 m deep.
■ Dig a drainage channel around the improved trench latrines to lead runoff water away from the trench.
■ Put plastic sheeting of at least 1 m wide on the ground along the sides of the trench. Half of its width
should be laying flat on the ground (preferably up to the drainage channel to reduce the risk of
erosion), where the other half should be folded so it hangs inside the trench. This plastic sheeting
will ease the daily maintenance and the backfill of the improved trench latrines once full.
■ Put the prefabricated (plastic) slabs down in such a way that the defecation holes are alternated in
direction; 180° shifted, meaning back-to-back for small slabs and side-to-side for big slabs (as per
figures) and secure them (e.g. with metal pegs).
■ Put clay (or compacted earth) around the slabs to avoid direct infiltration of runoff water, rendering
the trench edges unstable.
■ Install vertical stakes at the corners of the slabs. By adding some horizontal sticks on top and diagonal
poles at the sides, a more solid structure will be obtained. To have enough space available inside
the superstructure, the vertical stakes should be about 0.15 m away from the corners of the small
slabs.
■ Wrap a long piece of plastic sheeting of about 2 m wide (high) around an outer corner stake, and
secure it (e.g. with nails). The remaining part of the plastic sheeting has to be rolled off around the
other vertical stakes in a zigzag movement (as per figure), in order that the entrances are alternated.
This principle allows the rapid construction of a superstructure.
■ Attach bands of plastic sheeting to the horizontal sticks of the structure to form the latrines’ curtains.
Provide each curtain with horizontal sticks (bottom and middle), so that it won’t open constantly by
the wind. A roof of plastic sheeting should preferably be foreseen as well, certainly in areas where
it rains a lot.
■ Put a water container with a tap nearby the improved trench latrines to allow hand washing after
defecation. Make sure that an infiltration system (T.B. 4.06; 4.07; 4.08), preferably with a grease
trap (T.B. 4.04), is foreseen.

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■ Provide water and soap (or ash), and anal cleansing material if required (certainly in health
structures).
■ Try to ensure that the cover is always replaced over the defecation hole to reduce breeding of flies
and to lessen bad odours in and around the improved trench latrines’ superstructure.
■ Try to have the slabs and surroundings cleaned / disinfected on a daily basis. Never put disinfectants
(e.g. chlorine products) or any other chemicals in the trench as they might inhibit the natural
decomposition of the faecal material. The only situation in which it is permitted to pour disinfectants
or human wastes mixed with a (strong) chlorine solution into an improved trench latrine is during an
epidemic of highly infectious diseases (e.g. cholera, Viral Haemorrhagic Fevers).
■ Try to add wood ash into the trenches on a daily basis. This gives a perceptible odour reduction and
might accelerate the elimination of pathogens. Active lime will also reduce the odours but might slow
down the decomposition process of the excreta.
■ Follow closely if the wastewater facilities function properly and do the necessary maintenance on the
grease trap (T.B. 4.04).
Key Input
A. Positioning small slabs (0.8 x 0.6 m) - Temporary fencing material
B. Positioning big slabs (1.2 x 0.8 m) - Tape measure, string line, sticks
C. Cross section of trench (during and after use) - Shovels, hoes, picks, miner’s bar
- Clay (potentially some reinforced
concrete)
1. Trench - Prefabricated slabs with lid and pegs
2. Band of plastic sheeting - Stakes and ropes (for the superstructure)
3. Prefabricated slabs with lid (latter not indicated) - Non-transparent plastic sheeting
4. Plastic sheeting zigzagging around poles - Nails and hammer
5. Curtains of plastic sheeting - Water supply with tap and evacuation
6. Runoff drainage system
7. Attachment curtain (e.g. at least 200 l drum per 4 cubicles
8. Aquifer (water table) or better)
9. Impermeable layer (e.g. clay) - Soap or ash
- Anal cleansing material, (if required)
- Waste bin for sanitary napkins,
(if required)

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Remarks
■ When choosing the site, ensure that buildings (e.g. health structures) and living areas are not
downwind of the improved trench latrines.
■ Before the trenches can be excavated, the groundwater level has to be determined. In homogeneous
soils, the bottom of the trench should be at least 1.5 m above the highest possible groundwater
table. The required vertical distance for heterogeneous soils is difficult to predict however. The depth
of the water table can be estimated by verifying the water level in nearby wells. Another option is to
drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground,
as deep as 1.5 m beneath the required trench depth. When pulled out, the rod or (the earth inside)
the pipe should be dry. If not, the trench depth should be adapted accordingly. Soil saturated with
water after heavy rainfall might give a false impression of the actual water table level.
■ In less stable soils, the trench will have to be lined with vertical boards (wood, corrugated iron) that
are kept in place with horizontal struts. Sandbags filled with stabilised soil can also be an alternative.
■ If a high water table, rocky or sandy soil prevents the excavation and use of trenches, elevated
platforms may be built. It is also possible to use 200 litre drums, (partially) buried in the ground with
a defecation opening at the top, or to use slabs that can be set on top of the opened drums.
■ It might be necessary to build separate improved trench latrines for men and women, and foresee
certainly separated facilities for the staff in health structures.
■ A waste bin close to the improved trench latrines is recommended for the disposal of sanitary napkins.
■ In case the sanitary napkins of menstruating women and girls are washed an reused, it might be
appreciated if a discrete washing area with drying lines is foreseen nearby the improved trench
latrines for the ladies.
■ Slabs with adapted dimensions for the defecation hole and the footrests might have to be installed
for small children, certainly in health structures (e.g. paediatrics ward, feeding centre, Out Patient
Department). Potties, which can be emptied in the improved trench latrines, can be an alternative.
■ If there are physically impaired persons amongst the population, make sure to equip some of
improved trench latrines with specific features, such as a (removable) seat and handrails, because
some of them will be incapable of squatting (section 3.5 Further reading). Clean and disinfect these
features regularly.
■ Lighting at the improved trench latrines at night is highly recommended for safety / security reasons.
■ Insecticide Residual Spraying (T.B. 7.15) of the plastic sheeting superstructures has potentially a
high impact on the fly population.
■ When the trenches are nearly full (about 0.3 m underneath the slabs), they should be dismantled and
backfilled. Remove the superstructure and the slabs, and disinfect them. Before the backfilling takes
place, the part of the band of plastic sheeting that is positioned on the ground can be folded towards
the inside of the trench, on top of the excreta. When the plastic sheeting of the superstructure is still
in good condition, it can stay connected to the stakes, and be “replanted” around a new trench where
the prefabricated slabs are already installed. Do not dig at the same place again for at least two
years. Water-absorbing trees (e.g. mangos) can be planted inside the old trench to re-stabilize the
underground.
■ If people want to build their own facilities immediately, a shallow family improved trench can be an
option. Apart from the trench size (e.g. 0.5 x 0.3 x 0.5 m deep or 0.9 x 0.5 x 1.0 deep, depending on
the slab size) and the reduction in number to one slab, the principle is the same as for normal
improved trench latrines.
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T.B. 3.04 Simple pit latrines

For prolonged periods, the simple pit latrine is one of the easiest and fastest means of disposing
of human wastes. If well designed and built, correctly sited and well maintained, it contributes
significantly to the prevention of faeco-oral diseases. From a public health point of view, family
latrines are normally preferred over public latrines because they are often better maintained by the
owners.
Construction
■ Choose a site at least 30 m away (more for fissured underground and limestone) and downhill from
all water sources, storage and treatment facilities. The latrine (battery) must have easy access, not
less than 5 m and not more than 50 m away from the dwellings (< 30 m from the buildings within a
health structure).
■ Prepare the site for construction: remove all debris, flatten the surface, put up a temporary fence,
implement soil texture and permeability tests (T.B. 4.05), determine the depth of the water table and
bring in the needed material and equipment.
■ Lay out the base area (foundation) of the latrine battery as per figure B, using string lines.
■ Excavate the base platform and trench, as per figure B. Keep the sides of the trench as straight as
possible to obtain relatively smooth concrete surfaces afterwards.
■ Prepare and install the required reinforcing bars inside the base excavation as per figure C. Make
sure that the reinforcing bars stay at least 30 mm away from the sides (use spacers for the lower
re-bars). Vertical reinforcement bars can be used every 2 m to keep the middle and upper re-bars
in place during the casting of the concrete.
■ Prepare and pour the concrete (300 kg/m³; T.B. 2.05) inside the base excavation, and vibrate the
concrete to remove all the air (e.g. poke it rigorously with a reinforcing bar). Keep the concrete moist
for a week with plastic sheeting or jute sacking that needs to be wetted twice a day.
■ Start digging the latrine pit within the base, when its concrete has hardened for at least 3 days. Do
not dig underneath the concrete base. In homogeneous loam or clay soils (T.B. 4.05), the maximum
pit depth is limited to 2.5 m, and its bottom should be at least 1.5 m above the highest possible water
table.
■ Install perforated corrugated iron sheets vertically in the pit, overlapping each other partly, imbedded
by 0.2 m in the soil, and fixed to the concrete base (as per figure A). The perforations can be done
by drilling small holes or by means of a hammer and a pointed chisel.
■ Install prefabricated slabs with their cover on the concrete base, once the pit is completed. To ensure
a secure seating, the slabs should be fixed to its base (overlaps of at least 0.1 m) with a 10 mm thick
mortar layer (T.B. 2.05). An extra anchoring with metal pegs is advised for plastic slabs.
■ Construct a superstructure around the slab, adapted to local preferences. It may be built with
masonry-work, wood, corrugated iron or non-transparent plastic sheeting, but preferably local
materials (e.g. branches and mud) as long as this doesn’t have a too negative impact on the
environment (e.g. deforestation). The superstructure should have a door if local habits dictate. A
spiral-shaped superstructure without a door can also be used for a single or double latrine.
■ Fit a roof to the superstructure with its slope carrying rainwater towards the back of the latrines.
■ Make a drainage channel at the back and the sides of the latrines to lead the runoff water away, thus
protecting the pit walls against erosion.
■ Provide hand washing facilities nearby the latrines. Make sure that a grease trap (T.B. 4.04) and an
infiltration system (T.B. 4.06; 4.07; 4.08) are foreseen.

TECH-SAN-160_CH3 22/03/10 10:08 Page 24

■ Provide water and soap (or ash), and anal cleansing material if required (certainly in health
structures).
■ Try to ensure that the cover is always replaced on the defecation hole to reduce the breeding of flies
and to lessen bad odours in and around the latrine’s superstructure.
■ Try to have the slabs and surroundings cleaned / disinfected on a daily basis. Never put disinfectants
(e.g. chlorine products) or any other chemicals in the pit as they might inhibit the natural
decomposition of the faecal material. It is only permitted during an epidemic of highly infectious
diseases (e.g. cholera, Viral Haemorrhagic Fevers) to pour disinfectants or human wastes mixed with
a (strong) chlorine solution into a latrine pit.
■ Add wood ash to the pit, if possible daily. This gives a perceptible odour reduction and might
accelerate the elimination of pathogens. Lime also reduces the smell but might slow down the
decomposition process.
Key Input
A. Vertical cut of the simple pit latrine L = (n x b) + 1.4 m

B. Excavation for the concrete base
C. Detail of the base reinforcements With L: total length of the base
n: number of latrine slabs (maximum 6)
b: width of a latrine slab (maximum 1 m wide)
1. Pit (partly filled with excreta) - Temporary fencing material

2. Defecation hole - String line, sticks and tape measure
3. Slab with footrests - Shovel, pick, miner’s bar
4. Cover - 300 kg/m³ concrete: +/- 1.3 m³ per outer 1 m² cubicle
5. Superstructure + +/-0.7 m³ per extra inner cubicle (latrine battery)
6. Roof - Reinforcing bars
7. Concrete base - Tools to prepare and pour concrete
(shallow dugout and inner trench) - Jute sacking or plastic sheeting
8. Drainage channel - Corrugated iron sheets to reinforce the pit
(at the sides and back of latrine) - Prefabricated slab with cover
9. Aquifer (water table) - Material and tools for the superstructure and door
10. Mortar layer (at least 10 mm thick) - Water supply with tap and evacuation system
11. Corrugated iron sheets - Soap or ash, anal cleansing material (if required)
(pit reinforcement) - Waste bin for sanitary napkins (if required)
12. Example of a slab: concrete,
plastic, (wood)
Dimensions are indicated in m
3 24
TECH-SAN-160_CH3 22/03/10 10:08 Page 25

TECH-SAN-160_CH3 22/03/10 10:08 Page 26
Remarks
downwind of the latrines.
■ Latrines excavated in (unstable) soils have been known to collapse, sometimes resulting in serious
accidents. The construction method described above is for a latrine battery accommodating
maximum six slabs. It is an assured method for all kinds of loam or clay soils (T.B. 4.05) to prevent
(long) rectangular pits from subsiding. Even if the soil would cave in within the pit, the base and the
slabs will stay in place, avoiding personal injuries. This design also permits a potential re-excavation
of used latrines, if they have been closed for at least two years. Be aware however that the
construction method described above isn’t suited for sand or loamy sand soils, due to the risk of
collapse.
■ An alternative for all kinds of soils is the individual circular-shaped pit, which is often more difficult to
excavate but less due to collapse because of its natural arching effect. When necessary (certainly
for loamy sans and sand soils), the circular pit can be reinforced with one or more concrete rings (T.B.
2.06). Another alternative is to line the rectangular pit completely (T.B. 3.07). For simple pit latrines,
it isn’t necessary however to put a repartition wall between each latrine compartment. Still other
valid construction methods and materials exist, but fall out of the scope of these guidelines. Contact
your technical referent for more information, if needed.
■ Before the pit can be dug, the depth of the groundwater table has to be determined. In homogeneous
soils, the bottom of the pit should be at least 1.5 m above the highest possible groundwater table.
The required vertical distance for heterogeneous soils is difficult to predict however.
■ The depth of the water table can be estimated by verifying the water level in nearby wells. Another
option is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in
the ground, as deep as 1.5 m beneath the maximum pit depth (2.5 m). When pulled out, the rod or
(the earth inside) the pipe should be dry. If not, the pit depth should be adapted accordingly. Soils
saturated with water after heavy rainfall might give a false impression of the actual water table level.
■ Allow for a spare 0.5 m of depth in the calculation of the pit size to avoid unpleasant sights and
excreta splashing out during use. It also permits to cover the excreta in a safe manner when the
latrine (battery) is closed down, without causing fly and odour problems. This free space is not part
of the effective pit volume. A pit latrine battery constructed with the above method (max. depth of 2.5
m, thus an effective depth of only 2.0 m) will last for about 1.5 to ideally 2 years, if it is used normally
by 20 people per compartment (accumulation rate of 0.06 m³/person). Similarly, a single simple pit
latrine will last about 5 to 6 years for a family of 5.
■ Latrines can be dug in impermeable soils (e.g. clay), but due to the low infiltration rate, they will have
to be emptied frequently in a safe manner (T.B. 3.13).
■ If the subsoil is very rocky, the area flood prone or the water table high, the pit needs to be constructed
partially in the ground (at least 0.5 m deep) and the remaining aboveground part in a very well
compacted earth mound. Hence, a specific construction technique will have to be used, as described
in T.B. 3.12.
■ If it rains a lot in the region, the concrete base can be made a little higher aboveground, for the pit
to be less at risk of flooding. An additional mould will be needed to raise the base (foundation) by at
least 0.1 m. Be aware that increasing the height of the base will necessitate a considerable amount
of concrete.
■ The hardening of the concrete base depends on the ambient temperature. The proposed hardening
time of 3 days before the pit excavation can be started within the concrete base (whilst keeping it
damp) is for temperatures of 20 °C and above. For lower temperatures, it will be necessary to wait
longer.
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■ Itis recommended to use concrete (T.B. 3.05) or plastic slabs, certainly for health structures. The use
of wooden slabs should be avoided because of aging and termite problems. If used anyway, the
wood quality and its impregnation (e.g. with old engine oil against termites) is important. Wooden
planks have to be protected with plastic sheeting in order to make their maintenance easier. Slabs
of logs should be covered with compacted soil and plastic sheeting. A regular check up of the wooden
slabs and their replacement when necessary are essential safety measures.
■ In case the superstructure won’t be built with masonry-work, some vertical poles can be installed
before the concrete base is cast, in order to have attachments for the plastic sheeting, corrugated
sheets or local material.
■ Separate latrines might be needed for gender purposes. The health structure’s staff should always
have their own latrines, separated from the patients’ and visitors’ facilities. Also small children might
need their own adapted latrines (T.B. 3.06).
■ If there are physically impaired persons amongst the population, the superstructure size of some
latrines might have to be adapted. Make also sure to equip these adapted latrines with specific
features, such as handrails and a (removable) seat, because some of these physically impaired
people will be incapable of squatting (section 3.5 Further reading). Don’t forget to clean and disinfect
these specific features regularly.
■ An additional non-transparent screen or wall in front of the entry side of the latrine (battery) improves
the privacy, which might lead to a more frequent use of the facility.
■ Make sure that correct hand washing facilities with water and soap (or ash) are provided in the direct
neighbourhood of the latrines. Latrines for handicapped people (wheelchair) should be provided with
washing facilities within the superstructure. Make sure that the wastewater facilities are maintained
correctly.
■ A waste bin close to the latrines is recommended for the disposal of sanitary napkins.
■ In some contexts, it might be interesting to integrate the latrines into sanitary blocks, together with
personal hygiene facilities like (bucket) showers (T.B. 4.01). In case the women utilise reusable
sanitary napkins, special washing basins and drying lines could be provided in the female blocks.
■ Lighting in and around of the latrines is highly recommended at night for safety / security reasons.
■ Insecticide Residual Spraying (T.B. 7.15) of the interior superstructure walls (plastic sheeting
included) has potentially a high impact on the fly population.
■ When the latrines are nearly full (0.5 m from the slab), move the superstructure and slabs (if possible
and if they are still in good condition) to a neighbouring place, after having been disinfected. The old
pit can be filled with dry earth mixed with wood ash. In case the concrete base is still in a good
condition, it can be re-excavated at least 2 years after the latrine (battery) has been closed. However,
the corrugated iron sheets should be replaced as they will be (partly) corroded. If the latrines are
demolished, water-absorbing trees (e.g. mangos) can be planted inside the filled pit to re-stabilize
the underground.
■ Ventilated Improved Pit (T.B. 3.07) and twin pit latrines (T.B. 3.09) can also be chosen, but they are
more suited for stabilised situations, and certainly recommended for health structures.
■ In the first phase of the latrines project, the recommended ratio of 1 latrine per 20 persons might not
immediately be attainable, because of the time it takes to construct them.

TECH-SAN-160_CH3 22/03/10 10:08 Page 28
T.B. 3.05 Latrine slab

An appropriate latrine slab is an essential component of a latrine for safety, ease of use and
maintenance. Reinforced concrete slabs can meet these criteria and are easy to make for a
relatively low cost.
Construction
■ Make a metal or wooden mould with internal dimensions that are adapted to the slab size, and a
wooden or metal template for the defecation hole.
■ Place the mould on a flat surface covered by a layer of sand, plastic sheeting or paper.
■ Cut the iron reinforcing bars to length with a hacksaw or cutting pliers and join them with metal wire
(as per figure). Make 4 handles; per handle, bend a piece of re-bar in a U-shape integrating 2 pieces
of pipe.
■ Coat the inside of the mould and the contact surface of the template with an oily product such as used
engine oil, to avoid that the concrete would stick to them.
■ Place the reinforcing bars on spacers of about 3 cm high within the mould. Install also the 4 handles
at the slab corners, making sure that their integrated pipes will be imbedded in the concrete.
■ Put the template in the mould on its correct position (as per figure).
■ Prepare concrete of 300 kg/m³ (T.B. 2.05).
■ Pour the concrete, and vibrate it by tapping with a hammer on the sides of the mould.
■ Position immediately the foot rests (e.g. made of bricks) as per figure.
■ Sprinkle some cement directly on the wet concrete and polish the surface. Finalize the slab by making
sloped curves around the defecation hole and footrests (useful when cleaning the slab).
■ Cover the slab with plastic sheeting or jute sacking and sprinkle it twice per day with water to keep
it damp during the curing period.
■ Remove the mould and the template after 24 hours, recover the slab with the plastic sheeting or jute
sack and keep damp.
■ Wait for 7 days of curing in the shade for the concrete to gain strength, before installing the slab on
the pit.
■ Prepare a lid (e.g. wood, plastic or concrete) with a handle to cover the defecation hole.
Remarks
■ If embarking on a programme of latrine construction, it is well worth the trouble to build a workshop
for continuous slab production. This workshop should have a water point, a storage for tools and a
covered area for casting and curing the slabs.
■ The size of the slab has to be adapted to the pit size. However, for safety and practical reasons (slab
weight), it is strongly recommended to use the slab dimensions as proposed in the figure and to
adapt the pit size to the slab (T.B. 3.04). Be aware during the pit construction that the concrete slab
should extend at least 10 cm beyond each side of the latrine support to ensure a secure seating.
■ For a small number of slabs to be produced, the mould can also be replaced by a shallow excavation
in the ground, covered with plastic sheeting. The dimensions stay the same.
■ The template for the defecation hole should be tapered to ease its withdrawal from the concrete.
■ Don’t forget the handles as it is very difficult to move the slab without them. The figures suggests
handles that sink into the slab once it’s installed. This reduces the risk of people tripping over them
and eases the construction of the superstructure. Make sure the handles fall inside the lines indicating
the overlap with the pits lining. Simple handles imbedded in the concrete can do as well.
■ The footrests are important for the user to position himself correctly over the defecation hole (certainly
at night).
■ The dimensions of the drop hole and the footrests must be adapted for small children (T.B. 3.06).
■ If possible, make a gentle and smooth slope over the complete slab surface towards the defecation
hole; this will avoid stagnant liquids and will ease its cleaning.
■ Take care of the curing (7 days in the shade, kept damp): it greatly affects the strength of the slab.
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TECH-SAN-160_CH3 22/03/10 10:08 Page 29
Key Input
1. Defecation hole - Cement: 1/2 of a 50 kg bag
2. Footrests - Sand: about 35 l
3. 8 mm iron reinforcement bars - Gravel: about 70 l
4. Template for defecation hole (tapered) - Potable water (clean, non-salty)
5. Handles to ease the transport of the slab - Shuttering timber, height min. 70 mm: about 5 m
6. Lines indicating the overlap - Saw, hammer and nails
with latrine support / lining - Reinforcement bars, diameter 8 mm: 14 m
(at least 10 cm) - Hacksaw or iron bar cutting pliers and pincers
- Wire for joining reinforcement bars
Dimensions are in cm - Tape measure
- Shovel and bucket
- Trough or board for mixing concrete
- Trowel, float
- Bricks for the foot rests
- Pieces of (plastic) pipe
- Template

TECH-SAN-160_CH3 22/03/10 10:08 Page 30
T.B. 3.06 Children’s pit latrines

Small children might have problems using normal pit latrines because of the big size of the drop hole
and the position of the foot rests. They are often scared inside the closed superstructure of a normal
pit latrine as well. The children’s pit latrines are therefore an answer to these problems. If well
designed and built, correctly sited and well maintained, they contribute significantly to the prevention
of faeco-oral diseases.
Construction
■ Choose a site at least 30 m away (more for fissured underground and limestone) and downhill from all
water sources, storage and treatment facilities; the latrine (battery) must have easy access, not less
than 5 m and not more than 50 m away from the dwellings (< 30 m from buildings within a health
structure).
■ Prepare, excavate and line the pit in a similar way as described for a simple pit (T.B. 3.04) or a VIP (T.B.
3.07) latrine battery, depending on the soil type and the skills of the mason. In case the VIP latrine lining
is chosen, it isn’t necessary to put a closed separation wall in between each compartment, thus it’s only
required to construct the foundation circumference. The layer of lean concrete for stabilisation on the
bottom of the pit is highly recommended however.
■ Make slabs (T.B. 3.05 or 3.08, depending on the type of lining that has been chosen), but adapted to the
size of the children: a smaller defecation hole including a matching lid, footrests that are closer together
and an integrated handlebar, so that they can hold themselves in balance when they are squatting. The
ventilation pipe opening in the “VIP” slabs (T.B. 3.08) isn’t needed for children’s pit latrines.
■ Install the prefabricated slabs (with cover) on the latrines’ base, once it has settled for at least 3 days. To
ensure a secure seating, the slab should be fixed to its base (overlaps of at least 0.1 m) with a 10 mm
thick mortar layer (T.B. 2.05).
■ Construct a superstructure around the slabs that is large enough for the attendants to be able to walk
around the child during defecation (e.g. one open superstructure for two slabs). It may be built with
masonry-work, wood or plastic sheeting, but preferably local materials (e.g. branches and mud) as long
as this doesn’t have a too negative impact on the environment (e.g. deforestation). The superstructure
can be open at the front in order to have more light coming in, and the child not to feel imprisoned in a
rather small cubicle.
■ Fix a roof with the slope towards the back of the structure, away from the entrance.
■ Make a drainage channel at the back and the sides of the latrines to prevent runoff water entering the
pit and creating erosion of its walls.
■ Provide correct hand washing facilities in the direct neighbourhood of the latrines. Make sure that a
grease trap (T.B. 4.04) and an infiltration system (T.B. 4.06; 4.07; 4.08) are foreseen.
■ Provide water and soap (or ash), and anal cleansing material if required (certainly in health structures).
■ Try to ensure that the cover is always replaced on the defecation hole to reduce the breeding of flies and
to lessen bad odours in and around the latrines’ open superstructure.
■ Try to have the slabs and surroundings cleaned / disinfected on a daily basis. Don’t forget to clean and
disinfect the handlebars. Never put disinfectants (e.g. chlorine products) or any other chemicals in the
pit as they might inhibit the natural decomposition of the faecal material. It is only permitted during an
epidemic of highly infectious diseases (e.g. cholera, Viral Haemorrhagic Fevers) to pour disinfectants or
human wastes mixed with a (strong) chlorine solution into a latrine pit.
■ Add wood ash to the pit, if possible daily. This gives a perceptible odour reduction and might accelerate
the elimination of pathogens. Active lime will also reduce the smell but might slow down the
decomposition process of the faeces.
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TECH-SAN-160_CH3 22/03/10 10:08 Page 31
Key Input
1. Handle bar (for a child to hold on - Temporary fencing material

to when squatting) - Tape measure, string line and sticks
2. Slab with adapted footrests - Shovel, hoe, pick, miner’s bar
3. Defecation holes (adapted size for children) - Fired bricks or cement blocks / 300kg/m³
with lid concrete
4. Open superstructure - Reinforcing bars (8 mm)
5. Roof - Tools to prepare and cast concrete
6. Drainage channel - Jute sacking or plastic sheeting
- Prefabricated slab (adapted for children) with
cover
- Material and tools for the superstructure
- Water supply with tap and evacuation system
- Soap or ashes
- Anal cleansing material (if required)
Figure shows children latrines on a concrete base (as per T.B. 3.04). It can also be installed on a
complete lining (T.B. 3.07), depending on the soil conditions and/or the skills of the mason.
Dimensions (in cm) are indicative and have to be adapted according to the context.

TECH-SAN-160_CH3 22/03/10 10:08 Page 32
Remarks
■ When choosing the site, ensure that buildings (e.g. health structures) and living areas are not downwind
of the children’s latrines.
■ Before the pit can be dug, the groundwater table level has to be determined. In homogeneous soils, the
bottom of the pit should be at least 1.5 m above the highest possible groundwater table. The required
vertical distance for heterogeneous soils is difficult to predict however.
■ The depth of the water table can be estimated by verifying the water level in nearby wells. Another option
is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground,
as deep as 1.5 m beneath the required pit depth. When pulled out, the rod or (the earth inside) the pipe
should be dry. If not, the pit depth should be adapted accordingly. Soils saturated with water after heavy
■ Allow for a spare 0.5 m of depth in the calculation of the pit size to avoid unpleasant sights and excreta
splashing out during use. It also permits to cover the excreta in a safe manner when the latrine (battery)
is closed down, without causing fly and odour problems. The spare space is not part of the effective pit
volume. This means for instance that a pit with a maximum depth of 2 m (thus an effective depth of only
1.5 m) will only last for about 2 years if it is used normally by 20 children (accumulation rate of 0.04
m³/child).
■ An alternative construction method is the individual circular-shaped pit, which is often more difficult to
excavate but less due to collapse because of its natural arching effect. When necessary, the circular pit
can be reinforced with one or more concrete rings (T.B. 2.06). Other valid construction methods and
materials exist for (circular) latrine pits, but fall out of the scope of these guidelines. Contact your technical
referent for more information, if needed.
■ If the subsoil is very rocky, the area flood prone or the water table high, the pit needs to be constructed
partially in the ground (at least 0.5 m deep) and the remaining aboveground part in a very well compacted
earth mound. Hence, a specific construction technique will have to be used, as described in T.B. 3.12.
■ It is recommended to use concrete slabs (T.B. 3.05, 3.07), certainly for health structures. The use of
wooden slabs should be avoided if possible because of aging and termite problems. If used anyway, the
wood quality and its impregnation (with old engine oil against termites) is important. Wooden planks
have to be protected with plastic sheeting to make the maintenance easier. Slabs of logs should be
covered with compacted soil and plastic sheeting. A regular check up of the wooden slabs and their
replacement when necessary are essential safety measures.
■ In case the superstructure won’t be built with masonry-work, some vertical poles can be installed before
the concrete base (T.B. 3.04) is cast, in order to have attachments for the plastic sheeting, corrugated
sheets or local material.
■ As the superstructure is completely open for children’s latrines, it is impossible to create some darkness
inside the cubicles, and therefore the VIP fly trap principle (T.B. 3.07) won’t work. The open superstructure
also results in the need for lids, so the VIP ventilation principle won’t work either, meaning that ventilation
pipes aren’t necessary at all.
■ If there are physically impaired children, make sure to equip some latrines with specific features, such
as handrails and a (removable) seat because some of them will be incapable of squatting (section 3.5
Further reading). It’s even advised to provide all children’s latrines with handles.
■ Lighting in and around the children’s latrines is highly recommended for safety / security reasons.
■ Insecticide Residual Spraying (T.B. 7.15) of the interior superstructure walls (plastic sheeting included)
has potentially a high impact on the fly population.
■ When the children’s latrines are nearly full (0.5 m from the slab), move the superstructure and slabs (if
possible and if they are still in good condition) to a new pit, after having been disinfected. The old pit can
be filled with dry earth mixed with wood ash. In case the base is still in good state, it can be re-excavated
after at least 2 years. If the latrines are demolished, water-absorbing trees (e.g. mangos) can be planted
inside the pit to re-stabilize the underground.
■ In the first phase of the latrines project, the aim to have a ratio of 1 latrine per 20 children might not
immediately be attainable.
■ Potties can (sometimes) be an acceptable alternative to children’s pit latrines. They need to be emptied
and cleaned after each use.
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T.B. 3.07 Ventilated Improved Pit (V.I.P.) latrines

The VIP latrine outclasses the simple pit latrine by some particular features. The VIP latrine uses
the air movement across its ventilation pipe to draw gasses out of the pit, and thus to produce fewer
odour nuisances. Flies trying to leave the pit are attracted towards the light at the top of the
ventilation pipe, but as they fail to escape due to its screen, they die. This makes of the VIP latrine
a good fly trap as well.
Construction
■ Determine the effective pit volume, which is depending on the number of potential users, the accumulation
rate and the desired lifetime of the latrine (see section 3.4.6). If standardised VIP slabs (T.B. 3.08) with
fixed dimensions are used for a latrine battery with a certain total volume, only the required depth,
including the 0.5 m needed for the free space, should be determined.
water sources, storage and treatment facilities. The VIP latrine (battery) must have easy access, not less
than 5 m and not more than 50 m away from the dwellings (< 30 m from buildings within a health
structure).
■ Lay out the excavation area according to the outer dimensions of the foundation as per figure B, using
string lines. To ease the construction works afterwards, the lay out of the excavation area can be made
slightly bigger. For unconsolidated (e.g. sandy) soils, it might be necessary to dig conical walls to avoid
collapse.
■ Excavate the pit. The bottom of the pit should be at least 1.5 m above the highest possible water table.
■ Dig within the excavated pit a trench system of 0.25 m deep as per figure B.
■ Prepare and install some reinforcing bars inside the trench. Make sure that the reinforcing bars stay at
least 30 mm away from the sides and bottom of the trench (use spacers).
■ Pour concrete (300 kg/m³; T.B. 2.05) inside the trench system to form the pit’s foundation. Vibrate the
concrete to remove all the air. Keep the concrete moist for a week with plastic sheeting or jute sacking
that needs to be wetted twice a day.
■ Dig another 0.05 m of soil within the foundation compartments, after the concrete has settled.
■ Build on top of the foundation, which has hardened for at least 3 days, the open-jointed (honeycombed)
lining and the sealed (closed) partition walls that divide the pit into different compartments (as per figure
C). The lining and partition walls, erected in cement blocks or a double layer of fired bricks, should
overlap correctly in all the corners (as per figure D) to be able to resist the ground pressure.
■ Build a sealed lining with cement blocks or a double layer of fired bricks on top of the open-jointed lining
and partition walls.
■ Prepare on top of the lining and partition walls the casing for the reinforced concrete ring beam.
■ Prepare and install every 0.2 m the required reinforcing bars inside the casing (as per figure E). Make
sure that the reinforcing bars stay at least 25 mm away from the sides of the casing (use spacers).
■ Pour the concrete (300 kg/m³) inside the casing, while tapping gently on its sides. The concrete can also
be vibrated by poking it with a reinforcing bar. Keep the concrete moist for a week to ensure correct
curing.
■ Pour a layer of lean concrete (150 kg/m³; T.B. 2.05) at the bottom of the pit. It will give extra support to
the lining. Keep this concrete moist and cover the whole pit with plastic sheeting.
■ Install prefabricated VIP slabs (T.B. 3.08) on the ring beam that has hardened for at least 3 days. To
ensure a secure seating, every slab should have a good overlap over its entire circumference with the
lining and partition walls (respectively 0.15 and 0.075 m) and be fixed with a 10 mm thick mortar layer.
■ Backfill the space in between the pit lining and the excavated hole with gravel (honeycombed part) and
compacted soil (sealed part and concrete ring beam).
■ Add an impermeable layer (mortar or clay) against the aboveground part of the ring beam.
■ Construct a superstructure on top of the slabs, adapted to local preferences. It may be built with
masonry-work, wood or local materials. Plastic sheeting is not appropriate as it might not provide enough
darkness for the VIP principle to work (flies being attracted by light only entering via the vent pipe).
■ Fit a roof to the superstructure with its slope carrying rainwater towards the back of the latrines.

TECH-SAN-160_CH3 22/03/10 10:08 Page 34
■ Fix a plastic ventilation pipe with a diameter of 150 mm to each slab and secure it to the superstructure.
Put some mortar around the pipes where they pass through the roof.
■ Fit corrosion / UV-resistant screens at the pipes’ top and above the doors to avoid the entry and exit of
flies.
■ Make a drainage channel at the back and the sides of the latrines to lead the runoff water away.
Key Input
A. Vertical cut of the VIP latrine
B. Dimensions of the foundation (example for 3 compartments)
C. Dimensions of the lining and partition walls
D. Detail of the masonry overlap in a lining corner
E. Detail of the ring beam reinforcement
1. Effective pit volume (filled) - Temporary fencing material

2. Defecation or squatting hole without cover - String line, sticks and tape measure
3. Slab - Shovels, picks, miner’s bars
4. Footrests - Sand, cement, gravel and clean water
5. Superstructure (semi-dark inside) - Reinforcing bars
6. Roof - Tools to prepare and cast concrete
7. Ventilation pipe - Jute sacking or plastic sheeting
(internal size depending on material used) - Fired bricks or cement blocks
8. Fly screen - Masons tools
(corrosion and UV-resistant material) - Prefabricated VIP slabs
9. Drainage channel at the sides and back of latrine - Material and tools to build the superstructure
10. Aquifer (water table) - PVC pipe (preferable diameter of 150 mm)
11. Reinforced concrete foundation - Screen (e.g. mosquito netting)
12. Lean concrete for stabilisation (optional) - Experienced mason and 1 or 2 labourers
13. Open-jointed (honeycombed) lining - Water supply with tap and evacuation system
14. Sealed (closed) lining - Soap or ash, anal cleansing material (if
15. Reinforced concrete ring beam required)
16. Intermediate reinforced concrete ring beam - Waste bin for sanitary napkins (if required)
(depending on the height of the lining (> 3 m deep)
and the stability of the soil) L = (n x b) + 0.15m
17. Impermeable layer With L: total length of the foundation
18. Air and light inlet covered with mosquito netting n: number of slabs (max. 6)
(only one, area = at least 3 times the vent section) b: width of slabs

■ Do not use a cover on the defecation hole of a VIP latrine as this would stop the air circulation needed
for the ventilation.
■ Make sure water and soap (or ash) are always available at the nearby hand washing point.
■ Provide anal cleansing material if required (certainly in health structures).
■ Try to have the slabs and surroundings cleaned on a daily basis. Never put disinfectants (e.g. chlorine
products) or any other chemicals in the pits as they might inhibit the natural decomposition of the
faecal material. It is only permitted during an epidemic of highly infectious diseases (e.g. cholera, Viral
Haemorrhagic Fevers) to pour disinfectants or human wastes mixed with a (strong) chlorine solution
into a latrine pit.
■ Add wood ash to the pit, if possible daily. This reduces the odours even more and might accelerate
the elimination of pathogens. Lime also reduces the smell but might slow down the decomposition
process.
■ Pour once in a while a bucket of water through the vent pipes to remove spider webs and flies corpses
that could block the ventilation. Check also if the screens on top of the ventilation pipes and above
the doors are still intact and replace them when necessary.
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TECH-SAN-160_CH3 22/03/10 10:08 Page 36
Remarks
downwind of the VIP latrines. VIP latrines should also be built on an open space, away from trees,
buildings or other objects that could impede air movement.
■ Latrines excavated in (unstable) soils have been known to collapse, sometimes resulting in serious
accidents. The construction method described above is for latrine batteries accommodating up to 6
standard VIP slabs (T.B. 3.08), with a maximum pit depth of 3 m. It is an assured method for all kinds
of soils to prevent (long) rectangular pits from collapsing. For pits exceeding 3 m depth, it is
recommended to cast an intermediate ring beam halfway the height of the lining.
■ Allow for a spare 0.5 m of depth in the calculation of the pit size to avoid unpleasant sights and
excreta splashing out during use. It also permits to cover the excreta in a safe manner when the
latrine (battery) is closed down, without causing fly and odour problems. This free space is not part
of the effective pit volume.
■ Before the pit can be dug, the depth of the groundwater table has to be determined. In homogeneous
soils, the bottom of the pit should be at least 1.5 m above the highest possible groundwater table.
The required vertical distance for heterogeneous soils is difficult to predict however.
■ The depth of the water table can be estimated by verifying the water level in nearby wells. Another
option is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in
the ground, as deep as 1.5 m beneath the required depth. When pulled out, the rod or (the earth
inside) the pipe should be dry. If not, the pit depth should be adapted accordingly. Soils saturated with
water after heavy rainfall might give a false impression of the actual water table level.
■ Single VIP latrines can also be build with the method described above. An alternative is the individual
circular-shaped pit, which is often more difficult to excavate but less due to collapse because of its
natural arching effect. When necessary, the circular pit could be reinforced with one or more concrete
rings (T.B. 2.06). Still other valid construction methods and materials exist, but fall out of the scope
of these guidelines. Contact your technical referent for more information, if needed.
■ VIP latrines can be dug in impermeable soils (e.g. clay), but due to the low infiltration rate, they will
have to be emptied frequently in a safe manner (T.B. 3.13).
■ In case the soil is unstable, the pit will need to be supported with struts during the works or be
excavated conically.
■ If the subsoil is very rocky, the area flood prone or the water table high, the method described above
can be adapted with the pit partially constructed underground (at least 0.5 m deep) and the remaining
aboveground part in a very well compacted earth mound (T.B. 3.12).
■ The hardening of the concrete elements depends on the ambient temperature. The proposed
hardening time of 3 days before the construction can continue on the concrete elements (whilst
keeping them damp) is for temperatures of 20 °C and above. For lower temperatures, it will be
necessary to wait longer.
■ The doors of the VIP superstructure should be self-closing. Above each door should be an air hole
for ventilation purposes. This air hole should have a surface at least three times larger than the cross
sectional area of the ventilation pipe, and be covered with a screen (mosquito netting).
■ If it is acceptable by the population, the superstructure of a single or double VIP latrine can also be
made in a spiral form without a door. This still provides enough darkness inside for the VIP principle
to work.
■ The separation in individual compartments by solid walls going from the bottom until the top of the
pit is needed to avoid shortcuts of the air movement between the different defecation holes, which
would hamper the VIP ventilation principle. This means as well that every single compartment of
the VIP latrine battery should have its own ventilation pipe.
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■ Each ventilation pipe should be vertical, sticking out above the latrine’s roof by at least 0.5 m (as per
figure A). The hole where the vent pipe comes through the roof should be made watertight to avoid
leaks. It should also be flush with the slab’s underside. To ensure a better anchorage of the plastic
vent pipe at the bottom, a clamp can be connected at the level where it will be mortared in the slab.
An alternative is to provide the VIP latrine slab already with a short piece of pipe (spigot), being
anchored in the concrete. It should be flush with the underside of the slab and sticking out above by
at least 0.1 m. Once the slab is installed, the vent pipe can be slit over the spigot. This spigot
facilitates the construction, but makes the transport of the slab more difficult (without breaking the
spigot).
■ When PVC pipes are used as a vent pipe, their diameter should ideally be 150 mm, and at least 110
mm. Having a dark coloured plastic vent pipe at the outside of the superstructure and oriented
towards the sun might allow a better ventilation of the VIP latrine during wind still days, but
complicates the construction.
■ Instead of a round plastic vent pipe, local alternatives such as reeds or bricks covered with earth
plaster have been used already as well. When bricks are used for the vent pipe, its form will be
square with internal dimensions of at least 225 x 225 mm, because their rougher surface (still
preferably plastered) hinders the airflow. The size of the hole in the latrine slab should be adapted
accordingly.
■ The fly screen on the top of the vent pipe must be in stainless steel, aluminium or PVC coated
fibreglass, because the gasses escaping from the latrine are very corrosive to mild metal. Stainless
steel seems to be the best but also the most expensive material for the screen, while aluminium
seems to be the best quality/prize option. If really nothing else is available, painted metal mesh is
the last option.
■ Separate VIP latrines might be needed for gender purposes. The health structure’s staff should
always have their own latrines, separated from the patients’ and visitors’ latrines. VIP latrines are not
really suited for small children; therefore special children’s latrines might have to be built (T.B. 3.06).
■ If there are physically impaired persons, the size of the superstructure of some VIP latrines might
have to be adapted. Make also sure to equip these adapted VIP latrines with specific features, such
as handrails and a (removable) seat, because some of these physically impaired people will be
incapable of squatting (section 3.5 Further reading). Don’t forget to clean and disinfect these specific
features regularly.
■ An additional non-transparent screen or wall in front of the entry side of the VIP latrine (battery)
improves the privacy, which might lead to a more frequent use of the facility. However, this screen /
wall should not impede the air circulation needed for the VIP principle to work.
neighbourhood of the VIP latrines. VIP latrines for handicapped people (wheelchair) should be
provided with washing facilities within the superstructure. Make sure that the wastewater facilities are
maintained correctly.
■ A waste bin close to the VIP latrines is recommended for the disposal of sanitary napkins.
■ In some contexts, it might also be interesting to integrate the VIP latrines into sanitary blocks, together
with personal hygiene facilities like (bucket) showers (T.B. 4.01). In case the women utilise reusable
sanitary napkins, special washing basins with drying lines could be provided in the female blocks.
■ Outside lights around the VIP latrines are highly recommended for safety / security reasons.
■ Insecticide Residual Spraying (T.B. 7.15) of the VIP latrines’ interior superstructure walls has
potentially a high impact on the fly population.
■ When the pit is nearly full (0.5 m from the slab), close it down by filling the pit with dry earth mixed
with wood ash. Since VIP latrines demand a considerable investment, it should be checked first if
they can be emptied in a correct way (T.B. 3.13). With the complete lining, the pit is less at risk of
collapse, so water can be added to render the sludge more liquid. However, do not empty VIP latrines
manually for at least two years. Twin pit latrines (T.B. 3.09) could be considered as an alternative. If
the VIP latrines are demolished, water absorbing trees (e.g. mangos) can be planted in the pit to
re-stabilize the underground.

TECH-SAN-160_CH3 22/03/10 10:08 Page 38
T.B. 3.08 V.I.P. latrine slab

An appropriate VIP latrine slab is an essential component of a VIP latrine for safety, ease of use
and maintenance. Reinforced concrete slabs can meet these criteria and are easy to make for a
relatively low cost.
Construction
■ Make a metal or wooden mould with internal dimensions that are adapted to the slab size, and
wooden or metal templates for the defecation and ventilation pipe holes.
■ Place the mould on a flat surface covered by a layer of sand, plastic sheeting or paper.
■ Cut the iron reinforcing bars to length with a hacksaw or cutting pliers and join them with metal wire
(as per figure). Make 4 handles; per handle, bend a piece of re-bar in a U-shape integrating 2 pieces
of pipe.
■ Coat the inside of the mould and the contact surface of the templates with an oily product such as
used engine oil, to avoid that the concrete would stick to them.
■ Place the reinforcing bars on spacers of about 3 cm high within the mould. Install also the 4 handles
at the slab corners, making sure that their integrated pipes will be imbedded in the concrete.
■ Put the templates in the mould on their correct position (as per figure).
■ Prepare concrete of 300 kg/m³ (T.B. 2.05).
■ Pour the concrete, and vibrate it by tapping with a hammer on the sides of the mould.
■ Position immediately the foot rests (e.g. made of bricks).
■ Sprinkle some cement directly on the wet concrete and polish the surface, and finalize the slab by
making sloped curves around the defecation hole and footrests (useful when cleaning the slab).
■ Cover the slab with plastic sheeting or jute sacking and sprinkle it twice per day with water to keep
it damp during the curing period.
■ Remove the mould and the templates after 24 hours, recover the slab with the plastic sheeting or jute
sack and keep damp.
■ Wait for 7 days of curing in the shade for the concrete to gain strength before installing the slab on
the pit.
Key Input
1. Defecation hole (without cover) - Cement: 3/5 of a 50 kg bag
2. Footrests - Sand: about 42 l
3. Ventilation pipe hole - Gravel: about 84 l
4. 8 mm iron reinforcing bars - Potable water (clean, non-salty)
5. Handles to ease the transport of the slab - Shuttering timber, height min. 70 mm: about 5 m
6. Template for the defecation hole (tapered) - Saw, hammer and nails
7. Template for the ventilation pipe hole (tapered) - Reinforcing bars, diameter 8 mm: about 15 m
8. Lines indicating the overlap with the pit’s lining - Hacksaw or iron bar cutting pliers and pincers
- Wire for joining reinforcing bars
Dimensions are in cm - Tape measure
- Shovel and bucket
- Trough or board for mixing concrete
- Trowel, float
- Bricks for the foot rests
- Pieces of (plastic) pipe
- Templates
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Remarks
■ If embarking on a programme of latrines’ construction, it is well worth the trouble to build a workshop
for continuous slab production. This workshop should have a water point, a storage for tools and a
covered area for casting and curing the slabs.
■ The size of the slab has to be adapted to the pit size. However, for safety and practical reasons (slab
weight), it is strongly recommended to use the slab dimensions as proposed in the figure and to
adapt the size of the pit accordingly (T.B. 3.07). Be aware that the slab should extend 15 cm beyond
each side of the lining to ensure a secure seating. When several VIP slabs are positioned next to
each other, they should rest correctly on the pit’s repartition walls by at least 7.5 cm. The slabs
should be mortared to their supporting walls to avoid air movement shortcuts between the defecation
holes and to deny access to flies and other vectors.
■ For a small number of slabs to be produced, the mould can also be replaced by a shallow excavation
in the ground, covered with plastic sheeting. The dimensions stay the same.
■ Don’t forget the handles. It is very difficult to move the slab without them. The figures suggests
handles that sink into the slab once it’s installed. This reduces the risk of people tripping over them
and eases the construction of the superstructure. Make sure the handles fall inside the lines indicating
the overlap with the pits lining. Simple handles imbedded in the concrete can do as well.
■ Don’t forget the hole for the ventilation pipe (preferably a diameter of 15 cm for plastic pipes), as far
away as possible from the defecation hole (at least 30 cm), but free from the sides where the slab
will be seated on the supporting pit walls. An alternative is to integrate immediately a spigot (plastic
pipe sticking out by at least 0.1 m on top of the slab, but flush with its underside) on which the vent
pipe will be installed later.
■ The templates for the defecation and the ventilation pipe holes should be tapered to ease their
withdrawal from the concrete.
■ The footrests are vital for the user to position himself correctly over the defecation hole (certainly at
night).
■ If the slab is used for children’s latrines, the dimensions of the drop hole and the footrests must be
adapted (T.B. 3.06), and the vent pipe hole isn’t necessary, because the VIP principle won’t work
anyway with the open superstructure.
■ If possible, make a gentle and smooth slope over the complete slab surface towards the defecation
hole; this will avoid stagnant liquids and will ease its cleaning.
■ Take care of the curing (7 days in the shade, kept damp): it greatly affects the strength of the slab.
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T.B. 3.09 Twin pit latrine

Twin pit latrines may be used where toilets have to last for a long time (e.g. for public places, health
structures), so as to economise space and money in the long run. They also produce a good quality
soil conditioner. The latrine is built on a open lined pit divided in two by a closed partition wall. As
both pits are used in alternation, they can be emptied safely and reused. The system is thus
permanent and especially suited for stabilized situations. For collective facilities, several pits may
be constructed in series.
Construction
The construction of a twin pit latrine is very similar to a VIP latrine battery (T.B. 3.07) with two
compartments, but its design has some specific features, as described below:
■ Each individual pit should have enough storage capacity to last for at least two years.
■ To permit easy access to each pit during the emptying procedure, their dimensions have to be
adapted. The suggested outer dimensions for the lining of the complete twin pit latrine are 2.4 x 2.0
m, if this would permit to have the bottom of the pit still 1.5 m above the highest possible water table
(taking into account the accumulation rate and the free space of 0.5 m for backfilling; section 3.4.6).
For these lining measurements, the outer dimensions of the foundation should be 2.55 x 2.15 m. The
ring beam should include a central beam, which can carry standard size latrine slabs.
■ Standard size slabs (T.B. 3.05) can be used if the ventilation pipe is located outside the
superstructure. An alternative is to cast a big slab in situ over the whole area where the superstructure
will be constructed.
■ Per twin pit latrine, 8 small reinforced concrete slabs should be cast: (for the suggested lining
dimensions: each slab should be 1.0 x 0.3 m):
➞ 6 plain slabs with handles at their sides,
➞ 2 slabs with a ventilation hole according to the available vent pipe (ideally a PVC pipe with a diameter
of 150 mm, or at least 110 mm).
➞ The slabs will have to be mortared at the back of the lining.
➞ The ventilation pipes will have to be anchored to the outside of the superstructure to avoid being
blown over by heavy winds. A dark colour of the ventilation pipes will help the airflow during wind
still days, if the pipes are oriented towards the sun.
Operation
After a period of at least 2 years, the first pit will be full (filled to 0.5 m underneath the slab):
■ Fillthe first hole with a mixture of wood ash and dry earth.
■ Block its defecation hole with a cover fixed by a thin layer of mortar.
■ Open the second pit.
After a further period of at least two years, the second pit will be full (filled to 0.5 m under the slab):
■ Fill the second hole with a mixture of wood ash and dry earth.
■ Block its defecation hole with a cover fixed by a thin layer of mortar.
■ Open the small rectangular slabs of the first pit.
■ Take out the contents of the first pit, which has transformed into harmless matter (“compost”).
■ Put the small rectangular slabs back on a layer of mortar.
■ Unblock the defecation hole of the first pit.
In this way, the alternation between pits may be repeated indefinitely until the latrine is completely
worn out. The material taken out is inoffensive and is an excellent soil conditioner, with some fertilizing
capacity.

TECH-SAN-160_CH3 22/03/10 10:08 Page 42
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Key Input
1. Defecation hole in service - String line, sticks and tape measure
2. Defecation hole on standby (blocked) - Shovel, pick, miner’s bar
3. Slab (potentially cast in situ) - Sand, cement, gravel and clean water
4. Superstructure with door (semi-dark inside) - Reinforcing bars
5. Removable small slabs - Tools to prepare and cast concrete
6. Ventilation pipes - Jute sacking or plastic sheeting
7 - 8. Separated twin pits - Fired bricks or cement blocks
9. Screen (mosquito netting) - Masons tools
(corrosion and UV-resistant material) - Prefabricated standard and small slabs
10. Impermeable layer (mortar or clay) - Material and tools to build the superstructure
11. Drainage channel - PVC pipes (preferable diameter of 150 mm)
(at the sides and back of the latrine) - Screen (e.g. mosquito netting)
12. Aquifer (water table) - Experienced mason and 1 or 2 labourers
13. Reinforced concrete foundation (300 kg/m³) - Water supply with tap and evacuation system
14. Lean concrete layer (150 kg/m³) - Soap or ash, anal cleansing material (if required)
15. Open-jointed (honeycombed) lining - Waste bin for sanitary napkins (if required)
16. Sealed (closed) lining
17. Reinforced concrete upper ring beam (300 kg/m³)
18. Intermediate reinforced concrete ring beam
(300 kg/m³; optional, depending on the lining height)
19. Air and light inlet covered with mosquito netting Measurements are indicated in m
(only one, area = at least 3 times the vent section) Drawings not up to scale
Remarks
■ Before considering the construction of twin pit latrines, it is important to know if this technique is acceptable
for the population as it implies handling of “faecal” material during pit emptying (even if the material
doesn’t resemble excreta anymore, nor is it harmful to health). Social, religious and/or cultural factors
may forbid it and demand the use of another method for excreta disposal.
■ The correct size of each pit is essential: each one should permit the storage of faecal and anal cleansing
material for at least 2 years, during which all possible pathogens are certainly eliminated (biodegradation).
■ When access for physically impaired persons is required, the dimensions of the superstructure will most
probably have to be increased, implying that the pit will have to bigger as well.
■ The defecation hole that isn’t in use should be covered with a lid that can’t be removed easily (e.g.
mortared). However, do not put a lid on the defecation hole of the pit in use as this prevents the air
circulation and thus the VIP principle to work.
■ Installing only one door per twin pit superstructure reduces the risk that both defecation holes would be
opened and used at the same time, which would render their safe emptying process impossible.
■ The use and regular maintenance of a twin pit latrine are very similar to a normal VIP latrine (T.B. 3.07),
thus the related issues (e.g. gender separation, principle not suited for small children) and the facilities
(e.g. handle bars and movable seat for physically impaired people, hand washing facilities, light outside
latrine) are comparable as well.
■ It is possible to transform a twin pit latrine into a real ecological sanitation (Eco-San) latrine by separating
the urine from the faecal matter and stirring its content regularly (section 3.5 Further reading).
■ Adding regularly wood ash, some green organic waste and vegetables can help already to reduce bad
odours and potentially enhance the elimination of pathogens.
■ After a minimum of two years for normal twin pit latrines (potentially less for Eco-San latrines), the
“compost” may be taken out and be used as soil conditioner.
■ The emptying process is a good moment to do a complete check-up of the twin pit latrine. Any damages
should be repaired, in order to guarantee / increase the lifespan of the twin pit latrine.
■ Remember to provide protective clothing and washing facilities (at least water and soap) to the workers
emptying the pits.

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T.B. 3.10 Pour-flush latrines

Pour-flush latrines are relatively simple in design, but should only be considered where water for
flushing is abundant and where the system is technically and socio-culturally acceptable. The latrine
is fitted with a pan and a water-seal, which has the advantages to stop odours from coming out and
to prevent flies from reaching the excreta. Pour-flush latrines can be used as well for households
as for public buildings and health structures. The evacuation of the excrements and water can be
done towards a lined pit, onset (directly underneath the slab) or offset, or towards a septic tank
connected to an infiltration system or closed sewer for its effluents. Depending on the evacuation
system, pour-flush latrines can be expensive.
Design principles
Besides its important advantages, the pour-flush latrine has also considerable inconveniences:
■ Need of sufficient water throughout the year;
■ Not readily applicable in impermeable soils;
■ Need for intensive promotion in proper use and maintenance, when newly introduced;
■ Not suitable in climates where temperatures below 0 °C are reached;
■ Risk of blockages when solid materials (e.g. maize cobs, stones) are used for anal cleansing. Also
sanitary napkins shouldn’t be discarded in a pour-flush latrine.
Hence, opting for pour-flush latrines should be a rational choice; e.g. because the population is already
accustomed with this system and/or latrines have to be available inside a building.
The chosen excreta evacuation system of a pour-flush latrine will have an influence on its location,
design and construction steps:
Onset lined pit
■ This onset pour-flush latrine with its slab directly on top of the pit (figure A) is the simplest method.
It is obligatory that the pit has an open-jointed lining until the bottom because the amounts of water
used for flushing (and anal cleansing) might render the soil unstable and collapse.
■ The location and construction steps are similar to those described for the VIP latrine (T.B. 3.07), but
the VIP slab is replaced by a model fitted with a water pan and water-seal. A pour-flush latrine
battery doesn’t need the sealed partition walls inside the pit as a VIP latrine, but it certainly requires
the stabilisation layer in lean concrete (150 kg/m³) at the bottom of the pit to avoid implosion.
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Key Input
A. Pour-flush latrine onset directly over a lined pit
B. Pour-flush latrine connected to a septic tank.
1. Slab with footrests - Excavation tools
2. Water pan - Building material and tools (for pit or septic tank)
3. Water-seal (siphon) - Slab with pan and water trap
4. Drain pipe - (PVC) drainage pipe (min. 75mm, max. 120mm)
5. Simple pit or alternating offset twin pit - Materials and tools for superstructure
6. Intermediate reinforced concrete ring beam - Water supply with tap and evacuation system
(300 kg/m³; optional, depending - Soap or ash
on the lining’s height) - Soft anal cleansing material (if required)
7. Roof - Waste bin for plastic bottles / sanitary napkins
8. Masonry wall
9. Backfill (e.g. sand)
10. Superstructure
11. Septic tank
12. Separation wall
13. Outlet pipe towards an infiltration system / sewer
14. Aquifer (water table)
15. Drainage channel (at the sides and back of latrine)
16. (Reinforced) concrete foundation (300 kg/m³)
17. Impermeable layer
18. Ventilation pipe with screen
19. Access holes with cover
20. Lean concrete layer (150 kg/m³; stabilisation)
21. Open-jointed (honeycombed) lining
22. Sealed (closed) lining
23. Reinforced concrete ring beam (300 kg/m³)
Measurements are indicated in m
Drawings not up to scale

TECH-SAN-160_CH3 22/03/10 10:08 Page 46
Offset lined pit

■ The water-seal is connected via a pipe to a (double) offset pit, thus the water pan can be located
within a building or an independent superstructure. The offset location also makes it easier to empty
the pits when nearly full. Two offset pits with open-jointed lining put in parallel, each with an
accumulation capacity for at least 2 years, permit a safe long-term alternating use of the system.
■ Be aware that a minimum distance of 6 m between the pits and the dwellings / building foundations
must be respected. The pits must be at least 30 m away (more for fissured underground and
limestone) and downhill from all water sources, storage and treatment facilities.
■ For soils with a good infiltration rate (T.B. 4.05), round pits that are lined with perforated concrete rings
(T.B. 2.06) can be constructed. When alternating pits are installed, they should be at least 1.5 m
from each other.
■ For soils with a low infiltration rate (T.B. 4.05), large pits will be needed. Hence, the lined pits can be
constructed following the steps as described for VIP latrines (T.B. 3.07), with adapted dimensions.
The sealed partition walls aren’t required, but the lean concrete stabilisation layer at the bottom is
strongly recommended however. The VIP slabs need to be replaced by plain concrete slabs. It is
advisable to install small slabs with handles (e.g. 0.3 m wide) side-by-side to be able to remove
them more easily when the pit needs to be emptied (weight reasons). To avoid bad odours and to
deny access to vectors and other animals, the slabs should be mortared to the pit lining.
■ A shallow pit, with a foundation at the bottom and closed walls on top that are backfilled, form the
support for the slab that integrates the water pan with water-seal.
Septic tank
■ The water-seal is connected via a pipe to the septic tank (figure B), thus the water pan can be located
within a building or an independent superstructure. The septic tank is attached to an infiltration
system (T.B. 4.06; 4.07) or a closed sewer, if existent. When pour-flush latrines are used, the septic
tank is certainly the preferred option for health structures, but they have to be designed and
constructed by skilled people.
■ The location, design and construction of a septic tank are described in T.B. 3.11. Be aware that a
minimum distance of 6 m between the septic tank and the dwellings / building foundations must be
respected.
■ A shallow pit, with a foundation at the bottom and closed walls on top that are backfilled form the
support for the slab that integrates the water pan with water-seal.
■ Make sure that the users flush the latrine after each use. In order to obtain this:
➞ Install a water point with a regular supply nearby the latrines.
➞ Provide water containers with a suited volume to perform the flushing. Be aware that the amount of water
needed per flush depends on the diameter of the water-seal: as a rule-of-thumb; a 90 mm diameter
requires 2 – 3 l to flush effectively, whereas 4 – 5 l will be needed for a 120 mm diameter.
■ Verify if the users have a water container for anal cleansing. If not, the size of the flushing container can
be adapted or specific anal cleansing containers can be made available. Alternatives are to provide soft
anal cleansing material that can be flushed (e.g. toilet paper), or that every cubicle is foreseen with a
waste bin in which solid anal cleansing material can be deposited. These bins could potentially also be
used to discard single use anal cleansing containers (e.g. plastic bottles) and sanitary napkins.
■ Try to have the slabs with water pan and the surroundings cleaned on a daily basis. Never pour
disinfectants (e.g. chlorine products) or any other chemicals in the pour-flush latrines as they might inhibit
the natural decomposition of the faecal material. It is only permitted during an epidemic of highly infectious
diseases (e.g. cholera, Viral Haemorrhagic Fevers) to pour disinfectants or human wastes mixed with a
(strong) chlorine solution into a pour-flush latrine.
■ Check the pour-flush latrines frequently; if these toilets block they should be cleared quickly. Otherwise
the material blocking the latrine will solidify and plug the water-seal. Never allow the pit to fill above the
water-seal (siphon) level as it will clog up the whole system.
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Remarks
■ As a general rule, the pour-flush latrine is mainly suitable for regions where water is abundant and
habitually used for anal cleansing. In other cases, it is better to use dry pit latrines (T.B. 3.04), preferably
VIP types (T.B. 3.07) for public buildings or even twin pit latrines (T.B. 3.09) if the removal of the residues
is socio-culturally acceptable.
■ Pour-flush latrines should be avoided in impermeable soils (e.g. clay) due to the very low infiltration rate.
■ Allow for a spare 0.5 m of depth in the calculation of the pit size to cover the excreta in a safe manner
when the pour-flush latrine (battery) is closed down, without causing fly and odour problems. The free
space is not part of the effective pit volume.
■ In places where (pour-)flush systems are commonly used, prefabricated pans (porcelain, plastic,
smoothed cement) can often be found, but they are also available as emergency equipment. Verify
that the water-seal has a minimum diameter of 75 mm, otherwise the risk of blockages is very high.
■ The slope of the pipe behind the water-seal should be at least 2.5 %, but 5 % would be better. In case
the distance in between the water-seal and the pit / septic tank is more than 2 m, a manhole should be
foreseen in the middle to allow the pipe to be unclogged.
■ Separate pour-flush latrines might be needed for gender purposes. The health structure’s staff should
always have their own latrines, separated from the patients’ and visitors’ facilities. Also small children
might need their own adapted latrines.
■ If there are physically impaired persons amongst the population, the size of the superstructure of some
pour-flush latrines might have to be adapted. Make also sure to equip these adapted latrines with specific
features, such as handrails and a (removable) seat, because some of these physically impaired people
will be incapable of squatting (section 3.5 Further reading). Don’t forget to clean and disinfect these
specific features regularly.
■ An additional non-transparent screen or wall in front of the entry side of the latrine (battery) improves the
privacy, which might lead to a more frequent use of the facility.
■ It is essential to have a water point nearby so that the users can take water to flush the latrine after each
use. If the water supply would (partly) fail, closure of these latrines and (temporary) replacement by a
system not using water should be considered.
■ These water points could also be used for hand washing, thus soap or ash should be available. Pour-flush
latrines for handicapped people (wheelchair) should be provided with washing facilities within the
superstructure. Make sure that the wastewater facilities are maintained correctly.
■ It might be needed to install a refuse collection system nearby the pour-flush latrines to avoid users
discarding their solid anal cleansing material, their anal cleansing container (e.g. old mineral water bottle)
or their used sanitary napkins in the water pan itself, thus blocking the whole system.
■ In some contexts, it might be interesting to integrate the pour-flush latrines into sanitary blocks, together
with personal hygiene facilities like (bucket) showers (T.B. 4.01). In case the women utilise reusable
sanitary napkins, special washing basins with drying lines could be provided in the female blocks.
■ Light in and around the pour-flush latrines is highly recommended for safety / security reasons.
■ Insecticide Residual Spraying (T.B. 7.15) of the interior superstructure walls (plastic sheeting included)
has potentially an important impact on the fly population.
■ When the pit is nearly full (0.5 m underneath the slab), close it down by filling the pit with soil. Since
pour-flush latrines demand a considerable investment, it should be checked first if they can be emptied
in a correct way (T.B. 3.13). With the lining, the pit is less at risk of collapse, so plenty of water can be
added to render the sludge more liquid. However, do not empty the pit manually for at least two years.
If the pour-flush latrines are demolished, water absorbing trees (e.g. mangos) can be planted in their pit
to re-stabilize the underground. A septic tank can be emptied over and over again, but it has to be done
in a safe manner (T.B. 3.13).
■ When pour-flush latrines are required in acute emergencies, individual circular-shaped pits are
recommended. Their lining can be made with perforated concrete rings (T.B. 2.06) or drums. A
prefabricated (plastic) slab with water-seal (module) will have to be put on top of each lining and be
anchored with pegs in the soil.

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T.B. 3.11 Septic tank

A septic tank receives and pre-treats wastewater before disposal in an underground dispersal
system (preferably infiltration trenches) or a closed sewer. The septic tank can receive all domestic
wastewater (sewage and sullage). However, for big infrastructures like health structures and
schools, it is mainly meant for black wastewater (sewage), because the required volume of the
septic tank could become too big for the pre-treatment of all the grey wastewater (sullage) that is
generated.
Functioning principles
■A septic tank is a container, often rectangular in shape, built just underground, in which wastewater
is retained for 1 to preferably 3 days. During this period, the solid material settles. Over time, the
faecal material will be decomposed by an anaerobic bacteriological process, which reduces the
volume of the sludge. Although this biodegradation is reasonably active (depending on the
temperature), the sludge does accumulate, which means that the tank needs emptying at regular
intervals, generally every 1 to 5 years.
■ The effluent from the tank is still contaminated by pathogens, thus it cannot be released directly in
the open environment. Therefore, dispersal in the underground, preferably via infiltration trenches
(T.B. 4.07) is essential to benefit from the natural filtration process. In places where infiltration
trenches wouldn’t work because of the limited soil permeability, a filtration system will have to be
installed before the effluent can be disposed of into a river or a stream. A perfect alternative might
be a correct and closed sewerage system, if it would be already available at the site.
Design
Although a septic tank is constructed in a similar way as a grease trap (T.B. 4.04), it has its own
important design features, as following:
■ In order to reduce the concentration of suspended material in the effluent, the tank is divided into two
interconnected compartments, the first having double the volume of the second. The effective depth
of the liquid zone is 1.2 to 1.7 m. The total length of the tank is usually 2 to 3 times its width.
■ The volume of the septic tank is calculated on the basis of a 3 days retention time of the quantity of
water entering each day (see example below).
■ The septic tank has an access hole with cover for each compartment, to ease the sludge removal.
■ The septic tank needs a ventilation pipe for the gasses that are created during the decomposition.

■ The septic tank should be emptied frequently; a simplified estimation is when it is 1/3 full of sludge.
The frequency is thus given by:
n = 1/3 x (Veff / (S x N))
With n = number of years before de-sludging
Veff = effective volume of the septic tank; volume of the tank that can be filled in m³
S = sludge accumulation rate in m³/person year
N = number of users
■ The sludge accumulation depends on the temperature, but a figure of 0.025 – 0.03 m³ per person a
year can be considered sufficient as estimation, if only sewage passes through the septic tank. After
emptying the septic tank, it is necessary to refill it with water. Some of the old sludge can also be
poured into the tank, to accelerate the growth of decomposing bacteria.
Example
A health structure with 4 pour-flush latrines; according to the Essential Requirements (T.B. 1.08):
20 users each
Effective volume of septic tank: 12 m³ (5 m length, 2 m width and 1.2 m effective depth)
n = 1/3 x (12/(0.03 x 80)) = 1.67 year
Thus every 1.67 year (20 months), the septic tank should be emptied.
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Key Input
1. Floating material (oil, fat, grease) - Temporary fencing material
2. Clarified liquid - Plans
3. Settled solids - Shovels, picks, hoes, miner’s bars
4. Inlet tee - Builders tools
5. Outlet tee - Sand for sub-base
6. Partition wall to retain solids and floating material - Shuttering timber
7. Access holes with covers - Concrete (quantity calculated according
8. Ventilation pipe with screen to tank size), concrete blocks,
9. Reference level indicating effective depth prefabricated elements or complete component
- Pipes and inlet and outlet tees
A. 20 % of effective depth (minimum diameter 100 mm)
B. 40 % of effective depth - Ventilation pipe with Tee and mosquito netting
C. 20 % of effective depth
D. 40 % of effective depth
E. At least 75 mm
F. Effective depth of water (min 1.2 m, max 1.7 m)
G. At least 0.3 m
L. Total inner length of septic tank
Drawing not up to scale

TECH-SAN-160_CH3 22/03/10 10:08 Page 50
Remarks
■ It is not recommended for health structures to combine the degreasing of sullage (grey water) with
the pre-treatment of sewage (black water) by passing both through the same septic tank. To cope
with the considerable volumes of sullage generated in health structures, the required capacity of
their septic tanks might be very important in order to respect the minimum retention time for the
sewage (1 to preferably 3 days). Grease traps (T.B. 4.04) are definitely a better option for grey water
as their minimum effective volume should only be double the maximum hourly flow entering the trap.
■ The location of the septic tank is dictated by the position of the dispersal area (e.g. infiltration
trenches, T.B. 4.07), but it should also be nearby the buildings that it is serving. The tank should be
away from vehicular passage, but accessible for maintenance however.
■ Make sure there is enough land available for the underground dispersal system and that the soil
allows a sufficient infiltration rate (T.B. 4.05).
■ If the water table is not deep enough (should be at least 2 m deep) or the soil isn’t very absorbing,
do contact your technical referent for further advice.
■ A temporary fence should be installed before the works begin.
■ A septic tank may be built in situ in concrete or masonry-work (e.g. cement blocks) and made
watertight with plastering mortar (T.B. 2.05), or alternatively with prefabricated panels or a complete
tank of concrete, fibreglass or plastic. If built in situ, the construction steps as described for the
grease trap (T.B. 4.04) can be followed, taking in consideration the specific dimensions and ratios
of a septic tank.
■ Whatever the construction method, the tank must be watertight and strong enough to resist to soil
and possible groundwater pressures. It should rest on a sub-base of sand several centimetres thick.
■ The minimum diameter of the inlet and outlet pipes with their respective T-piece should be at least
100 mm, and their slope at least 2.5 %, although 5 % is preferable.
■ The gasses resulting from anaerobic decomposition in the septic tank should be evacuated by a
ventilation pipe with a minimum diameter of 100 mm (preferably 150 mm, if available). The pipe
should be installed at such a place and such a height that there is no odour nuisance (take into
account the dominant wind direction). It is preferably located directly on top of the septic tank, if
possible. The outlet of the ventilation pipe must have a stainless steel, aluminium, PVC coated
fibreglass or even a nylon screen to avoid vectors entering. Regular checks of this screen are strongly
recommended, and it should be replaced when it is not longer intact.
■ Chlorine products and detergents used for a health structure’s normal maintenance and cleaning will
not affect the tank’s functioning (bacterial activity). However, high dosages of disinfectants or any
other chemicals should not be evacuated via the septic tank as they might inhibit the natural
decomposition of the faecal material.
■ It is not necessary to use special additives in the septic tank to be re-activated after it has been
emptied. Some of the old sludge could be added to accelerate the growth of decomposing bacteria,
but generally the new faecal material collected in the septic tank is rich enough in micro-organisms
to start the biodegradation.
■ Septic tanks should be inspected regularly; once every 6 months for public buildings and health
structures.
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T.B. 3.12 Raised pit latrines in problem soils

In some areas, it is difficult to build latrines because of unfavourable (soil) conditions like a rocky
bottom, risk of flooding, or a high water table. An option to provide adequate sanitary facilities in
these situations is to raise the latrine pit partly aboveground. Whereas the aboveground part of the
pit should be completely watertight, the underground part (at least 0.5 m deep) must be permeable
enough to allow the infiltration of liquids. Simple pit, VIP and twin pit latrines can all be raised.
Construction
■ Determine the effective pit volume, which is depending on the number of potential users, the accumulation
rate and the desired lifetime of the latrine (section 3.4.6).
water sources, storage and treatment facilities; the latrine (battery) must have easy access, not less than
5 m and not more than 50 m away from the dwellings (< 30m from buildings within a health structure).
■ Prepare the site for construction: remove all debris, flatten the surface, put up a temporary fence, implement
soil texture and permeability tests (T.B. 4.05), and determine the depth of the water table. The depth of
the water table can be estimated by verifying the water level in nearby wells. Another option is to drive a
metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground, at least 2 m
beneath the ground surface. When pulled out, the rod or (the earth inside) the pipe should be dry. Soil
■ Decide on the maximum depth of the underground part, with respect for the minimum required vertical
distance of 1.5 m between the bottom of the pit and the highest possible water table. As such, in order to
leave an additional 0.5 m depth available for the infiltration of liquids, the highest possible water table
should be at least 2 m deep for homogeneous soils. The required vertical distance for heterogeneous soils
is difficult to predict however.
■ Calculate the remaining height needed for the aboveground part (receiving slabs with standard dimensions)
to obtain the desired total volume, including the 0.5 m required for the free space. In case the height of
the aboveground part would surpass 2 m, non-standardised concrete slabs with a bigger size can be
used, but be aware of the weight increase this will imply.
■ Bring in the needed material and equipment, based on the calculations and decisions made.
■ Lay out, using string lines, the excavation area according to the outer dimensions of the foundation (as
per figure B, or a bigger surface if non-standardised slabs or a raised twin pit latrine are desired).
■ Excavate the pit as deep as possible, keeping its vertical walls straight
■ Dig within the excavated pit a trench system of 0.25 m deep (as per figure B).
■ Prepare and install some reinforcing bars inside the trench. Make sure that the reinforcing bars stay at least
30 mm away from the sides and bottom of the trench (use spacers).
■ Pour concrete (300 kg/m³; T.B. 2.05) inside the trench system to form the pit’s foundation. Vibrate the
concrete to remove all the air. Keep the concrete moist for a week with plastic sheeting or jute sacking
that needs to be wetted twice a day.
■ Dig another 0.05 m of soil within the foundation compartments, after the concrete has settled.
■ Build on top of the foundation, which has hardened for at least 3 days, the open-jointed (honeycombed)
lining and the sealed (closed) partition walls that divide the pit into different compartments (as per figure
C). The lining and partition walls, erected in cement blocks or a double layer of fired bricks until
approximately 0.1 m underneath the ground surface, should overlap correctly in all the corners (as per
figure D) to be able to resist the ground pressure.
■ Arrange on top of the lining and the partition walls the casing for the intermediate concrete ring beam.
■ Prepare and install every 0.2 m the required reinforcing bars inside the casing (as per figure E).
be vibrated by poking it with a reinforcing bar. Keep the concrete moist for a week to ensure correct curing.
■ Pour a layer of lean concrete (150 kg/m³; T.B. 2.05) at the bottom of the pit. It will give extra support to the
lining. Keep this concrete moist for a week and cover the whole pit with plastic sheeting.
■ Backfill the space in between the pit lining and the excavated hole with gravel (honeycombed part) and
compacted soil (intermediate concrete ring beam).
■ Build on top of the intermediate ring beam that has hardened for at least 3 days the sealed lining and
partition walls to a height of maximum 2 m. The lining and partition walls, built with cement blocks or a
double layer of fired bricks, should overlap correctly in all the corners.

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■ Arrange on top of the lining and the partition walls the casing for the upper concrete ring beam.
■ Prepare and install every 0.2 m the required reinforcing bars inside the casing (as per figure E).
be vibrated by poking it with a reinforcing bar. Keep the concrete moist for a week to ensure correct curing.
■ Build a compacted earth mound around the whole construction. This can be done in several soil layers,
each one watered and rolled to be compacted. The mound slope depends on the stability of the soil used.
At the top of the earth mound, it is advisable to foresee a little platform around the structure for safety
reasons. Plant in a later stage some grass on the mound to reduce its erosion.
■ Add an impermeable layer (mortar or clay) against the aboveground part of the upper ring beam.
■ Install prefabricated slabs (T.B. 3.08) on the upper ring beam after it has hardened for at least 3 days. To
ensure a secure seating, every slab should have a good overlap over its entire circumference with the
lining and partition walls (respectively 0.15 and 0.075 m) and be fixed with a 10 mm thick mortar layer (T.B.
2.05).
■ Construct the superstructure with its potential accessories, keeping local preferences in mind. As a raised
latrine is an important investment, it’s recommended to make the superstructure also in durable materials.
The superstructure should have a door.
■ Fit a roof to the superstructure with its slope carrying rainwater towards the back of the latrine (battery).
■ Make a drainage channel at the back and the sides of the latrine (battery) to lead the runoff water down
and away, thus protecting the whole construction against erosion.
■ Build an access ramp (for impaired persons) and/or a stairway in concrete or masonry-work on the earth
mound to allow easy access to the latrine (battery). A handrail is strongly recommended because the
access can get slippery when wet.
Key Input
A. Vertical cut of the raised VIP latrine
B. Dimensions of the foundation
C. Dimensions of the compartments (lining and partition walls)
D. Detail of the masonry overlap in a corner of the lining
E. Detail of the ring beam reinforcement
1. Effective pit volume (filled) - String line, sticks and tape measure
2. Defecation or squatting hole without cover - Shovels, picks, miner’s bars
3. Slab - Sand, cement, gravel and clean water
4. Footrests - Reinforcing bars
5. Superstructure (semi-dark inside) - Jute sacking or plastic sheeting
6. Roof - Building tools for concrete, masonry-work
7. Ventilation pipe - Fired bricks or cement blocks
(internal size depending on the material used) - Prefabricated slabs
8. Fly screen - Material and tools for the superstructure
(corrosion and UV-resistant material) - PVC pipe (diameter of 150 mm), screen
9. Drainage channel at the sides and back of latrine - Additional soil for the earth mound
10. Aquifer (water table) - Roller to compact the earth mound
11. Reinforced concrete foundation (300 kg/m³) - Material and tools for the stairway / ramp
12. Lean concrete layer (150 kg/m³) - Water supply with tap and evacuation
13. Open-joint lining (cement blocks / fired bricks) - Soap or ash, anal cleansing material
14. Sealed lining (cement blocks / fired bricks) - Waste bin for sanitary napkins
15. Reinforced concrete ring beams
16. Impermeable layer L = (n x b) + 0.15m
17. Stairway or access ramp (for wheelchair users)
with railing With L: total length of the foundation
18. Earth mound n: number of slabs (max. 6)
19. Air and light inlet covered with mosquito netting b: width of slabs
(only one, area = at least 3 times vent section)
Dimensions are indicated in m Drawings not up to scale
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Remarks
■ When choosing the site, ensure that buildings (e.g. health structures) and living areas are not downwind
of the raised pit latrines. If the VIP model is chosen, it should be built on an open space, away from trees,
buildings or other objects that could impede air movement.
■ The construction method described is for raised pit latrine batteries of up to 6 standard slabs. As a raised
pit latrine is a considerable investment, there is a tendency to make it more as a VIP model (as per figure
A) or even as a twin pit model. The special features for these models are described in T.B. 3.07 and 3.09.
■ Single (simple) raised pit latrines can be build as well with this method. An alternative is the individual
circular-shaped raised pit latrine. This can be made by installing perforated concrete rings underground,
and plain concrete rings (T.B. 2.06) aboveground within a compacted earth mound. The rings should be
cemented and preferably bolted together to be watertight.
■ Be aware that the infiltration rate of a raised pit latrine can be low, certainly when the permeable part of
the lining is limited in size. This could mean that the pit will have to be emptied on a regular basis (T.B.
3.13), certainly when water is used for anal cleansing. As such, raised pit latrines should preferably not
be made with a pour-flush system as lots of water will be introduced (T.B. 3.10).
■ In case the water table level is less than 2 m deep, the normal construction of raised latrines with earth
mound won’t be sufficient to avoid microbiological contamination of the groundwater. Following options
are possible under these circumstances:
➞ Make a pit with its bottom close to or even within the aquifer, which will result in contaminated groundwater.
But it is usually easier and cheaper to develop onsite sanitation and find an alternative solution for the
water supply (e.g. during emergencies, it is easier to supply potable water than to evacuate excreta on
a daily basis). However, an in-depth assessment is required before the construction of the latrines begins,
to make sure that the groundwater is not exploited for human consumption at present, nor will be in the
near future.
➞ Install an impermeable reservoir, partly underground in a pit (even within the aquifer) and partly
aboveground in an earth mound, and closed on top with latrine slabs. This impermeable reservoir can
for instance be a large (round) plastic or fibreglass water storage tank, weighted down so it doesn’t float
if it would be located inside the aquifer. This avoids groundwater contamination, but the tank will often
have to be emptied in a safe manner (T.B. 3.13). The solution of an impermeable reservoir can also be
interesting for excreta disposal facilities that have to be constructed on rocky grounds.
■ In case of very permeable or fissured soil, the risk of microbiological contamination of the groundwater can
potentially be reduced by making the excavation a lot bigger (e.g. 1 m on all sides,) and by backfilling the
gap between the hole walls and the permeable lining with fine sand, topped up with compacted soil at the
level of the sealed lining. The sand layer will filter the pathogens out to a certain extent, which will reduce,
but not completely avoid the contamination of the groundwater.
■ In case the underground soil is too unstable, the pit will need to be supported with struts or be made
conical.
■ Allow for a spare 0.5 m of depth in the calculation of the pit size to avoid unpleasant sights and excreta
splashing out during use. It also permits to cover the excreta in a safe manner when the latrine is closed
down, without causing fly and odour problems. The spare space is not part of the effective pit volume.
■ Separate raised pit latrines might be needed for gender purposes. The health structure’s staff should
always have their own latrines, separated from the patients’ and visitors’ latrines. Special facilities or
potties might be needed for children as well.
■ If there are physically impaired persons, the size of the superstructure might have to be adapted. Make also
sure to equip the adapted latrines with specific features, such as handrails and a seat, because some of
these people will be incapable of squatting (section 3.5 Further reading). Additional attention will have to
go to the earth mound, like a more gentle slope. An access ramp will be essential for people in a wheelchair.
neighbourhood of the raised pit latrines. Make sure that the wastewater facilities are maintained correctly.
■ A waste bin close to the trench latrines is recommended for the disposal of sanitary napkins.
■ Outside lights around the raised pit latrines are highly recommended for safety / security reasons.
■ Insecticide Residual Spraying (T.B. 7.15) of the raised pit latrines’ interior superstructure walls has
potentially a high impact on the fly population.
■ The operation and maintenance activities are similar to the type of latrine chosen, e.g. simple pit, VIP or
twin pit latrines (T.B. 3.04; 3.07; 3.09).
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T.B. 3.13 Emptying latrines and/or septic tanks

Emergency latrines are mostly demolished when they are full. However, excreta disposal facilities,
where the investment was significant merit to be emptied for reuse. Their design (e.g. twin pit latrine,
septic tank) is sometimes even developed to be emptied. Nevertheless, it should be verified
(normally already during the designing phase) if social, religious and/or cultural factors do not forbid
this action.
Implementation
Manually
Due to the contamination risks, latrines should not be emptied manually, except if they have been
closed down for at least two years. The design of the latrine should permit manual emptying (e.g. twin
pit latrine). However, in many countries, this practice is socio-culturally not acceptable for the
population.
Vacuum suction tank
This system, which is often used for sludge trucks, is very effective because it “sucks” up the sludge
by means of under-pressure that is created in a sewage tank. As the moving parts of the “vacuum”
pump don’t get in contact with the sludge, the breakdown frequency of such a pump should normally
be low. Another advantage is that this system can be used (at least theoretically) for all kinds of excreta
disposal systems (latrines and septic tanks), as long as the sludge is still liquid enough (this is not the
case for twin pit and Eco-San latrines that transform faeces into solid compost). The liquid sludge of
septic tanks and latrines is emptied quite quickly. However, this fast “suction” can lead to the collapse
of partially lined or unlined pit latrines. The other inconvenience is that these systems are very
expensive.
Trash pump
Although resembling motor pumps used for water, trash pumps have some specific features. Their
inlet isn’t located at the centre of the impellor, but above. Their impellor has only a few solid blades,
potentially with cutting edges. Another difference with a motor pump is that their pump house can
easily and rapidly be opened for de-blocking and cleaning purposes. Hence, these centrifugal trash
pumps are specially designed to drain liquid sludge that contains quite some solid particles (e.g. with
diameters up to 30 mm). They can be used to empty septic tanks or latrine pits containing a lot of
liquids. The use of a strainer with rather big holes is obligatory.
Diaphragm (membrane) sludge pump
These volumetric pumps are specially designed to drain sludge still containing relatively big solid
particles (e.g. with diameters up to 60 mm). So they are suited to empty septic tanks and latrines if their
sludge is liquid enough. The maximum delivery head and flow (T.B. 2.26) of a diaphragm pump are
only half or even less of those of a trash pump with a similar engine, but it can deal with double sized
particles. These membrane pumps are often driven by combustion engines. The use of a strainer with
rather big holes is advised.
Submersible grinder pumps
These centrifugal pumps have to be lowered in the sludge. Depending on their hardness, potential
“solid” particles present in the liquid sludge (up to a certain size) will be grinded into small pieces by
the cutting blades of the impellor. These pumps aren’t really suited for latrines having their slab fixed
on the pit because their diameter is often too big to be lowered via the defecation hole. These pumps
are more appropriate to empty septic tanks. As an electrical motor drives this kind of pumps, an
adapted generator will often be needed for field use. Verify if the chosen generator is adapted to the
starting current of the pump motor.

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Motor pump
In the early stages of an emergency when no other alternatives are available yet, a standard 3” motor
pump can be used to empty the emergency latrines, at least when they contain a lot of liquids. This
can be the case for latrines built in an underground that doesn’t have a high infiltration rate (e.g. clayey
soil; T.B. 4.05) and where the users do anal cleansing with water. The sludge can also be liquefied more
by adding water before the pumping starts, but this increases the risk of the latrine pit collapsing. A
motor pump used for emptying sludge should never be used anymore for other purposes, and certainly
not for potable water!
Transport tanks
Sludge trucks / “vacuum suction” systems have their transport tank integrated. For the other pump
systems, (round) metallic or solid plastic tanks can be used. They need to be leak proof and have big
drains to ease the removal of the sludge. The tanks have to be correctly fixed to their transport means
(e.g. a truck) to avoid accidents. In the very first phase of an emergency, a 2 or 5 m³ (transport) bladder
can be used if no other means are available at all. This bladder should never be used anymore for other
purposes afterwards, certainly not for potable water!
Key
A. “Vacuum suction” tank
B. Trash pump / motor pump
C. Diaphragm (membrane) sludge pump
D. Submersible grinder pump
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Remarks
■ Never empty a latrine / septic tank manually with recipients such as a bucket. Pathogens present in
the sludge are serious health hazards to the workers. The only exceptions are the twin pit latrines
where the excreta has been transformed into harmless compost (at least if the decomposition time
of minimum 2 years has been respected) or where ecological sanitation systems are used (Eco-San
is only briefly mentioned in these guidelines).
■ Always verify if a municipal or private sludge truck is available (for rent) in the region. Before signing
a contract with the owners, check if the sludge truck functions properly, how much capacity it has,
where they dump the excreta and if they have the permission to do so.
■ All systems, except the submersible grinder pumps are “suction” systems, thus they are not able to
remove sludge out of deep pits (and certainly not deeper than 7 m) and/or pits that are located far
from the “suction” system because the liquids can be quite viscous.
■ All the equipment and the surroundings that have been in contact with the sludge should be
thoroughly rinsed with clean water immediately after the works.
■ Equipment that has been into contact with sludge should never be used anymore for other purposes
afterwards.
■ Make sure that the sludge tanks don’t leak because they will leave a contaminated trail over the
whole transport route.
■ The sludge should be buried at a safe place where it will not cause any public health or environmental
risks, or it should be brought to a certified treatment plant (although that the latter is not often available
in low-income countries). The burial trench should be at least 800 m away from dwellings, 50 m
away from water points, and for homogeneous soils at least 1.5 m above the highest possible
groundwater table (at the end of the rainy season). The required vertical distance for heterogeneous
soils is difficult to predict however.
■ Regular checks should be performed to verify if the sludge is correctly disposed of at the right spot.
■ Make sure that the operators have good protective clothing and do wash thoroughly their hands with
water and soap after finishing the job (e.g. before the lunch, at the end of the working day). Daily
showers are also highly recommended. Do foresee the necessary facilities for these essential
hygiene practi

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Disposal of runoff
water and wastewater
Narrative
Technical briefs
T.B. 4.01 Showers
T.B. 4.02 Washing facilities
T.B. 4.03 Manhole / Collection - Distribution box
T.B. 4.04 Grease trap
T.B. 4.05 Soil stability and permeability tests
T.B. 4.06 Soak away pit
T.B. 4.07 Infiltration trench
T.B. 4.08 Evapo-transpiration area
Chapter 4
Disposal of runoff water and wastewater - draft 4 1

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4 2
Disposal of runoff water and wastewater - draft
TECH-SAN-160_CH4 22/03/10 10:09 Page 3
4.1 Why do runoff water and wastewater have to be disposed of?

The health risks due to pollution carried by wastewater as well as the presence of stagnant water are
the following:
■ Spread and multiplication of pathogenic agents such as cholera vibrio, schistosomonas;
■ Chemical contamination of water (e.g. nitrates, detergents) and ecological disturbance /pollution of
aquatic environments (ground and surface water);
■ Production of noxious and corrosive gases;
■ Breeding of insect vectors (e.g. mosquitoes).
Other nuisances are runoff water and wastewater entering in and/or causing erosion to shelters and
other buildings, roads, pit latrines, waste pits which can lead to difficult and unsafe access to these
facilities and even bigger health risks (e.g. flooded latrines which spread the excreta all over).
4.2 What kinds of wastewaters do exist?

A clear distinction has to be made in between runoff water (e.g. rainwater that doesn’t infiltrate naturally
in the ground) and wastewater (used water). As long as the runoff water doesn’t get in contact with
waste (water), it isn’t considered being contaminated, thus it doesn’t need real “treatment”. However,
standing runoff water can be a breeding ground for vectors, and thus needs to be removed via a
separated evacuation system.
Risks associated with wastewaters depend on their origin and thus their degree of pollution, and it is
useful to classify them as follows:
■ “Domestic” wastewater
➞ Sewage (black water): water carrying excreta in suspension, thus containing bacteria, viruses,
faecal parasites and also nitrogen
➞ Sullage (grey water): water from water distribution points, kitchens, (hand) washing areas and from
health centres, often containing detergents (with nitrogen and phosphorus components), grease
and fats, as well as (faecal) micro-organisms, suspended and/or dissolved organic matter.
■ Specific wastewater from humanitarian interventions
➞ Sullage coming from laboratories: they may contain hazardous chemical substances, as well as
micro-organisms (e.g. of faecal origin).
➞ Liquid residues from water treatment systems: bawwater or sedimentation sludge will be highly
concentrated with dirt and chemicals when coagulants are used.
■ Agricultural wastewater
➞ High concentration of nitrates and pesticides in water supply.
■ Industrial wastewater
➞ Wastewater from mining
➞ Contamination of surface water and groundwater by chemicals.
4.3 Where / When should runoff water and wastewater management

be implemented and by Who?
All runoff water should always be controlled to avoid risks of flooding or stagnant water. In order not
to contaminate the big amounts of runoff water that can’t be infiltrated, a separated and appropriate
evacuation system for the wastewater and the rainwater has to be foreseen.
For every situation where water is supplied, there will be wastewater generated. Therefore, there
should always be a removal and “treatment” system, which prevents stagnant water and local
contamination of potable water resources.

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Wastewater within a humanitarian context can be found at a lot of different places; for instance:
■ Water points: e.g. spillage around wells and taps, leading to standing water
■ User points: e.g. kitchen, laboratory, showers (T.B. 4.01), washing areas (dishes, bathing, laundry;
T.B. 4.02), hand washing stations.
■ (Pour-) flushing toilets.
■ Water treatment sites: e.g. sludge from assisted sedimentation or from backwashing of filters.
Appropriate facilities should always be foreseen close to the site where the wastewater is generated.
Wastewater from laboratories (mixed with chemicals) and health structures do often demand some
extra attention however. In these cases, additional support must be required from your technical
referent.
The construction, operation and maintenance should be discussed and agreed upon with all the
stakeholders (e.g. aid-agency, population, local authorities) in order to have the facilities build, used and
maintained correctly (e.g. no washing at water points lacking a grease trap, no dumping of solid waste in
the open drainage canals). Health promotion activities can help to achieve this.
4.4 How should runoff water and wastewater be managed?

For correct planning and organisation of runoff water and wastewater disposal, it is necessary to follow
all the different steps described in the chapter 1. Within a humanitarian context, a lot of the facilities
that generate and dispose of wastewater will have to be provided according to the essential water and
sanitation requirements for health structures or camps (T.B. 1.08; 1.09), but adapted to the needs,
habits and culture of the beneficiaries (e.g. traditionally, do the people stand or kneel during laundry
activities). The more users’ friendly and appropriate the facilities are, the more they will be used.
Information and promotion activities will need to be organized for the population to use and maintain
the facilities correctly.

The technical process of runoff water and wastewater management consists of:
1. Removal of the water (“transport”)
2. Potential pre-treatment of the water
3. Final disposal
1. Removal
A removal system should be able to evacuate runoff water and/or wastewater, so as to avoid stagnant
water, and to channel it to the treatment / disposal site without contaminating the local environment.
The collection surface for runoff water or wastewater should be gently sloped (at least 1%) and
preferably cemented. The removal system design may be based on different techniques:
■ Open channel
This is the most simple and least costly technique but it entails maintenance problems: e.g. blockages,
stagnant water, damage to the sides of the channel, people dumping their garbage in it. This technique
should only be used for drainage of runoff water or for evacuation of sullage over short distances. The
channel should preferably be cement-lined and with enough slope to be self-cleansing (about 1.5 %). In
case cement-lining would be impossible, the open channel could be reinforced with boulders to avoid
collapses but leaving enough gaps for the water to pass easily.
■ Gravel drain
For sullage, a wide piece of plastic sheeting can be laid in an open channel, filled up with coarse gravel
and finally folded over the gravel to form a sort of pipe. The whole gravel drain should be covered with
an earth layer. As this type of drain is impossible to unblock, the sullage should never contain
suspended or greasy material. It should only be used in (the early stages of) an emergency, for
example at a dispensary or a laboratory.
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■ Pipe
This is the most effective way of removing runoff water and all kinds of wastewater, but also the most
expensive one. Various types of pipe may be used (e.g. PVC, polyethylene, cement), with a minimum
diameter of 100 mm. The slope (minimum 1% and minimum 1.5 % for black water) and the pipe diameter
should be adequate for the flow, and the pipes should be buried. Special care should be taken at crossing
places of vehicles and big animals (e.g. plastic pipe covered by concrete slabs or installed within a bigger
diameter steel pipe). Manholes and collection boxes (T.B. 4.03) should be included when long and/or
complex drainpipe systems are installed. These can help during the regularly needed checkups in order
to deal with blockages.
2. Potential pre-treatment
It may be necessary to pre-treat the water to remove solid or dissolved matter that could hamper the
removal and/or the final disposal:
■ Screen to remove floating and bulky objects.
■ Sand trap to separate sand and soil, via sedimentation.
■ Grease-trap (T.B. 4.04) to eliminate oily and greasy material (e.g. soap) in wastewater (sullage).
The sand and grease trap can be combined.
■ Septic tank (T.B. 3.11) to eliminate faecal material in sewage.
■ Sedimentation hole to eliminate flocks from water treatment.
If not well operated and/or maintained, all these structures can block the wastewater system and
possibly become ideal vector breeding sites as well.
3. Final disposal
Where rainwater doesn’t infiltrate naturally in the ground within few hours, the runoff water can be
evacuated directly to surface water like rivers or streams, but downhill of existing water intake points.
Swamps or lakes can also be considered as possible evacuation locations when no water is taken for
consumption at these places. As runoff water shouldn’t be contaminated, the evacuation can be done
without specific treatment, except possibly the removal of floating and bulky objects.
For wastewater however, many different techniques exist and the choice of a system, or a combination
of several, depends on the type and the quantity of wastewater to be treated.
In settings of low-income countries, the methods, as described in these guidelines, should be as
simple, as affordable and as durable as possible, so that they can continue to be operational.
Completely natural treatment methods are therefore preferable. Infiltration combines the final disposal
with a form of natural treatment. It uses the natural capacity of the soil to fix particles present in the
water by filtration, and to purify the water by a process of biological decomposition capable of retaining
organic matter including micro-organisms, and some chemical pollution.
This natural capacity is always extremely variable, depending on the soil type (ground condition):
■ A mature organic-rich soil is host to intense biological activity favouring purification, but it blocks
rapidly and so has a reduced infiltration potential;
■ Conversely, a sandy soil (generally considered as a good filter) with coarse structure may have an
infiltration rate which is too rapid and which does not allow sufficient time for purification if the water
table is too close to the surface;
■ For the same reasons, a fissured rock would only have a small purifying capacity.
In practice, following parameters should be studied in order to design the wastewater facilities:
■ The slope of the ground (topography; T.B. 2.24): a slope too steep may encourage water to remerge
and thus to contaminate the ground surface.
■ The infiltration rate: determined by percolation tests with potable water (T.B. 4.05).
■ The groundwater level: a high level (e.g. during the rainy season) will increase the risk of groundwater
pollution and won’t permit the infiltration of large amounts of wastewater.

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The principle of infiltration is used (sometimes in combination with other principles) in the following final
disposal techniques:
■ Soak away (SA) pit (T.B. 4.06),
■ Infiltration trench (IT) (T.B. 4.07),
■ Evapo-transpiration (ET) area (T.B. 4.08),
■ Irrigation furrow (IF) (only for spilled clean water at water points),
■ Sewer (S).
Overview of the different steps for runoff water and different kinds of common wastewater:
Removal Pre-treatment Final Disposal
Runoff water Channel, Drain Not needed River, Stream

Water point spillage Channel, Drain, Pipe Not needed IT, SA, IF, ET, S
Sullage (grey water) Pipe Grease trap IT, SA, ET, S
Sewage (black water) Pipe Septic tank IT, SA, ET, S
If all final disposal methods for wastewater fail where it rains a lot, there is still the possibility to mix
the wastewater with the runoff water and to drain everything away towards surface water without
further pre-treatment, except possibly the removal of floating and bulky objects. This dilution will reduce
the concentration of pathogens and thus the risk of contamination. But the drainage should be done
in an as large and as fast flowing river as possible, and downstream of sites where surface water is
collected (e.g. water supply intake). It should also be verified downstream if other people than the
beneficiaries do use the surface water for their daily needs and if the discharge has a potential negative
impact on their health (e.g. by bacteriological analyses).
4.5 Further reading

Willey, 1993
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T.B. 4.01 Showers

General hygiene is important to reduce certain diseases, and thus morbidity and even mortality.
Showers should provide a hygiene facility for the beneficiaries without creating environmental health
risks (e.g. stagnant water). They should be built close to a water point and their design should be
adapted to the habits of the users (bucket shower, overhead shower). Proposed hereafter is just
one possible model, mainly for emergencies.
Construction
■ Choose a site in the neighbourhood of dwellings / (health structure) buildings and close to a water point.
The site should have enough space and capacity to infiltrate wastewater (T.B. 4.05).
■ Prepare the site for construction: remove all debris, flatten the surface, install a temporary fence and bring
in the needed construction material and equipment.
■ Lay out the area with dimensions of at least 2.5 x 2.2 m, using string lines. This size will permit to build
a double shower, with a drainage channel included at the back.
■ Excavate from this area all soil containing dust, hidden debris and decomposing vegetation (humus), and
dig a little deeper at the back to prepare the open drainage channel.
■ Make holes of another 0.4 m deep nearby the corners and in the middle of the area, with a snail house
shape as indicated on the figure.
■ Anchor plastic pipes in the holes, sticking vertically out of the ground by at least 0.3 m. These holes will
facilitate the insertion of the superstructure poles in a later stage.
■ Construct a casing for the slab and drainage channel, at least 0.1 m above the ground level. An alternative
is to use only the excavation as casing and to build protective kerbs afterwards on the edges of the slab
and drainage channel.
■ Prepare the excavated area for the concrete to be cast, if needed:
➞ For an unstable ground, spread a layer of sand and gravel on the whole area and compact it well.
➞ For a stable but permeable ground, put a piece of plastic sheeting on the whole excavated area,
including its edges and the casing.
➞ For stable and impermeable ground, no specific features need to be foreseen.
■ Prepare and cast lean concrete (150 kg/m³; T.B. 2.05) to form the slab and the drainage channel. The
concrete should be vibrated to remove all oxygen. Once the concrete starts to settle, create for the slab
a slope of 1 to maximum 4 % towards the open drainage channel, needing itself a perpendicular slope
of 1.5 %. Try to obtain a smooth surface because it will help to drain the wastewater away. However, the
slab should not become slippery as this could lead to accidents.
■ Cover the slab and drainage channel with thick sacking that is regularly wetted or with plastic sheeting
(that will keep the humidity inside), and let it cure for at least 1 week.
■ Connect the shower via a grid and a grease trap (T.B. 4.04), to an infiltration system like a soak away
pit (T.B. 4.06), an infiltration trench (T.B. 4.07), an evapo-transpiration area (T.B. 4.08) or a closed sewer
system.
■ Make a superstructure with poles and plastic sheeting or waterproof local material. It is strongly
recommended to install a roof over the showers with separate drainage to avoid too much rainwater
evacuating via the grease trap and infiltration system, which will eventually lead to their breakdown. If the
separate drainage is extended around the structure, runoff water can be evacuated without eroding the
showers.
■ Fence off the area with a permanent structure to protect it against animals.
Maintenance
■ Make sure that the concrete slab and the superstructure of the showers are cleaned and disinfected
with 0.1% chlorine solution (T.B. 2.20) every day.
■ Make sure that the grid retaining solids from going into the grease trap and infiltration facilities is
checked / cleaned on a daily basis.
■ Make sure that the grease trap is maintained on a weekly basis (T.B. 4.04).

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Key Input
1. Shower slab (1 to max 4 % slope) - Shovels, hoes and pick
2. Drainage channel (1.5% slope) - String line, sticks and tape measure
leading via grate and grease trap to an - Spirit level
infiltration / disposal system - Plastic sheeting or jute sacking
3. Superstructure (e.g. non-transparent plastic)
- Sand, cement and gravel
4. Entrance of the shower (curtain) - Clean water
5. Strong poles (possibly connected diagonally)- Casing material (wooden planks)
6. Curtain support - Trowel, float, long flat lath
- Plastic pipes (PVC)
Dimension (in m) is indicative - Poles, plastic sheeting or local waterproof
and has to be adapted according to the context material
- Big and small hammer
- Nails and rope
- Temporary and permanent fence material
Remarks
■ Several of these shower constructions can be put in rows. The amount of showers needed depends on
the number of potential users (1 shower / 40 persons; T.B. 1.08; 1.09).
■ The location of the shower unit should not be too remote from the dwellings / (health structure) buildings,
to increase the comfort but even more to reduce potential sexual violence. The location should also permit
to enter the shower in a discrete manner (e.g. not in the middle of a public court).
■ An additional non-transparent screen in front of the entry side of the showers improves the privacy, which
might lead to a more frequent use of the facilities. In certain cultures, the use of showers might drastically
increase when they are integrated within a comfort zone together with latrines and washing facilities for
sanitary towels. In other places, it might be better to keep the showers completely separated from the
latrines, to avoid confusion in their use.
■ Also for privacy purposes, avoid elevated areas (e.g. heaps of excavated soil) nearby the showers.
■ It is also important in most cultures to have separated shower facilities for men and women. It is strongly
recommended to have separated showers as well for the staff in health structures.
■ In all cases, the showers should be adapted to the habits (e.g. bucket shower, overhead shower with
running water) and the average height of its users. In case of overhead showers with running water, be
aware that the water consumption will increase drastically, meaning that the capacity of the wastewater
facilities will have to be adapted as well.
■ Special attention should go as well to showers for physically impaired people. The water supply should
be close to the showers and easy accessible. More space, a seat and handle bars should be available.
It is recommended that in-patient health structures have such adapted shower facilities.
■ For hygienic reasons, it should be avoided that showers are used for washing laundry or dishes.
■ The slab and drainage channel can also be made with bricks that are covered with cement plaster (T.B.
2.05), but this construction is generally less strong than concrete.
■ The curing of the slab is important to obtain its strength (T.B. 2.05)
■ It is recommended to install a hook within the superstructures to allow users to hang up their clothes
■ In places where people defecate in the showers, the bottom of the superstructure panels could start just
above ankle height (about 0.2 m) to avoid people squatting down. This system cannot be used in all
cultures, which has to be verified during the assessment.
■ A good drainage with grid, settlement tank with grease trap and disposal / infiltration system is essential
to avoid the shower area to become a puddle of stagnant water and thus a potential health hazard.
■ Plastic bags are often used to transport the soap for washing. These bags are often discarded in the
drainage system, which will clog up. To reduce this risk, a waste bin needs to be installed nearby the
shower and its purpose explained to the users. Do not forget to empty and maintain the bin.
■ Soap and buckets should be supplied to allow people to wash themselves.
■ In certain countries, the shower might be replaced by a sauna (beyond the scope of these guidelines).

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T.B. 4.02 Washing facilities

A washing area should provide a hygiene facility to do the laundry or the dishes, without creating
environmental health risks (e.g. stagnant water). Its design should be adapted to the habits of the
population, particularly concerning the position generally used by women to wash clothes or dishes
(e.g. crouching or standing up). The facility described here is about the simplest possible to build.
Construction
■ Choose a site in the neighbourhood of the dwellings / (health structure) buildings and close to a
water point. The site should have enough space and potential to infiltrate wastewater (T.B. 4.05).
■ Prepare the site for construction: remove all debris, flatten the surface, install a temporary fence and
bring in the needed construction material and equipment.
■ Lay out the area using a string line. An area of 1.5 x 1 m must be considered as the minimum space
needed for one user doing the laundry. A larger width will raise the comfort for the individual user,
whereas the total length is linked with the potential number of persons using the facility at the same
time. Be aware however that the bigger the size of a concrete slab, the higher the risk of cracking.
So it is better to construct several washing facilities of reasonable size (e.g. 4 m length) instead of
a huge one.
■ Excavate from this area all soil containing dust, hidden debris and decomposing vegetation (humus).
■ Prepare the excavated area for the concrete to be cast. In case of:
➞ an unstable ground, spread a layer of sand and gravel on the whole excavated area and compact
it well.
➞ a stable but permeable ground, put a piece of plastic sheeting on the whole excavated area,
including its edges.
➞ a stable and impermeable ground, no specific features need to be foreseen; except if the excavated
area is deep and requires some backfilling with a compacted layer of sand and gravel.
■ Prepare and cast lean concrete (150 kg/m³; T.B. 2.05) to form the double sloped slab and the
drainage channel. The concrete should be vibrated to remove all oxygen. Once the concrete starts
to settle, create slopes of maximum 4 % along the whole area’s length, both leading to the drainage
channel in the middle, needing itself a perpendicular slope of 1.5 % (the direction of all slopes are
indicated by the arrows on the figure). Try to obtain a smooth surface because it will help to drain
the wastewater away. However, the slab should not become slippery as this could lead to accidents.
■ Cover the whole slab with thick sacking that is regularly wetted or with plastic sheeting (that will keep
the humidity inside) and let it cure for at least 1 week.
■ Construct on the circumference of the concrete slab a protective kerb with fired bricks or cement
blocks, leaving an opening at the level of the drainage channel. The protective kerb should rise at
least 0.1 m above the ground level.
■ Construct a simple and open collection box (T.B. 4.03) at the end of the drainage channel.
■ Cover all the surfaces of the protective kerb and collection box) with two layers of cement plaster
(each 10 mm thick; T.B. 2.05), and smooth it well. Let it cure for several days, preferably a week.
■ Connect the collection box of the washing facility via a grease trap (T.B. 4.04) to an infiltration system
like a soak away pit (T.B. 4.06), an infiltration trench (T.B. 4.07), an evapo-transpiration area (T.B.
4.08), or a sewer system. To avoid the connection pipes in between the wastewater facilities getting
blocked with big (waste) fragments, a grid should be installed inside the collection box.
■ Install preferably a roof over the washing facility with a rainwater harvesting system (T.B. 2.09) and/or
a separate drainage to avoid too much runoff water evacuating via the grease trap and infiltration
facility, which will eventually lead to their breakdown. If the separate drainage is extended around the
structure, runoff water can be evacuated without eroding the washing facilities.
■ Fence off the area to protect it against animals.
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Maintenance
■ Make sure that the slab of the washing facilities is cleaned and disinfected with 0.1% chlorine solution
(T.B. 2.20) every day.
■ Make sure that the grid retaining solids from going into the grease trap and the infiltration facilities
is checked / cleaned on a daily basis.
■ Make sure that the grease trap is maintained on a weekly basis (T.B. 4.04).
Key Input
1. Washing slab (sloping towards drainage - Shovels, hoes and picks
channel, maximum 4 %) - String line, sticks and tape measure
2. Drainage channel (1.5 % slope) - Spirit level
3. Drainpipe towards grease trap and final disposal - Plastic sheeting or jute sacking
4. Collection box with grid - Sand, cement and gravel
5. Soil (possibly covered with sand / gravel or plastic) - Clean water
6. Lean concrete slab - Fired bricks or cement blocks
7. Protective kerb - Trowel, float, cement-mixing trough
- Roof material and tools
- Temporary and permanent
fencing material
Measurements (in m) are indicative and have to be adapted according to the context.

TECH-SAN-160_CH4 22/03/10 10:09 Page 12
Remarks
■ The location of the washing facilities unit should not be too remote from the dwellings / (health
structure) buildings to increase the comfort, but even more to reduce the potential sexual violence.
■ If people prefer to wash clothes standing up, a raised concrete tub that can easily be emptied, or a
raised slab (e.g. at table height) is required. Clothes or dishes are also sometimes washed within a
basin or 200 l drum cut in half.
■ The number of washing facilities needed depends a lot on the habits of the users. It is also strongly
recommended that every health structure has a washing facility.
■ Special attention should go to the design of washing facilities used by pregnant women or/and
(temporary) disabled people. Often, they won’t be able to crouch down, so (slightly) raised facilities
(attention to the height) with the possibility to sit down, potential handle bars and sufficient space
might in some cases be needed.
■ Although similar facilities can be used for washing clothes or cleaning the dishes, it’s strongly
recommended to separate both activities completely. Dirty clothes can contain faecal material, and
are therefore incompatible with eating utensils.
■ The slab and drainage channel can also be made with bricks that are covered with cement plaster
(T.B. 2.05), but this construction is generally less strong than concrete.
■ The curing of the slab is important to obtain its strength (T.B. 2.05)
■ A good drainage with grid, grease trap and disposal / infiltration system is essential to avoid that the
washing area becomes a puddle of stagnant water.
■ In low-income countries, the cooking pots are quite often cleaned with sand / earth and water. To
avoid the risk that the drainage / infiltration system blocks rather rapidly, a grease trap with integrated
settlement tank is recommended. This can easily be obtained by making a standard grease trap
bigger (standard size calculated according the maximum hourly flow of wastewater; T.B. 4.04). Mainly
its depth will have to be increased to raise its storage capacity for the sand / earth.
■ Plastic bags are often used to transport the soap for washing. These bags are often discarded in the
drainage system, which will clog up. There is also the risk that food residues will be disposed of in
the drainage. To reduce these risks, a waste bin needs to be installed nearby the washing area and
its purpose explained to the users. Do not forget to empty and maintain the bin.
■ Drying lines should be part of the washing areas in health structures. This helps avoiding people lying
clothes on the ground to dry. A roof should be installed above the drying lines, certainly during the
rainy season. It is also strongly recommended that where possible, the clothes and linen are ironed
before being used again (e.g. for protection against Myasis).
■ Soap and buckets might have to be supplied to allow people to improve their hygiene.
■ During the acute phase of an emergency in a camp, it is possible to make washing areas by using
only plastic sheeting (the same as being used for temporary shelters). The ground surface within a
shallow excavation must be carefully prepared and all sharp objects (e.g. stones, roots) removed.
A sand – gravel mixture compacted within the excavation provides the slopes for the working surface
and drainage channel. These slopes should be lined with a double thickness of plastic sheeting.
The edges of the plastic should be fixed with stones and covered with well-compacted earth. This
technique only lasts a few days because the plastic sheeting gets damaged very quickly and/or
might get stolen.
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T.B. 4.03 Manhole / Collection - Distribution box

Manholes permit to verify the correct functioning of underground wastewater pipes, and potentially
to unclog them. A manhole is usually foreseen at every 10 to 15 m length of pipe and at each
crossing and/or sideways connection of pipes. Collection boxes are needed to bring wastewater
coming from different directions together in one evacuation pipe, and should allow as well an internal
check of the underground disposal system. Distribution boxes are similar to collection boxes, but
their design with multiple evacuation pipes at the bottom leads the wastewater away towards
different directions. They all need to be maintained and cleaned at least once a month.
Construction
■ Foresee extra space for manholes / collection-distribution boxes at the described places, while
digging the trenches for a piped wastewater evacuation and dispersal system. The size of the extra
excavation depends on the depth of the piping system. The deeper the pipes, the deeper and also
the wider the manhole / collection-distribution box (for people to enter completely) and thus their
excavation need to be. This means also a serious increase in costs. The minimum operational inner
size is 0.60 x 0.60 m, to allow entering a device to unblock the system.
■ Build the manholes / collection-distribution boxes out of concrete or masonry-work (fired bricks,
cement blocks or stones according to what is available) and foresee holes for the pipes. The bottom
of the manholes / collection-distribution boxes must be constructed with a gradient equal to the slope
of the pipes they will be connected to (at least 1%), and have a shape that helps to lead the
wastewater into the evacuation pipes.
■ Install the pipes (diameter of at least 100 mm) in the manholes / collection-distribution boxes. Each
evacuation (outlet) pipe should be at the same level as the bottom of their respective manhole /
collection-distribution box.
■ Make each manhole / collection-distribution box as watertight as possible by covering all its inner and
outer surfaces with cement plaster (T.B. 2.05), and give particular attention to the pipes passages.
For the outer surfaces, only one 10 mm layer is required, whereas internally it is recommended to
add a second 10 mm layer once the first one has dried. Smooth the second inside layer well because
this will ease the maintenance afterwards.
■ Install a solid (watertight) lid on each manhole / collection - distribution box to avoid access to vectors.
■ Backfill the space in between each manhole / collection - distribution box and its respective excavated
hole with compacted soil.
Remarks
■ Make sure to install a temporary fence around the works to avoid accidents.
■ Avoid having an evacuation pipe higher than the bottom of its manhole / collection-distribution box
because it will produce stagnant water and dry blockings if the water would evaporate.
■ Installing a complete pipe through the manhole / collection box, with its upper half been cut out at
the section where it passes the box (see drawing), is a good alternative because it simplifies the
works to make the construction watertight.
■ Be aware that a concrete lid of 0.80 x 0.80 x 0.07 m weighs about 95 kg. For the maintenance to be
done regularly (e.g. once a month), it’s important that the lid has good handles and isn’t too heavy
(maximum 50 kg if it is to be opened by a single maintenance person). It’s recommended for big
concrete lids to make them in several parts or to choose a lighter but still solid and watertight material.
■ In the first phase of an emergency, manholes and collection-distribution boxes can also be made out
of 200 l drums. The recommendations for normal manholes and collection boxes (e.g. the position
of the evacuation pipe, the shape of the bottom and sealed pipe entrances) are also valid for
temporary models.
■ The manhole construction can also be used in (potable) water systems to render the valves and
connections protected and accessible. Provide the lid of the manhole with a padlock to avoid that
people would fiddle with the valves.

TECH-SAN-160_CH4 22/03/10 10:09 Page 14
Key Input
A. Front view of a collection box
B. Side view of a collection box
1. Watertight casing - Detailed construction plans

2. Removable lid (each element < 50 kg) - Cement, sand, gravel, clean water
3. Handle - Shuttering timber (for concrete)
4. Incoming pipe A - Bricks / blocs / stones
5. Outlet pipe - Masonry tools
6. Pipe B* (represented here as an incoming pipe) - 6 mm reinforcing bars (lid)
7. Cemented slope - Shovel, hoe, pick, miner’s bar
- Pipe: (min. diameter 100 mm PVC pipe)
- Temporary fence material
*: - When pipe B isn’t located at the bottom of the box (as indicated on the figure), it’s an incoming pipe,
and the facility functions like a collection box
- When pipe B is located at the bottom of the box, it’s an outlet, and the facility functions like a
distribution box (e.g. infiltration trenches; T.B. 4.07 and evapo-transpiration area; T.B.4.08)
- If there is no pipe B, the facility functions as a manhole.
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T.B. 4.04 Grease trap

A grease trap is used for separating oil, fat and some solid materials from the wastewater before
its disposal in the ground, or even in a sewer system. If oil, grease and solid materials are left in
the effluent, they very quickly clog an infiltration system.
Principle
Two simple types of grease traps may be distinguished, and the choice between one of them will often
be decided by the materials and skills available:
■ With an elbow at the inlet and a “Tee” at the outlet (easiest solution; “A type” on the figure)
■ With separating partitions until the bottom (better retrieval of solid material; “B type” on the figure).
Any grease trap operates with three zones:

■ An inlet zone that slows down and distributes the effluent in the trap;
■ A middle zone where fatty material floats and accumulates at the surface, and where heavier solids
settle to the bottom;
■ An outlet zone where grease-free water flows out towards the underground dispersal system or the
underground sewer system.
Construction
■ Choose a place as close as possible to the site where the wastewater is generated, with easy access
and in front of the dispersal system: soak away pit (T.B. 4.06), infiltration trench (T.B. 4.07),
evapo-transpiration area (T.B. 4.08) or sewer.
■ Design the grease trap and draw a detailed plan. It should be rectangular in shape with its in- and
outlet as far as possible from each other. The effective volume of the grease trap (volume actually
filled with wastewater) should be enough to allow a sufficient retention time of the wastewater for the
oil and fat to be separated, and for the solids to settle. As a general rule, consider that the effective
volume should at least be double the maximum hourly flow entering the trap; e.g. for 100 l of
wastewater entering per hour during the peak moment, the effective volume of the grease trap should
be at least 200 l.
■ Prepare the site for construction: remove all debris, lay out the area, install a temporary fence and
■ Excavate at the chosen place, along the evacuation pipe trench, the area for the grease trap. The
excavation dimensions must be bigger than the size of the grease trap to be built.
■ Build the grease trap using locally available means and materials like cast concrete or masonry-work
(fired bricks, cement blocks or stones), and foresee openings for the pipes. Make sure that the casing
sticks out of the ground by at least 0.1 m to avoid runoff water entering the grease trap.
■ Position the inlet and outlet pipes (diameter of at least 100 mm) carefully in order to facilitate the flow
and the operation of the trap (see drawings).
■ Make the grease trap as watertight as possible, by covering all its inner and outer surfaces with
cement plaster (T.B. 2.05), and give particular attention to the pipe passages. For the outer surfaces,
only one 10 mm layer is required, whereas internally it is recommended to add a second 10 mm layer
once the first one has dried. Smooth the second inside layer well because this will ease the
maintenance afterwards.
■ Install a removable cover, equipped with handles. It should fit well on the trap and have a certain
weight to avoid unauthorized opening (by children for instance), but still light enough to be opened
regularly by a single maintenance person (maximum 50 kg).
■ Backfill the space in between the grease trap and the excavated hole with compacted soil.
■ Dig trenches around the grease trap to lead also the runoff water away.

TECH-SAN-160_CH4 22/03/10 10:09 Page 16
Maintenance
■ Make sure that the fat, grease and oil are removed from the grease trap on a weekly basis.
■ Bury the grease layer or possibly discard it in the residues pit in case of a health structure.
■ Don’t forget to remove once in a while also the solids that have settled on the bottom of the grease
trap. To ease this maintenance, a pump capable of pumping solids (e.g. motor pump, dewatering
pump) and a recipient (e.g. bladder) can be used. This pump and the recipient can never be used
anymore for potable water!
Key Input
A. Model with elbow and tee
B. Model with baffles
1. Watertight casing - Detailed construction plans

2. Removable lid with handles (each element < 50 kg) - Fired bricks or cement blocks / concrete
3. Inlet elbow, 90° - Cement, sand, (gravel), clean water
4. Outlet tee - Shuttering timber
5. Inlet - Reinforcing bars (6 – 8 mm)
6. Outlet - Shovel, hoe, pick and miner’s bar
7. Separating partitions (baffles) - Masonry tools
8. Middle zone (separation of fat, grease and oil) - Minimum 100 mm PVC pipe, or elbow
9. Settled solids and Tee
10. Reference line indicating effective depth - Cover (e.g. concrete, metal, solid plastic)
(max. water level) - Temporary fence material
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Remarks
■ Even in situations where a (closed) sewer system exists, wastewater (grey and black) should be
pre-treated before being released (at least respectively by a grease trap or a septic tank).
■ Runoff water should never pass through the grease trap because it isn’t needed (contains normally
no oil, grease or fat), and its effective volume would need to be huge to obtain a sufficient retention
time for the high quantity of diluted wastewater.
■ Concrete covers of grease traps are often a lot heavier than 50 kg, which explains partly why these
facilities aren’t well maintained. If concrete is used for the cover, the grease trap should be designed
in such a way that the lid is divided in several parts, but still closes tightly to avoid vectors entering.
Other lighter and resistant materials like metallic sheets (treated against rust), aluminium or plastic
should also be considered for the cover of the grease trap.
■ The “B type” partition baffles help to reduce the amount of settled materials escaping from the grease
trap. The (PVC) pipes passing through, or the honeycombed part in the partitions should be at least
100 mm above the bottom of the grease trap.
■ Good maintenance is the key to an effective grease trap as it will limit odours and avoid fat and oil
getting into the infiltration / sewer system.
■ The oil and fat coming out of a grease trap should never be disposed of in an organic waste pit or a
latrine. They would clog the vertical infiltration walls of the pit, therefore obstructing the liquids to
infiltrate into the ground.
■ To be able to perform the maintenance correctly, the staff needs protective clothing such as
(watertight) heavy-duty rubber gloves, overall, mask, boots and other material such as collection
and transport recipients, a pump, a wheelbarrow and shovels.
■ The maintenance team should be able to recognize when a grease trap doesn’t function properly.
Some indicators can be:
➞ soapy water enters the infiltration system (e.g. to be seen at its distribution box).
➞ infiltration system starts to overflow (although other reasons can be the cause as well).
➞ grease trap overflows (possibly due to bad maintenance or a wrong design).
■ In emergency situations and where the amount of wastewater is very limited (peak flow < 50 l/h), a
grease trap can be constructed out of a 200 l drum, an elbow and a T-piece (according to the “A
type”).
■ Grease traps can also be made out of rectangular plastic containers, or even bought ready-made
(importation probably needed).

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T.B. 4.05 Soil stability and permeability tests

The surface of the Earth consists of consolidated (stone / rock formations) and unconsolidated
(soil) material, the latter being categorised in numerous soil textures. A precise description of the
numerous textures is beyond the scope of this manual. However, every texture has its own stability,
which has its influence on the lifespan and stability (risk of collapse) of ground works like for latrines
and waste pits. Texture tests allow the estimation of the soil stability. All soil textures also have their
own permeability, influencing the infiltration capacity. The measurement of the soil permeability by
means of percolation tests allows:
- the estimation of the infiltration capacity of a soil to be used for the dispersal of effluents;
- the potential sizing of a dispersal system.
Soil texture test
Soil texture is the relative proportion in percentage of sand, silt and clay-sized mineral particles in the
fine-earth fraction of the soil. The physical properties of soils depend largely on their texture: e.g. sand
is gritty and has very good drainage capacities, but it is unstable with regards to excavations; clay
feels slick and sticky, and exhibits plasticity when mixed with water, to which it is relatively impermeable,
but it is stable against collapse when dry; silt feels smooth and velvety (like flour). Loams are composed
of sand, silt and clay, in different proportions, having an influence on their properties (e.g. water
retention, plasticity, permeability). The soil texture can be determined on the field with the following
test (adapted from Lindbo et al.):
1. Humidify the soil enough to be able to mould it like putty, but without saturating it.
2. Can a ball be made of the soil?
No Yes
Sand Other soil textures
3. When pressing the ball between thumb and forefinger, does

the soil form a ribbon that extends beyond the forefinger?
No Yes
Loamy sand Loams or clays
4. Is it possible to make the ribbon

longer than 25 mm before it breaks?
No Yes
Other loams or clays
Wet a small sample of the ribbon
excessively in the hand palm and
rub it with the forefinger. If it feels:
gritty ➞ Sandy loam
smooth ➞ Silt loam
neither ➞ Loam
5. Is it possible to make the ribbon
longer than 50 mm before it breaks?
No Yes
Wet a small sample of the ribbon Wet a small sample of the ribbon
excessively in the hand palm and excessively in the hand palm and
rub it with the forefinger. If it feels: rub it with the forefinger. If it feels:
gritty ➞ Sandy clay loam gritty ➞ Sandy clay
smooth ➞ Silty clay loam smooth ➞ Silty clay
neither ➞ Clay loam neither ➞ Clay
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Percolation test
Although the determination of the texture gives already an indication on the permeability of the soil
(see table hereafter), it is recommended to do a percolation test as well.
■ Make at least 3 test holes, each one with a diameter (D) of 0.15 m and 0.5 m deep on the proposed site.
■ Fill the holes completely with potable water and leave overnight (or at least for several hours) to
bring the soil to a saturated state.
■ Fill the test holes the next day with potable water to a height of 0.3 m (if the water levels in the holes
are still at or above 0.3 m height overnight, the permeability will certainly be too low for infiltration
systems).
■ Measure the water levels in the holes after 30 minutes and again after 90 minutes.
■ Calculate the average difference in water levels of the three holes (h) corresponding to this period
of 60 minutes, in order to determine the average water volume (Vav) that has been infiltrated per hole:
Vav (l) = 3.1416 x D²/4 (m²) x h (m) x 1000
■ Extrapolate this average infiltrated water volume per hole (vertical infiltration area of about 0.15 m²) to
an infiltration surface of 1 m² over a 24 hours period in order to obtain the infiltration rate in l/m² day:
Infiltration rate (l/m² day) = Vav (l)/0.15 (m²) x 24 (hours)
■ Compare the result with the infiltration rate values of potable water for different soil textures
represented in the table hereafter. Thus an indication for the infiltration rate of wastewater for this soil
is obtained as well.
Key Input
1. (Permeable) soil at the site proposed for a dispersal system -1 operator
2. Test holes (diameter = 0.15 m, depth = 0.50 m) -1 hand auger or pick and shovel
3. Test holes filled with 0.30 m of water -1 watch or stopwatch
-1 tape measure

TECH-SAN-160_CH4 22/03/10 10:09 Page 20
Formulas
Volume of effluent to be infiltrated (l/day)

Effective infiltration surface (m²) =
Soil infiltration rate (l/m² day)
Soak away pit (round model) (T.B. 4.06)

In case the water table level isn’t a limiting factor for the design of a soak away pit, its diameter can
be chosen and thus the minimum depth calculated. It is recommended however for safety reasons that
an unlined soak away pit doesn’t exceed a depth of 2 – 3 m (depending on the soil texture).
Effective infiltration surface (m²)
Depth of soak away pit (m) = + 0.5 m
3.1416 x pit diameter (m)
The 0.5 m is the estimated depth of the pipe outlet and the surface above isn’t effective for
infiltration. This supplementary depth might have to be adapted to the real depth of the pipe outlet.
If the water table level is relatively high and represents thus a limiting factor for the soak away pit’s
depth, the diameter will have to be adapted to the maximum depth that can be admitted. Make sure
that the bottom of the soak away pit is always at least 1.5 m above the highest water table level (rainy
season). Following formula can be used:
Diameter of soak away pit (m) =
3.1416 x (max. pit depth – 0.5) (m)
The 0.5 m is the estimated depth of the pipe outlet and the surface above isn’t effective for
infiltration. This supplementary depth might have to be adapted to the real depth of the pipe outlet.
Infiltration trench (T.B. 4.07)
Once the effective infiltration surface is known, the length of infiltration trenches can be calculated:
Length of infiltration trench (m) =
2 x effective depth of trench below drain pipe (m)
The effective depth is the infiltration height underneath the perforated pipe The bottom of the trench
should be at least 1.5 m above the highest water table.
Example of dimensions of a dispersal system
The effluent of the septic tank of a health centre must be eliminated with infiltration trenches.
■ The effluent volume to infiltrate is 500 l/day.
■ The infiltration rate of the soil is estimated at 10 l/m² day.
■ The trenches will have an effective depth of 0.5 m.
- The effective infiltration surface is calculated according to the following way:

Volume of the effluent (l/day) = 500 = 50 m²
Infiltration rate (l/m² day) 10
- A trench is made of two vertical walls; the total length of the trench is obtained by:
Infiltration surface (m²) = 50 = 50 m

2 x effective depth (m) 2 x 0.5
At least two trenches of 25 m length will be required (the maximum length of a single infiltration trench is
limited to 30m). An alternative is to make infiltration trenches with the typical trident form (T.B. 4.07);
each trench with a minimum length of 17 m. Notice that only the vertical surfaces (and not the bottom)
of the trench have been taken into account in the calculation of the infiltration surface.
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TECH-SAN-160_CH4 22/03/10 10:09 Page 21
Remarks
Soil texture test
■ Each time a pit or trench has to be dug, soil texture tests should be performed to determine the risk of
collapse. The soil texture might change as the excavation gets deeper. Therefore might it be necessary
to repeat the soil texture test at different depths, certainly when the colour of the soil changes and/or when
it feels differently. It is also recommended to do soil texture tests at different places along a trench
excavation. The soil humidity also plays a role in its stability (the wetter, the faster is will collapse).
■ Pits with a partial lining (T.B. 3.04) can be excavated in soils with sand or loamy sand textures to a depth
of 2 m only, whereas the depth can be increased to 3 m in soils with mainly dry loam and/or dry clay
textures.
■ The table represents the approximate infiltration rate estimations of potable water and wastewater
according to the soil texture:
Soil texture Infiltration rate Infiltration rate of
of potable water (l/m² day) wastewater (l/m2 day)
Sand and loamy sand 2400 – 720 50 – 33
Sandy loam and loam 720 – 480 33 – 25
Sandy clay loam, silt loam, 480 – 120 25 – 12
clay loam, silty clay loam and silt
Sandy clay, silty clay and clay 120 – 24 16 – 4
Clay is not suitable for soak away pits or infiltration trenches Adapted from Lindbo et al.
Percolation test
■ This method of evaluating the soil permeability depends very much on the homogeneity of the soil.
Therefore, a single percolation test has to be taken with precaution, as its results might not always
represent the reality. It is advised to perform several percolation tests over the foreseen length of long
trenches. As the excavation progresses, a number of percolation tests should also be done at different
depths, certainly when the colour of the soil changes and/or when it feels differently. However, as such
a test is quite time consuming, it isn’t required for pits constructed during acute emergencies.
■ As the percolation test is done with potable water, it does not take into account the clogging effect of the
discharge of effluents carrying solids. Even spilled water at water points where there aren’t washing
activities will contain some solids. But in general, the soil may be considered as having a sufficient
infiltration rate for a dispersal system if the level in each hole of the percolation test falls at least by 0.10
m during the 60 minutes period.
■ It has been found that in the long run, the infiltration rate for different soil textures is more or less the same
once the soil surface is partially clogged. To be on the safe side, it’s better to work on the basis of 10
l/m²day for the infiltration of wastewater effluents and 20 l/m²day for water from a water point where no
washing activities are done (e.g. tap stand).
■ Be aware that the greater the permeability of the soil (good infiltration), the higher the risk of the
wastewater contaminating the (ground)water. This should be taken into account for the vertical distance
in between the bottom of pits / infiltration systems and the groundwater table. For homogeneous soils,
the minimum vertical distance should be at least 1.5 m. It is also recommended as a general rule to
install pits / infiltration systems downhill from groundwater points at a minimum distance of 30 m. This
is to prevent microbiological contamination of the groundwater if wastewater would infiltrate until the
aquifer. The minimum distances (vertically and horizontally) are difficult to predict for fissured soils,
unfortunately.
■ It is important to know that when the infiltration capacity of an underground dispersal system (e.g. soak
away pit, infiltration trenches) is calculated, only its vertical surfaces (and not the bottom) can be taken
into account. This is due to a bacteria layer that will form rather quickly on the bottom of the dispersal
systems, which will become impermeable after a while, and thus inhibit all infiltration
■ In case you would notice that your first infiltration facility doesn’t function as predicted by the permeability
test, do not hesitate to construct new ones with oversized dimensions or change the technique (e.g.
evapo-transpiration; T.B. 4.08).

TECH-SAN-160_CH4 22/03/10 10:09 Page 22
T.B. 4.06 Soak away pit

A soak away pit allows the disposal of a limited amount of wastewater from for instance a water
point, kitchen or shower by infiltration into permeable soil, after having passed the necessary
pre-treatment.
Construction
■ Choose a site as close as possible to the grease trap, but at least 6 m from dwellings, 7.5 m from
trees or hedges and 3 m from property boundaries. The site should preferably be downhill and at least
30 m away from (ground)water sources if it is a “domestic” soak away pit.
■ Determine the dimensions of the soak away pit, based on soil texture and permeability tests (T.B.
4.05), the level of the water table and the quantity of wastewater to be infiltrated.
■ Prepare the site for construction: remove all debris, lay out the area, install a temporary fence and
■ Dig the trench for the incoming pipe, with a slope of at least 1 %, 0.3 m wide and at least 0.3 m deep.
■ Dig a circular pit to the required dimensions. Measure the effective depth from the bottom of the
incoming trench until the bottom of the pit. If the pit is deep and/or the soil is unstable, support the
sides with wooden planks and poles during the excavation.
■ Fill the soak away pit with stones up to the level of the trench bottom. The stones should be clean,
with a diameter of 0.05 to 0.15 m.
■ Lay, potentially on a layer of sand, the incoming pipe (min. diameter 100 mm; at least 1% slope)
until the middle of the pit. Clear the stones around the pipe end to create an empty space to aid flow
dispersal.
■ Place a large flat stone over the end (outlet) of the pipe and add a layer of stones (at least 0.1 m thick).
If a flat stone can’t be found, a concrete plate can be used as well.
■ Cover the stones with geo-textile, or if not available, perforated plastic sheeting.
■ Fill the hole with earth and compact it and plant grass on top if the water and/or wind erosion is
severe.
Key Input
1. Permeable soil - Tape measure
2. Incoming pipe (min. diameter 100 mm) - Shovels, hoes, picks and miner’s bars
3. Compacted earth - Wheelbarrow
4. Cleared space at the end of the pipe - Pipe, minimum 100 mm diameter, in PVC or cement
5. Geo-textile or perforated plastic sheeting - Geo-textile or plastic sheeting
6. Clean stones (boulders) - Stones (0.05 – 0.15 m diameter)
7. Flat stone or concrete slab - Temporary fence material
8. Water table - Reinforcing bar or ½” galvanised pipe and hammer
9. Wastewater infiltrating in the soil
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TECH-SAN-160_CH4 22/03/10 10:09 Page 24
Remarks
■ Soak away pits can only infiltrate limited amounts of (pre-treated) wastewater. To determine the
dimensions of the pit, it is important to evaluate the infiltration capacity of the soil and to allow for a
possible increase in the amount of wastewater to be disposed of. Be aware that the infiltration will
only take place via the vertical walls of the pit, thus its bottom should not be included as infiltration
surface (due to an “impermeable” bacteria layer forming on the bottom).
■ The bottom of the soak away pit should be at least 1.5 m (preferably 3.0 m if connected to a septic
tank) above the highest possible water table (during the rainy season). If the groundwater table is
rather high, opt for infiltration trenches (T.B. 4.07). The depth of the water table can be estimated by
verifying its level in nearby wells. Another option is to drive a metal bar such as a reinforcing rod or
(several pieces of) ½” galvanized pipe in the ground to a depth, as deep as 1.5 m beneath the
required pit depth. When pulled out, the rod or (the earth inside) the pipe should be dry. Soil saturated
with water after heavy rainfall might give a false impression of the actual water table level.
■ Even with a water table that is always very deep, it is recommended to restrict the depth of a soak
away pit (preferably to 3 m maximum) to limit the risk of collapse during the excavation works.
■ If stones aren’t available for the reinforcement of the soak away pit, tree branches or bamboo can
be used to construct a circular lining. But soak away pits made with these materials have a shorter
lifespan (maximum 2 years),and are therefore only admissible during (the acute stages of) an
emergency. Soak away pits are sometimes also lined with masonry-work or even concrete rings, with
a concrete slab on top. Make sure that these models have enough holes in their lining to drain the
liquids through their sides. Anyhow, their infiltration surface will be drastically reduced due to the
lining. As these kinds of soak away pits are already a serious investment, infiltration trenches
are probably a better option for sullage. Lined soak away pits can be a rather cheap alternative
however for pour-flush toilets in comparison to a septic tank.
■ There is sometimes a tendency not to cover the soak away pit with compacted earth, certainly in dry
and hot areas. The idea is to use the heat of the sun assisting in the evaporation of the wastewater.
Nevertheless, it is strongly recommended to cover the soak away pit as the geo-textile or perforated
plastic sheeting over the stones prevents soil from getting between the stones and clogging the
system, but still permitting air to get in and gasses to come out of the pit.
■ A grease trap (T.B. 4.04) should be installed in front of the soak away pit when the wastewater
originates from a kitchen, showers, a sink or a washing area, in order to avoid clogging by oil and
fat.
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T.B. 4.07 Infiltration trench

Infiltration trenches may be used for the underground dispersal of wastewater from for instance
kitchens and health centres, after having passed the necessary pre-treatment. They may equally
be used for disposing of effluents from septic tanks.
Construction
■ Choose a site as close as possible to the grease trap, but at least 6 m from dwellings, 7.5 m from trees
or hedges and 3 m from property boundaries. The site should preferably be downhill and at least 30 m
away from (ground)water sources.
■ Determine the dimensions of the trench or trenches according to the soil texture / permeability tests,
the level of the water table and the quantity of wastewater to be infiltrated (T.B. 4.05).
■ Prepare the site for construction: remove all debris, lay out the area with string line, install a temporary
fence and bring in the needed construction material and equipment.
■ Dig the trenches (about 0.3 m wide and at least 0.3 m deep) for the incoming pipe (at least 1% slope)
and the union pipes to form the trident pattern for the drains (at least 1.5 m apart from each other).
■ Dig the actual infiltration trenches to the required dimensions as indicated on the figure (with a slope
of 0.2 % to maximum 0.5 %). The maximum length of a single infiltration trench is limited to 30 m, this
to have a good wastewater repartition.
■ Construct a distribution box at the end of the incoming pipe trench and potentially 3 manholes where
the dispersal drain pipes will end (T.B. 4.03).
■ Install the incoming pipe and the union pipes with elbows (min. diameter 100 mm) in the trenches,
potentially on a layer of sand, and make the connections with the distribution box watertight.
■ Rake the sides and bottom of the infiltration trenches. Do not walk in the trenches after this work.
■ Fill the infiltration trenches with clean (uniform sized) gravel up to the level where the union pipes end,
respecting the 0.2 – 0.5 % slope (min. thickness of the gravel layer: 0.15 m, but preferably up to 1 m).
■ Lay the drains (perforated / porous pipe, or pipe sections with loose joints, minimum diameter of 100
mm), respecting the slope of 0.2 - 0.5 %. Plug the far ends with a cap and make the connection with
each potential manhole watertight.
■ Fill the infiltration trenches with clean gravel to a thickness of at least 0.05 m over the drains.
■ Cover the gravel with geo-textile, or if not available, perforated plastic sheeting.
■ Backfill all the trenches to the top with earth and compact it lightly.
■ Plant grass on top after one or two weeks to limit erosion.

TECH-SAN-160_CH4 22/03/10 10:09 Page 26
Key Input
A. Longitudinal section
B. Bird’s view of the multiple trench system
C. Cross section
1. Permeable soil - Tape measure, string lines and pegs

2. Clean gravel - Shovels, hoes, picks, miner’s bars and wheelbarrow
3. Incoming pipe - Reinforcement bar or ½” galvanised pipe and
4. Drain pipe hammer
5. Geo-textile or perforated plastic sheeting - PVC pipes, (min. diameter 100mm)
6. Compacted earth - Drainpipes (perforated or porous pipe or pipe
7. Plug at the end of the drain pipe sections with loose joints)
8. Distribution box - 2 elbows for drain pipes
9. Manhole (optional) - 3 end caps for drain pipes
10. Water table - Construction material for distribution box /
11. Union pipes with elbow manholes
- Geo-textile or plastic sheeting
- Grass
Figures not up to scale
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Remarks
■ Dispersal systems using simple or multiple trenches with infiltration pipes are a good alternative to
soak away pits:
➞ for somewhat less permeable soils or where there are large quantities of effluent;
➞ in the case of a high water table or where there are rocky layers near the surface.
■ To estimate the dimensions of the trench, evaluate the infiltration capacity of the soil (T.B. 4.05) and
allow for a possible increase in the amount of wastewater to be disposed of. As the infiltration rate
of the soil might differ over the length of the infiltration trench, the rate should be verified at several
locations along the projected trench.
■ Enough space should be available to install infiltration trenches (e.g. in high-income countries, a
minimum ground surface area of 30 m² is foreseen for about 500 l of wastewater per day). Be aware
that the infiltration will only take place via the vertical walls of the infiltration trench, thus the bottom
should not be included as an infiltration surface (due to an “impermeable” bacterial layer forming on
the bottom).
■ The bottom of the infiltration trenches should be at least 1.5 m (preferably 3.0 m if connected to a
septic tank) above the highest possible water table (during the rainy season). The depth of the water
table can be estimated by verifying its level in nearby wells. Another option is to drive a metal bar
such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground, as deep as 1.5 m
beneath the required trench depth. When pulled out, the rod or (the earth inside) the pipe should be
dry. Soil saturated with water after heavy rainfall might give a false impression of the actual water
table level.
■ The dispersal trenches should be at least 1.5 m apart from each other. The distribution box with
inspection cover (T.B. 4.03) installed at the beginning of the drains is to ensure that the effluent flow
is well divided over the different pipes. The small manholes installed at the end of the infiltration
pipes could facilitate the unblocking of the drains if their end caps can be removed.
■ The dispersal drain pipes should have their holes starting at least 0.5 m away from the distribution
box.
■ The geo-textile or perforated plastic sheeting over the gravel bed prevents the entry of soil, which
could block the system and/or limit the infiltration, but still allows air to go in and gasses to get out
of the trenches.
■ Cut the grass regularly in order not to become a breeding and/or hiding ground for vectors.
■ A grease trap (T.B. 4.04) should be installed in front of the infiltration trenches when the wastewater
originates from a kitchen, showers, a sink or a washing area, in order to avoid clogging by oil and fat.

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T.B. 4.08 Evapo-transpiration area

Evapo-transpiration is useful in hot arid areas where a soak away pit or infiltration trenches cannot
be used because of “impermeable” soils (e.g. clay or rock). It combines evaporation of water from
the soil and transpiration by the vegetation, after that the effluents have passed the necessary
pre-treatment.
Principles
Evapo-transpiration is a complex phenomenon that varies with the latitude, the season and the period
of the day. An acceptable approximation can be given by:
Evapo-transpiration rate (mm of water per day) = 0.8 x Evaporation rate of an open basin
The “ground” dimensions of an evapo-transpiration area may be calculated on this basis, in the
absence of other data.
Effective area = volume of wastewater (m³/day)/evapo-transpiration rate (m/day)
If the evaporation rate is not known, it may be roughly measured using an open square (1 m²) basin
filled with water that is placed on the ground. Measure the water height in the basin over several days
and calculate the average. Know that 1 mm of water evaporated within the square 1 m² basin
represents 1 l.
Construction
■ Choose a site as close as possible to the grease trap, but at least 6 m from dwellings, 7.5 m from
trees or hedges and 3 m from property boundaries. The site should preferably be downhill and at least
30 m away from (ground)water sources.
■ Determine the dimensions of the evapo-transpiration area according to the information above.
■ Prepare the site for construction: remove all debris, lay out the area with string line, install a temporary
fence and bring in the needed construction material and equipment.
■ Dig the trenches (about 0.3 m wide and at least 0.3 m deep) for the incoming pipe (at least 1% slope)
and the union pipes to form the trident pattern for the drains (at least 1.5 m apart from each other).
■ Excavate the evapo-transpiration area with a 0.2 % slope, at least 4 m wide, maximum 30 m long
and about 0.25 m deeper than the end of the union pipe trenches (but not deeper than 0.75 m
overall).
■ Construct a distribution box at the end of the incoming pipe trench and potentially 3 manholes where
the dispersal drain pipes will end (T.B. 4.03).
■ Install the incoming pipe and the union pipes with elbows (min. diameter 100 mm) in the trenches,
potentially on a layer of sand, and make the connections with the distribution box watertight.
■ Install the dispersal drains (perforated PVC pipe with a minimum diameter of 100 mm) on a bed of
clean uniform sized gravel (diameter of 20 – 50 mm), while respecting the foreseen slopes of about
0.2 %. Make the connections with the union pipes watertight, and interconnect the far ends of the
dispersal drains.
■ Fill the evapo-transpiration area with a layer of clean uniform sized gravel, at least 0.1 m above the
dispersal drains and cover it with geo-textile. If geo-textile isn’t available, it can be replaced by a
thin layer of fine gravel mixed with clean coarse sand to avoid that fine soil particles will get in
between the uniform gravel and cause blockages. If needed, clean sand can also be added on top
of this thin layer until 0.2 m underneath the ground surface.
■ Cover the evapo-transpiration area with about 0.2 m water absorbing topsoil. In case the topsoil
would not be very water absorbing by itself, it can be mixed with clean sand.
■ Backfill the incoming trench with slightly compacted soil.
■ Build an embankment around the complete evapo-transpiration zone to protect it from runoff water.
■ Plant or sow over the whole area a quick-growing local grass that has a high water consumption.
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Key Input
A. Longitudinal section
B. Bird’s view (exploded views at certain places)
1. Impermeable soil - Tape measure, string line and pegs

2. Clean gravel - Shovels, hoes, picks, wheelbarrows
3. Incoming pipe - PVC pipes (min. diameter 100mm)
4. Union pipes - Dispersal drains (perforated min. diameter 100 mm)
5. Drains interconnected with elbows and tee - 4 elbows and 1 tee for union and drain pipes
6. Geo-textile (or coarse sand / gravel mixture) - Gravel (diameter 20 – 50 mm)
7. Topsoil - Geo-textile or coarse sand and fine gravel mixture
8. Quick-growing grass - Construction material for distribution box / manholes
9. Runoff protection embankment - Water absorbing soil (and possibly clean sand)
10. Distribution box - Quick-growing grass
- Reinforcing bar or ½” galvanised pipe and hammer

Figures not up to scale

TECH-SAN-160_CH4 22/03/10 10:09 Page 30
Design calculation example

A dispensary in a hot, dry tropical zone generates 300 l of wastewater per day. The rocky soil will not
allow underground dispersal. The evaporation rate is a very high 10 mm/day.
Evapo-transpiration rate = 0.8 x 10mm/day = 8 mm/day or 0.008 m of water/day
Effective area = (0.3 m³/day)/(0.008 m/day) = 37.5 m² (in practice about 4 m x 10 m ground surface)
ATTENTION: values for evapo-transpiration of only 2 mm of water per day (2l/m² day) have been
recorded in arid areas of the northern hemisphere.
Remarks
■ The evapo-transpiration area is only suitable for hot, windy, arid or semi-arid climates and can only
deal with very limited wastewater volumes.
■ The evaporation rate (minimum, maximum and average) for a certain region might be found in
specialized literature, universities or weather stations (e.g. airports). It can also be found by putting
a water recipient (with a surface of minimum 1 m²) outside (but not exposed to the rain) and by
measuring every day how many mm of water has evaporated. It’s important to know that the longer
the measuring period lasts, the more precise the average results will be.
■ Small manholes installed at the end of the infiltration pipes could facilitate the potential unblocking
of the drains (if their end elbows or Tee can be removed; T.B. 4.07). The distribution box and the
potential manholes should have an inspection cover.
■ The dispersal drain pipes should have their holes starting at least 0.5 m away from the distribution
box.
■ Choose a short-rooted grass that needs a lot of water for growth. Trees absorbing a lot of water (e.g.
papaya) might break the pipes with their roots, thus they shouldn’t be used for this purpose.
■ Cut the grass regularly in order not to become a breeding and/or hiding ground for vectors.
■ A grease trap (T.B. 4.04) should be installed in front of the evapo-transpiration area when the
wastewater originates from a kitchen, showers, a sink or a washing area, in order to avoid clogging
by oil and fat.
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TECH-SAN-160_CH5 22/03/10 10:10 Page 1
Collection and Disposal

of Refuse
Narrative
Technical briefs
T.B. 5.01 Collective dustbins
T.B. 5.02 Refuse pit
T.B. 5.03 Controlled tip
Chapter 5
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Collection and Disposal of Refuse - draft 5
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5 Collection and Disposal of Refuse - draft
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5.1 Why does refuse have to be managed correctly?

The accumulation of refuse (solid waste) creates a health risk, a nuisance as well as an environmental
pollution problem. The health risks are essentially related to the proliferation of insect vectors and
rodents:
■ The breeding of flies that play a major role in the transmission of faeco-oral diseases;
■ Mosquitoes of the Aedes genus (responsible for the transmission of dengue, yellow fever and other
arboviruses) that lay eggs in water accumulated in empty tins, drums, tyres, etc.;
■ Mosquitoes of the Culex genus (liable to transmit microfilariases) which breed in stagnant water
heavily loaded with organic matter;
■ Rodents attracted by the refuse, which are directly or indirectly responsible for the transmission of
various diseases such as plague, leptospirosis and salmonella, and whose presence attracts snakes.
Another health risk can be for human scavengers looking for useful material that can lead to injuries
and all kinds of diseases (e.g. tetanus).
In addition to these health risks, poor management of the collection and disposal of refuse may involve
the pollution of surface water and/or groundwater. Incorrectly discarded waste also increases the risk
of fire and enables a rapid spread of it when started. Smoke emissions containing pathogens and
hazardous by-products (carbon monoxide, sulphur dioxide, dioxin, furans and heavy metals) can occur
when waste is burned in an open fire. Lastly, the aesthetic aspects (sight and smell) are far from
negligible. These risks and nuisances are all the more serious at high population densities.
5.2 What is considered as refuse?

Refuse is all the solid material that is considered to be non-useful, thus people want to dispose of.
Others might still find a purpose for this material and recycle it in its original or a different form, to be
used for its original or a different purpose. Refuse can be domestic waste, or waste related to
professional activities. Solid waste that is generated by patients and their visitors at health centres
can also be considered as refuse. Medical waste however is specific and is dealt with in a separate
chapter of these guidelines (see Chapter 6).
The type and quantity of refuse produced by a community are extremely variable. The main factors
affecting the composition of refuse are:
■ The geographic region: e.g. often more plastic in Asia than in Africa;
■ Socio-cultural: material levels and living standards may create great variations, as poor people in
low-income countries have a tendency to recycle more;
■ Seasonal variations: different kinds of food during different seasons;
■ The importance and diversity of refuse-generating activities: e.g. workshops, markets;
■ The packaging of food rations: mainly brought in by aid-agencies.
The density of refuse can be estimated to be between 100 to 200 kg/m³. The daily generated volume
varies between 0.5 and 10 l/person. In general, it may be assumed that the daily volume of refuse will
be small (on average more towards 0.5 l/person) when dealing with a population of rural origin and
where the basic ration is under the form of dry foodstuffs (as is often the case during the initial phases
of an emergency operation). But these quantities can rise quickly when aid-agencies start with the
distribution of individually packaged food rations, which can’t be reused / recycled. The amount of
refuse generated in urban areas is often higher as well than in rural zones. The percentage of
putrescible matter may range from 20 to 70%. These figures present orders of magnitude, and in
practice the quantity and volume (or density) of refuse should be determined for each situation. Its
composition is only really important when disposal is by means of incineration or composting, as it has
an impact on these forms of waste treatment.
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5.3 Where / When should refuse management be implemented and by Who?

Refuse can be generated at many different places such as domestic level, workshops, warehouses,
slaughter areas, markets, food distribution points, aid-agency premises or health structures. It is
obvious that collection and correct disposal of refuse always have to be done to avoid health risks as
well as pollution problems, certainly in high population densities where the risks and nuisances are all
the more serious. The refuse disposal management in rural areas can be done on a “household” level
by the population, but for camps and collective buildings / centres (e.g. after a natural disaster) a
collective approach might often be more appropriate, certainly in the early stages of an emergency.
The long-term refuse disposal management for urban zones, also mainly a collective approach, falls
out of the scope of these guidelines. The focus in this chapter will be mainly on emergencies.
The choice, the implementation and the maintenance of the refuse disposal method should be
discussed and agreed upon with all the stakeholders (e.g. aid-agency, population, local authorities) in
order to have the facilities installed, used and cleaned correctly (e.g. at public institutions such as
markets, slaughterhouses and food distribution points; choice of the collective site for final disposal).
Health promotion activities can help to achieve this.
5.4 How should domestic refuse be managed?

5.4.1 Planning and organization
For correct planning and organisation of refuse disposal, it is necessary to follow all the different steps
described in chapter 1. Some specific points directly related to domestic refuse disposal, are gathered below.
If “household” level management is chosen, the strategy will mainly focus on promoting the system,
informing the population how to make and to use a refuse pit (which can be shared by several
households in camps for instance), and lending them tools and material for the construction of the pit
and for the collection of the waste.
For a collective management, focus will go more towards finding correct spots to construct collective
burial places or controlled tips and setting up temporary storage, general collection and transport
systems. Staff will need to be trained to do correct operation (e.g. collection, transport and final disposal
of waste) and maintenance (e.g. waste container, collectives burial places).
It will also be necessary to promote the collective refuse disposal system to the population, to inform
them on the existence and the correct use of the facilities like the waste containers, and possibly to
provide material for the domestic collection of the waste at their dwelling. The more users friendly the
facilities are, the more they will be used. Correctly maintained facilities will also be needed to keep the
population motivated to continue using them. For a more durable solution, the population themselves
should perform the maintenance of the provided material, even the waste containers.
Segregation of different kinds of waste is interesting, but will be extremely difficult to achieve during
an emergency situation. Most of the “waste” that still has a value (e.g. aluminium cans) will be recycled
anyway.

Household level management Collective management
Temporary Storage Waste bin (at dwelling level) 100 l drum (max. 15 m away)
Collection Household member Team (2.5 pers/1000 inhabitants)
Transport Manual Cart / motorised vehicle
“Treatment” Generally not recommended Only if specialised equipment
(incineration, composting) and personnel are available
Final Disposal Domestic refuse pit Burial trenches or controlled tip
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Household refuse disposal management

■ Temporary storage, collection and transport
At dwelling level, people can use a simple recipient (e.g. bucket) to temporary store their waste, but
very often a family member will collect and transport the refuse directly to the final disposal place.
There are no vehicles required because this place is located nearby the dwelling.
■ “Treatment”
On household level, incineration / burning of refuse is generally not recommended, as the food
residues contain a lot of liquids. It means that a lot of fuel will be needed for their incineration, which
is (very) costly. As wood is often used for “incineration” / burning in low-income countries (certainly in
emergencies), it would lead to an even higher stress on the local environment. It may even be
dangerous when it is done on a large scale, due to air pollution and the increased fire risk.
Composting is a biological decomposition of organic matter in the presence of air, as opposed to
anaerobic decomposition that takes place in septic tanks for instance (and which is very smelly).
Composting can only be considered if the population has already an extensive experience in this
matter or if a complete project with appropriate material, intensive training and monitoring is set up.
Be aware that composting doesn’t always correspond to the habits and culture of the population. For
these reasons is composting often not recommended in (acute) emergency situations.
■ Final disposal
The easiest way of final disposal is to throw the refuse in a pit (T.B. 5.02). The bottom of the pit should
be at least 1.5 m above the highest possible water table (during the rainy season), because this
reduces the chance of microbiological contamination of the groundwater virtually to nil in homogeneous
soils. The needed depth for fissured soils is difficult to predict however. The refuse needs to be covered
every day with a layer of 0.10 m of compacted soil or 0.25 cm of non compacted soil, to avoid bad
odours and vectors or other animals being attracted to it. Fencing is necessary to avoid people falling
in the pit, certainly at night. Chopped up organic waste could also be buried in very shallow trenches
of little gardens to be used as nutrition supplements for the crops. This demands a daily management,
which is most probably a too heavy burden, certainly in emergencies. Another alternative is to give the
organic waste to “domestic” animals as food.
Collective refuse disposal management (within refugees / IDP camps)

■ Temporary storage (in refuse containers)
The objectives are to gather the refuse in order to facilitate the collection and to avoid its dispersion by the
wind and animals. Half 200 l metal drums are generally used (T.B 5.01), but other recipients (e.g. plastic
containers) can do also as long as they can’t be blown over by the wind. However these containers must
be solid and have a volume of at least 60 l and maximum 100 l. The bottom of the collective dustbins
should be pierced so that they do not retain decomposition liquids (bad odour) and to avoid that they would
be used for other purposes. The dustbins should be provided with covers and with handles for easy lifting.
In the first instance, one container per ten to fifteen families may be provided, placed at a reasonable
distance from the dwellings (preferably not less than 5 m and no more than 15 m away).
Certain structures need particular storage systems, either because of the specific nature of their refuse
(e.g. specific workshops like garages), or because of the large volumes produced (e.g. market,
slaughterhouse, various workshops). For public places, a team will be needed to remove the waste
that has been dropped directly on the ground / floor.
■ Collection and transport
Collection should preferably be done daily to avoid the hatching of flies and odour problems. The
collection of the contents of the waste container, including incorrectly discarded waste, may be done
with motorised vehicles (pickup, truck, tractor with trailer), but it may be more reliable logistically to use
handcarts or animal carts. Moreover, it is difficult, specially in emergency situations, to commit a
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motorised vehicle exclusively to this task. The bottom of the carts can be perforated with small holes
(about 10 mm diameter) to allow sand to fall out of the waste in order to diminish its weight. Whatever
vehicle is used, they should be equipped with simple tools like brooms, shovels and disinfection
equipment to clean the storage facilities on a regular basis.
Circuits must be established and teams (e.g. 2.5 persons/1000 inhabitants) formed. A circuit must be
allocated to each team. After its introduction, the collection system should be supervised and evaluated
periodically if the circuit and the resources are appropriate and sufficient.
These two steps of storage and collection require the co-operation of the population, which should also
be involved regularly (once or twice per month) in a general clean up of the camp, including the market,
the dwellings and their surroundings.
■ “Treatment”
Incineration can only be an appropriate treatment method when real (domestic) refuse incineration
plants with qualified personnel are available and operational (e.g. Eastern countries). As the distance
in between the camp / setting and the incinerator will most probably be long, trucks will be needed and
thus the costs will rise significantly. The incineration itself might be rather expensive as well. So it will
be only under specific circumstances that incineration can be considered as an option (e.g. lack of
space in the setting, legislation). “Incineration” or burning refuse in or even outside the camp / setting
itself must be avoided as it increases the health risks due to air pollution and fire hazard.
Composting at communal level is an interesting but difficult technique to manage, certainly in (acute)
emergencies, because the waste should be properly segregated before by the population. It needs
special care and your technical referent must be involved because composting may cause health risks
and serious odour nuisances if not implemented correctly.
■ Final disposal
Dumping of waste (in or even outside a camp / setting) should be avoided at all times as it attracts
vectors and scavengers (animals and humans), thus forming a serious direct health risk. There is also
the risk of environmental pollution (e.g. pollution of surface and/or groundwater) and fire.
An efficient and rather cheap way of final disposal is burial. Still, special attention should go to the
potential risk of environmental pollution and thus indirect health hazards when refuse is buried. The
construction of the pits / trenches should follow the same rules as for building latrines, as the risk of
polluting the water table is similar.
Burial can be done on a collective level in trenches, which can be constructed, operated and
maintained with (only) manual means, as long as the quantities of refuse stay reasonable. For very big
quantities of refuse, it might be necessary to use controlled tipping (T.B. 5.03). This procedure requires
sufficient space at a distance at least 800 m away from the dwellings and an access to mechanical
equipment (e.g. trucks, bulldozers). The refuse must be covered daily to avoid vectors (e.g. insects,
rodents) or other animals (e.g. dogs, foxes, seagulls) to be attracted. Access to the site should be
restricted by a fence. If a good drainage is not ensured, there is a great risk of the trenches / controlled
tip turning quickly into sickening swampy areas.
■ Protective clothing for the staff
All staff involved in the collective disposal of refuse will need the following protective clothing:
➞ Overall
➞ (Heavy-duty) boots
➞ Heavy-duty gloves
➞ Mask
It is recommended to foresee a washing place for the staff, where there is at least water and soap
available.
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5.5 Further reading

Willey, 1993
Water, Engineering & Development Centre (WEDC), 2002
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T.B. 5.01 Collective dustbins

The dustbins may be used along paths and roads in a refugee camp, public places like a market
or school, or on the compound of a health structure. The objectives are to gather the refuse in order
to facilitate the collection and to avoid its dispersion by the wind and animals.
Construction
■ Cut a 200 l oil drum in two.
■ Make sure that the sharp edges are worked in such a way that they can’t injure the operator.
■ Pierce about 20 holes in the bottom to let decomposition liquids (leachates) drain out and to avoid
theft (people using the drum for other purposes).
■ Fix two handles on the sides of the drum for carrying.
■ Prepare a cover with a handle for opening and make sure there aren’t any sharp edges.
■ Fix the cover on the open end of the drum with a heavy duty hinge or an alternative (e.g. metallic
wire).
■ Paint the inside and outside of the dustbin with anti-corrosion paint.
■ Paint the outside in a bright and attractive colour to make it clearly visible.
■ Make a support. In the first stage of an emergency a metal or wooden support can do. In a later stage,
the support can be made with bricks.
■ Dig a hole where the dustbin will be placed, preferably 0.5 m deep, at least with the same diameter
as the dustbin, and fill it with stones or gravel to drain the leachates.
■ Place the dustbin with its support on the leachates drainage hole.
Remarks
■ Plastic drums / bins can be an alternative solution, but they have to be solid. They have to have a
volume of at least 60 l, but not more than 100 l to ease handling. These plastic waste bins should
be provided with a lid, handles and a pierced bottom to drain the leachates (and to avoid
non-appropriate use). Due to their light weight, a good support will be needed to avoid that they will
be blown over or even away by the wind.
■ Attach the cover in such a way that it falls shut every time it is dropped. This is the only way to be
sure that the dustbin is always covered.
■ Allow one dustbin for every 10-15 shelters / houses, and others along roads and in public places
(schools, markets).
■ Organize daily refuse collection and disposal.
■ Organize regular cleaning and disinfection (0.1% chlorine solution, T.B. 2.20) of the dustbins and
drainage holes. Rinse the bins thoroughly with clean water after disinfection.
■ Collective dustbins that are in poor shape or heavily corroded should be replaced and repaired if still
possible. The repaired dustbins can join the reserve stock that should be kept at all times.
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Key Input
1. Cover - 1 drum, 200 l
2. Handles - 1 cold chisel or metal saw
3. Heavy duty hinge (e.g. strong rope, piece of tire) - Wire, nuts and bolts, or pop rivets for fixing
4. ½ (metal) 200 l drum handles and hinges
5. Pierced bottom - 1 hinge (or a piece of rubber / leather / rope)
6. Support to attach the cover
7. Hole with stones or gravel (drainage) - Wood / metal for the support or bricks /
8. Hammered edges stones, cement, sand and masonry tools
- 1 shovel, 1 hoe, 1 pick axe
- Anti-corrosion paint
- Colour paint
- Stones or gravel for leachates drainage
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T.B. 5.02 Refuse pit

In an emergency situation, an appropriate way to dispose of household refuse (not medical waste)
is burial in collective or family refuse pits, certainly if there are not enough transport means and/or
land available for controlled tipping. The high liquid content of this type of refuse does not allow the
waste to be burned with simple means; apart from using a lot of fuel, its incomplete combustion
could even be a health risk factor. This treatment method also increases the risk of fire drastically.
Construction and use
■ Respect the minimum distances to avoid the risk of contaminating water points.
➞ The distance from water points must be >15 m if the pit serves fewer than 10 families, >30 m in all other
cases.
➞ The distance from dwellings must be >10 m if the pit serves fewer than 10 families, >30 m in all other
cases.
■ Make a fence around the area foreseen for the hole in order to avoid accidents and to prevent the entry
of scavengers (human or animal).
■ Dig a circular hole, leaving the soil to one side (to be used for the daily covering of refuse). For security
reasons, the pit should not be deeper than 2 m, and the walls have to be made conical in order to reduce
the risk of collapse, or reinforced with removable struts during the excavation.
■ The bottom of the pit should be at least 1.5 m above the highest possible water table. The depth of the
water table can be estimated by verifying its level in nearby wells. Another option is to drive a metal bar
such as a reinforcing rod or (several pieces of) ½” galvanized pipe into the ground, as deep as 1.5 m
beneath the required pit depth. When pulled out, the rod or (the earth inside) the pipe should be dry. Soil
■ Dig a drainage ditch around the pit to avoid it would flood. The ditch can be connected to the big drainage
canals of the site if existing.
■ Dispose of the refuse in the pit, covering it each day with a compacted soil layer of minimal 0.1 m thick.
■ Backfill the hole completely with compacted soil when the refuse level is 0.5 m underneath the ground
surface. A metal grid can be put on top of the refuse before the final backfilling takes place. Coming
across the grid during future excavations will indicate that a pit has already existed on the same spot. It
is also possible to plant on the old refuse pits fast growing vegetation (e.g. eucalyptus), which can be
used as firewood afterwards. If there is no other available solution remaining, it should be safe after at
least 6 months to dig at the same spot again (if no dangerous wastes have been thrown in).
Key Input
A. Cross section of refuse pit
B. Minimum safety distances
1. Pit - Pick axe, shovel and hoe
2. Refuse, day 1 - Buckets (to lift out the earth)
3. (Compacted) earth, day 1-Miner’s bar - Reinforcing bar or ½” galvanised pipe and hammer
4. Refuse, day 2 - Stakes and fencing material
5. (Compacted) earth, day 2 - 2 people for 1 day (depending on the size of the pit)
6. Fence
7. Excavated earth
8. Water table
9. Drainage ditch
10. Dwellings
11. Refuse pit
12. Latrine
13. Well
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Remarks
■ The refuse pit can also be used for rural waste management in small villages within stabilized
situations.
■ The pit should be circular because it will be more resistant against collapse due to its natural arching
effect. The less stable the soil, the more the walls of the pit should be conical. If the soil is too
unstable, it may be useful to support the pit walls (e.g. with planks, bamboo).
■ Only throw household refuse in the pit. The chance of microbiological contamination of the
groundwater is very limited in homogeneous soils if the bottom of the pit is more than 1.5 m above
the aquifer.
■ Do not throw in hazardous waste (e.g. old engine oil or even oil filters) because this could lead to a
long lasting chemical pollution of the aquifer, even if the bottom of the pit is more than 1.5 m above.
■ Although (potentially contaminated) medical waste can be buried, it has to be done in a completely
controlled manner with specifications beyond this simple refuse pit; e.g. specially designed pits (see
chapter 6), away from the population and integrated within a fenced waste zone or controlled landfill.
■ It is potentially hazardous for people’s health and the environment to burn household refuse in an
open fire (e.g. smoke, risk of fire), so the a collective or family waste pit should not be used for that
purpose. The use of volume reducers and small incinerators (as described in T.B. 6.05 and 6.06)
should be exclusively reserved for some medical wastes (mainly “soft” waste).
■ It is essential that refuse is covered with earth (and possibly with wood ashes) immediately after
disposal to avoid attracting flies and rodents, to limit the risk of refuse been blown away and to
reduce the nuisances (e.g. bad odour, visual).
■ In case a new pit is being dug at the same spot at least 6 months after the old one has been closed,
be aware that plastics and potential glass will still be “intact” and the latter might cause injuries.
■ As the population has to do its own waste management with this facility, a good health promotion
campaign and some training for proper use and maintenance might have to be organized for them.
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T.B. 5.03 Controlled tip

This technique is used to eliminate community’s wastes. Its feasibility is essentially dependent on
the land surface available and/or the availability of collection and transport equipment like animal
carts or lorries. The high liquid content of this type of refuse does not allow the waste to be burned
with simple means; apart from using a lot of fuel, its incomplete combustion could even be a health
risk factor. This treatment method also increases the risk of fire drastically.
Construction
■ Calculate the length of trenches needed using the following rule of thumb:
for a width of 1.5 m at a depth of 2 m,

dig at least 1 linear m of trench per 200 people per week
■ Choose a flat area at least 800 m away from the dwellings and the living areas should not be
downwind from the tip.
■ Take also into account the distances from water resources, which should never be less than 50 m
away and which should be uphill from the tip. The bottom of the trenches should be at least 1.5 m
above the highest possible water table, this if the soil is homogeneous. This is to avoid that the
leachates (liquids dripping out of the waste) would cause a microbiological contamination of the
aquifer. The depth of the water table can be estimated by verifying its level in nearby wells. Another
option is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe into
the ground, as deep as 1.5 m beneath the required trench depth. When pulled out, the rod or (the
earth inside) the pipe should be dry. Soil saturated with water after heavy rainfall might give a false
impression of the actual water table level. In case the water table is too high, a different spot should
be selected.
■ Surround the tip with a fence to avoid accidents and to prevent the entry of scavengers (human or
animal)
■ Prepare the site for construction: remove all debris, lay out the area and bring in the needed
construction material.
■ Dig the trenches with conical walls, and its bottom should preferably be covered with clay, special
plastic lining or even better a combination of both. But it’s very doubtful that the material and certainly
the time will be available in emergencies to perform these environmental protection works.
■ Dig a surface water drainage ditch around the whole area to avoid runoff water going through. The
lowest corner of this ditch should lead to an infiltration facility, which is foreseen with an overflow
towards the big drainage canal to evacuate water that doesn’t infiltrate during heavy rainfall.
Operation
■ Collect the refuse and take it to the tip.
■ Dump the refuse at one end of the trench and cover it immediately with at least 0.25 m of
non-compacted earth. The following load should be dumped next to the first, and so on until the
trench is full.
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Key Input
A. Controlled tip
B. Detail of trench in use
Construction
1. Fence - Plenty of land
2. Trench (part) waiting for use - Reinforcing bar or ½” galvanised pipe,
3. Trench part already full and covered hammer
4. Alley (wide enough for the passage of the - Mechanical shovel or numerous workers
refuse collection vehicle) with digging equipment (shovels, hoes,
5. Drainage ditch to build the bridge crossing picks)
the drainage ditch - Poles / tree trunks or concrete slab
6. Bridge (crossing point of ditch) - Stakes and fencing materia
7. Lowest corner (towards infiltration facility with overflow)
8. Cart / lorry bringing refuse Operation
9. Excavated earth used progressively for covering - Lorry or cart for transporting refuse
10.Runoff direction - Trained personnel, permanently at the tip
11.Refuse - Shovels for covering refuse
12.Layer of backfilled earth - Overall, heavy duty boots and gloves for
staff
- Brooms and 0.05% chlorine solution
for daily cleaning of the cart or lorry
- Washing facilities with water and soap
Remarks
■ This technique needs a lot of land and (rather) sophisticated equipment for its implementation, which
can entail heavy costs.
■ The fence and guards are essential to avoid scavenging and accidents at the tip.
■ The staff should be trained for their task and should wear protective clothes like an overall, a mask,
(heavy-duty) boots and heavy-duty gloves. Washing facilities (at least water and soap) with the
related wastewater structures should be available at the site.
■ It is strongly advised to vaccinate all the staff coming potentially in contact with waste against
Hepatitis B and Tetanus.
■ The compulsory distance from dwellings demands the use of a lorry or (animal) carts. The bottom
of the carts can be perforated by small holes (1 cm diameter) to allow sand to fall out of the waste
in order to diminish its weight. The transport means should be disinfected daily with a 0.05 % chlorine
solution and then rinsed thoroughly with clean water.
■ If there is no other solution available, the trenches that have been covered for at least 6 months can
be excavated again to be reused as a controlled tip. Be aware however that plastics and potential
glass will still be “intact” and the latter might cause injuries. When hazardous wastes have been
disposed of in the trenches, they should not be reopened.
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Medical Waste
Management
Narrative
Technical briefs
T.B. 6.01 Sharps containers
T.B. 6.02 Sharps pit
T.B. 6.03 Safety box reducer
T.B. 6.04 Mass vaccination campaign waste
(temporary safety box reducer)
T.B. 6.05 Temporary volume reducer
T.B. 6.06 Permanent batch incinerator
T.B. 6.07 Residues (ash) pit
T.B. 6.08 Organic waste pit ("Placenta" pit)
T.B. 6.09 Waste zone
T.B. 6.10 Protective clothing and equipment
Chapter 6
1
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6 Medical Waste Management - draft
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6.1 Why is medical waste management important?

Despite all existing hygiene precautions, nosocomial infections affect at least 5 to 15% of the patients
entering health structures in high-income countries. The problem of nosocomial infections is most probably
higher in low-income countries. In India, the nosocomial infection rate is estimated around 30%. The main
reasons of those infections are insufficient hand washing, the use of non-sterile invasive devices, insufficient
general hygiene and bad medical practices, but also to some extent incorrect medical waste management.
Similarly to excreta, wastewater and refuse, improper disposal of medical waste can cause environmental
pollution, together with serious smell and visual nuisance problems, and it also leads to health risks. Typical
health risks related to improper medical waste management are:
■ Direct contact with the waste, potentially resulting in its pathogens entering the human body:
➞ Through a puncture, abrasion or cut in the skin (e.g. medical staff recapping used hypodermic
needles leading to needle stick injuries; unaware and unprotected non-medical staff handling waste,
including sharps; children playing with discarded used needles; patients being injected with recycled
single use needles, as is the case in some low-income countries).
➞ Through the mucous membranes (e.g. ocular contact).
➞ By ingestion (through hands / mouth contact).
➞ By inhalation
■ Air pollution:
➞ Hazardous smoke emissions occur when medical waste is burned at low temperatures in a poorly
designed incinerator or when the incineration is not properly conducted (e.g. when the incinerator
is not preheated, an open fire in a pit). These emissions contain thermo-resistant pathogens and
toxic by-products like carbon monoxide, sulphur dioxide, dioxins, furans, heavy metals, or other
chemical agents when for instance expired drugs are burned.
■ Pollution of water resources and the soil:
➞ Untreated medical waste contaminating the soil and ground / surface water used for drinking with
pathogens (e.g. faecal coliforms, hepatitis, polio and tetanus) or chemical substances.
■ Increased presence of vectors:
➞ Proliferation of vectors (e.g. flies, mosquitoes, rodents) in discarded medical waste.
The variety of health risks suggests that not only the medical and non-medical staff of health structures
are at risk, but also the patients and their visitors. Other people at risk are the personnel of possible
external support services (e.g. laundry, waste management), the population living in the neighbourhood
where medical waste is handled incorrectly, and specially human scavengers recuperating medical
waste. Since HIV/AIDS has appeared, more attention has been given to medical waste management
with the formulation of the universal and standard precautions.
6.2 What is considered as medical waste?

It concerns the characteristic waste generated during medical activities (within health structures). To
have a pragmatic and comprehensible medical waste management system for low-income countries,
it is recommended to classify the medical waste according to “common disposal properties”:
■ Sharps: objects that can be responsible of perforations or cuts of the skin (e.g. needles, scalpels,
ampoules, broken glass).
■ “Soft” waste: includes dressings (wet or dry), packaging, paper, cardboard, plastic, syringes without
needle.
■ Organic waste: placentas, aborted foetus, amputated limbs, organs, body fluids.
■ Hazardous waste: a clear distinction should be made in between recurrently generated hazardous
waste and inappropriate / expired hazardous products. The former, generated on a daily, weekly or
two-weekly basis, should be dealt with immediately, whereas the inappropriate / expired hazardous
waste should be taken care of in special elimination campaigns (e.g. once every six months). The
latter falls outside the scope of these guidelines (section 6.5. Further reading).
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However, both kinds of hazardous waste categories are to be found in the following subcategories:
➞ Laboratory waste: diagnostic test kits and chemical reagents.
➞ Biological hazardous waste: Tuberculosis sputum; urine, stool and body fluid (e.g. blood) samples
from potentially infected patients; cultures of bacteria; all mostly coming from the laboratory.
➞ Pharmaceutical waste: opened but unused drugs, cold chain damaged vaccines, expired and/or
unwanted drugs.
➞ Expired disinfectant solutions: all solutions that have been prepared since a certain period (e.g.
0.05 % chlorine solution after 1 day, 1 % chlorine solution after about a week).
➞ X-ray related waste: slightly radioactive waste, expired film and mainly the chemicals to develop the
photos.
➞ Insecticides: leftovers of prepared insecticides used in vector control activities within or outside the
health structure, expired or inappropriate products.
➞ Specific hazardous waste: groups a lot of products that can be common as well as rather particular
to certain medical activities within a health structure. Some examples of specific hazardous waste
are:
• Material used to prepare and administer cytotoxic drugs (e.g. syringe, needle, gown, respirator).
• Waste with heavy metal content (e.g. batteries, broken appliances containing mercury such as
thermometers and blood pressure gauges).
• Pressurised containers (although mainly recycled).
• Waste from activities related to the health structure (e.g. engine oil of the ambulances, generators,
motor pump).
Medical waste is part of health care waste, which also includes excreta, wastewater and administrative
waste. Waste discarded by the patients and visitors is actually refuse (see Chapter 5), but when
generated in small quantities and well segregated by them, it can be integrated within the medical
waste management. So can food packaging and plastic beverage bottles be considered as soft waste.
Food residues, also from the kitchen, can be part of the organic waste. Food residues from patients
having very infectious diseases like cholera and viral haemorrhagic fevers should not leave the health
structure and should therefore always be considered and discarded as organic waste. Small amounts
of vegetation waste (e.g. dead tree leaves) can be considered as organic waste, but for bigger
quantities it is best to handle it as refuse (see Chapter 5).
6.3 Where / When should medical waste management be implemented

and by Who?
Correct medical waste management should be implemented and promoted in all health structures,
from the smallest health post to the biggest hospital, going over nutritional feeding centres, isolation
centres (e.g. cholera, viral haemorrhagic fevers) and medical laboratories. Furthermore, this should be
done in all situations, from the acute phase of an emergency until stabilized situations (with the
management system adapted to the actual stage of the intervention).
The hygiene committee of the health structure, consisting of key medical and non-medical staff,
potentially representatives of the local and health authorities, the neighbourhood and the aid-agency
should play a central role in medical waste management.
The possible treatment and final disposal should preferably be done on the site of the health centre
itself, in a well-defined area, the waste zone (T.B. 6.09). This principle has the following advantages:
■ The potential treatment and final disposal of the waste can be done by clearly defined, trustworthy
and trained persons.
■ The medical waste remains within the health structure, thus there isn’t a risk of being misused
externally.
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The segregation of the medical waste should be done by the medical staff, where the collection should
be taken care of by the cleaners, or ideally by the one or two waste managers. The latter are
responsible for and specialised in the collection, potential temporary storage, possible treatment and
final disposal of the waste. They also take care of the waste zone in general. It is important however
that all the staff (medical and non-medical) receive adequate training, and use the necessary working
gear and equipment (T.B. 6.10).
In addition, patients, attendants and visitors should also be informed where to store the waste they
generate. Information campaigns towards the population living nearby a place where medical waste
is handled and towards potential human scavengers should be foreseen.
6.4 How does medical waste have to be managed?

Health structures are responsible for ensuring that their medical waste is rendered harmless to all
people potentially at risk. Therefore, good medical waste management should result in waste being:
■ Non contaminated
■ And/or inaccessible to people and vectors.
For correct planning and organisation of medical waste management, it is necessary to follow the
different steps described in chapter 1. Some specific points directly related to medical waste
management are gathered below.
For acute emergencies, the essential requirements (T.B. 1.08) regarding medical waste can often be
applied immediately after an initial assessment. For chronic emergencies and stabilized situations
however, an additional in-depth assessment should be conducted in order to have the essential
requirements integrated in a context adapted manner. Special methodologies (section 6.5 Further
reading) exist to help in the in-depth assessment.
An important issue in the planning phase during chronic emergencies and stabilized situations is that
the strategy is defined in collaboration with the hygiene committee, and if possible formalized in a
memory of understanding.
Providing only technical solutions (based on the described general recommendations) are not sufficient
to implement a correct medical waste management system. They must be completed by general and
specific technical trainings directed towards medical and non-medical staff, and health promotion
towards patients. The management system must combine safety features with easy to use measures,
adapted to the needs, habits, culture and other constraints of the users. Obviously, the national
legislation regarding medical waste, if existing, should be respected.
In order to be able to implement as soon as possible the technical training of all the staff, it is often
worthwhile to start with a temporary waste zone based on emergency facilities like a temporary safety
box reducer (T.B. 6.04) and a temporary volume reducer (T.B. 6.05), even in a chronic emergency or
stabilized situation.
For hospitals up to 100 beds, the general recommendations are normally sufficient. It might be
necessary for infrastructures with more than 100 beds to double or triple the facilities (e.g. two
incinerators, double the number of organic waste pits, of which two are operational at the same moment
in order not to be filled up too quickly and allow the decomposition of the waste). For 300 beds and
more, other solutions for the medical waste are probably required (e.g. factory made incinerators).
It is recommended to vaccinate the medical and non-medical staff who are potentially exposed to
medical waste, at least against Hepatitis B and Tetanus.
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Medical Waste
Segregation Sharps Soft waste Organic waste
▼ ▼ ▼ ▼
Temporary storage Yes Yes No

▼ ▼ ▼ ▼
Treatment No Yes No
(burning / incineration) ▼ ▼ ▼
▼
Final disposal Sharps pit Refuse pit Organic pit

The entire technical process should preferably be done on the compound of the health structure to
avoid as much as possible accidents (e.g. needle stick injuries). If any waste has to leave the
compound anyways, extra security measurements should be taken, which might require support from
your technical referent. To achieve a correct medical waste management, different “technical” steps
for sharps, “soft” and organic waste have to be accomplished, as presented in the table hereunder.
Hazardous waste demands specific attention for their entire technical process, and advice should be
asked at your technical referent.
Segregation
The segregation process and corresponding management has to be as simple as possible. Therefore,
no difference is made between contaminated and non-contaminated waste. The segregation of the
medical waste in the different categories as described before should be done by the medical staff (e.g.
doctors, nurses, laboratory technicians, pharmacists) at the place and time that the waste is generated.
Attempting to segregate the medical waste at any other place or time introduces additional and
non-acceptable risks.
The kind of recipients to use for the segregation depends on the category of waste generated:
■ Sharps: modified drugs container, Reusable Sharps Container, commercial disposable sharps
container.
■ Soft waste: plastic buckets with a capacity of 20 to 60 l, all of the same colour, with a well fitting lid.
■ Organic waste: plastic buckets with a well fitting lid, a capacity of 15 – 20 l for deliveries and 40 – 60 l
for the operating theatre. All should have the same colour, but different than those for the soft waste.
Collection and temporary storage
The frequency of medical waste collection depends on the type of waste category. Sharps should be
collected at regular intervals or at the latest when the disposable (single use) container (T.B. 6.01) is
¾ full, “soft” waste on a daily basis and organic waste as soon as possible after the intervention.
Sharps and “soft” waste can be stored temporarily in safe containers within the waste zone (although
not recommended) whilst organic waste has to be disposed of immediately.
Treatment and/or final disposal
If possible, every health structure should have a waste zone (T.B. 6.09), where the waste can be
treated and/or disposed of. This zone will be composed of several facilities:
■A temporary storage area for the soft waste,
■ An incinerator (T.B. 6.06) or temporary volume reducer (T.B. 6.05),
■ Different waste pits: sharps pit (T.B. 6.02), equipped or not with a safety box reducer (T.B. 6.03),
residues (ash) pits (T.B. 6.07), organic waste pits (T.B. 6.08),
■ A place to wash the waste recipients, including appropriate wastewater facilities (Chapter 4).
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The size of the waste zone depends on the amount of waste that is generated, thus on the size of the
health structure itself and on the number of patients that are treated each day. The quantity of medical
waste generated daily in low-income countries varies normally between 0.3 to 1.5 kg/bed (or 2 to 3
l/bed). The actual quantity of waste generated per category must be determined by each health
structure itself in order to set up a correct medical waste management system. It is important to foresee
sufficient space for the waste zone, as new pits will have to be dug once the old ones are nearly full.
However, the different treatment / disposal facilities must be kept rather close together, to avoid
spreading of the contamination over a large area and to provide an “ergonomic” and convenient
working environment for the waste manager.
Few medical waste treatment methods are appropriate, affordable or available in the field. Burning in
a volume reducer or preferably incineration in a double combustion incinerator often remain the most
suitable treatment methods for soft waste in low-income countries. An exception may be urban
situations where the space to build an incinerator is limited or where the smoke would cause a nuisance
to the neighbours. Another exception could be very small health structures (in rural areas) where the
production of medical waste is limited and the available space on the compound large enough for land
filling.
Burning and incineration with limited means are too complicated (thus potentially dangerous) and too
energy (fuel) consuming for sharps and most organic waste, thus the treatment is by-passed for these
categories. Sharps and organic waste are disposed of directly in their respective pits.
Food residues can be disposed off in the organic waste pit if they are produced in small quantities (less
than 10 l/day), if not the pit will fill up too fast. For higher quantities, burial at an “official” landfill should
strongly be considered. Composting could also be an alternative but to do it correctly, it demands
motivation and specific knowledge, which falls out of the scope of these guidelines.
Recurrently generated hazardous waste has to be managed on a case-by-case basis. Small amounts
of chemical liquids (e.g. lab reagents and X-ray developing products) can be diluted with plenty of
clean water before being discarded via a sink connected to a closed sewer system or a river with a
substantial flow. Bio-hazardous waste like tuberculosis sputum, bacteria cultures or blood samples
should be incinerated whilst adding sufficient combustibles, and preferably be autoclaved before when
coming from the laboratory. Materials being used to administer cytotoxic drugs (not including sharps)
should be collected separately and be incinerated in a double combustion incinerator with additional
fuel to ensure a high combustion temperature. Glass bottles containing (bio-)hazardous samples or
opened vials still containing vaccines have to be disposed of in a completely lined sharps pit or have
to be encapsulated. Urine and stools can be disposed of in pit latrines, as long as the safety distances
with water points are respected (Chapter 3). Disinfectant solutions can be “recycled” for cleaning the
floors of non-critical areas (e.g. NOT for an operating theatre). Prepared but leftover insecticides that
have been used for spraying health structures indoors can be utilised to treat the latrines. For the
correct management of specific hazardous waste, ask advice to your technical referent.
Inappropriate / expired hazardous products have to be eliminated according to the national legislation
(if existing) or during specially organised (six monthly) campaigns, based on the feedback of your
technical referent on the hazardous waste list that you have send (section 6.5 Further reading).
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6.5 Further reading

Médecins Sans Frontières
Medical Waste Management in Low-Income Countries CD-ROM
Contains following manuals:
■ Medical Waste Management in Low-income Countries, 2010
■ Manufacturing Sheets for Waste Zone Facilities in Emergencies, 2006
■ Safety Box Reducer: Construction & Operation Manual, 2010 (2nd edition)
■ Incineration in Health Structures of Low-Income Countries: Construction & Operation
of the De Montfort Incinerator, 2010 (2nd edition)
■ Waste Zone Operators Manual, 2010 (2nd edition)
■ Hazardous Waste Management within Health Structures of Low-income Countries,
2010 (2nd edition)
Médecins Sans Frontières, 2010
Post exposure prophylaxis (PEP). A guideline in case of accidental exposure to blood.
Médecins Sans Frontières, internal document, January 2000.
A. Prüss, W.K. Townend
Management of waste from health-care activities: Teacher’s Guide
A. Prüss, E. Giroult, P. Rushbrook
Safe management of waste from health-care activities
WHO
Guideline for safe disposal of unwanted pharmaceuticals in and after emergencies
World Health Organisation, 1999.
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T.B. 6.01 Sharps containers

Sharps are considered to be part of the most dangerous medical wastes. They are at the basis of
most accidents that happen to the medical staff in health structures. In addition, other groups of
people within health structures (e.g. patients, non-medical staff like the cleaners) are potentially
also at risk of sharps injuries. It is therefore of utmost importance that sharps wastes are
immediately discarded in correct sharps containers, when and where they are generated.
Principle
Commercial disposable (single use) sharps containers are easily available in high-income countries,
but often unaffordable for low-income countries, certainly when the aid-agency pulls out. Thus, it is it
often necessary to find cheaper, but as safe alternatives. To have good and safe sharps containers,
they must:
■ be puncture resistant.
■ be made out of solid material that doesn’t have a big recycling value.
■ be leak proof.
■ have a sufficient volume (at least 0.5 l, preferably 1 l).
■ be affordable for low-income countries.
■ be easily available.
■ have a facility that allows the separation of a needle from a syringe with a one-hand movement.
■ be able to receive other sharps than needles as well (e.g. blades, scalpels, glass).
■ be fixed in every treatment room (e.g. on the wall nearby the place where the injections are given)
or on a tray / trolley for treatment at the patients’ bed within the wards.
Based on these specifications, glass / plastic infusion and beverage bottles are prohibited and it is
strongly recommended not to use soft drinks / beer cans as sharps containers either. Correct
alternatives are modified empty generic drugs containers, preferably the sturdy plastic models,
although that metallic ones can also be used.
Procedure
Transformation of a plastic generic drugs pot into a disposable (single use) sharps container:
■ Choose an empty drugs container that is sturdy, has enough storage capacity and a well fitting lid.
It should also be well rinsed with water and dried afterwards.
■ Make with a cutter knife a triangular hole in the top of the lid nearby its edge (see figure). The hole
size depends on the sharps waste that has to be disposed of. Make sure that at least one corner of
the triangle has a sharp angle to facilitate the one-hand removal of the needle from a Luer syringe.
■ Put some glue for plastics on the circular inner edge of the lid and remount it on the container. The
container can only be used once the glue has dried and the lid is securely fastened.
■ Provide a holder system for the sharps container to be fixed to a wall, tray or trolley; e.g. Velcro
straps or a PVC pipe (connector) with strong elastic bands. It’s important that the sharps container
can be removed from the holder for final disposal, but it should stay immobile during the segregation
of the sharps (e.g. needle being separated from its syringe). The holder should be strong enough for
prolonged periods.
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Key Input
A. Single use sharps container
B. Holder for the sharps container
C. Installation of the holder
D. Reusable Sharps Container
1. Container (empty drug pot) - Generic drugs container
2. Lid - Glue (plastic or superglue)
3. Triangular hole - Cutter knife
4. Holder (PVC pipe) - Velcro straps / PVC pipe (connector)
5. Holes enabling the fixation of the holder with elastic band
6. (Metallic) U-profile - Metallic U-profile
7. Screws - Screws
- Screwdriver
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Remarks
■ Sharps should be segregated where and when they are generated, by the (para-)medical staff (e.g.
doctors, nurses, laboratory technicians, pharmacists).
■ Needles should never be recapped after use because the risk of injuries is extremely high during this
action.
■ The right location of the sharps containers must be decided in close collaboration with the medical
staff.
■ A single use sharps container should be collected and brought to the waste zone for final disposal
when it is ¾ full.
■ Sharps should not be burnt in volume reducers or even in good auto-combustion incinerators as
they will stay sharp and thus form a risk for injuries when the residues are removed from the furnace.
This could potentially lead to an infection of the waste manager during the manipulation of other
medical waste. The people emptying full residues (ash) pits that contain rusty sharps (metal of sharps
will corrode after they have been exposed to high temperatures) could be exposed to Tetanus. Glass
sharps often explode when they are burnt or incinerated, which can lead to injuries of the waste
manager.
■ The waste manager should discard the single use sharps containers within a sharps pit (T.B. 6.02).
The containers can never be opened, emptied nor reused.
■ Make sure there are always enough disposable sharps containers in stock, which are ready to use.
■ The triangular hole of a self-made sharps container (modified drugs container) is not adapted to
remove a needle from a Luer-lock syringe, because of its screw pitch.
■ When generic drugs pots aren’t available (in sufficient amount), or when people try to recycle them,
the Reusable Sharps Container (RSC) can be an interesting alternative. This solid container
corresponds to the specifications mentioned above and can be used for most kinds of sharps
generated in health structures, including needles connected to Luer-lock syringes. However, sharps
that are too long like the Auto-Disable (AD) syringes, (razor)blades with a long handle and very long
needles (e.g. lumbar puncture needles) should not be introduced in the RSC because it will be very
difficult to remove them afterwards. The RSC is provided with an opening mechanism that enables
the safe disposal of the sharps in their designated pit. As the mechanism should be locked with a
padlock, only the waste manager can open the container. To avoid sharps being stuck inside by
overfilling the container, it has to be emptied regularly (daily or at least once a week if very few
sharps are generated). Before the container goes into circulation again, its outside should be
disinfected with a swap soaked in a 0.1% chlorine solution (T.B. 2.20) and rinsed very well with clean
water. A small amount of chlorine solution (1-2 ml) can also be left within the RSC to reduce blood
stained sharps sticking to its inside. Make sure that the responsible (waste manager) will not try to
introduce his hand inside the RSC to remove those sharps. Check that the padlock is put back and
the key is removed before the RSC goes back into circulation (see section 6.5 Further reading).
■ As the needle can’t be separated from Auto-Disable (AD) syringes (normally only to be used for
immunisation activities), they have to be collected in their whole within cardboard safety boxes. The
cardboard safety boxes must then be burned in a (temporary) safety box reducer (T.B. 6.03 and
6.04).
■ Other long sharp objects like scalpels / razorblades with long handles and very long needles can also
be collected in safety boxes and then burned in a safety box reducer (T.B. 6.03), or even collected
in big modified drugs containers which can be discarded directly in the sharps pit.
■ It is recommended to segregate (big) glass vials and ampoules in separate closable containers (big
drugs pots or small buckets) in order to reduce their volume in specially designed glass crushers,
placed directly on top of the sharps pit. For mass vaccination campaigns, the empty vials / ampoules
should be encapsulated (section 6.5 Further reading).
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T.B. 6.02 Sharps pit

Sharps are considered to be part of the most dangerous medical wastes. Metal sharps won’t melt
in an auto-combustion incinerator, stay sharp and sometimes even contaminated when the
combustion is ineffective in inactivating heat-resistant micro-organisms. Glass sharps might explode
in the fire and therefore become a danger for the operator and/or damage the incinerator. A sharps
pit is a simple, efficient and safe facility for final disposal of sharps, at least if it’s managed correctly
(with complete encapsulation when the pit is nearly full).
Construction
■ Choose an appropriate place within the waste zone (T.B. 6.09) for the construction of a sharps pit. In case
there would be a lot of glass to be disposed of (e.g. empty vials, ampoules), it’s advisable to construct
at least two sharps pits in order to have a reserve pit immediately available when the first one is filled
up.
■ Prepare the site for construction: remove all debris, flatten the surface, put up a (temporary) fence, do a
soil texture test (T.B. 4.05) and bring in the needed construction material and equipment. Normally the
preparation of the different waste zone facilities is done all at the same time.
■ Lay out the area for the excavation of the sharps pit. The area should be larger than the actual size
(lining) of the sharps pit itself. The sharp pit’s volume is not only depending on the size of the health
structure and the number of patients, but also on the type of interventions (e.g. in some places, most of
the treatments are done by injections). An example on volume calculation is given below.
■ Dig the pit and check that its bottom is more than 1.5 m above the highest possible water table. The depth
of the water table can be estimated by verifying its level in nearby wells. Another option is to drive a
metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground, as deep as
1.5 m beneath the required pit depth. When pulled out, the rod or (the earth inside) the pipe should be
dry. Soil saturated with water after heavy rainfall might give a false impression of the actual water table
level.
■ Cast a closed foundation in concrete (300 kg/m³; T.B. 2.05) with a minimum thickness of 0.2 m on the
bottom of the pit.
■ Line the pit completely from the bottom till the top (at least 0.1 m above the ground surface) with plain
concrete rings that are cemented and preferably also bolted together (T.B. 2.04), or with closed
masonry-work, made watertight with cement plaster (T.B. 2.05). For the outer surfaces of the sharps pit,
only one 10 mm layer of cement plaster is required, whereas internally it is recommended to add a
second 10 mm layer once the first one has dried.
■ Backfill the space in between the lining and the excavated hole with gravel and compacted soil.
■ Put a reinforced concrete slab on top of the pit’s lining. This slab can be cast in situ as it should not be
removable, or it can be made like a latrine slab (T.B. 3.05) and secured on the lining with a 10 mm layer
of mortar. The slab should only have a round hole in the middle, large enough to fit the drop pipe.
■ Place the drop pipe, with its diameter adapted to the available sharps containers and about 1 m in length,
in the slab’s hole and secure it with mortar. To ensure a better anchorage, a clamp can be connected to
the drop pipe at the level where it will be mortared in the slab. Equip the drop pipe with a cover to avoid
vectors and rainwater entering the pit.
■ Add an impermeable layer (mortar or clay) against the aboveground part of the lining.
■ Make a drainage channel around the pit to prevent runoff water entering and to protect its walls (although
the pit should be more or less watertight with the complete lining).
Operation
■ Dispose immediately of the sharps (with their disposable container) into the pit when they arrive at the
waste zone. Make sure that the drop pipe’s cover is always replaced after having disposed of the sharps.
■ Close down the pit permanently when the level of the sharps is 0.30 m underneath the slab. The drop
pipe should be cut at its base. Concrete or preferably a mixture of cement, lime and some water (weight
ratio: 3, 3, 1) should be poured into the hole to encapsulate the sharps completely.
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Example of the volume calculation

■ 500 needles = about 1 l (safe estimation).
■ If 500 needles are generated per week, the required pit size for 20 years will be:
1 l x 52 weeks x 20 years = 1040 l = about 1 m³.
■ Be aware however that single use sharps containers also take up quite some space as they can
only be filled to ¾ of their volume. Other sharps like ampoules and vials require a lot of space as
well, certainly when they are not crushed. So double or even triple the calculated useful volume!
■ Don’t forget to add a free space above the waste (at least 0.30 m deep) to allow complete
encapsulation!
Key Input
1. Pit - Reinforcement bar or ½” galvanised pipe
2. Slab and hammer
3. Drop pipe with cover - Shovels, hoes, picks, miner’s bars
4. Sealed lining - Concrete (300 kg/m³) and reinforcement
5. Sealed (closed) concrete foundation bars (foundation)
6. Soil - Concrete (rings), bricks or cement blocks,
7. Drainage channel sand and cement or a metal / plastic recipient
8. Impermeable layer (drum) in the 1st phase
9. Water table - Material to bolt the rings together
(spanners, bolts and nuts)
- Reinforced concrete slab (potentially made in situ)
- Pipe (PVC, metal; diameter: 110-150 mm)
with a cover
- (Temporary) fence material
- Mason’s tools
- Protective clothing for operators
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Remarks
■A watertight sharps pit also permits to discard very small amounts of recurrently generated hazardous
waste (e.g. broken mercury thermometer, itself encapsulated within an empty plastic drugs container and
covered with plaster or a cement – lime – water mixture).
■ If the soil is unstable, reinforce the vertical walls with removable struts during the excavation or make the
pit conical.
■ Alternative methods:
➞ If the subsoil is very rocky, the area flood prone or the water table high, the pit may have to be partially
constructed aboveground in a very well compacted earth mound. A complete lining that is entirely
watertight is essential (T.B. 3.12).
➞ A sharps pit can also be made of a big round plastic / polyester reservoir that is normally used for water
storage. Such a reservoir can even be put in the water table as it is completely watertight and corrosion
resistant. But during the construction, a concrete layer should be poured on its bottom to weigh it down
in order to avoid that the reservoir would float when standing in a high water table. A heavy concrete
slab should still be installed on top of the plastic / polyester reservoir, in which the drop pipe is integrated.
These kinds of reservoirs can’t be used however when a safety box reducer (T.B. 6.03) will be installed
on top of the sharps pit because of the damages that the hot ashes falling in would cause.
■ The volume of the sharps pit should be calculated according to the amounts of sharps that will be
generated over a period of at least 5 years.
■ The diameter of the drop pipe is important: it should be possible to drop the unopened disposable sharps
containers (e.g. modified drugs containers) inside the pit without any obstructions, or to fit the discharge
outlet of a Reusable Sharps Container. The length of the pipe is to prevent people reaching in the pit,
trying to recuperate sharps..
■ Only dispose of sharps (with disposable container) in the pit. Do not throw in other kinds of waste.
■ The drop pipe, slab and surroundings should be cleaned regularly and preferably occasionally sprayed
with a 0.1 % chlorine solution (T.B. 2.20).
■ In acute emergencies (e.g. temporary health structure in a camp) or within the first phase of medical waste
management, it is possible to make a “sharps pit” out of a single or double 125 l plastic recipient or a
200 l drum (preferably plastic but metal can do as well). As it is a “temporary sharps pit”, it is
recommended to foresee some handles on the drum to be able to remove it afterwards. A hole adapted
to the size of the available sharps containers should be made in the top cover of the recipient / drum and
a drop pipe with a length of 1 m installed. A metallic pipe can be welded to a metallic drum with some
external reinforcements. A plastic drop pipe can be glued in some kind of flange (purchased or self-made;
section 6.5 Further reading) that can be connected to the recipient / drum with bolts. Another alternative
is to make a concrete slab to anchor the drop pipe and to place the slab over the recipient / drum. The
recipient / drum can (partly) be buried while the majority of the drop pipe has to stay aboveground. This
temporary sharps pit is to be used as a normal model.
■ In urban areas (e.g. slums) where there isn’t enough space to make a permanent sharps pit, such a
temporary model can be useful as well. With a reduced drop pipe length, the “transitory sharps pit” can
also be located at a safe place aboveground where there isn’t access for unauthorised personnel.
■ Once the health structure is dismantled or the “transitory sharps pit” is ¾ full, the recipient / drum should
be dug out and/or transported to a safer area (e.g. the waste zone of a long-term hospital or a controlled
landfill) where it will need to be encapsulated with a cement, lime and water mixture (3, 3, 1 parts by
weight) or concrete before final burial.
■ Auto-Disable syringes and cardboard safety boxes that are used in the health structure within an
immunisation program for instance, shouldn’t be disposed as such in a sharps pit as they take up too
much space. A safety box reducer, preferably in heat resistant bricks, should be constructed on top of
the sharps pit, next to the drop pipe (T.B. 6.03). Make sure that the concrete slab is designed to withstand
the additional weight of the volume reducer.
■ In case a lot of glass waste is generated (e.g. ampoules, vials), a glass crusher should be installed on
top of the sharps pit (section 6.5 Further reading). Contact your technical referent for more information.
■ The operator (waste manager) should receive intensive training and a complete set of protective clothing,
which should always be worn during operation and maintenance (T.B. 6.10).
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T.B. 6.03 Safety box reducer

Sharps are considered to be part of the most dangerous medical wastes. The normal practice of
sharps being discarded directly in a sharps pit is unfeasible for Enlarged Programs of Immunisation
(EPI) because most often Auto-Disable (AD) syringes are used. As their needle can’t be
disconnected, the AD syringes represent a big volume that would fill up the sharps pit too fast.
These syringes are therefore collected in cardboard safety boxes and burned in a safety box
reducer. Its design is such that when the safety boxes are burned, the residues fall straight into the
sharps pit, thus nobody gets in contact with the burnt sharps. Do take into consideration that glass
sharps (e.g. vials, ampoules) might explode and therefore form a danger for the operator, thus they
should not be collected in the safety boxes.
Construction
■ Measure the size of the commonly used safety boxes and adapt the reducer design accordingly.
■ Choose and prepare within the waste zone (T.B. 6.09) an appropriate place, and dig the sharps pit
(as explained in T.B. 6.02). Take the dominant wind direction into consideration for its location to
avoid smoke nuisances, and stay away from objects that can catch fire. Make the pit twice as large
sideways or dig a separate sharps pit to accommodate the safety box reducer.
■ Construct the sharps pit in concrete or “watertight” masonry-work as described above (T.B. 6.02). Its
reinforced concrete slab on top should have a drop pipe next to a hole just as big as the internal
surface of the safety box reducer (the standard size of the hole is two refractory bricks deep and one
wide; normally 0.46 x 0.23 m). The reinforced concrete slab should be able to resist the weight of
the safety box reducer (the standard model can weigh up to 400 kg).
■ Build two closed layers of refractory (heat-resistant) bricks around the hole in the concrete slab
(section 6.5 Further reading). The bricks should be put together with a very fine layer of refractory
cement (2 - 3 mm smeared directly on the refractory bricks). Keep the refractory bricks away from
humidity and direct heat (e.g. direct sunlight) because the latter has a bad influence of the strength
of the refractory cement.
■ Foresee four openings in the refractory bricks when the third layer is constructed in a similar manner
as described above. The four holes can be obtained simply by installing two refractory bricks ¾ in
length in the middle of the long sides of the safety box reducer. The easiest way to obtain a ¾
refractory brick is to make a (small V-shaped) cut all around the brick and than break it in two with
a good blow by means of a hammer and a flat chisel.
■ Install a prefabricated grid, made out of reinforcement bars welded together.
■ Build another three closed layers in a similar way as above.
■ Build another five layers in a similar way as above, but the front side should be left open. Therefore,
four bricks will have to be cut in half in the same manner as described above.
■ Place a prefabricated metallic cover on top of the refractory bricks, which is foreseen with a hole for
the chimney and a hanging loading door (potentially with locking mechanism).
■ Construct an outer metallic hull or a normal brick wall around the refractory part of the safety box
reducer, leaving a free space of some centimetres, and/or construct a roof above to protect it from
harsh weather conditions (refractory bricks should not get wet).
■ Fit a chimney with head cap on the hole in the cover. The chimney should be at least 2 m high and
be secured to the fence of the waste zone or with cables to the ground.
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Operation
■ Open the loading door and check if residues from the previous cycle are remaining in the safety box
reducer. Push them down into the sharps pit with a long solid poking bar before starting a new cycle.
■ Place a closed safety box on its side via the loading door within the reducer.
■ Pour some kerosene over the safety box, mainly on and around its handle.
■ Light the safety box at its handle and check if the fire takes well. In case the fire would die out, some
extra combustibles like paper, cardboard and dry coconut shells or wood can be added to help
starting the combustion.
■ Close the loading door when a good fire has started.
■ Monitor the combustion, but be careful for explosions when glass sharps would accidentally have
been included in the waste. As the combustion progresses, the residues should fall straight in the
pit.
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Key Input
1. Pit - Reinforcement bar or ½” galvanised pipe
2. Concrete slab and hammer
3. Drop pipe with cover - Temporary fence material
4. Sealed lining - Shovels, hoes, picks, miner’s bars,
5. Sealed (closed) concrete foundation - Concrete (300 kg/m³), reinforcement
6. Soil bars (foundation)
7. Drainage ditch - Concrete rings or bricks / blocks, cement and sand
8. Impermeable layer (mortar) - Reinforced concrete slab (300 kg/m³)
9. Water table or made in situ
10. Safety box reducer - Pipe with cover (PVC, metal; diameter: 150 mm)
11. Chimney with head cap - Refractory bricks and refractory cement
12. Vertical loading door - Mason’s tools, including hammer and flat chisel
13. Disposal hole for residues to fall in the pit - Steel frame with vertical loading door, metal grid
14. Grid (at 3rd layer) - Chimney and head cap
15. Metallic cover - Protective clothing for builders and operators
Remarks
■ The design of the safety box reducer should permit that the residues with the burned needles fall directly
into the sharps pit. The vertical entrance and its size should allow that only one safety box can be loaded
at the time, rendering the access difficult for the recipients of other kinds of waste.
■ Although the safety box reducer is similar to the principle described in T.B. 6.04 (Mass vaccination
campaign waste), this device should not be used to reduce the sharp waste generated during big
campaigns because the sharps pit designed for long-term use would fill up too fast.
■ The volume of the sharps pit should be calculated according to the amounts of sharps that will be generated
over a period of at least 5 years. Take into consideration that the residues of burned safety boxes do take
up more space than individual needles. When a correct combustion takes place, a volume reduction of at
least 90 % should be obtained (the residues volume < 10 % of the original safety box volume).
■ Important: foresee an additional depth of 0.30 m in the calculation of the pit size for final encapsulation.
It is not part of the effective pit volume.
■ Refractory cement can be aggressive. It is thus recommended to wear the needed protective clothing
during the construction process (at least thin gloves).
■ It is also possible to make a safety box reducer from a metal 200 l drum.
■ To avoid that the safety box reducer and its waste load get wet (and hence is more difficult to burn), a
roof should be constructed above, if possible. Do not use combustible building material for the roof.
■ Use this reducer only for safety boxes containing Auto-Disable (AD) syringes, and potentially very long
needles, scalpels and razorblades with a long non-detachable plastic handle that don’t fit in a normal
sharps container. Never put organic waste (e.g. placentas, food residues), explosive objects (e.g. aerosol
cans) and/or materials that give off toxic fumes (e.g. drugs) in the safety box reducer.
■ As glass might explode when heated, it shouldn’t be burned in the safety box reducer. In case there
would be a lot of glass waste (e.g. empty vials, ampoules) being generated, it’s advisable to construct
at least a second regular sharps pit from the beginning in order to have a reserve one immediately
available when the first one is filled up. A glass crusher directly installed above the sharps pit (section
6.5 Further reading) will allow a drastic volume reduction of the glass waste, resulting in a longer lifespan
of the pit. Contact your technical referent for more information.
■ The sharp waste should be eliminated as soon as possible once it’s brought to the waste zone.
■ Do not add any other potential safety boxes before the first one is really burning well.
■ If residues remain in the safety box reducer, the air draught might be hindered during the next cycle, with
a bad combustion as a result. Do not empty the safety box reducer via the loading door, but push the
possible remaining residues downwards with a poking bar before starting the next combustion cycle.
■ The operator of the safety box reducer (waste manager) should receive intensive training and a complete
set of protective clothing, which should always be worn during operation and maintenance (T.B. 6.10).
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T.B. 6.04 Mass vaccination campaign waste (temporary safety box reducer)
Most of the waste generated during mass vaccination campaigns are sharps. Sharps are considered
to be very dangerous medical waste. The normal practice of sharps being discarded directly in a
sharps pit is unfeasible during mass vaccination campaigns because most often Auto-Disable (AD)
syringes are used. As their needle can’t be disconnected, the AD syringes represent a big volume
that would fill up the sharps pit too fast. These syringes are therefore collected in cardboard safety
boxes, transported to a centralised place and burned in a temporary safety box reducer. Its design
is such that when the safety boxes are burned, the residues fall straight into a pit, thus nobody gets
in contact with the burnt sharps. Do take in consideration that glass sharps (vials, ampoules) might
explode and therefore form a danger for the operator. Thus, it’s strongly recommended that this kind
of waste is disposed of by encapsulation without treatment.
Construction
■ Cut the upper and bottom lids completely out of a metallic 200 l drum to obtain an open cylinder, which
will become the temporary safety box reducer. Make sure that the sharp edges are worked in such a way
that they can’t injure the operator.
■ Make 10 holes in the circumference of the cylinder at about 1/3 of its height. As such, five metallic
reinforcement bars can be slid parallel to each other in the drum.
■ Cut the upper lid completely out of another metallic 200 l drum to make a container that will collect the
burnt residues. Make sure that the sharp edges are worked in such a way that they can’t injure the
operator.
■ Choose an appropriate place for the installation of the temporary safety box reducer, preferably within
an existing waste zone (T.B. 6.09). Take the dominant wind direction in consideration to avoid smoke
nuisances and stay away from objects that can catch fire.
■ Dig a hole according to the size of a 200 l drum and place the residues collection drum inside. Its top
should just be reaching the surface.
■ Put two metallic beams or a metallic grid with rather large holes (at least 0.1 x 0.1 m) over the collection
drum. The material used should be strong enough to support a metallic 200 l drum full of filled up safety
boxes. Be aware that the metal of the grid might get hot, loose partly its rigidity and potentially bend.
■ Put the temporary safety box reducer on top of the metallic beams or grid.
■ Make sure there is a fence around this temporary facility and allow only access to authorised personnel
in order to avoid accidents.
■ Make a drainage channel around the whole facility to prevent runoff water entering in the pit.
■ Make sure there is also a short term but safe storage place nearby for the safety boxes, with a roof
during the rainy season because it is essential to keep the big amount of waste dry.
Key Input
1 Pit (with open metallic drum integrated) - Shovel, hoe, pick axe, miner’s bar
2. Metal grid or beams on top of the pit - Poles, fence material
3. Metal drum 200 l (completely open cylinder) - At least 2 metal drums of 200 l (e.g. fuel drum)
4. Metal grill in drum (5 parallel bars) - Cold chisel and hammer
5. Fence - Metal saw
6. Entrance with door - Pair of pincers and wire
7. Drainage channel - Heavy grating / reinforcement bars / beams
- Poking bar
- Combustibles: kerosene, paper, dry coconut shells,
wood
- Matches or lighter
- Concrete or a mixture of cement, lime and water
- Tools to prepare the mixture
- Protective clothing for the manufacturers
and operators
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Operation
■ Push, by means of a poking bar, the potential remaining residues of the temporary safety box reducer
into the collection drum, before starting a new cycle.
■ Place a closed safety box inside the temporary safety box reducer and pour some kerosene on and
around its handle.
■ Light the safety box at its handle with a piece of burning paper and give the fire the time to take well.
In case the fire would die out, some extra combustibles like paper, cardboard and dry coconut shells
or wood can be added to help starting the combustion.
■ Add some more safety boxes onto the fire once a nice combustion has started.
■ Monitor the combustion from a distance, and be careful for explosions when glass sharps would
accidentally have been included in the safety boxes.
■ Keep on monitoring with precaution and add batches until all safety boxes have been burnt or until
the end of the working period. In case the residues don’t fall into the pit, push them down with a
poking bar.
■ Remove the safety box reducer and the beams / grid when the collection drum inside the pit is filled
up to 4/5 of its height, or when all the safety boxes are burnt. It is recommended to strike the safety
box reducer a couple of times with the poking bar or a hammer, so that some last sharps might fall
into the “pit”. In case all the waste has been burnt, consider the alternative to bury also the grid and
the safety box reducer.
■ Encapsulate the residues by pouring concrete or preferably a mixture of cement, lime and some
water (weight ratio: 3, 3, 1) inside the collection drum and once settled, cover everything with
compacted earth.
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Remarks
■ During a mass vaccination campaign, it is a common policy to bring back all the waste to a safe
centralized place, where the quantity will potentially be checked by the medical staff and where it can
also be eliminated. It is therefore interesting to choose as centralised place a health centre with an
existing waste zone. The safety box reducer can be situated within or next to this waste zone, and
its location should be where its smoke won’t bother the health services nor the population.
■ If needed, place the burner underneath some kind of roof (do not use combustible building material)
to avoid that the waste load gets wet (and thus is more difficult to burn).
■ The amount of safety boxes to be burnt during a mass vaccination campaign is often that high that
a single residues collection drum won’t be sufficient. In that case, a trench with several collection
drums will need to be prepared. Attention needs to be given that nobody, including the operator can’t
fall in the open drums.
■ When there aren’t enough drums available, other material (e.g. concrete rings, bricks) to line the pit
should be looked for to permit a correct encapsulation afterwards. In the worst case scenario, the
temporary safety box reducer can also be placed directly over the pit, which bottom should preferably
be more than 1.5 m above the water table. The depth of the water table can be estimated by verifying
its level in nearby wells. Another option is to drive a metal bar such as a reinforcing rod or (several
pieces of) ½” galvanized pipe in the ground, as deep as 1.5 m beneath the required pit depth. When
pulled out, the rod or (the earth inside) the pipe should be dry. Soil saturated with water after heavy
■ In case of an extremely big mass vaccination campaign, several temporary safety box reducers can
be put together and be used simultaneously to speed up the elimination process.
■ The complete temporary safety box reducer facility should be ready before the first waste arrives.
■ The waste should be eliminated as soon as possible once it has arrived at the centralized place, but
only after clearance of the medical staff .
■ Never over-fill the reducer with safety boxes as this could hinder the free air circulation (causing a
lack of oxygen), resulting in a bad combustion. Thus, it is better to burn small numbers of safety
boxes at the time and gradually introduce new batches.
■ When a correct combustion takes place, a volume reduction of at least 90 % should be obtained (the
residues volume <10 % of the original safety box volume). Volume reductions up to 96 % have
already been noticed.
■ Wet cotton balls, used to clean the skin before vaccination, can be collected in a carton and burned
in the temporary safety box reducer. However, it is probable that some additional combustibles will
be needed.
■ As glass might explode when heated, the vials or ampoules generated during the mass vaccination
campaign shouldn’t be burned in the temporary safety box reducer. It is recommended to encapsulate
them immediately in drums, which should be buried within the same waste zone where the safety
boxes are treated or in a controlled tip (T.B. 5.03) or a sanitary landfill.
■ Never put organic waste (e.g. placentas, food residues), explosive objects (e.g. aerosol cans) and/or
materials that give off toxic fumes (e.g. drugs) in the temporary safety box reducer. Always seek
advice from your technical referent before, in case of doubt.
■ If residues remain in the temporary safety box reducer, the air draught might be hindered, with a bad
combustion as a result. Therefore, push the remaining residues downwards with a poking bar, before
starting m a new burning cycle.
■ The temporary safety box reducer and the potential open part of the pit should be covered when not
in use, in order to avoid that residues would be blown away by the wind.
■ The operator of the temporary safety box reducer (waste manager) should receive appropriate
training and a complete set of protective clothing and equipment, which should always be used
during operation and maintenance of the facility (T.B. 6.10).
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T.B. 6.05 Temporary volume reducer

As soft waste represents the biggest quantity of all the medical waste that is generated in a health
structure, it’s important to reduce its volume drastically before it is finally disposed of into a residues
(ash) pit. In an acute emergency, a temporary volume reducer can achieve this objective efficiently.
A permanent incinerator should replace the temporary volume reducer if the health structure
becomes permanent.
Construction
■ Obtain a 200 l metal drum.
■ Cut out its top cover over around 2/3 of its perimeter. Keep the cut out as it will be used as the loading
door.
■ Cut a hole in the remaining part of the top cover. Its size should be adapted to the diameter of the chimney
that will be installed (minimum 100 mm).
■ Cut out a panel of about 0.4 m wide x 0.25 m high at the lower part of the drum’s cylinder. Keep the cut
out panel because it will be used as the ash door.
■ Prepare a metal plate with a length that is equal to the internal height of the drum and a width that is the
same as the straight part of the loading door.
■ Perforate the metal plate over its complete surface with 10 mm holes about 20 mm apart from each
other.
■ Make sure that all the sharp edges of the drum, the loading door, the ash door and the perforated plate
are worked in such a way that they can’t injure the operator.
■ Slide the perforated plate into the drum and fix it to divide the inside into two chambers of unequal volume.
■ Connect the loading door to the top of the drum with a hinge mechanism (e.g. solid hinges with a minimal
size of 50 mm) and attach a handle so that it may be opened and closed easily. The handle should be
designed in such a way that the loading door cannot pivot towards the inside of the drum.
■ Join the ash door with a hinge mechanism to the bottom of the drum and install a handle, designed in
such a way it can be attached to the drum’s cylinder.
■ Cut some rigid metal grating to the same size as the inner cross section of the large chamber (in front
of the perforated metal plate), and fix it horizontally about 0.2 m from the bottom of the drum. The grating
will separate the soft waste from the ash part of the volume reducer.
■ Fit the chimney solidly on the hole that is made in the drum’s top cover. The chimney must be at least 2
m high, and equipped with a head cap.
Operation
■ Collect all the soft waste bins before the burning is started.
■ Remove the ashes of the previous cycle via the ash door and discard them in the residues pit (T.B. 6.07).
■ Open the loading door and put some paper, cardboard and combustibles (e.g. dry firewood, dried coconut
shells) in the volume reducer. Some kerosene can be added as well to ease the lighting of the fire.
■ Close the loading door.
■ Light the paper / cardboard through the ash door. Once the fire takes off, the ash door can be closed.
Give the fire the time to take well.
■ Introduce via the loading door a small batch of soft waste (equivalent to the content of a waste bin) once
the fire is burning well.
■ Close the loading door immediately again.
■ Monitor the combustion. If the fire would start to die out, add via the loading door some combustibles like
dry wood or coconut shells.
■ Introduce a second batch of soft waste when the first one is nearly completely burnt.
■ Keep on monitoring the combustion and adding small batches of soft waste as described above.
■ Let the fire die out by itself once all the waste is burnt.
■ Disinfect the empty soft waste bins with a 0.1% chlorine solution (T.B. 2.20), rinse them with clean water
and finally clean them with water and soap (never mix chlorine and soap together).
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Key Input
A. Top of the drum (part not cut out) - Metal drum of 200 l (e.g. fuel drum)
B. Hole for the chimney - Hammer
C. Combustion chamber (large) - Metal saw or cold chisel
D. Cut-out of the cover - Pair of pincers and wire
- Metal plate (same thickness as drum)
- Spanners, file
1. Metal drum, 200 l - Drill machine with drill bits or large punch
2. Perforated metal plate - System to fix the hinges,
3. Perforations in the metal plate for draught perforated plate and chimney
4. Loading door to the drum (e.g. nuts and bolts, welding machine)
5. Chimney with head cap - Metal chimney pipe and head cap
6. Ash door (can be used to regulate the draught) - Heavy mesh, grating or reinforcement bars
7. Metal grating (or heavy mesh) - 4 solid metal hinges or an alternative
- Paper, cardboard, kerosene, dry coconut shells,
wood
- Matches or lighter
- Scoop and brush to collect residues
- Protective clothing for operators
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Remarks
■ Place the temporary volume reducer in the foreseen waste zone, at a location where the smoke
won’t bother the health services nor the neighbouring population. The required height of the chimney
depends on the surrounding obstacles (e.g. buildings and vegetation), so its outlet should normally
be above them.
■ Alternative: it’s possible to remove the bottom of the drum completely and to place the volume reducer
immediately over the residues (ash) pit by means of metallic beams or a metallic grid with big holes
(at least 0.1 x 0.1 m). The material used should be strong enough to support a metallic 200 l drum
full of waste. Be aware that the metal of the grid might get hot, loose partly its rigidity and potentially
bend. This system has the advantage that all the residues fall immediately in the pit, although it
might still be necessary to push them down before a new combustion cycle is started. The
inconvenience is that the residues pit can’t be closed easily at the end of a cycle and ashes could
be blown away by the wind.
■ Place the volume reducer underneath a roof (do not use combustible building material) to avoid that
the waste load gets wet during the rainy season and thus is more difficult to burn. The roof also
helps to reduce a little bit the drum corrosion.
■ Even under the best circumstances, a drum volume reducer that is frequently used will not last very
long. This is due to corrosion, enhanced by the corrosive gasses that are generated when burning
soft waste and the heat produced inside the drum.
■ Clean out the ash part of the volume reducer before each new cycle is started, otherwise the air
draught will be hindered, resulting in a bad combustion. Do not empty the volume reducer via the
loading door.
■ Do not try to over-economize on combustibles (e.g. paper, cardboard, dry firewood, dried coconut
shells): always preheat the volume reducer and keep a good fire going to guarantee the best
combustion possible.
■ Never over-fill the temporary volume reducer with soft waste: this would block the free circulation of
air (causing a lack of oxygen), resulting in a bad combustion and thus more toxic fumes. Thus, it is
better to burn small batches (e.g. content of a 20 l waste bin) at the time and once they are nearly
completely burned, a new batch can be introduced.
■ The opening of the ash door may be adjusted to regulate the draught. However, it is preferable to
burn with the ash door closed, if the draught is sufficient.
residues volume <10 % of the original volume).
■ Never burn sharps (e.g. needles, scalpels, ampoules, vials), organic waste (e.g. placentas, food
residues), explosive objects (e.g. aerosol cans) or materials that give off toxic fumes (e.g. drugs) in
a volume reducer. Other facilities should be available (see appropriate Technical Briefs) in the waste
zone to dispose of them. In case of doubt, always seek advice from your technical referent.
■ The operator of the temporary volume reducer (waste manager) should receive an appropriate
training and a complete set of protective clothing and equipment, which should always be used
during operation and maintenance of the facility (T.B. 6.10).
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T.B. 6.06 Permanent batch incinerator

As soft waste represents the biggest quantity of all the medical waste that is generated in a health
structure, it’s important to reduce its volume drastically before it is finally disposed of into a residues (ash)
pit. A permanent, mostly auto-combustion incinerator should not only achieve this treatment objective,
but in comparison with a volume reducer also render the remaining solid residues and fumes:
■ more decontaminated (exempt of pathogens)
■ less offensive (unrecognisable solid residues / the emissions the least toxic possible with limited
means).
Principle
The “ideal” permanent incinerator for normal sized health structures within low-income countries should
respond to the following specifications:
■ Composed of a primary and secondary combustion chamber to extend the retention time of the gasses
in a hot environment. It allows to drastically reduce the number of thermo-resistant pathogens and to burn
off more (toxic) emissions.
■ Build in refractory material (heat resistant bricks and cement) to extend its lifetime and to have less
temperature variations when new or wet waste is introduced.
■ Simple design using appropriate technology.
■ Affordable at purchase and low running and maintenance costs.
■ Able to reach at least 850°C during incineration.
■ Able to incinerate at least 10 kg of soft waste per hour.
■ Consists of an auto-combustion system, which functions mainly on the burnable waste and doesn’t need
additional fuel, except during the start up phase to preheat the incinerator, and when extremely wet or
some specific (bio-)hazardous waste has to be incinerated. It results in an important reduction of the
amount of additional combustibles needed.
Always seek advice from your technical referent in case of doubt for the choice of an appropriate incinerator.
Operation
For factory made incinerators, the instructions from the manufacturer should be followed precisely. Below
is a general description of how to use a batch auto-combustion incinerator (e.g. the De Montfort):
■ Make sure all the soft waste bins have been collected before the incineration starts.
■ Empty the ashtray containing ashes and residues from the previous incineration cycle into the residues
(ash) pit (T.B. 6.07). An extra sweep inside the incinerator with a long-handle broom might be necessary
to remove residues that fell beside the ashtray.
■ Open the loading door and put some paper, cardboard and combustibles (e.g. dry firewood, dried coconut
shells) in the incinerator.
■ Close the loading door.
■ Light the paper / cardboard through the ashtray door. Once the fire takes off, close the ashtray door.
■ Give the fire the time to take well and to preheat the incinerator. The preheating should last until a roaring
fire is heard or at least until good flames are visible in the secondary combustion chamber (this can be
seen via the peephole at the back side of the incinerator, if available).
■ Introduce via the loading door a small batch of soft waste (equivalent to the content of a waste bin), once
the fire is burning well.
■ Close the loading door immediately again.
■ Monitor the combustion in the primary and secondary combustion chambers (if possible): if the fire would
start to die out in one of the chambers just after a new batch of waste went in, add via the loading door
some combustibles like dry wood or coconut shells.
■ Introduce a second batch of soft waste when the first one is nearly completely burnt.
■ Keep on monitoring the combustion and adding small batches of soft waste as described above.
■ Let the fire die out by itself once all the waste is burnt.
■ Disinfect the empty soft waste bins with a 0.1 % chlorine solution (T.B. 2.20), rinse them with clean water
and finally clean them with water and soap (never mix chlorine and soap together).
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Key
1. Refractory bricks
2. Primary combustion chamber
3. Loading door with handle
4. Air inlet
5. Ashtray / door
6. Secondary combustion chamber
7. Chimney with head cap
8. External wall (bricks, metal hull)
9. Grate
10.Concrete slab
Figure adapted from the De Montfort incinerator
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Remarks
■ Skilled people are needed for the construction of incinerators. Since refractory cement can be
aggressive, it is recommended to have the builders wear the needed protective clothing during the
construction process (at least thin gloves).
■ If refractory bricks and cement aren’t available on the spot, look in neighbouring countries or order
from high-income countries (e.g. in Europe). Correct refractory bricks for batch (auto-combustible)
incinerators have a high density (weight of about 4.5 kg/brick) and are made out of kaolin enriched
with alumina (Al2O3; concentration ideally around 60 %). This material has a high resistance to
temperature variations, which occur each time a new batch of soft waste is manually introduced via
the loading door.
■ Position the incinerator in the foreseen waste zone, at a location where the smoke won’t enter the
health structure’s buildings nor bother the neighbouring population.
■ The required height of the chimney (preferably in stainless steel or thick plated metal tubes) depends
on the surrounding objects (e.g. buildings and vegetation), with its outlet always well above them.
Be aware that a higher chimney creates more draught, which has an influence on the combustion
temperature (can be positive or negative). The admission of air is also function of the size of the air
inlets.
■ Position the incinerator underneath a roof (do not use combustible building material) to avoid that the
waste load gets wet and thus is more difficult to incinerate. The roof also helps to reduce the corrosion
of the (hot) metallic parts of the incinerator.
■ Big incinerators take longer to preheat and therefore need a lot more combustibles, thus it is advisable
to construct (rather) small incinerators. For large health structures where the capacity of a small
incinerator doesn’t seem to be sufficient, it is often more appropriate to build two small ones than one
big incinerator. Only for very big hospitals (> 300 beds), larger models of commercially available
incinerators might be needed.
■ Do not scale up the size of existing designs because this might have serious consequences on the
efficacy of the incinerator.
■ Empty the incinerator’s ashtray each time before a new incineration cycle is started, otherwise the
draught will be hindered, resulting in a bad combustion with more toxic fumes. Do not empty the
incinerator via the loading door.
■ Do not try to over-economize on combustibles: always preheat the incinerator and keep a good fire
going to guarantee the best combustion possible.
■ Never over-fill the incinerator with soft waste: this would block the free circulation of air (causing a
lack of oxygen), which would result in a bad combustion and thus more toxic fumes. Thus, it is better
to incinerate smaller batches at the time and once they are nearly completely incinerated, a new
batch can be introduced.
residues volume <10 % of the original volume).
■ Never incinerate sharps (e.g. needles, scalpels, ampoules, vials), organic waste (e.g. placentas,
food residues), explosive objects (e.g. aerosol cans) or materials that give off toxic fumes (e.g. drugs)
in a batch (auto-combustion) incinerator. Other facilities should be available (see appropriate
Technical Briefs) in the waste zone to dispose of them. In case of doubt, always seek advice from
your technical referent.
■ Bio-hazardous waste like tuberculosis sputum and blood can be incinerated if enough fuel (e.g. dry
wood or coconut shells) are added to compensate for the heat loss due to the liquid nature of the
waste. Always seek advice from your technical referent in case of doubt
■ Attention: when the loading door is opened, a big flame might shoot out. Some flames might be
noticed as well via the air inlet when the loading door is closed again. The operator should stand
away from the flames.
■ The operator of the incinerator (waste manager) should receive an intensive training and a complete
set of protective clothing and equipment, which should always be used during operation and
maintenance (T.B. 6.10).
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T.B. 6.07 Residues (ash) pit

When soft waste is burnt in an incinerator or a (temporary) volume reducer, ashes and some
unburned residues will be generated, thus an appropriate final disposal method is required. The ash
pit is a simple and efficient facility for these residues and it corresponds to the principle of onsite
final disposal. A simple (unlined) pit with a temporary slab can do for acute emergencies. A longer
lasting solution as described below is required however for chronic emergencies and stabilised
situations.
Construction
■ Choose within the waste zone (T.B. 6.09) an appropriate place to construct the residues pits, nearby
the volume reducer / incinerator. It is recommended to construct at least two ash pits from the
beginning in order to have a reserve readily available when the first one is full.
■ Prepare the site for construction: remove all debris, flatten the surface, implement a soil texture test
(T.B. 4.05), determine the depth of the water table and bring in the needed material. Usually the
preparation of the different waste zone facilities is done at the same time.
■ Determine the amount of residues to be disposed of, based on the volume of soft waste that is
generated on a daily basis. After a correct combustion, the residues volume should represent less
than 10 % of the original volume.
■ Determine the required capacity of a single residues pit. The suggested lifespan is two years at least.
■ Prepare, excavate and line the pit in a similar way as described for a simple pit latrine (T.B. 3.04) or
a VIP latrine (T.B. 3.07), depending on the soil type and the skills of the mason. The same excavation
can be used to construct the two residues pits at the same time when a closed separation wall is built
in the middle. In case the water table doesn’t permit deep excavation, each pit can be increased in
size by foreseeing two or more standard size slabs next to each other. In this case, it isn’t necessary
to put a closed separation wall in between each “cubicle”. The layer of lean concrete for stabilisation
on the bottom of the pit is recommended however.
■ Make a concrete standard size slab (T.B. 3.05 or 3.08, depending on the type of lining, but without
the ventilation pipe). The drop hole’s shape and size (square of about 0.3 x 0.3 m), hence the location
of the reinforcement bars need to be modified. Provide a lid for the drop hole, preferably connected
to the slab with some kind of heavy-duty “hinges”. The lid can be made in wood (emergency
situations), but preferably in concrete or metal.
■ Install the prefabricated slab with its lid on the residues pit’s lining / base, once it has settled for at
least 3 days. To ensure a secure seating, the slab should be fixed to its lining / base (overlaps of at
least 0.1 m) with a 10 mm thick mortar layer (T.B. 2.05).
■ Make a drainage channel around the pit to lead runoff water away, protecting its walls against erosion.
Operation
■ Remove the ashes and other residues from the incinerator / (temporary) volume reducer before a new
cycle is started, and dispose of them in the residues pit. Make sure that the residues are always
covered with the slab’s lid or by at least 0.1 m of compacted soil when there is no slab (emergency
situations).
■ Close down the pit when the residues’ level is about 0.3 m underneath the slab. For acute emergency
settings, remove the temporary slab, put a metal grid on top of the residues and backfill the remaining
space with compacted soil. Coming across the grid during future excavations will indicate that a pit
has already existed on the same spot. In chronic emergencies and stabilised situations, the remaining
space needs to be backfilled with soil without removing the concrete slab. It is possible to empty a
residues pit that has been closed down for at least two years. However, special precautions should
be taken to avoid injuries with sharps that have accidentally been discarded in the residues pit. The
residues can be taken to a controlled tip (T.B. 5.03) or sanitary landfill.
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Key Input
1. Pit - String line, sticks and measuring tape
2. Slab - Shovel, hoe, pick axe, miner’s bar
3. Lid - Fired bricks / cement blocks and/or
4. Base / lining sand, cement, gravel and clean water
5. Soil - Reinforcement bars (diameter 8 mm)
6. Drainage channel - Tools to prepare and cast concrete; mason’s tools
7. Mortar layer (at least 10 mm thick) - Jute sacking or plastic sheeting
8. Corrugated iron sheets (pit reinforcement) - Prefabricated slab with lid
9. Water table - Protective clothing for operators
- Experienced mason and 1 or 2 labourers
Lining represented in the figure is similar to the method used for a simple pit latrine (T.B. 3.04), but also
other methods can be used (e.g. T.B. 3.07).
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Remarks
■ Wood ash can be used for several purposes (e.g. covering excreta for odour reduction in latrines, hand
washing), but the ash from incinerated / burnt soft waste should only be discarded at a safe place.
■ If the pit is dug in one time until the required depth and the soil is unstable, the vertical walls should
be reinforced with removable struts during the excavation, or the hole should be made conical.
■ The bottom of the pit should be at least 1.5 m above the highest possible water table. The latter can
be estimated by verifying the water level in nearby wells. Another option is to drive a metal bar such
as a reinforcing rod or (several pieces of) ½” galvanized pipe in the ground, as deep as 1.5 m beneath
the required pit depth. When pulled out, the rod or (the earth inside) the pipe should be dry. If not,
the pit depth should be adapted accordingly. Soil saturated with water after heavy rainfall might give
a false impression of the actual water table level.
■ Another construction method for residues pits is the individual circular-shaped pit, which is often
more difficult to excavate but less due to collapse because of its natural arching effect. This can be
particularly interesting for emergency residues pits that won’t be lined. When necessary, the circular
pit can be reinforced with one or more concrete rings (T.B. 2.06). Other valid construction methods
and materials exist for circular pits, but fall out of the scope of these guidelines. Contact your technical
referent for more information.
■ Alternative methods:
➞ If the subsoil is very rocky, the area flood prone or the water table high,, the pit may partially be
constructed in the ground and the remaining aboveground part in a very well compacted earth
mound. A different technique (T.B. 3.12) will have to be used. For big health structures generating
large quantities of incinerator residues, long aboveground “trenches” might be more appropriate.
➞ A residues pit can also be made of a big round plastic / polyester reservoir that is normally used for
water storage. Such a reservoir can even be put in the water table as it is completely watertight and
corrosion resistant. But during the construction, the reservoir should be weighted down (e.g. with a
concrete layer or big stones on its bottom) in order to avoid that it would float when standing in a
high water table. Hot ashes should not be discarded in such a residues pit.
■ If it rains a lot in the region, the lining / base can be made a little higher aboveground, for the pit to
be less at risk of flooding.
■ The calculated pit volume should include a free space above the residues of at least 0.30 m high. It
isn’t part of the effective pit volume, but will allow the pit to be closed properly once it’s nearly full.
■ For acute emergencies, a temporary wooden slab or layers of compacted earth can do. For chronic
emergencies and stabilised situations, a concrete standard size slab is recommended as it still has
a reasonable weight that can easily be removed.
■ For a large pit with several slabs, each one should have its own covered 0.3 x 0.3 m drop hole,
allowing an equal residues repartition over the pit. All of the slabs have to be sealed to each other
with mortar.
■ Only discard incinerated / burnt residues of soft waste in the pit. Do not throw in any other kinds of
waste, and certainly not sharps!
■ It is essential that the residues are covered immediately after disposal, to avoid that the wind would
blow the ashes away (causing potentially respiratory infections) and/or that unburned residues would
attract vectors (e.g. flies).
■ The slab and surroundings should be cleaned regularly.
■ The operator (waste manager) should receive intensive training and a complete set of protective
clothing, which should always be worn during operation and maintenance (T.B. 6.10).
■ If a residues pit is emptied (at least two years after it has been closed down), all its slabs should be
removed to permit easy access and safe working conditions. Once all the slabs are removed, wait
some time before entering into the pit to evacuate all potential hazardous gasses.
■ During works within a used residues pit, make sure that the person inside the pit has a strong rope
around his waist. This rope permits colleagues standing at the side of the pit to lift the person out if
something goes wrong.
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T.B. 6.08 Organic waste pit (“Placenta” pit)

Organic waste contains too many liquids to be suitable for incineration with volume reducers or
batch auto-combustion incinerators. The temperature reduction due to the evaporation of the liquids
will result in the formation of more toxic gases, the survival of potential thermo-resistant pathogens
or even in bringing the combustion to a halt. Hence, many combustibles will be needed for the
correct incineration of organic waste. Burial (with natural decomposition) is a simpler and more
efficient disposal method. “Individual burial” would be too time consuming, but “collective burial” in
an organic waste pit is appropriate.
Construction
■ Choose an appropriate place within the waste zone (T.B. 6.09) to construct the organic waste pits. It is
strongly recommended to construct at least two organic waste pits from the beginning in order to have
a reserve immediately available when the first one is full.
■ Prepare the site for construction: remove all debris, flatten the surface, implement soil texture and
permeability tests (T.B. 4.05), determine the depth of the water table and bring in the needed material
and equipment. Usually the preparation of the different waste zone facilities is done all at the same time.
■ Determine the volume of organic waste that needs to be disposed of over a period of at least a week.
■ Determine the required capacity of a single organic waste pit. The suggested lifespan is 2 years at least.
■ Prepare, excavate and line the pit in a similar way as described for a simple pit latrine (T.B. 3.04) or a
VIP latrine (T.B. 3.07), depending on the soil type and the skills of the mason. The same excavation can
be used to construct the two organic waste pits at the same time when a watertight separation wall is
built in the middle. In case the water table doesn’t permit deep excavation, each pit can be increased in
size by foreseeing two or more standard size slabs next to each other. In this case, it isn’t necessary to
put a separation wall in between each “cubicle”. The layer of lean concrete for stabilisation on the bottom
of the pit is highly recommended for the VIP construction method however.
■ Make a concrete standard size slab with ventilation hole (T.B. 3.08), but the drop hole’s shape and size
(about 0.3 x 0.4 m), hence the location of the reinforcement bars need to be modified. Provide a lid for
the drop hole, preferably connected to the slab with some kind of heavy-duty “hinges”. The lid can be
made in wood (emergency situations), but preferably in concrete or metal that needs to be protected
against corrosion (as the gasses within the pit are aggressive). A small piece of plastic pipe (diameter
of at least 100 mm, preferably 150 mm and about 200 mm high) should be integrated in the slab’s
ventilation hole.
■ Install the prefabricated slab with its lid on the lining / base of the organic waste pit, once it has settled
for at least 3 days. To ensure a secure seating, the slab should be fixed to its lining / base (overlaps of
at least 0.1 m) with a 10 mm thick mortar layer (T.B. 2.05).
■ Place the plastic ventilation pipe over the small pipe integrated within the slab. The pipe should be at least
2.5 m long, with its outlet higher than the potential obstacles in the direct vicinity (e.g. buildings, trees).
To prevent from being blown over during heavy winds, the ventilation pipe should be anchored to the
fence of the waste zone or with cables to the ground. The outlet of the pipe should have a rain cap (Tee),
being covered with a (preferably stainless steel) screen to avoid that vectors would enter inside the pit.
■ Make a drainage channel around the organic waste pit to lead runoff water away, thus protecting its
walls against erosion.
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Key Input
1. Pit - String line, sticks and measuring tape
2. Slab - Shovel, hoe pick axe, miner’s bar
3. Lid - Fired bricks / cement blocks and/or
4. Base / lining sand, cement, gravel and clean water
5. Permeable soil - Reinforcement bars (diameter 8 mm)
6. Drainage channel - Tools to prepare and cast concrete; masons tools
7. Mortar layer (at least 10 mm thick) - Jute sacking or plastic sheeting
8. Ventilation pipe - Prefabricated slab with lid
9. Tee with mosquito netting - Protective clothing for operators
10. Corrugated iron sheets - PVC pipe (preferably diameter 150 mm)
(pit reinforcement) - Piece of stainless steel or nylon mosquito net
11. Water table - Experienced mason and 1 or 2 labourers
Lining represented in the figure is similar to the method used for a simple pit latrine (T.B. 3.04), but also
other methods can be used (e.g. T. B. 3.07).
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Operation
■ Dispose of the organic waste into the pit immediately when it arrives at the waste zone. Use only one
pit at the time. Make sure that the pits are always closed with the slab’s lid.
■ Disinfect the empty organic waste bins with a 0.1 % chlorine solution (T.B. 2.20), rinse them with clean
water and finally clean them with water and soap (never mix chlorine and soap together).
■ Close down the pit when the level of the organic waste is about 0.5 m underneath the slab. Put a thick
layer of wood ash on top of the organic waste and top up with compacted soil if the pit is closed
permanently. Do not use ash from burnt soft waste for this purpose. Most organic waste will
decompose into harmless matter, so it is normally possible to empty a pit that has been closed down
for at least two years. Be aware however that bones of amputated limbs will still be intact. The
population could perceive the removal of these remainders as offensive. Take also special
precautions to avoid injuries with sharps that have accidentally been discarded in the organic waste
pit. A new permanent burial place should be found for the organic waste remainders, potentially a
controlled tip (T.B. 5.03) or a sanitary landfill.
Remarks
■ For very small health centres with only an occasional delivery (e.g. max. 3 per month) and no other
medical interventions that generate organic waste, an organic waste pit isn’t required. The placentas can
be discarded in a simple pit or V.I.P. latrine.
■ If the pit is dug in one time until the required depth and the soil is unstable, the vertical walls should be
reinforced with removable struts during the excavation, or the hole should be made conical.
■ The bottom of the pit should be at least 1.5 m above the highest possible water table. The latter can be
estimated by verifying the water level in nearby wells. Another option is to drive a metal bar such as a
reinforcing rod or (several pieces of) ½” galvanized pipe in the ground, as deep as 1.5 m beneath the
maximum pit depth. When pulled out, the rod or (the earth inside) the pipe should be dry. If not, the pit
depth should be adapted accordingly. Soil saturated with water after heavy rainfall might give a false
impression of the actual water table level.
■ Another construction method for an organic waste pit is the individual circular-shaped pit, which is often
more difficult to excavate but less due to collapse because of its natural arching effect. This can be
particularly interesting for emergency organic waste pits that won’t be lined. When necessary, the circular
pit can be reinforced with one or more perforated concrete rings (T.B. 2.06).
■ If the subsoil is very rocky, the area flood prone or the water table high,, the pit may partially be constructed
in the ground and the remaining aboveground part in a very well compacted earth mound. A different
technique (T.B. 3.12) will have to be used.
■ If it rains a lot in the region, the lining / base can be made higher, for the pit to be less at risk of flooding.
■ The calculated pit volume should include a free space above the waste of at least 0.50 m high. It isn’t
part of the effective pit volume, but will allow the pit to be closed properly once it’s nearly full.
■ In the very early stages of an emergency, layers of compacted soil or a temporary wooden slab can do
to cover the organic waste, but must be replaced as soon as possible with a slab of more durable material
(e.g. concrete). To be able to empty an organic waste pit safely, its slab should be completely removable,
hence having a reasonable weight. It is therefore strongly recommended to use an adapted version of
the standard size concrete VIP slab (adapted from T.B. 3.08).
■ For a large pit with several slabs side-by-side, each one should have its own covered 0.3 x 0.4 m drop
hole, allowing an equal organic waste repartition over the pit. However, one ventilation pipe can be
sufficient for the whole pit. All of the slabs have to be sealed to each other with mortar.
■ The small plastic pipe in the ventilation hole should be flush to the bottom of the slab in order to avoid
too many (burnable) gasses accumulating in the pit. To ensure a better anchorage, a clamp can be
connected to the small pipe at the level where it will be mortared in the slab. To ensure a better evacuation
of the gasses, the slab can be slightly tilted upwards towards the ventilation pipe.
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■ Only discard organic waste in the pit. Don’t throw in any other kinds of waste, and certainly not sharps!
■ Do not smoke when opening an organic waste pit because flammable gasses like methane might have
accumulated underneath the slab!
■ It is essential that the organic waste is covered immediately after disposal, to avoid bad odours and
vectors (e.g. flies) being attracted to them.
■ Adding lime to the organic waste pit can reduce drastically the smell, but might slow down the
decomposition process. This might eventually result in the pit filling up faster. A better option is to introduce
occasionally some wood ash, which does reduce the odours as well and might increase the
decomposition rate. Besides, wood ash can often be obtained for free. However, do not use ash residues
from the incinerator / volume reducer (incinerated / burnt soft waste).
■ The slab and surroundings should be cleaned and disinfected regularly. Check frequently if the ventilation
pipe isn’t blocked. Remove all material that could obstruct the ventilation of the pit by pouring some
water trough the pipe. Check also if the screen is still intact and replace when necessary.
■ The operator (waste manager) should receive intensive training and a complete set of protective clothing,
which should always be worn during operation and maintenance (T.B. 6.10).
■ If an organic waste pit is emptied (at least two years after it has been closed down), all its slabs should
be removed to permit easy access and safe working conditions. Once all the slabs are removed, wait
some time before entering into the pit to evacuate all hazardous gasses.
■ During works within a used organic waste pit, make sure that the person inside has a strong rope around
his waist, which permits colleagues standing at the side of the pit to lift him out if something goes wrong.
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T.B. 6.09 Waste zone

The waste zone is a special area within the compound of the health structure where all types of
medical waste can be disposed of. This zone concentrates the different treatment / final disposal
facilities to avoid that the contamination is spread over a large area. It also has the advantage of
providing an “ergonomic” working environment for the operator responsible of the area (waste
manager).
Site selection
Choose a site for the waste zone that should ideally correspond to the following expectations:
■ Located within the compound of the health structure.
■ Away from groundwater points and preferably downhill from them to avoid direct contamination
(minimum distance from groundwater points > 30 m and > 50 m when organic waste pits are
present).
■ Not liable to flooding.
■ Water table stays rather low, even during the rainy season.
■ Downwind of the health structure’s buildings and of the surrounding dwellings (for dominant winds).
■ Easily accessible (even by truck for big infrastructures) to bring in waste and combustibles or to
evacuate waste residues when emptying the residues or organic waste pits.
■ Easy to drain runoff water away.
■ Enough space available (for a possible extension).
Key Input
1. Waste bins’ temporary storage place (under roof) - Detailed plans (of different facilities)
2. Incinerator / volume reducer - Experienced labour
3. Washing area (concrete slab with a protective kerb) - Construction material and tools
4. Water supply
5. Grid leading to a grease trap followed
by an infiltration system / sewer
6. Roof (with its slope indicted by the arrow)
7. Residues (ash) pits
8. Organic waste pits
9. Sharps pit (with potentially a safety box reducer)
10. Runoff water drains (preferably cemented)
11. Fence
12. Door (with padlock)
13. Concrete floor (for chronic emergencies
and stabilised situations facilities)
14. Gravel (can be replaced by concrete for a cleaner
/ long-lasting waste zone)
15. Parking place for a possible pushcart
16. Closed storage space for tools and/or wood
(used to start the incinerator / volume reducer)
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Remarks
■ The type of facilities that are needed within the waste zone and their capacity depend on the types
and amounts of wastes that are generated. The amounts of wastes are depending on the type of
the health structure itself (e.g. OPD, IPD, hospital), its activities (e.g. operating theatre, maternity,
laboratory) and its size, and also on the number of patients that are “passing by” every day (e.g.
an organic waste pit is often not necessary in small structures or camp situations). It is important
however to foresee enough space, as new pits might have to be dug once the old ones are nearly
full.
■ For emergencies, a simple waste zone can be made with temporary facilities (a temporary volume
reducer, an emergency sharps pit made out of a drum, temporary ash and organic pits, and a
washing area). Although temporary, the lay out of the waste zone must be respected to facilitate
the work of the waste manager. In case the temporary health structure is closed, it is advised to
remove the emergency sharps pits and to bury them in a safe area after having been encapsulated
(T.B. 6.02).
■ In case the construction of the complete waste zone would take long, a temporary waste zone
with acute emergency facilities should be made as a first step, even for chronic emergencies and
stabilised situations. This will enable to start immediately with correct medical waste management
(T.B. 1.08), certainly if the staff has already been trained in segregating the waste and the use of
the waste zone facilities.
■ The site must be completely fenced and have a runoff water drain system.
■ A roof has to be foreseen for the incinerator / (temporary) volume reducer(s) and for the temporary
storage area for the soft waste, to avoid that it gets wet (and thus becomes more difficult to burn).
It is also recommended to construct a roof over the potential safety box reducer, although that a
protective hull (made with bricks or metallic sheets) can already be sufficient.
■ The residues (ash) pit and the organic waste pit come preferably in pair and can potentially be
reused. It’s suggested not to put a complete concrete floor around the ash and organic waste pits,
to be able to construct additional ones within the same waste zone when needed. Gravel around
the pits is essential however as it will avoid that the waste zone turns into a mud pool.
■ A washing area is essential for disinfecting, rinsing and cleaning the empty waste containers.
Water supply, chlorine solutions and soap are essential for the washing area.
■ A grease trap and infiltration system (T.B. 4.04, 4.06, 4.07 and 4.08) are necessary for the
washing area.
■ The waste zone and all reusable containers need to be inspected regularly and replaced when
necessary.
■ Only the responsible of the waste zone (waste manager) should have access to this site. In
situations where the cleaning staff would do the waste collection and transport towards the waste
zone, it can be interesting to leave an opening in its fence where the containers can be shifted
through without having to enter the area.
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T.B. 6.10 Protective clothing and equipment

Protective clothing for the maintenance staff is an essential part in conducting safe medical waste
management. A good outfit might also raise to some extent the self-esteem of the maintenance
staff as they are all too often forgotten. Good equipment and tools will also render the workload
easier to bear.
Implementation
The main objective of protective clothing is to reduce the physical harm risk for the staff during their
potentially dangerous activities. The protective clothing will have to be adapted according to the kind
of activities performed by the staff. If the cleaners have to work with dangerous goods (e.g. highly
concentrated chlorine solutions), a plastic apron, rubber gloves and goggles are essential besides the
standard overall. The waste manager should have the same protective clothing as the cleaners,
including a respirator, a face shield, heavy duty boots and preferably armoured gloves when he
operates the incinerator. A poncho / rain coat and rubber boots come in handy during the rainy season
for those staff working outside.
Besides the protective clothing, the staff should also receive correct equipment. This equipment should
not only ease the work of the staff but also render it safer. Correct equipment includes amongst others:
■ brooms,
■ swaps,
■ disinfectants,
■ good waste bins (right size and colour) with well fitting lids,
■ gardening tools,
■ cart / trolley adapted to transport all the waste bins / sharps containers to the waste zone,
■ soap to wash their hands and the waste containers.
Finally, the staff should be trained in using the equipment, the material (specially the use of disinfectants
or other chemical products) and all the facilities correctly. Safety should be an important issue in the
training package.
Remarks
■ Make sure that the staff wears the protective clothing during work.
■ Make sure that the staff washes their hands after having taken off their protective clothing.
■ In big health structures (e.g. hospitals), a washing facility with shower should be foreseen for the staff,
allowing them to take a shower before leaving (T.B. 4.01).
■ The staff should be responsible for their designated protective clothing and equipment. If old gear is
torn, it should be brought in to receive a new set.
■ The working gear should preferably stay at the health structure, certainly during epidemics as they
might be contaminated. Therefore, a changing place and a locker have to be foreseen.
■ The working clothes will have to be washed regularly. If a laundry facility is part in the health structure,
the clothes can be integrated in this circuit. If a laundry facility is not available, other arrangements
will have to be made.
■ Besides the protective clothing, it is strongly advised to vaccinate all the staff coming potentially in
contact with medical waste against Hepatitis B and Tetanus.
■ The staff should be informed that all (work related) accidents must be reported and that a medical
follow-up is available to reduce the risk of the accident related infection.
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Key
1. Heavy-duty (thick / armoured) gloves / rubber household gloves (when working with chlorine)
2. Overall or long sleeve shirt and working trousers
3. Good boots with strong soles (heavy duty shoes)
4. Apron
5. Respirator (when working with volume reducer / incinerator)
6. Face shield or goggles (when working with chlorine and/or a volume reducer / incinerator).
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Vector Control
Narrative
Technical briefs
T.B. 7.01 Mosquitoes

T.B. 7.02 Flies (non biting)
T.B. 7.03 Sandflies
T.B. 7.04 Fleas
T.B. 7.05 Lice
T.B. 7.06 Rodents
T.B. 7.07 Mites
T.B. 7.08 Bedbugs
T.B. 7.09 Cockroaches
T.B. 7.10 Characteristics of public health pesticides
T.B. 7.11 Understanding pesticides labels
T.B. 7.12 Safe packaging, transport, storage and disposal
of pesticides
T.B. 7.13 Safe use of public health pesticides
T.B. 7.14 Insecticide residual sprayer
T.B. 7.15 Insecticide Residual Spraying campaign
T.B. 7.16 Long-lasting insecticidal Nets (LN’s)
T.B. 7.17 Impregnation of nets, clothing and curtains
T.B. 7.18 Insecticidal dusting
T.B. 7.19 Rodent control
T.B. 7.20 Protective Clothing
Chapter 7
Vector Control - draft 7 1

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7 2
Vector Control - draft
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7. 1 Why carry out vector control ?

In low-income countries, vector-borne diseases such as malaria, dengue, leishmaniasis and sleeping
sickness are common and among the important causes of morbidity and mortality.
Reasons for increased risk of vector transmitted diseases include:
■ refugees or displaced populations may lack immunity to a disease or a particular strain of the disease
in the settlement area (e.g. malaria)
■ refugees or displaced populations having fled through an area infested with certain vectors (e.g.
sandflies transmitting leishmaniasis)
■ refugees or displaced populations live in crowded and unsanitary conditions, that result in a sharp
increase of vectors - this may be compounded by a lack of sufficient water for personal and domestic
hygiene (e.g. body lice transmitting typhus)
■ poor housing favours an increase in vectors exposure, and the spread of the associated
communicable diseases.
■ being located in an area which supports significant vector populations (e.g. mosquitoes in a swampy
area)
■ loss of livestock, eventually causing vectors to feed increasingly on humans
■ lack of food and adequate health services
Health structures are generally crowded with weakened people and high densities of pathogens are
met. Without general vector control measures, the risk of further infection of the patients, caretakers,
and visitors increases dramatically (e.g. body lice transmitting typhus). In addition, if the prevalence
of vector-borne diseases is low in the area, small scale vector control measures in health structures
are particularly important since the health structure is likely to be the major source of pathogens.
7.2 What is vector control ?

7.2.1 Vectors in precarious situations
A vector carries and transmits infectious pathogens directly or indirectly from a reservoir (e.g.
environment, animal, human) to another host either mechanically or through its bodily functions.
Infection can occur via biting (e.g. malaria transmitting mosquitoes), via (skin) penetration (e.g. typhus
transmitting lice) or the gastrointestinal tract (e.g. food contaminated by flies). It is important to
distinguish between a nuisance, and a mechanical and/or biological vector spreading a communicable
disease:
Nuisance
It is their presence in large numbers that defines a pest population as merely a nuisance (e.g. bedbugs)
instead of a vector. Control methods are generally designed to reduce the pest population or reduce
the pest-human contact.
Mechanical vectors
These vectors transmit pathogens by transporting them on their feet or mouthpart (e.g. housefly). In
this way pathogens are spread from contaminated material (e.g. faeces) to human foodstuffs, drinks,
faces or eyes. Mechanical vectors are usually only one of several transmission routes for a particular
disease. Diarrhoeal diseases, for example, as well as being transmitted mechanically by vectors are
also transmitted through poor hygiene and contaminated water. Control measures for mechanical
vectors are designed to reduce their population, and/or the likelihood of disease transmission (e.g.
covering food to prevent vector access).
Biological vectors
Biological vectors may be a serious threat to health, even when their numbers are relatively low. These
vectors are by nature involved in the life-cycle of the pathogen, which must pass through the vector in
order to mature. The pathogens are acquired from, and are transmitted to, a human or animal host
when the vector takes a blood meal (e.g. plasmodium cells via mosquitoes). Control measures are

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designed to reduce the likelihood of person-vector contact, reduce the risk of the vector population
becoming infectious and reduce the survival rate of the vector (e.g. Long-lasting insecticidal Net).
Following groups of vectors are considered of main interest in precarious situations. The biology, public
health significance, methods of detection and simple control measures for these groups are described
in the respective technical briefs.
- Mosquitoes (T.B. 7.01) - Fleas (T.B. 7.04) - Mites (T.B. 7.07)
- Flies (non-biting) (T.B. 7.02) - Lice (T.B. 7.05) - Bedbugs (T.B. 7.08)
- Sand flies (T.B. 7.03) - Rodents (T.B. 7.06) - Cockroaches (T.B. 7.09)
7.2.2 Vector control

Control of these vectors, through personal protection and/or environmental and/or chemical control,
has a documented impact on the reservoir and/or on the transmission of important disease pathogens.
Knowledge of the biology of each vector is an essential condition of effective control measures. It is
useless to try to combat body lice by treating head hair, or to try to control Culex larvae by treating clean
standing water. It is vital to know how, where and when to act.
Nevertheless, it is possible to identify some principles common to all vector control programmes:
■ Complete eradication is generally unattainable. The objective should be to keep the vector
population below a level at witch it poses a too great risk of an epidemic.
■ The aim should be to make the local environment unfavourable for the development and survival
of the vector
■ Vector control is generally more effective if it is focused on immature forms of the vector.
7.3 Where/When should vector control be implemented and by Who?

Appropriate vector control measures must be implemented in endemic zones and/or in epidemic-prone
contexts and/or when there is a high presence of the vector. They must always be implemented in
camps and all types of health structures, from small health centres to large hospitals including
disease-specific programmes (e.g. kala-azar, yellow-fever, HIV) and Therapeutic Feeding Centres.
This as specified in the essential water and sanitation requirements (T.Bs. 1.08, 1.09).
Particular attention should be given to vector control:
■ In prevention of epidemics where it should take place immediately following identifiable alarm signals
for a specific epidemic area (e.g. migration of large number of non-immune persons into high
transmission areas, abnormally heavy rain, flooding, high minimum temperature).
■ In epidemic control where outbreak detection takes place in the early stages and vector control
activities can be achieved sufficiently early to cut off the peak in transmission.
■ In areas of known intense seasonal transmission (and associated high morbidity and mortality) where
vector control activities just before the peak season can reduce transmission.
The control of a specific vector, in an open setting outside a health structure or refugee or displaced
camp requires a deeper understanding of the vector biology and of its interaction with humans and the
environment, as well as expertise in specific vector control measures. These guidelines do not have
the scope to deal with such issues in sufficient detail.
Timing of the vector control activities depend on the context but the desired outcome is to achieve the
required coverage before the start of the transmission and to maintain a residual effect for its duration.
Timing can have significant operational implications where transmission is largely confined to one
season. In areas where transmission is more or less constant throughout the year the timing is less
of an issue.
A big factor in the effectiveness of vector control activities is a clear allocation of responsibility, at both
a strategic level and at implementation level. Where the aid agency is working in health structures
that are part of local or national health infrastructures it is especially important to define ultimate
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responsibility with a view to the future running of the vector control activities. Once an agreement of
responsibilities is reached amongst all the involved counterparts it should be formalised in writing. An
important body, in terms of providing direction and feedback to any vector activities, is the
hygiene/health committee which should be present in all health structures.
Implementation of the vector control measures should be managed by a suitably experienced
technician. The execution of environmental vector control measures requires relatively little technical
skills once the facilities are installed, and will typically be carried out by trained health structure
cleaners, caretakers or grounds men. Avoid people with the following risk condition when selecting staff
to make up a chemical vector control team: pregnancy or lactating; alcoholism; history of liver or nerve
disorder; heavy smoking; allergies or skin diseases. More subjective criteria are also important: like
professional integrity, meticulous work and neatness and tidiness.
Chemical control measures involving pesticides and other toxic chemicals require expertise and should
only be carried out by those who have received appropriate training on safe and effective procedures
(T.B. 7.13). Even for apparently straightforward application of public health pesticides, a minimum of
protective clothing is required (T.B. 7.20)
Each person is responsible for their own personal protection against disease transmitting vectors. The
personal protection strategies are simple and can potentially be implemented individually. However
they need to be supported by appropriate and simultaneous promotional activities. Otherwise it may
be difficult to persuade persons to protect themselves especially when they are not greatly bothered
by bites from the vectors present.
7.4 How to carry out effective vector control ?

As with all interventions, the project cycle of assessment, strategy planning, implementation, monitoring
and evaluation should be followed when setting up a vector control intervention. The below comments
highlight some specific key considerations related to the planning and organisation of vector control
activities:
Assessment & analysis
Assessment should be based on the essential requirements, checklists and the accompanying
guidelines on appropriate usage of vector control tools (T.B’s. 1.06, 1.08, 1.09).
Strategy planning
The vector control activities should be guided by national legislation and clear objectives that address the
vector-related priority problems identified in the assessment and analysis. Common objectives of
vector-control activities include: preventing or controlling outbreaks, stopping preventable deaths from
vector-borne disease, minimising illness from vector borne diseases or protecting the population subgroups
with reduced immunity. The objectives of the vector control activities can only be achieved with appropriate
vector control measures addressing the context specific epidemiological situation and risk factors. Vector
control may have no impact if it targets the wrong vector, uses inappropriate or ineffective methods, or
targets the right vector at the wrong place and/or at the wrong time. The selected vector control measures
should be appropriate for controlling the specific vector species, given its breeding, flight range and resting
behaviour. Also, the measures should be simple to understand and apply. Where vector-borne diseases
become a problem, using chemicals should always be regarded in combination with environmental
sanitation and promotional activities. When considering the use of chemical control measures it should be
remembered that although public health pesticides are relatively safe, they can be toxic and dangerous
to both living creatures and the environment if not used properly (T.Bs. 7.10, 7.11, 7.12 and 7.13). All vector
control activities should be based on the national and international protocols. Certain vectors rapidly
develop resistance to particular pesticides and the choice of pesticide should take this into account. The
decision to carry out a chemical control program and the choice of the pesticide should always be made
in consultation with your technical referent.

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Implementation
Staff training is very important in vector control interventions, particularly where chemical control
measures are being used. Inappropriate usage and disposal of pesticides is the most common problem
and has detrimental effects on people and the environment. Comprehensive training should be given
to all staff on safe and correct usage of chemical control measures. All employees, patients of the
health structure, as well as the whole camp population should be given information on both personal
protection methods as well as their role in the general vector control activities.
Monitoring/Evaluation
Monitoring will ensure a vector-borne disease outbreak is detected early and will prevent any waste of
resources on inappropriate control measures. Evaluation will measure the effectiveness and impact of the
activities. Vector control requires close management of personnel to insure that work is carried out in
accordance to pre-defined standards and strategies. Consistency of effort is very important in vector control
(e.g. small lapses in sanitation activities like open disposal of food waste can result in a rodent or fly
invasion within days). Therefore the performance of staff involved in on-going sanitation/vector control
activities should be continuously monitored and regularly evaluated. The details of intermittent vector
control activities, such as insecticide residual spraying or impregnation of bednets, should be recorded in
a specific logbook. Such records are essential to inform upon the appropriateness of future activities e.g.
the timing to repeat insecticide residual spraying. Recorded information should include; why, what, where,
when, who and how the particular activity was carried out. As well as monitoring the vector control activities
themselves, attention should be paid to environmental factors, external to the health structure or camp
which may affect the prevalence of vectors, and their associated diseases, in the area. For instance,
seasonal changes in climate or a substantial influx of new beneficiaries may result in increased disease
transmission by vectors. It is essential for the vector control planners to work closely with the health care
staff and those responsible for epidemiological assessment and monitoring. Monitoring will ensure a
vector-borne disease outbreak is detected early and will prevent any waste of resources in inappropriate
control measures. It is important that clear case definitions are adopted and whenever possible laboratory
confirmation of the initial suspected cases is sought. In addition to the routine health information system,
there must be a standard procedure for immediately reporting vector-borne diseases with epidemic
potential indicating the location of suspected cases. From the very onset, a map of the area should have
been sketched showing where population clusters, suspected cases, and potential vector breeding sites
are located. Because each vector species has a characteristic breeding and biting habit , they should be
monitored using different vector-specific methods and indicators (T.B. 7.01 until 7.09).
Evaluation can be based on direct observation (e.g. proper use of LN, state of pit latrines, food preparations
and refuse collection sites). It can also be more formal by re-assessing against the initial assessment and
essential water and sanitation requirements (T.Bs. 1.06, 1.08, 1.09).
7.4.2 Vector control strategies

Different vector control strategies are presented here. Generally the most effective control of any vector
will utilise a range of different activities which intervene in various aspects of the reservoir and
transmission routes.
Environmental control
■ Site selection and planning:
It is important to select a site that does not expose the patient, refugee or displaced population to
excess risk for vector-borne diseases. Sometimes the choice of a site is limited by politics, security or
other factors (T.B. 1.10).
■ Water management
Environmental control methods include avoiding the creation of breeding sites like pools of standing
water inside and outside (e.g. open water reservoirs, flower pots, bottles, old tyres, stagnant water
and blocked drains) and removal of existing breeding sites (by filling or draining them). However good
local knowledge and entomological expertise are required to target the most productive breeding sites
in the surrounding and to avoid wasting time and recourses on unimportant breeding sites.
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■ Safe excreta disposal:

Basic sanitary engineering measures should be taken whenever possible to reduce the opportunities
of insect vectors breeding. Latrine design should minimize the access of vectors to reduce the
opportunity for them to breed e.g. use of lids, VIP latrine or water seal designs (Chapter 3).
■ Waste management
Waste collection and disposal points should be sealed from the environment e.g. garbage bins with
lids, waste pits with a lid, or covered daily with ashes/soil in acute emergencies) (Chapters 5 and 6).
■ General construction
Building design should minimize mechanically the access of vectors into the structure e.g. insect
screens, sealing of openings under doors, rodent baffles on drainpipes.
■ Removal of vegetation
Mowing or even burning of vegetation (control the risk of fire) in the vicinity of camp sites and buildings
can be recommended to control mites and ticks. Piles of decaying grass clipping, compost heaps and
other accumulations of rotting vegetable matter serve as good breeding places for flies. Nevertheless,
there is no evidence that the widely advocated practice of cutting down grass and bush around houses
in general reduces malaria transmission. Clearing of vegetation may however be effective in removing
resting places for adult mosquitoes, promote the evaporation and drying up of small accumulations of
water and make breeding sites more visible for control purposes.
Personal Protection
Personal protection methods may offer significant safety using simple, small and portable equipment
against infection and vector nuisance. Methods include:
■ Personal hygiene and behaviour:
Regular and complete personal hygiene (e.g. hand and face washing, washing of body and clothes
with soap, food covers) will reduce the chance of disease transmission by flies or lice. Sufficient water
is necessary for personal and domestic hygiene. This also requires the availability of sanitary facilities
and the promotion of personal hygiene within the project team, health structures and/or camp
population.
■ Protection by clothing:
Clothing can be an effective physical barrier against several biting insects and can therefore reduce
the risk of disease transmission. Effectiveness of protection will increase with the thickness of the
material and the amount of skin covered. The impregnation of clothes with a repellent offers better
protection and typically lasts for a few days. The impregnation of clothes with an appropriate insecticide
is also an option and typically lasts for about 5 washes.
■ Repellents:
Repellents can be either natural or chemical products to be used as protection against insects. They
can be applied on the skin or clothes. Natural products are often country specific. Chemical
products such as DEET ®(NN diethyl 3 methylbenzamide) are usually more effective and longer
lasting than natural products. They occur in a range of applications such as lotions, sprays and
creams. Applied on the skin they usually offer protection for between 6 and 8 hours, limited by the
sweating of the person. They do not offer the required protection for a person asleep throughout the
night. Cutaneous use of DEET® does not provoke undesirable reactions with adults. Repetitive
cutaneous use of DEET® is not recommended for pregnant women and young children (below 30
months). For them it is more appropriate to use the repellent on their clothing instead.
■ Coils:
Coils can be used as a quick and easy way to neutralise insects in rooms or enclosed areas where no
electricity is available. Burning coils vaporise an insecticide into the air and this has, where ventilation
is limited, a knockdown effect on mosquitoes. Public health pesticides present in coils are formulated
at a relative low dosage. The quality of coils can vary greatly and some are completely ineffective. In

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some countries, coils are formulated with organochloride compounds which gives rise to serious health
concerns. Still the most commonly used active ingredient belongs to the group of quick knock-down
pyrethroid. In confined area’s such as a closed tent or a non-ventilated room, the smoke may cause
irritation to the eyes and lungs. Depending on the active ingredient, burning coils may also have a
repellent effect on mosquitoes in open veranda’s. If the coils are used outdoors it is important that
they are upwind of the people to be protected.The whole period of burning normally lasts between 6
and 8 hours and one coil can be used for a room of approximately 35 m³. The coils should be lit just
before the mosquitoes become active. To increase efficiency, convenience and safety, coils should be
burnt in special holders.
■ Electric vaporizer systems:
Electric vaporizer systems are products requiring an electrical heating device to evaporate an
insecticide from a base, which may be composed of any suitable material and which is referred to as
“refill”. The heater and refill are a unit and must be used together. These systems have been designed
mainly for the control of mosquitoes and work only with an reliable electric power supply. The heating
devices should provide a sufficient duration of operation and should not be affected by tropical climate,
such as heat combined with high relative humidity. The active ingredients used in these systems belong
to the natural pyrethrins and quick knock-down pyrethroids.
■ Aerosols:
Aerosol sprays can be used when a room or closed area needs to be cleared of flying or crawling
insects. Flying insect killer aerosol (FIK) use a short lasting insecticide easily dispersed in space. The
active ingredients in FIK are usually from the pyrethroid family. In FIK, a combination of a killing agent
and a knock-down agent is very common. The knockdown effect of the aerosols will eliminate most
flying insects within 15 minutes. Their residual effect is very limited which means that a cleared room
can be reinvaded by insects about 20 minutes after treatment. It also means that there is little risk of
toxic residues in the treated area. After spraying, the room must be left immediately and stay close for
about 20 minutes. The windows must be opened to ventilate after re-entry.
Crawling insect killer (CIK) aerosol however exhibit excellent residual effect due to their adherence to
surfaces .Those designed to be applied directly onto insects such as cockroaches, silverfish, bugs
and ants have also very good knock-down effect. If applied as surface spray, the residual effect may
last several weeks (4 to 8 or even up to 12 weeks) depending on the physical properties of the surface,
the active ingredient applied and its formulation. Most aerosols contain flammable substances and
they should not be directed on fires or smouldering objects (do not smoke, disconnect electric
equipment while spraying), and be protected from direct sunlight and temperatures exceeding 50°C.
Follow carefully the application instructions and safety measures indicated on the spray cans. Empty
pressurized spray cans should be disposed of in an enclosed sharp pit (if few in number, T.B. 6.02) or
by encapsulation if more numerous.
■ Long-lasting insecticidal Nets (LN; T.B. 7.16):
Insecticide-treated nets are one of the major ways to control malaria and they are accepted worldwide by
communities affected by malaria. Their correct utilisation reduces the survival chance of the vector and
interrupts malaria transmission. Apart from their killing effect, nets will also avoid mosquito feeding, hence
reducing the reproductive potential of vectors that feed on human blood. Insecticide treated nets have the
same disabling effect on other biting insect vectors like lice, fleas and sand flies. They also protect against
spiders and cockroaches. Within a health structure they prevent the spread of vector borne diseases, by
isolating patients and limiting thus further transmission of the pathogen; this is especially important in the
context of malaria, yellow fever, dengue and leishmaniasis. Traditional insecticide-treated nets require
re-impregnation (T.B. 7.17) every six to twelve months which is difficult to implement. The best results can
be obtained with Long-lasting insecticidal Nets (LN), which retain their insecticidal properties for two to six
years, the life span of the net, thus making re-treatment unnecessary (T.B. 7.16). These LN would be
expected to retain chemical activity for at least 20 standard washes as defined by WHO. The use of LN is
strongly recommended over the use of nets that require re-impregnation.
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A requirement for successful use of insecticide-treated nets is that the malaria transmitting vector
feeds at a time and place when people are using the LN. LN’s will only have an impact on malaria
transmission if they are properly used and maintained, hence the importance of appropriate and
simultaneous promotional activities. The use and acceptance of LN depend on a range of social and
cultural factors that should be identified and taken into consideration prior to distribution. The
identification of these social and cultural factors is less relevant when implementing LN in a health
structure but occasional evaluation of their actual use by sleeping patients is recommendable.
■ Other insecticide-treated materials (T.B. 7.17):

Blankets and shelter material are often distributed as part of the emergency response and these materials
may constitute the only surfaces suitable or readily available for insecticide treatment. In areas where
mosquitoes bite early in the evening, before patients go to sleep under nets, use of insecticide-treated
curtains over openings such as windows, doors and eave gaps may provide protection.
Chemical control
■ Insecticide Residual Spraying (IRS; T.Bs. 7.14, 7.15)
IRS is widely used for vector control, especially against mosquitoes, triatomine bugs (vector of Chagas
disease) and sand flies. Its objective is to ensure the safe and correct application of a residual
insecticide dose to surfaces on which vectors may rest, usually ceilings, inside surfaces of tents and
walls and the lower surfaces of large furniture. It is an effective means of interrupting malaria
transmission through killing adult female mosquitoes after feeding but before they can transmit the
infection to another person. As such, it is not useful for the control of mosquitoes which tend to rest
outdoors. However, it may be effective against outdoor biting vectors which enter houses for resting
after feeding. IRS is only effective if adequate coverage is achieved and if the insecticide is correctly
applied. The selection of the insecticide has to take into account the susceptibility of local vectors and
duration of the residual effect in relation with the length of the transmission season. Prior to implement
IRS, verify these issues with your technical referent.
■ Insecticide zoo-prophylaxis
Insecticide zoo-prophylaxis could be used in settings where vectors bite domestic animals as well as
humans. Rather than being applied to houses, the insecticide is applied to the hair and skin of domestic
livestock, such as cattle, goats and sheep, using a sponge or animal dip. A specific dose can also be
applied between the shoulder blades from where it spreads over the skin. Trials of this method have
shown its effect on malaria and tryponosomiasis transmission reduction.
■ Insecticidal dusting (T.B. 7.18)
An insecticidal dust consists of talcum powder, or another inert carrier powder, mixed with insecticides.
In health structures, insecticidal dusting can be applied on rodent footpaths and habitats. When the
rats groom themselves, the dust spreads on their fur, thus killing their fleas. Prior to dusting people
against lice, verify with your technical referent the insecticide to be used.
■ Rodenticides (T.B. 7.19)
An important method to reduce rats and mice related health risks is poisoning them with rodenticides.
Complete eradication remains very difficult as only a limited area can be targeted with rodenticides.
The control campaign should be accompanied by promotional activities on proper household hygiene
behaviour. Use chronic or slow acting poison instead of acute poison to limit the risk of accidental
poisoning of humans and non-targeted animals.
■ Larviciding
Larval control is most practicable where the vector breeding sites are limited in number and relatively
permanent in time. It requires the ability to locate and map out a very large proportion of the breeding
sites within vector flight range of the community which it is required to protect. It is complex, requires
expertise, but can significantly affect vector densities. In areas where it is an acceptable option, larval
control must be carried out thoroughly to have an impact. The most commonly used larvicide is the
temephos®, an organophosphate which is effective and safe in drinking and bathing water. It is to be

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applied at very low concentrations. Some living organisms, such as bacteria (e.g. Bacillus
Thuringiensis israeli) can also be used against vector larvae as they contain toxins against larvae.
■ Space spraying
A space spray is a liquid insecticide, dispersed into the air in the form of millions of tiny droplets. It
remains only effective while the droplets remain airborne. The aim of space spraying is usually to
rapidly reduce populations of flying insects to reduce or interrupt temporarily the transmission cycle of
insect borne diseases. Mosquitoes, houseflies, and other biting flies may be targeted by space
spraying. Nevertheless space spraying is complex, require expertise and only have a temporary effect
with little or no residual effect. As such space treatments must be considered in conjunction with other
control methods where possible.
7.4.3 Vector control strategies in malaria transmission

Malaria is a most important vector-borne disease worldwide in terms of morbidity and mortality. It is
considered to be one of the five top causes of child mortality in the acute phase of a majority of refugee
emergencies. All malaria is transmitted by the Anopheles mosquitoes.
Mosquitoes behaviour
Several aspects of mosquitoes behaviour are relevant when determining a vector control strategy:
Feeding time and location: most Anopheles feed at night but each species feeds at a particular time of
night. Some mosquitoes prefer to feed inside houses and others outside. In Africa, it can be assumed
(until proved otherwise) that malaria vectors bite at night and rest indoors. Control measures can thus be
taken accordingly. Host preference: Some mosquito species prefer to feed on humans and others on
animals; several species feed partly on humans and partly on animals. Species that have a strong
preference for feeding on humans tend to be the most dangerous vectors because they are the most likely
to transmit malaria pathogens. Resting location: after feeding, a female mosquito needs somewhere to rest
while digesting the blood meal and developing its eggs. Some species rest inside, while others go and
find places outdoors. IRS is not useful for the control of mosquitoes which tend to rest outdoors. However,
it may be effective against outdoor biting mosquitoes which enter houses for resting after feeding. Choice
of egg laying site: Anopheles mosquitoes have different preferences for breeding sites or larval habitats,
and lay their eggs in a wide variety of water bodies. Individual species tend to choose a narrow range of
egg laying sites. Flight range: Most Anopheles mosquitoes do not fly more than 3 km from where they begin
their lives. Malaria risk can be reduced by installing health structures or refugee or displaced camps further
than 3 km from breeding sites.
Malaria control strategies
Malaria control strategies that kill and reduce the density of the vector (e.g. larviciding, space spraying)
or that reduce the intensity of the contact between vector and person (e.g. non-impregnated nets,
screening houses, repellents, protective clothing) have a lower impact than strategies reducing the
survival chance of the vector (e.g. IRS, LN, zoo-prophylaxis). Adequate coverage of human habitations
with IRS and LN reduces the survival chance of mosquitoes that enter dwellings to seek a blood meal
and shortens their average lifespan. This reduces the proportion of mosquitoes living long enough for
the malaria cycle to be completed and thus becoming infective. A decreased proportion of old malaria
infective mosquitoes in the total female mosquito population considerably reduces malaria
transmission. As such, and where possible, the malaria control methods of choice are IRS within the
inside surface of houses or tents (T.B. 7.14, 7.15) and LN distribution (T.B. 7.17). Both are about
equally effective against mosquito species that bite at night and rest indoors like it is the case, unless
proven otherwise, in Africa for malaria vectors (Anopheles),.
IRS and/or LN
The final choice to implement IRS, and/or a distribution of LN can only be made after studying both
options in detail in the given context. There is no “standard” best approach for a given situation as the
final decision to implement either IRS and/or distribute LN will depend on many factors, and advantages
and disadvantages will have to be weighed to each other (see hereunder)
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IRS LN
Advantage Disadvantage Advantage Disadvantage
Can not be looted, stolen or Can not be moved if the Can be transported by Can be looted, stolen or
sold population is displaced beneficiaries if they have sold
to move.
Protect the whole family -Might be improperly or not
and does not require any used at all
significant behaviour -Space in the shelter might
change. be insufficient to put up
enough nets to protect the
whole family
A high coverage is easy to To be effective, more The personal protection -A high coverage is difficult
obtain in a short time frame. than 80% of the shelters provided allows to obtain.
need to be sprayed so it deployment in a -Low retention rates in
cannot be targeted progressive way, starting camps where families
specifically to vulnerable with low population choose to sell the net to
groups. coverage. Distribution increase family food intake.
can also be targeted to
vulnerable groups
Will only remain effective Can remain effective for 3
for 3-6 months, so it to 5 years
needs to be repeated
Often quick to implement, Net distribution can be
especially in camp settings complex to organise. It will
and emergencies. require community
participation and
promotional activities.
In areas where malaria In areas where malaria Only one distribution
transmission is confined transmission is constant, each 3-5 years
(largely) to one season, one IRS needs to be
IRS is needed per year repeated every three to
six months.
Low start-up cost Higher start-up cost but
long impact (3-5 years)
In acute emergencies, IRS is often used initially, especially when LN are not readily available on the ground. It is
quick to deliver and high coverage is easy to obtain at relatively low cost. When IRS needs to be continued for
many years, there may be an attrition of people’s acceptance to spraying. In contrast, LN’s are more suitable for
progressive introduction and incorporation into population habits.
7.5 Further reading

Clinical Guidelines,
MSF, 2007
L. Lacarin, R. Reed,
Emergency Vector Control Using Chemicals
WEDC, Loughborough University, 1999.
J. Rozendaal.
Vector Control: Methods for Use by Individuals and Communities
World Health Organisation (Geneva), 1997.
M. Thomson.
Disease Prevention through Vector Control: Guidelines for Relief Organisations
Oxfam Publication (Oxford), 1995.

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T.B. 7.01 Mosquitoes

Mosquitoes are a large arthropod group found around the world. The most important genera in
terms of disease transmission are the Anopheles, Aedes and Culex. Their life cycle is closely linked
with water.
Biology
Mosquitoes have four distinct stages in their life cycle: egg, larva, pupa and adult. The first three
phases are aquatic. Under good conditions, the entire period from egg to adult takes about 7-13 days.
Males only feed on flowers nectar. The females usually mate only once but produce eggs throughout
their life. Each blood-meal is often followed by laying eggs. Their adult lifespan varies from one to
several weeks. Depending on the species, female mosquitoes are able to lay between 30 to 300 eggs
at a time. For their blood-meal, the female mosquitoes are attracted by odour (e.g. smelly feet), carbon
dioxide and body heat.
Most Anopheles mosquitoes breed in non-polluted water sources e.g. pools, quiet places in
slow-running streams, rice fields, leaf axils of certain plants and puddles of rain water. Eggs are laid
individually and float on the water’s surface. Only older females (2 weeks or more) can transmit malaria.
They usually fly, noiseless, up to 3 km from their breeding site but have been found to be carried by
the wind up to 30 km from their breeding site.
Aedes (aegypti) mosquitoes mainly breed in relatively clean water in the domestic environment e.g.
small water storage tanks inside/outside houses, roof gutters, leaf axils, bamboo stumps and temporary
containers (e.g. used car tyres, tin cans). Single eggs are laid close to the water surface.
Culex mosquitoes prefer breeding in water polluted with organic material like refuse , excreta or rotting
plants (e.g. in soak away pits, pit latrines, septic tanks, blocked drains, canals). Eggs are laid in rafts
of over 100 and float on the water’s surface.
Health Importance
■ Anopheles: transmits malaria and filariasis (Bancroftian and Brugian).
■ Aedes: transmits yellow fever, dengue, filariasis (Bancroftian) and other viral diseases.
■ Culex: transmits filariasis (Bancroftian), Japanese encephalitis and other viral diseases.
Detection
■ In Africa it can be assumed until proven otherwise that malaria transmitting Anopheles species bite
essentially at night and rest indoors; control measures can be taken accordingly. They are often
found resting inside houses in dark corners of rooms/latrines/showers. Anopheles are most easily
monitored in their adult form through the following methods: morning indoor collection of mosquitoes
resting on the wall using a simple tube; morning indoor pyrethrum spraying (e.g. with aerosol spray)
and collection of dead mosquitoes on white sheets spread on the ground (also under the beds and
furniture); night time capture on human bait or alternatively with battery powered light trap collections.
■ Aedes species bite mainly outdoors, in the morning and early evening during cocktail hour (dusk).
Aedes are also better monitored through larval surveys of domestic water containers. For example,
in larval surveys for yellow fever and dengue control, the results are expressed in terms of standard
indices of Aedes aegypti (e.g. Breteau Index) to predict the chances of disease transmission in a
population.
■ The most common Culex species bite during the night, indoors and outdoors. Culex are better
monitored (and controlled) through larval surveys of drains loaded with organic material and pit
latrines because they often produce enormous numbers of eggs that can easily be detected.
Control
Mosquitoes control activities should systematically be integrated, as per essential requirements (T.Bs.
1.08, 1.09), in endemic zones or during outbreaks of malaria, yellow fever, dengue, lymphatic filariasis
and/or when there is a high presence of the vector. Personal protection methods may additionally
offer significant protection against infection and mosquito nuisance.
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Contact your technical referent to obtain information about mosquito behaviour as several aspects
of it are relevant when determining a vector control strategy (section 7.2.2).
■ Strategies aiming to reduce the survival chances of Anopheles like the use of Long lasting insecticidal
Nets (T.B. 7.16) or Insecticide Residual Spraying (T.Bs. 7.14, 7.15) are the most successful for
reducing malaria transmission (more detailed control measures are presented in section 7.2.3).
■ Aedes is often associated with human dwellings where its breeding site can be any open container
of water. Control measures aim at getting rid of these types of sites, or at protecting them e.g. a
cover, mosquito netting). Large containers of water should be frequently, at least once a week,
emptied.
■ Control measures of Culex aim to eliminate bodies of stagnant water loaded with organic matter
(e.g. latrines), or if not, then to eliminate surface vegetation in stagnant water and verify that these
water bodies are at least 1.2 m deep.
Key
Criteria for recognition of the different mosquitoes genera

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T.B. 7.02 Flies (non biting)

Domestic flies are widespread across the world and they are the insects most closely associated
with humans. The housefly, the face fly and the blowfly are considered to be of main health
importance, because they carry pathogens from human to human or from faeces to food.
Biology
The life cycle of the fly consists of four stages: egg, maggot (larva), pupa and adult. A single female
housefly can lay up to 2000 eggs a month. Eggs are deposited in various habitats, especially in
garbage and human and animal wastes. Depending on the temperature, it takes from one to six weeks
for the egg to develop into an adult. Adult flies have a life span of three weeks to three months,
depending on the climate and the species of concern. Flies feed on all kinds of human waste, garbage,
sweat and excreta (human or animal).
■ The housefly breeds in organic domestic waste in urban areas and tends to breed in animal
excrement in rural areas. Contrary to popular belief, houseflies do not lay their eggs in latrines.
■ The face fly breeds predominantly in human faeces on the soil surface, but not in covered pit latrines.
They are known to feed on the secretion produced by eyes of people, especially children, and hence
they are an agent in the transmission of the eye disease trachoma.
■ The blowfly has a strong preference for breeding in pit latrines, decomposing meat, garbage and
animal excrement. Simple pit latrines in refugee camps often provide an ideal breeding site. Blow
flies rarely enter houses, but are very active in market places. They are easily recognized by their
shiny green colour.
Housefly
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Health Importance
The non-biting flies of health importance usually hover around food, carrion, garbage, and human and
animal waste. When they land, they may either transfer or carry pathogens that attach on their legs
and other parts of their bodies. These pathogens may then be mechanically transferred to humans
and/or animals. Even though they can also be transmitted via fly faeces, pathogens do not undergo
biological transformation in the flies. Pathogens that are carried by flies are known to be responsible
for enteric infections (e.g. dysentery, diarrhoea, typhoid and certain helminth infections), eye infections
(e.g. trachoma, epidemic conjunctivitis), poliomyelitis and some skin infections (e.g. leprosy, mycoses).
Flies are usually not associated with cholera. A larger infectious dose of cholera bacteria is required
for direct cholera transmission than the body surface of the fly allows to carry. However, once a small
number of cholera bacteria is deposed on non-covered food it can incubate and multiply until the
infective dose it reached.
Detection
It is more difficult to monitor non-biting fly populations than mosquito populations. Rather than counting
the number of flies collected over time per sticky trap, monitoring of fly populations is best carried out
as part of larval control and sanitation inspections, especially around feeding centres, hospitals,
latrines, and refuse disposal sites.
Control Methods
Fly control activities should systematically be integrated, as per essential requirements (T.Bs. 1.08,
1.09), in endemic zones or during outbreaks of enteric and eye infections, and/or when there is a high
presence of the vector.
Larval sites (the places where eggs are laid and where the larvae develop) are very often a product
of human activity. The basic principle of all control measures should be to reduce or remove these sites,
or to prevent access to it by flies. Without these environmental hygiene measures, all control efforts
are in vain.
Personal protection methods (e.g. Long-lasting insecticidal Nets (LN), T.B. 7.16) may offer significant
protection against infection and fly nuisance.
Flies should preferably be controlled by improving environmental sanitation and hygienic conditions:
■ Reduce or eliminate fly breeding sites (e.g. dead animals and waste from slaughter houses should
correctly be disposed of as soon as possible).
■ Reduce sources that attract flies from other areas (e.g. limit open defecation, cleaning of animal
excreta in cattle raising area’s, make smooth floors in feeding centres (smoothed cement or plastic
sheeting) to enable cleaning of spilled food).
■ Prevent contact between flies and disease causing germs (e.g. isolate patients under LN, make
covered refuse containers available in laboratories and health centres).
■ Protect food, eating utensils and people from contact with flies (e.g. promotional messages)
■ Ensure good removal and disposal of wastewater, particularly at washing area’s for clothes and
cooking utensils.
■ Add ashes to latrine pits after each defecation, or at least every morning and night, to reduce the
contact between flies and excreta.
Recourse to chemical intervention should be avoided as much as possible, because of the rapidity of
appearance of resistant strains which render this option costly and ineffective.
In the case of massive infestation or when the presence of flies creates a concrete risk of increased
spread of pathogen, or when an operating theatre or treatment room must be protected, the use of
larvicides and adulticides should be considered but always in tandem with environmental measures.
An option to destruct larvae is the use of larvicides on larval sites (e.g. in case of massive infestation
by larvae of a defecation trench or latrine). To destruct adults, treatment with a residual effect should

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be done on the surfaces where flies land and rest at night. These places may differ according to the
species and the climate. In general they are external surfaces of buildings (in hot countries), trees,
fences, dustbins, animal shelters. Spraying of the interior walls of the latrines is also an interesting
option.
In certain places (e.g. operating theatre, dispensary, kitchen) strips of gauze or cotton impregnated with
insecticide (T.B. 7.17) may be used. Use 1 m length of impregnated strip per m² of ground surface area
to be protected and renew the impregnation every 2 months. This in addition to the recommended
insecticide residual spraying (T.B. 7.15).
Remarks
■ Covering faeces/domestic waste with a thin layer of soil (less than 0.25 m non-compacted and 0.1
m compacted) may increase fly breeding since it remains a habitat but is likely to dry out more slowly.
■ Controlling flies with public health pesticides should be undertaken with an understanding of the
resistance status and only during outbreaks of vector-borne disease as a supplement to
environmental measures. Because flies can develop resistance to public health pesticides very
quickly, chemicals should be used only for a short period of time.
■ IRS of the inside of pit latrine shelters is recommended to control adult flies.
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T.B. 7.03 Sandflies

Sandflies are small (2 to 3 mm) long bloodsucking biting flies that are important as vectors of
leishmaniasis and that can cause a serious but localized biting nuisance.
Biology
The life cycle of the sandfly consists of four stages, namely egg, larva, pupa and adult. The total life
cycle, from egg to adult, last from 1 to 4 months depending on the species and temperature. Females
deposit 40 to 60 elongated and shiny brown eggs after a blood meal. The sandflies deposit their eggs
in humid places on damp soil rich in humus, like ventilation shafts of termite hills, cracks in mud walls,
and amongst tree roots. The larvae feed on decaying organic matter. Large populations of sandflies
can build up at places where cattle are kept at night. The cattle provide a source of blood while the
stable or house provide suitable resting places. Only the female sandfly bites and it needs several
blood meals prior to laying eggs. Blood is taken from humans and animals such as dogs, livestock,
snakes, rodents and birds. Sandflies become infected with leishmaniasis by ingesting blood from an
infected reservoir host (e.g. domestic animals, infected people). Sandflies are able to survive in dry
environments by withdrawing to cool humid resting sites during the day and become active at night.
Sandfly

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Health importance
Sandflies can transmit two types of leishmaniasis: cutaneous and visceral. Visesceral leishmaniasis
is highly fatal. Leishmaniasis is endemic in about 90 countries in 4 continents. The saliva of sandflies
can enhance the virulence of inoculated Leishmania parasites. Species present in the Mediterranean
region can transmit sandfly fever, a viral disease also known as Pappataci fever or three day fever.
Detection
The sandflies can often only be found close to breeding places. The sandflies can only cover a radius
of a few hundred meters of their breeding places as they are weak fliers. As a result, biting is restricted
to areas where suitable breeding sites occur. The adult sandflies are usually active at dusk and dawn
and during the night, although they can bite during the day when disturbed. They usually rest in the
daytime in sheltered, dark humid sites, such as those used for breeding, but also in tree holes, caves,
houses and stables; other resting places near houses are crevices in walls, stacks of firewood and
rubbish.
Control Methods
Sandfly control activities should be systematically integrated, as per essential requirements (T.Bs.
1.08, 1.09), in endemic zones or during outbreaks of leishmaniasis and/or when there is a high
Personal protection methods may additionally offer significant protection against infection and sandfly
nuisance. As sandflies are still very sensitive for public health pesticides the use of impregnated
mosquito nets is highly recommended. Vector control measures like Insecticide Residual Spraying
(T.B. 7.15) can be effective where transmission occurs in and around the home. Where transmission
occurs in the wild, people can use repellents or impregnated clothing or simply keep away from areas
where sandflies are known to breed or rest. Zoo-prophylaxis (e.g. pyrethroid impregnated collars)
may be a ways to control transmission from the animal reservoirs (like dogs or other domestic animals).
Spraying insecticide at larval stage is usually not possible as little is known about where the larvae are.
Remarks
■ Impregnated nets with mesh size of 196 holes/inch² are recommended against sandflies but, in
certain climates, the reduced airflow though the very small holes can reduce the feeling of comfort
under the net. An impregnated nets with mesh size of 156 holes/inch² can also be used.
■ Other biting flies transmitting important diseases are the Tsetse fly transmitting African sleeping
sickness and the Blackfly transmitting river blindness. Their control demands the implementation of
a specific programme; the complexity of such a programme is beyond the scope of this guide.
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T.B. 7.04 Fleas

Fleas are small (1-4mm) long, wingless, bloodsucking insects, in close relation with their host, that
have a characteristic jumping movement. The most important species are the rat flea, the human
flea, the cat flea and the sand or jigger flea.
Biology
The life cycle of fleas consists of four different stages: egg, larva, cocoon and adult. Their
developmental stages all occur on land. Under optimal conditions the development from egg to adult
takes 2-3 weeks. Both female and male fleas take blood meals. Fleas breed close to the resting and
sleeping places of the host (e.g. in dust, dirt, rubbish, floor and wall cracks, carpets). Fleas may survive
in their cocoon for up to a year. The vibrations of people moving into a vacant building can cause many
fleas to emerge simultaneously from the cocoons, all looking for blood meals. Fleas move around by
jumping; some species can jump as high as 0.25 m. Adult fleas can survive for several months without
food.
The larvae of jigger fleas develop in dusty or sandy soil. Jigger fleas maintain themselves in a domestic
environment by breeding on livestock and domestic animals.
Cat flea

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Health Importance
Rat flea bites can cause irritation, serious discomfort and loss of blood. Human contamination may take
place through a rat flea bite (plague) or through rat flea excreta (typhus). As such, dust containing rat
flea excreta may be highly contaminating, if not neutralized by a chlorine solution. The human flea is
in spite of its name less important. Cat fleas incidentally transmit tapeworms. Jigger fleas are a serious
pest in tropical Africa. The female jigger flea burrows into the soft skin of the foot and ankle in order to
lay her eggs, which can cause secondary infections.
Detection
Heavy infestations of fleas are recognized by marks of undigested blood on clothing and bedding
and/or by massive skin irritation. A scratching cat or dog is an indication of a flea infestation.
Control Methods
Flea control activities should be systematically integrated, as per essential requirements (T.Bs. 1.08,
1.09), in endemic zones or during outbreaks of plague, Typhus and/or when there is a high presence
of the vector.
Personal protection methods may offer significant protection against infection and fleas nuisance. An
effective repellent, such as DEET®, applied to skin and clothing prevents fleas for a few hours from
attacking. Longer lasting protection is obtained by dusting clothing with insecticide powder (T.B.7.18)
or by using impregnated clothing. Wearing shoes prevents jigger flea bites.
Fleas and their eggs, larvae and cocoons can be effectively removed by keeping houses well swept
and floors washed. Due to their close relationships with rodents, long-term control of fleas is best
achieved by household hygiene, elimination of food sources and through rodent control (T.B. 7.19).
Remarks
■ When a flea-borne disease (e.g. plague or murine typhus) is present or threatens, flea control must
precede rodent control. When deprived of their normal rodent host, fleas are likely to transfer to
humans.The control measures during epidemics of plague and murine typhus are therefore carried
out in two stages:
1. Insecticidal dusting of rodent footpaths and habitats (T.B. 7.18).
2. Rodent control (T.B. 7.19).
■ A combined rodent and flea control using baited traps is possible using baits that combine insecticide
and rodenticide characteristics. After bait ingestion, the flea will die first due to the insecticide that
will diffuse through the rodents skin and the rodent itself will die later due to the prolonged rodenticide
exposure.
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T.B. 7.05 Lice

Lice are small (3-4mm) bloodsucking insects that live on the skin of mammals and birds. The
species that have adapted themselves to humans are the head louse, the body louse and the crab
or pubic louse.
Biology
The aforementioned species live only on humans and have a life cycle that constitutes three different
stages: egg, nymph and adult. Development from egg to adult takes about two weeks and occurs only
in a warm environment, close to human skin. Body lice lay eggs on clothes. Eggs or “nits” of head and
pubic lice are attached to hairs. They cannot be separated for long from their human host, their sole
source of blood meal, and will starve to death after two or three days of separation. The life span of
human lice is up to 30 days under optimum conditions.
Key
A. Head louse /body louse
B. Crab or pubic louse

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Health Importance
Neither head lice nor pubic (crab) lice, are vectors of disease but are a nuisance. Only the body louse
is a vector of human diseases. It transmits Typhus fever, Trench fever and Relapsing fever.
Transmission of Typhus fever and Trench fever is through louse faeces. The fine, dry faeces can infect
(scratch) wounds or the mucous membranes of the nose and mouth. Humans may become infected
of Relapsing fever by crushing infected body lice between the fingernails or the teeth. The disease
organisms are thus released and can enter the body through abrasions, wounds or through the mucous
membranes of the mouth. Bites of body lice can cause skin irritation leading to various skin infections.
Lice infestations, of all species, can cause severe irritation and itching.
All lice are spread by close human contact. Body lice live in the clothing of the host and are transmitted
either by direct or indirect contact (sharing of bedding, combs, clothing, towels or by sitting on infested
seats). The prevalence of body lice is closely related to the socioeconomic, hygienic and environmental
sanitation status of any given population. Body lice are most common in colder areas where people
do not frequently wash or change clothes. Human-to-human transmission of head and pubic lice is
most commonly by direct contact. Head lice are generally found on children in all levels of society. The
pubic louse is probably also very common but little information is available on the frequency of its
infestation other than they are transmitted (not exclusively) through sexual contact and often associated
with other sexually-borne diseases.
Detection
Lice are spread by close human contact and are, therefore, most commonly found on people living in
overcrowded, unhygienic conditions, as in poorly maintained hospitals, jails and camps. They are also
spread by direct contact between people in overcrowded transport vehicles and markets. Body lice and
nits are most commonly found in clothes, mainly on undergarments, socks or clothing close to skin.
They leave the clothing only to go to feed and when the blood meal is completed, they return to the
fibres of the clothes where eggs are laid in the seams. Scratch marks (often with secondary infection)
on the upper back, around the belt line and in the armpits may be seen. Head lice are most often
found on children, primarily on the hair of the head, though they can sometimes be found in the
eyebrows: presence of live lice and/or live nits (eggs) attached to the base of the hair (particularly at
the back of the neck and near the ears) and itchy scalp. Scratch marks, eczema and secondary
infections may be seen. The influence of length of hair and frequency of infestation appears to be
unresolved. The pubic or “crab” louse lives mainly in the pubic or genital region of the human body
although it is frequently found on the eyelashes and other hairy area’s (armpits, abdomen, tights) in
cases of heavy infestation.
Control Methods
Lice control activities should be systematically integrated, as per essential requirements (T.Bs. 1.08,
1.09), in endemic zones or during outbreaks of Typhus fever, Relapsing fever, Trench fever and/or
when there is a high presence of the vector. Control measures include reduction of overcrowding and
improvement of individual and community hygiene. Regular body washing and use of clean clothes
usually prevents body louse infestations. Soap and cold water are not sufficient to eliminate lice from
clothing. Treatment of clothing by damp heat (15 to 30 minutes at 60°C and dry in sun) and by dry heat
(ironing) must be undertaken. In areas where water is scarce, washing facilities are lacking and/or
people own a single piece of clothing, this may be complicated. A more practical solution is insecticidal
dusting (T.B. 7.18) or impregnation of clothing (T.B. 7.17) or to seal the clothing in a closed plastic bag
for 2 weeks.
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Insecticide application to the hair gives the most effective control of head lice (contact your medical
referent). Head shaving is not recommend. Disinfect combs, brushes, hats and bedding of individuals
infested with head lice (wash at 60°C). Examine all contacts and treat those infected. Shaving of the
infested pubic hairs from the body has been replaced by the application of insecticidal formulations
(contact your medical referent). In heavy infestations, all hairy areas of the body below the neck should
be treated. Simultaneous treatment of partners is recommended.
Remarks
■ Because the disease organism of louse-borne typhus (and trench fever) can remain alive for at least
two months in dried louse faeces, be careful when handling clothing or bedding of patients with
typhus.
■ If possible, inform people of the danger of crushing lice between fingernails or teeth.
■ Shaving of the hair is not always culturally appropriate and without replacement/disinfection of the
razor between persons it entails a risk for transmission of diseases such as skin infections, impetigo
and ringworm as well as blood infections such as HIV, hepatitis B and hepatitis C.
■ The use of different types of combs, sold for the control of head lice, is not effective.
■ Pubic lice infestation should be regarded as a warning of the possible presence of another sexually
transmitted infection and considered as an opportunity to examine the patient and provide education
on the risk and prevention of sexually transmitted diseases.

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T.B. 7.06 Rodents

Rats and mice can be found in almost all human communities and the nuisance, health threats and loss
of foodstuffs that they cause can be very serious. Four species are of particular health importance: the
brown or Norway rat, the black or roof rat, the multi-mammate rat and the house mouse.
Biology
The life span of rats is up to two years under optimum conditions and three years for mice. The brown
rat is larger than the black rat and is not well adapted to hot climates. They principally live in sewers
and holes, and they feed on refuse and human excreta. Brown rats build their nests in burrows, a small
snug place affording shelter or retreat. The black rat can be found under the roof of any type of building,
where they also build their nests. If the rats live outside a building, their nest can be found on the
ground, in vegetation or in trees. Black rats have a very varied diet. The multi-mammate rat is less
domestic than others and can multiply rapidly. The house mouse nests in any place where there is soft
fibrous material for making a shelter. The smallest hole a young mouse can enter is 6 mm diameter.
Key
A. Roof rat
B. Norway rat
C. House mouse
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Health Importance
Rodents and rodent-borne diseases may become serious problems in refugee and displaced
population camps that have existed for some time. These problems may result from uncontrolled and
accumulating solid waste, which greatly increases rat breeding. Rodents are associated with disease
transmission to humans in a number of ways: through biting (e.g. rat-bite fever and rabies), through
their urine or faeces (e.g. leptospirosis, salmonellosis, lassa fever), through infected rat fleas (e.g.
murine typhus and plague), and through infected ticks (e.g. lyme disease, relapsing fever). People
can also contract leptospirosis from handling the dead bodies of infected rats or get trichinosis from
eating undercooked meat from pigs that have eaten the dead bodies of infected rats. Finally rats can
cause important damage by destroying or contaminating food or drugs stocks.
Detection
Information about rodents can be collected in interviews with people. A person who is familiar with the
signs and traces of rats can perform fairly rapidly a survey of a rather large area. The mayor signs are
faecal droppings, rodent runways, rodent footprints or tail marks in dust and tracking powders, gnaw
marks of rats/mice, burrows, and nests. Rodent odours, especially of house mice, and the typical noise
produced by rodents are indicative of their presence. This information can be obtained during dusk or
early evening surveys. These may be undertaken at random, or trough the selection of potential trouble
spots. Strong flashlights can be used to search in such places as under buildings, refuse disposal
areas and harbourage. Maps are essential for this type of work and if they are not available, sketch
maps should be made by the workers.
Control methods
Rodent control activities should be systematically integrated, as per essential requirements (T.Bs.
1.08, 1.09), in endemic zones or during outbreaks of Lassa fever, Salmonelosis, Leptospirosis, Plague
and Hanta fever and/or when there is a high presence of the vector (T.B. 7.19). Proper household
hygiene may offer significant personal protection against infection and rodent nuisance.
Remarks
■ Particular attention should be paid to protecting vulnerable patients from being bitten by rats. Those
suffering from leprosy (due to their lack of sensations) or babies may be especially defenceless
when sleeping.
■ Reducing access to buildings requires careful attention as rats can pass through very small holes
and can even climb vertical walls with a rough surface.
■ Caution to safe handling of trapped rodents. The multi-mammate rat is the natural reservoir for
the Lassa fever virus. The virus is spread through the urine of the rats. If trapped, these rats must
be disposed of without direct contact between the human and the rat as caged they urinate wildly
and become covered with the virus This might also include safe handling of rodents in regards to
rabies risk, especially with live animals (e.g. drown rat in trap and handle corpse with gloves).

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T.B. 7.07 Mites

Mites are small (1-2 mm) ectoparasites living on mammals, birds and humans. The major mite
pests that are of medical importance to humans are: the biting mite or “chigger“ and the Scabies
mite.
Biology
The biting mite or “chigger” has egg, larval, nymphal and adult stages. The immature stages are similar
to the adults but smaller. Only the larvae of biting mites feed on human tissue. The nymphs and adults
live in the soil and feed on other mites and small insects. After emerging from the eggs, the larvae crawl
onto grasses and low-lying vegetation and wait till they can attach themselves to an animal or human
host. The larvae remain attached and feed on the skin of the host for between two days and a month,
depending on the species. Then they drop to the ground and enter into the soil to develop into the
harmless nymhal and adult stages. The mites favour bamboo bushes, but are also found in a number
of other habitats with low-lying vegetation.
Almost the complete life of the Scabies mite is spent on and in the human skin where they feed on the
epidermis of the host, procreate and lay their eggs. The total life cycle, from egg to adult, may take as
little as 2 weeks. The females may live on people for 1-2 months. Away from the host they survive for
only a few days. Fertilized female mites burrow tiny, winding tunnels in the surface of the skin
progressing 2 to 3 mm per day. The tunnels can be seen as very thin twisting lines a few millimetres
to several centimetres long. Larvae leave the maternal tunnel, burrow elsewhere in the epidermis or
remain at the base of a hair follicle where they transform into an adult. Scabies are usually transmitted
by close personal contact, for a minimum of 15 minutes, as between people sleeping together or during
sexual intercourse. The scabies mites are unlikely to be acquired by someone sleeping in a bed
previously used by an infested person, but may be passed on in underclothes.
Key
A. Biting mite (larva, parasitic on animals and humans)
B. Scabies mite
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Health Importance
Biting mites can transmit a number of diseases, of which scrub typhus is the most important one.
Many people show allergic reactions to mites or their bites. Scabies mites cause an itching condition
of the skin known as scabies. Scabies results from an allergic reaction to the infection of the skin
caused by the burrowing of the mites. Outbreaks of scabies are frequently reported in places where
people live in overcrowded, unhygienic conditions (e.g. refugee camps) and where there is poor
personal hygiene.
Detection
The presence of winding tunnels (scabies mite) or bites (biting mite) on the skin indicate mite
infestation. Scabies infection can be confirmed by applying ink to infested areas and then washing it
off, thus revealing the burrows. Scabies mites are commonly found where the skin is thin and wrinkled
(back of knees, inside of elbows, nipples). In young children they may also be found on the face.
Control Methods
Mites control activities should be systematically integrated, as per essential requirements (T.Bs. 1.08,
1.09), in endemic zones or during outbreaks of scrub typhus and scabies and/or when there is a high
Personal protection methods may additionally offer significant protection against infection and mite
nuisance. Avoid terrains infested by biting mites, wear shoes and apply repellents to skin or clothing.
Under conditions of frequent exposure, the best protection is given by impregnated clothing and tucking
the trousers inside the socks. Personal protection against scabies requires good general hygiene, so
distribute soap and supply adequate water for laundry and washing.

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T.B. 7.08 Bedbugs

Two species of bedbugs feed on humans, the common bedbug and the tropical bedbug. Both have
flat oval shaped bodies with no wings and are 4-7mm in length.
Biology
There are three stages in the bedbug’s life: egg, nymph and adult. Complete development from egg
to adult takes from six weeks to several months, depending on temperature and availability of food.
Bedbugs cannot develop in temperatures below 13ºC. Adults can survive for years without food. Both
male and female bedbugs feed on the blood of sleeping persons at night. The blood meal takes about
10-15 minutes and is repeated about every 3 days. After feeding, the nymph resembles an animated
drop of blood. In the absence of humans they feed on mice, rats, chickens and other animals. During
the day, bedbugs hide in dark dry places (e.g. beds, mattresses, cracks in walls and floors, furniture).
Hiding places are also used for breeding. Because they have no wings, bedbugs travel only short
distances. They spread from one house to another mainly in second-hand furniture, bedding and
sometimes clothes.
Bedbug
Health Importance
Bedbugs are not involved in the transmission of diseases but their bites cause significant discomfort,
irritation and loss of sleep. In heavily infested houses where people may receive one hundred or more
bites a night, it is possible that the blood loss causes mild anaemia in infants.
Detection
Bedbugs can move rapidly when disturbed and are not easily detected while biting. A house with
“bedbug” infestation may be recognized by the distinctive bed bug odour and by the blood stains of
squashed bugs. Infestations can be detected by the examination of likely hiding places for the presence
of live bugs, cast-off nymphal skins, eggs and excreta (visible as small brown marks on bed sheets).
Live bugs can be detected by spraying with aerosol spray can into cracks and crevices, thus irritating
them and driving them out of their hiding places.
Control Methods
Bedbug control activities should be systematically integrated, when there is a high presence of this
biting nuisance. Significant protection against infection and bedbug nuisance is offered by providing
a Long-lasting insecticidal Net (T.B. 7.16) and Insecticide Residual Spraying (T.B. 7.15). This in addition
to regular airing of the bedding in the full sun, improvement of the general hygiene measures, use of
repellents and aerosols.
Remarks
■ Incase of insecticide residual spraying (T.B. 7.15) special attention should be given to the furniture
and cracks and crevices in walls and floor. Rooms should be treated in the morning so they are
dry and suitable for re-entry in the evening. Hand dusters might be used to dust mattresses and
bedding, to avoid wetting them (T.B. 7.18). Bedding can also be impregnated with a safe
insecticide that does not irritate the skin (T.B. 7.17).
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T.B. 7.09 Cockroaches

Cockroaches are very agile and fast insects. They live in colonies and range in size from 2 - 80mm.
Adult cockroaches may or may not possess wings but are always able to walk.
Biology
The life cycle of a cockroach consists of three stages: egg, nymph and adult. Depending on the
species, temperature and humidity, the eggs hatch after one to three months. They reach full size
between 2 and 12 months depending on the species. Cockroaches have a varied diet ranging from
excreta to human food, from cardboard to clothes.
Cockroach
Health Importance
Domestic pest cockroaches have been documented to affect human health in several ways. They
proliferate in the most hidden places (e.g. sewers), then thread their way everywhere and can play a
role as mechanical carrier of pathogens or parasites (e.g. human intestinal parasites). Cockroaches
are also known to harbour a wide variety of microbial pathogens for which they serve as potential
transit host. Some people may become allergic (e.g. asthma) to cockroaches after frequent exposure.
Detection
Cockroaches are most active at night when they search for food in kitchens, food stores, rubbish bins,
drains and sewers. A particular behaviour of cockroaches is their habit of regurgitating fluid from their
mouth while dropping faeces at the same site where feeding is occurring. They also produce
secretions which give a persistent and characteristic odour to areas visited by them. During the day
they hide in wall cracks, furniture and other secure places like bathrooms, cupboards and sewers.
Cockroaches have been spotted on the face of sleeping persons feeding on their eye secretions, as
well as in the mouth of snoring persons. The presence of several sizes of nymphs and egg cases is
an indication of a well established colony.
Control Methods
Cockroaches control activities should be systematically integrated when there is a high presence of
this vector. The key to cockroach control is cleanliness. Infestations can be dealt with by chemical
control measures, followed by environmental management to deprive the cockroaches of food and
shelter.
Chemical control remains the single most effective method for the control of established infestations.
Several pesticide gels allows fast and drastic cockroaches eradication in health structure and
warehouses by applying a few drops per m². Current practice is to use products belonging to several
different classes of chemicals to delay the build-up of resistance.

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T.B. 7.10 Characteristics of public health pesticides

Public Health pesticides are pesticides that are used in the control of public health significance.
They include vector control pesticides, household insecticides and professional pest management
pesticides. Public health pesticides can be classified into four main groups - organochlorines,
organophosphates, carbamates and synthetic pyrethroids - according to their chemical structure,
toxicity and precautions for use.
Principles
Toxicity and hazard levels
The toxicity of an insecticide is given as the dose required to kill 50 % of a sample of test animals, often
rats, in a specific time, and is referred to as the lethal dose 50 (LD50). It is expressed in mg/kg body
weight. The lower the LD50 value, the greater the toxicity of the insecticide. The World Health
Organisation (WHO) divides pesticides into five classes, according to the health risk presented by
short exposure to the particular pesticide.
Class Hazard level User restrictions for operators

Ia Extremely hazardous Special licence for operator
Ib Highly hazardous Educated, trained operator. Must be under strict supervision
II Moderately hazardous Trained operator. Must carefully respect safety measures
III Slightly hazardous Operator must observe normal safety measure, but with attention
0 Not hazardous in normal use Operator must observe labels and follow proper hygiene measures
Classification of public health pesticide

Organochlorines
The main representative of this class is DDT® which use has considerably declined in recent decades,
mainly due to its environmental and potential health impact. DDT® has a residual effect of six months
or more. It is, depending on the formulation, moderately hazardous to mammals. DDT® is not
recommended for use in Insecticide Residual Spraying (IRS) activities. The other members of this
family which have been used in malaria control are Lindane® and Dieldrin®. Dieldrin® had to be
abandoned because of its toxicity to humans and Lindane® because of widespread resistance
problems. Organochlorines are not recommended for use in health care programs.
Organophosphates
This family includes some extremely toxic public health pesticides. The organophosphates used for
insecticide residual spraying are low to moderately hazardous to mammals. Regular medical check-ups
of sprayers and other insecticide handlers, is recommended when spraying. Organophosphate
poisoning should be considered as a medical emergency, requiring immediate treatment. They have
a residual effect of two to three months.
Organophosphates used for insecticide residual spraying are Malathion, Fenitrothion and
Pirimiphos-methyl . Temephos is an organophosphate regularly used as active ingredient in the
larvicide Abate®. Temephos has a low toxicity, but some problems have occurred with resistance.
Carbamates
Carbamates are more expensive than organophosphates and are exclusively used against adult
insects. Carbamates have a residual effect of two to three months, and are moderately hazardous to
mammals with relatively high acute oral toxicity. The wettable powders (WP) formulations should be
supplied in water soluble sachets, each one sufficient for a single pump charge. This avoids handling
during weighing of the formulation and the associated exposure of the operators.
Propoxur and Bendiocarb are carbamates used as active ingredient in WP for IRS (T.B. 7.15).
Bendiocarb is moderately hazardous and very toxic to fish and ducks.
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Synthetic pyrethroids
Synthetic pyrethroids are widely used in public health in a variety of formulations. Synthetic pyrethroids
have a residual effect of up to a year but have a low persistence in the environment. They have a
relatively low mammalian toxicity, but are highly toxic to fish. The field use of pyrethroids, in the
recommended concentrations, with the normal precautions for insecticide use, poses little or no
hazards to applicators.
Permethrin is moderately hazardous. It is effective, provokes little or no irritation in direct contact
with the skin and is widely used. Deltamethrin is moderately hazardous. It is effective and widely
used. Other synthetic pyrethroids often used are Alpha-cypermethrin, Cyfluthrin, Cypermethrin,
Etofenprox and Lambda-cyhalothrin
Resistance to public health pesticides
Use of pesticides on a vast and increasing scale has led to the widespread development of resistance.
It is considered that the most practical approach to resistance management in spraying programs is
the rotation of unrelated public health pesticides according to a pre-arranged plan in response to the
results of resistance tests (e.g. from synthetic pyrethroids to carbamates). WHO has developed
standard test kits for determination of susceptibility to pesticides of vectors and pests of public health
importance as well as guidelines on monitoring of resistance. Ask for advice of your technical referent
prior to ordering public health pesticides.
Legislations
The use of public health pesticides is regulated, depending on the country. The product should be
specifically intended to be used for public health and should have received an approval by WHO
Pesticide Evaluation Scheme (WHOPES). Before an insecticide is used in a particular country, it must
be authorised for use in the country. The Ministry of Health can provide a list of registered public health
pesticides. Gain a letter of permission for importation from the relevant authorities before purchasing
and shipping and importing non-registered pesticides.
International and local markets offer a great variety of substandard pesticide and equipment products;
these may fail in operational conditions and could cause unnecessary health and environmental risks.
Public health pesticides are closed articles and should not be purchased locally. This to guarantee
that the quality of the public health pesticides used are conform to the specifications of WHOPES.
Ask for advice of your technical referent prior to ordering public health pesticides.
Remarks
■ The choice of public health pesticides should not be made without the consent of your technical
referent.
■ Public health pesticides, conform to the specifications of WHOPES, might be made available rapidly
from the MoH or the national malaria control program.

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T.B. 7.11 Understanding pesticides labels

Public health pesticides should be packed and labelled according to WHO specifications. The label
should indicate the content, the safety instructions (e.g. hazard warnings, recommended protective
clothing) and the possible measures to be taken in case of accidental swallowing and/or
contamination.
Principles
Trade names
Insecticide compounds may be sold under different names. Do not confuse these names with the type
of active ingredient (a.i.). For example, a commonly used insecticide formulation for residual spraying
is sold under the trade name K-0thrine®, its active ingredient however is deltamethrin.
Concentration
Following the trade name is a number that refers to the concentration. The concentration of the product
represents the percentage of active ingredient (a.i.) in the formulation. Insecticide compounds are
available in a number of different concentrations.
If the concentrate is 25%, it contains 250 gram a.i. per kg in the case of a powder. The amount of a.i.
in liquid formulations are usually expressed as weight/volume (w/v) . If the concentrate is 25%, w/v it
contains 250 gram a.i. per litre in the case of a liquid.
In case they are expressed as weight/weight (w/w) consult the label carefully, it should also give the
amount of a.i. per litre. Convert this to a percentage w/v before proceeding with the application
calculations. For example, if the label indicates that the formulation is 8% w/w, but also indicates that
it contains 100 g a.i. per litre, convert this to a percentage w/v (Calculation: 100 g / 1000 ml = 10% w/v).
The trade name does not always represent exactly the concentration. For example “K-Othrine WP
50®“ contains 50 g a.i. per kg, thus only has a concentration of 5 %.
Formulation
Public health pesticides are rarely used in their pure form, but are available in special formulations,
adapted to the required application method. A formulation is a mixture of one or more active ingredients
(a.i.) together with other materials (e.g. solvents, carriers) to make it appropriate to use.
Following the trade name and concentration are the international codes for technical and formulated
pesticides. They consist of 2 letters that indicate the type of formulation. Below are presented some
of the codes.
Remarks
■ Always store pesticides in their original containers.
■ Consult product labels for instructions concerning storage and transport conditions.
■ Public health pesticides are often classified as “toxic chemicals” and are therefore subject to strict
packaging and shipping certificate requirements for transportations.
■ Do not use public health pesticides left over in your stock if they are damaged or inadequately
labelled.
■ Public health pesticides can be purchased in many different-sized containers or tablets. They also
come in pre-weighted sachets that contain the exact amount of insecticide to be diluted into a
standard 10 litre sprayer; where possible it is strongly advised to use these products for ease and
safety reasons.
■ Sprayers used for insecticide should never be used to spray chlorine, as both product are
incompatible.
■ Insecticidal residual spraying with wettable powder can be applied on porous surfaces like brick
walls, mud walls, grass structures, water based painted walls but it does not adhere well and is less
effective on plastic sheeting, canvas tents and oil based paint.
■ Insecticidal residual spraying with suspension concentrate can be applied on plastic sheeting, canvas
tents, oil based painted walls but penetrates and is ineffective on porous surfaces like brick walls,
mud walls, grass structures.
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Key
Information provided by the label of an insecticide (example of a bag of wettable powder)
1. Weight
2. Trade name
3. Active ingredient
4. Concentration
5. Formulation

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Formulation Description Application Advantage Disadvantage

of content
Wettable a.i. (2,5 - IRS (T.B. 7.15), - easy to transport, store - deposits left on
powder 80%) after water and use surfaces
(WP) + inert carrier addition - effective on porous - suspension needs
+wetting surfaces (mud, bricks, continuous stirring
agent concrete) and on water - ineffective on
based painted walls. plastic sheeting,
-not expensive canvas tents, oil
-good homogeneity on the based paint
treated surface
-adaptable to all types of
a.i.
Suspension a.i. (10 - Insecticide - easy to manipulate - ineffective on
concentrate 50%) Residual - good coverage of porous surfaces
(SC) + wetting Spraying (IRS) treated surface and on water based
agent (liquid, (T.B. 7.15), after - washable painted walls
not an water addition - effective on smooth - expensive
organic surfaces as plastic - storage problems
solvent) sheeting, tent canvas, oil
based paint
Dustable a.i. (0.5 - Dusting - ready to use (no need - even application is
powder 10%) + inert (T.B. 7.18) for water) difficult
(DP) carrier - not expensive - emitted cloud is
(talcum, - easy to treat where uncontrollable
gypsum) access is difficult - storage problems
in humid climates
Emulsifiable a.i. (2.5 - IRS (T.B. 7.15), - easy to manipulate - expensive
concentrate 25%) after water - no notable residues on - smell
(EC) + addition surfaces -sensitive to cold
petroleum-ba -allows large distribution during storage
sed solvent of a.i. -danger of
+ emulsifier -good penetration in (phyto)toxicity
vegetation
Granules a.i. (0.5 - Larviciding - easy and ready to use - expensive
(GR) 5%) - allows better penetration - heavy
impregnated of dense vegetation
in inert -no storage problems
carrier (clay,
kaolin etc)
Ultra low a.i. + solvent Space spraying - ready to use - experience
volume liquid - fast action (knockdown required for safe
(UL) effect) usage (operator
- large surfaces treated in and population
short periods safety)
-good penetration in -wind can cause
dense vegetation drift of the spray
- expensive
- wetting agent: allows mixing with water

- emulsifying agent: allows mixing with water
- solvent: as most public health pesticides are insoluble in water, the most commonly used solvents
are gas oil, kerosene or even acetone or xylene.
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T.B. 7.12 Safe packaging, transport, storage and disposal of pesticides

Public health pesticides are relatively safe; misuse is the most common problem. Still the toxic
nature of public health pesticides necessitates certain precautions in their packaging, transport,
storage and disposal. Expired pesticides pose a risk to people, animals and the environment. Good
management of ordering/purchasing and planning of pesticide usage should minimise the need for
pesticide disposal.
Principles
Packaging
■ Purchase pre-packed pesticides
■ Assure that packaging of pesticide can withstand transport, handling and the climatic and storage
conditions to which they will be exposed. Pesticide containers should be clearly labelled, rigid, leak
proof, weather and rat resistant. Wettable powders must be packed in moisture-proof bags to
maintain their good suspensibility.
■ Re-pack pesticides where existing containers are damaged or deteriorating; they should also be
relabelled. Place damaged paper or plastic bags containing solid formulations inside a transparent,
heavy polyethylene plastic bag so that the contents and label are visible
Transport
■ Do not transport pesticides in vehicles also used for the transport of food.
■ Do not transport pesticides in the driver compartment.
■ Keep the vehicle well ventilated and avoid exposure of pesticides to heat and sunlight.
■ Take special care when handling drums in which pressure has built up, particularly if the pressure is
so high that it has caused the drum to balloon. The lids of such drums should never be removed in
one movement, instead they should opened little by little to allow a controlled release of pressure.
■ Always repack drums with leaks or with worn corners at the base prior to further transport. Put straw
(or other absorbent material) in the bottom of the vehicle. This should be incinerated where possible
or otherwise burned on arrival.
■ Load with care, pack the drums closely together and tie them down to avoid them jumping up and down.
■ Protect certain powdered products against rain.
■ Instruct the driver to keep public health pesticides safe from children and animals, and secure from
damage and theft.
■ Instruct the driver on emergency procedures in case of an accident (e.g. switch off engine and
disconnect battery, keep public away, contain spills with earth or sand).
Storage
■ Store pesticides in a place that can be locked and is not accessible to children or other unauthorized
people. Never keep pesticides in a place where they might be mistaken for food or drinks. Storage
conditions are specified on the insecticide package.
■ Keep pesticides in a dry, well-ventilated place, away from sunlight and heat and separated from
other chemical materials (e.g. medicines, fuel and chlorine). Some public health pesticides can
convert to more toxic chemicals if they are stored at high temperatures.
■ Use the older pesticides in the warehouse prior to opening newly purchased products.
■ Observe strictly expiry dates specified on insecticide packaging.
■ Stock containers and cardboard boxes safely on stacks with limited height to ensure stability.
■ Inspect all containers regularly for damage, leaks, expiry dates and product decomposition.
■ Treat leakages or spilling as follows:
➞ Lay a ring of absorbent material (e.g. sawdust, dry earth or lime) around the spilled product.
➞ Wet the area with a detergent solution (e.g. 10% saturated sodium carbonate solution, or a 5%
caustic soda solution).
➞ Scrub the floor within the ring and then sweep the solution into the absorbent material.
➞ Encapsulate the absorbed material once after all liquid has been absorbed. Repeat if necessary.
➞ Clean the equipment with a detergent solution.

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■ Raise the containers off the ground (e.g. pallets) especially if there is any risk of flooding.
■ Use anti-rust paint if there is any trace of oxidation on the metal drums.
Disposal
Unfortunately, there are limited disposal methods that are safe and generally applicable under
circumstances prevailing in low-income countries. As such avoid accumulation of unwanted pesticides.
Unwanted pesticide stocks may be:
■ Products that are no longer needed for their intended use.
■ Products that have exceeded their expiry date and should no longer be used.
■ Products that have deteriorated physically or chemically to a degree that makes them unusable.
■ Products that cannot be identified because their label is absent or cannot be read due to damage or
language.
■ Containers that have leaked, exposing products.
■ Products that are bought and subsequently banned by international law and cannot be used.
Always seek advice from your technical referent prior to recycling, neutralizing, destructing or isolating
expired pesticide, pesticide waste, used containers and contaminated materials.
High temperature incineration (e.g. cement factory kilns) is the preferred method for the safe disposal of
the majority of unwanted pesticides. Encapsulation (chaper 6) is an alternative in the case incineration is
not an option. In low-income countries, empty insecticide containers are often highly valued and sold or
exchanged as storage containers for other materials such as fuel, chemicals and even food or drinks.
Such practices are dangerous and should be prevented, for example, by puncturing any empty insecticide
containers that cannot be returned to the supplier for safe disposal or re-use. Outer cartons and packaging
material, lightly contaminated with product residues, can be incinerated in an isolated area downwind of
the nearest habitation. Plastic containers should be triple rinsed and incinerated in the way recommended
for lightly contaminated packaging materials. The rinsate should be used to dilute the next spray solution
or safely disposed of into pit latrines, if available, or into pits dug especially for this purpose far away from
sources of drinking water. The ashes can be disposed off in ash pit (T.B. 6.07). Non-combustible insecticide
containers should not be burned. They should be encapsulated after they have been triple-rinsed and
crushed or shredded. Containers may be retained as spares to replace leaking or deteriorating drums
with the same product. Old and deteriorated drums can also be used as raw material at a steel smelter.
They should be triple rinsed, punctured and crushed before being sent to the smelter.
Remarks
■ Some public health pesticides, such as formulations containing deltamethrin as active ingredient, are
corrosive to some metals.
■ Wear the appropriate clothing whenever exposure to public health pesticides is a possibility (T.B.
7.20)
■ All containers should be marked “not for storage of food or water”. They should be stored securely
to prevent theft.
■ Do not reformulate products without seeking advice from your technical referent
■ Surplus pesticides that are in good condition can be transferred to other responsible users. Transfers
should, ideally, be carried out through a reputable pesticide supplier who is familiar with the product.
■ Never pour the remaining pesticide into rivers, pools or drinking water sources. Some public health
pesticides, such as pyrethroids, are very toxic to fish.
■ Unwanted insecticide stocks need to be disposed of in a responsible way in consultation with your
technical referent.
■ Inorganic materials and organic products containing heavy metals such as mercury and lead are not
suitable for incineration. Seek advice from your technical referent for a context dependent solution.
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Key
A. Improper storage of public health pesticides
B. Proper storage of public health pesticides.

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T.B. 7.13 Safe use of public health pesticides

Public health pesticides are potentially hazardous if used incorrectly. They involve chemicals that
are toxic to some degree. Besides the active ingredient, the formulation compounds (e.g. organic
solvents) may also be responsible for side effects. Absorption by humans can occur through contact
(skin), inhalation (lungs) and ingestion (mouth). It is essential that safety precautions are taken to
protect both the personnel involved in chemical vector control as well as the beneficiaries.
Principles
Strategy
■ Take extra precautions in choosing public health pesticides and deciding when, how, and for how
long to apply them.
■ Pesticides may cause local effects when they come into contact with the body, or more
widespread general effects after they have actually entered the body. Pesticides can enter the
body in three ways:
➞ Skin contact: the skin does not act as a complete barrier and pesticides may be absorbed into the
body if skin contact occurs;
➞ Inhalation: pesticides may produce fumes or dust which can be absorbed through the lungs.
➞ Ingestion: This mode of entry is likely to produce more severe poisoning. It may occur
accidentally.
Precautions for personnel
■ Always read the instructions for use and respect the application rates.
■ Instruct and train properly all personnel with emphasis placed on safe practices.
■ Use protective clothing (T.B. 7.20) while handling and spraying public health pesticides
■ Avoid skin contact. Never stir liquids or scoop pesticides with bare hands. If the pesticide gets on
the skin, wash off immediately with water and soap.
■ Use dedicated equipment for measuring out, mixing and transferring pesticides. Ensure that any
mixing takes place outside or in well-ventilated places. It is strongly recommended to purchase
pre-packed pesticides of an appropriate quantity, even though they are more expensive.
■ Take great care when opening pesticide containers.
■ Do not eat, drink or smoke while working.
■ Change/wash your clothes immediately if they become soaked with pesticides.
■ Wash hands and face with water and soap after spraying and before eating, smoking or drinking.
■ Shower or bathe using soap at the end of every day’s work and change into clean clothes.
■ Wash your overalls and other protective clothing at the end of each working day in water and soap
and keep them separate from the rest of the family’s clothes (T.B. 7.20).
■ Provide two complete sets of protective clothing and individual protective equipment to personnel
involved in chemical vector control. This allows them to have one set in use while the other is
being washed.
■ Include information on symptoms of accidental poisoning and the immediate treatment protocol in
any training aimed at those involved in an pesticide operation
■ Repeatedly inform personnel to report to their supervisor immediately if they do not feel well or in
case of any incident.
If these precautions are scrupulously respected, risks are extremely limited when working with
sufficiently trained personnel that is adequately supervised.
Precautions for beneficiaries
■ Plan vector control activities always in consultation with the hygiene/health committees of the
health structure.
■ Inform patients, health structure staff or the affected community, when chemical control methods
are implemented, about the type, the timeframe and associated risks of the planned activity.
■ Brief the hospital staff /householde on how to recognize the symptoms of poisoning.
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Symptoms of poisoning
■ Symptoms of poisoning or over-exposure appear rapidly, usually within 1 hour after exposure.
■ In case of poisoning with organophosphates or carbamates, nausea, headache, fatigue, and mental
or muscle disorders tend to be the first symptoms, followed by vomiting, abdominal cramps,
diarrhoea, heavy sweating and salivation. Critical cases may result in paralysis and breathing
problems followed by convulsions and a loss of consciousness, leading to coma, respiratory arrest
and death.
■ Pyrethroids have weak toxicity in mammals and only oral doses in excess of 15 g are poisonous to
humans. They can cause abnormal sensations of the face, irritation symptoms of the skin and the
upper respiratory tract in case of occupational poisoning (inappropriate handling). In case of
poisoning due to ingestion, initial symptoms are mainly digestive (epigastric pain, nausea and
vomiting).
Safety instructions for dealing with pesticide poisoning:

All the staff should be fully aware of the following simple rules to follow in case of a pesticide
poisoning:
■ Remove patient from contact with pesticide.
■ Act calmly, keep patient comfortable and strictly at rest.
■ Remove contaminated clothing, wash exposed skin thoroughly with water and soap.
■ Flush the eyes with large amounts of clean water for approximately ten minutes when pesticide
has come into contact with them; eyelids should be kept open during flushing.
■ Pay attention to breathing, give artificial respiration if required.
■ Lay patient on their side in the safety position.
■ Induce vomiting if highly toxic material has been swallowed, but only if the patient is conscious.
■ Get medical assistance.
Remarks
■ Medical staff should be aware of which pesticides are being used and the actions that need to be
taken in case of poisoning. Use of some pesticides like rodenticides requires presence of antidotes.
A stock of injectable atropine must be kept on hand in case of potential organophosphate and
carbamate poisoning.
■ Supervisors of staff working with pesticides must be able to quickly diagnose a case of poisoning and
take the appropriate actions.
■ Protective clothing can be an important source of exposure to operators if it is not either carefully
washed or discarded after use.
■ In low-income countries, empty pesticide containers are highly valued and often sold or exchanged
as storage containers for other materials, even for food and drinks. Pesticide containers can never
be made sufficiently clean to be safely used for storing food or drinks. Such practices are dangerous
and should be prevented, for example, by puncturing and encapsulation of all empty pesticide
containers that cannot be returned to the supplier for safe disposal or re-use.
■ Always have a shower system available (e.g. bucket of water and soap).

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T.B. 7.14 Insecticide residual sprayer

Suitable spraying equipment that is properly used ensures a safe application of insecticide applied
uniformly at the recommended dosage over all sprayed surfaces on which vectors may rest, like
ceilings, walls and the lower surfaces of large furniture.
Principles
Application of spray
■ Use a hand compressed sprayer consisting of a tank holding a liquid insecticide formulation, which
can be pressurized by means of a hand pump fixed to it. The compressed air forces the liquid out
the tank via a hose with a cut-off valve, a lance and a nozzle.
■ Spray the insecticide suspension evenly at the recommended dosage. The following factors
determine how much insecticide is sprayed on a surface:
➞ The concentration of insecticide in the one meter every 2.2 seconds -weighted sachet or dose per10
litres sprayer)
➞ Type of nozzle (the flat spray nozzle used for wall spraying produces a spray with an angle of 80°)
➞ The discharge of the sprayer (760 ml/min at tank pressure of 280 kPa)
➞ The air pressure in the sprayer (maintain at 170-380 kPa)
➞ The distance from the nozzle tip to the surface being sprayed (0.45 m)
➞ The speed of application over the surface (19 m² per minute)
■ Respect these factors so that the application rate will be 40 ml/m² (calculation: 757 ml/min divided
by 19 m²/min = 40 ml/m²). This means that 10 litres of spray suspension can spray 250 m²
(calculation: 10.000 ml divided by 40 ml/m² = 250 m²).
Check sprayer
■ Use WHO approved hand operated compression sprayer.
■ Examine the sprayer to ensure that all parts are present, assembled correctly and in good condition.
■ Check that the correct type of nozzle is fitted and that it is not damaged or eroded.
➞ The flat-fan nozzle (E8002) delivers a fan-shaped spray, and is used for residual wall spraying. This
flat-fan nozzle produces a spray with an angle of 80° and 760 ml per minute at a standard tank
pressure of 280kPa.
➞ The solid stream nozzle is used to treat cracks and crevices for control of bedbugs, soft ticks,
cockroaches and ants.
➞ The hollow-cone nozzle can be used to spray breeding sites of mosquitoes but also tick and mite
habitats in vegetation.
➞ The solid-cone nozzle is used to spray mosquito breeding sites.
■ Protect the nozzle by putting the lance in the bracket and nozzle cup of the sprayer when it is not in
use.
Test spraying with water
■ Wear protective clothing (T.B. 7.20)
■ Use clean water to ensure that the equipment operates properly and does not leak before using an
insecticide (often a cause for poisoning).
■ Pour clean water through a sieve into the tank and never fill the tank more than 3/4 full.
■ Fit the lid and turn the handle to lock the lid into position.
■ Operate the pump using both hands and with a foot on the footrest. Pump to the full working pressure.
The lower and upper limits for the working pressure are 170 kPa (25 psi) and 380 kPa (55 psi).
■ Maintain pressure between these two values during spraying by occasional re-pumping. If you hear
a hissing sound of escaping air, the tank is losing pressure, most probably via an accessory on the
tank, and this should be repaired.
■ Check to make sure there are no leaks along the lance and hose, especially where the hose joins
the tank and the trigger on/off valve.
■ Operate the trigger on/off valve to make sure that spray is emitted.
■ Check the spray pattern from the nozzle by spraying a dry wall surface. Look to see that the pattern is even
and without streaks. Ensure that the nozzle does not drip when the trigger on-off valve is released.
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Checking nozzle discharge

■ Pump to the full working pressure.
■ Open the trigger on-off valve for one minute, collect the discharge and measure the amount in a
measuring jug. Repeat this procedure a further two times and calculate the average discharge.
■ The discharge should be about 760 ml/min. If the discharge is incorrect, check the nozzle and the
screen filters to ensure they are not clogged. If necessary replace the nozzle. Repeat the discharge
test until the correct volume is obtained.
■ The opening in a nozzle is very small and must not be damaged. Clogged nozzles should be put in
clear water for several hours before the blockage is removed by a very soft toothbrush. Never clean
nozzle with a hard pin or piece of wire and never put the nozzle to your mouth to blow through it.
Preparation of the insecticide spray
■ Identify a suitable WHOPES approved insecticide for public health use. Most public health pesticides
available for residual spraying come in pre-weighted sachets that contain the exact amount of
insecticide to be diluted into a standard 10 litres sprayer. Note that different surfaces such as grass
or plastic sheeting might require a different insecticide or formulation (T.B. 7.11).
■ Obtain, where possible, the water required for the mixing of insecticides on site.
■ Prepare the insecticide spray according to the manufacturer’s instructions in a separate recipient, mix
thoroughly and pass it through a sieve when pouring it into the sprayer. Never fill the tank more than
3/4 full.
The Spraying technique
■ Pump until the pressure gauge shows 380 kPa (55 psi)
■ Spray a vertical swath from roof to floor, using a downward motion, to complete one swath.
■ Time your spray speed to cover one meter every 2.2 seconds, i.e., 4.5 seconds for a 2 m high wall.
Timing may be aided by mentally counting “one thousand and one – one thousand and two – one
thousand and three -…“.
■ Step sideways and spray upwards from floor to roof, using an upward motion. Respect an overlap
of 5 cm. with the previous swath.
■ Keep the spray tip about 45 cm from the wall to ensure the correct swath width of 75 cm wide. Lean
forwards as you spray from top of the wall and move back as you bring the nozzle downwards. Move
forward again when you are approaching the floor..
■ Shake the tank regularly to maintain a homogeneous formulation.
■ Do not let spray drip on the floor.
■ Continue to spray the whole surface with alternating downwards and upwards motions.
■ Do not expose a pressurised pump to the sun.
■ Re-pressurize the tank when the pressure gauge falls below 170 kPa (25 psi)
Cleaning and storage of equipment after use:
■ Empty the spray tank after use; never store a spraying product in the apparatus. Latrine walls can
be sprayed with remaining insecticide solution in the tank (T.B. 7.02).
■ De-pressurize the tank. Pour out any remaining insecticide into pit latrines or specific infiltration
pit; any insecticide needs to be diluted with more water before being put into pits.
■ Fill the tank half-full with clean water.
■ Close the lid, pump up to 380 kPa (55 psi) pressure and spray water through the nozzle.
■ De-pressurize the tank, and shake it so that all inside surfaces are washed.
■ Pour out any remaining water into pit latrines or into a specific disposal pit.
■ Remove, clean and reassemble the spray filter which is located in the valve handle
■ Remove, clean and reassemble the nozzle tip
■ Check parts (such as nozzles and seals) carefully for signs of wear
■ Ensure that the moving parts are lightly oiled regularly.
■ Clean the outside of the tank.
■ Turn the tank upside down with an open lid, open the on/off valve and let all the water drain out of
the hose and lance
■ Ensure the lance is placed in its holder when not in use; this protects the nozzle. When storing the
sprayer for a long period hang it upside down with the lid open to allow air circulation.

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Remarks
■ When spraying smooth surfaces, such as plastic sheeting, tent canvas, oil based paint, the run-off
might be too important when the spray speed to cover one meter is every 2.2 seconds. In this case
double the application speed, wait until the sprayed surface is dry and spray a second time in order
to obtain the recommended dosage (g a.i. /m²).
■ Both the insecticide and the spraying equipment must be WHO Pesticide Evaluation Scheme
(WHOPES) approved. It is strongly recommended to order public health pesticides through your
technical referent. Suitable public health pesticides can possibly be made available locally by the
Ministry of Health or national malaria control programs.
■ Spray persons must use protective clothing (T.B. 7.20) and use public health pesticides safely (T.B.
7.13). In hot and humid climates the wearing of protective clothing may be uncomfortable. Public
health pesticides should therefore be applied during the cooler hours of the day, to minimize neglect
of the safety rules.
✮ Set up a training area for practical training so that each spray man can learn the correct spraying
technique to spray at the proper rate to cover 19 m² per minute. Nine vertical strips must be sprayed.
The spray men should spray at an uniform rate starting at the top left corner of the wall and moving
downwards to the bottom. A distance of 45 cm must be kept between the nozzle tip and the surface
area. To keep this distance in training, a wooden stick can be attached to the lance.
■ Be aware of the need for spare parts when planning a spraying operation. E.g. nozzle tips need to
be changed every 20 working days.
■ Regular cleaning and maintenance of compression sprayers is essential to ensure optimum
performance and to maximize their working lifespan.
■ Always carry out cleaning/maintenance wearing the appropriate protective clothing
■ Respect the precautions during spraying: do not smoke, do not eat, do not drink, avoid touching other
people, wash hands and remove protective equipment after spraying. Do no spray when it is windy.
Key Input
A. WHOPES approved hand operated compression Hand operated compression
sprayer
1. Nozzle Nozzles (solid stream, flat fan,
2. Spray tank hollow cone, solid cone)
3. Hose Bucket
4. Pump Sieve
5. Trigger on/off valve Measuring container
6. Lance Chronometer
7. Funnel with sieve Insecticide
8. Bucket for insecticide spray preparation Toothbrush
B. Types of nozzles Protective equipment (hat, face
9. Solid stream shield, face mask, overalls, gloves,
10. Flat fan apron, boots)
11. Hollow cone Vertical surface (19 m2)
12. Solid cone Wooden stick
C. How to unclog a nozzle
C. Spraying technique
D. Nozzle discharge pattern on vertical surface
13. Wooden stick attached to the lance
14. Wall
15. Run-off
16. 80° fan
17. Rebound
18. Deposit of insecticides
19. Fallout
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T.B. 7.15 Insecticide Residual Spraying campaign

Insecticide Residual Spraying (IRS) is widely used for vector control, especially against mosquitoes,
triatomine bugs and sand flies. Its objective is to ensure the safe and correct application of a residual
insecticide to surfaces on which vectors may rest, usually ceilings, walls and the lower surfaces of
large furniture. Spraying may need to be repeated at least every 6 months depending on the length
of the transmission season and the residual life of the insecticide on the treated surface.
Principles
Essential conditions for the success of an IRS campaign are:
■ Ability to asses whether malaria prevention is appropriate for the target group (Chapter 1, section
7.2.3).
■ The local vector enters habitations to feed and rest indoors after feeding.
■ The local vector is not resistant to the insecticide intended to be used.
■ The majority of the population lives in shelters with plain walls, such as huts, tents or houses. Huts
made of branches with wide voids or gaps will be difficult to spray.
■ The population sleeps indoors during the main biting period of the vector.
■ The population is not nomadic (the structures should be (semi) permanent and not changing within
the next week/month).
■ The willingness of the population to accept spraying.
■ The capacity to organise the spraying activities on time. The ideal time to implement the IRS
campaign requires a review of previous malaria data. In area’s where transmission is seasonal, the
implementation should be done preferably before the increase in transmission. In areas of intense
all year-round transmission, the IRS will be highly effective whenever it is implemented given that
spraying is repeated at least every 6 months (depending on the residual life of the insecticide used
as per box C).
■ The ability to collect and map the location and number of shelters to be sprayed.
■ The capacity to spray a high enough proportion of houses and rooms in the target area to ensure
that the majority of mosquitoes are exposed to the insecticide or that more than 80% of the shelters
will be correctly sprayed to ensure mass protection effect..
■ The spray team is trained in the safe and effective application of insecticides.
■ The ability to organise an information campaign for the targeted population about IRS, its purpose
and benefits. The information to be disseminated will depend on the outcome of the assessment.
Without the support of the hospital staff and/or the community, its leaders and the authorities, an IRS
campaign will most probably not be successful.
Insecticide requirements
■ Estimate the total surface A (m²) to be sprayed considering the number of units to be treated and the
average surface area of each unit (m²). Doors and windows must be sprayed inside and outside.
Walls and ceilings must be sprayed indoors. Floors and outside walls will not require spraying.
■ Determine the type of surface (mud, grass, brickwork, plastic sheeting, oil/water paint) to be sprayed.
■ Identify a suitable WHOPES approved insecticide for public health use (box C). Note that different
surfaces such as grass or plastic sheeting might require a different insecticide or formulation (T.B.
7.11). Before an insecticide is used in a particular country, it must be authorised for use in the country
(T.B. 7.10).
■ Be aware that most public health pesticides, available for residual spraying come in pre-weighted
sachets that contain the exact amount of insecticide to be diluted into a standard 10 litres sprayer.
■ Note that one 10 litre sprayer can spray 250 m² (T.B. 7.14). Determine the amount of pre-weighted
sachets to be ordered based on the total surface A (m²) to be sprayed.
■ Calculate, in case the insecticide is supplied in bulk, the exact amount of insecticide to be diluted into
a standard 10 litres sprayer as per box A, B or C. Given that one 10 litre sprayer can spray 250 m²,
calculate the total amount of insecticide required based on total surface A (m²) to be sprayed.

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The spraying team

■ The number of people needed will depend on the context (e.g. the level of the emergency, skills and
experience of the team, the climate, the terrain, the number and density of the shelters, the logistical
support). The area that can be sprayed by one spray person can be estimated between 1000 and 2000
m² per day. Determine the amount of sprayers to be ordered based on the total surface A (m²) to be
sprayed.
■ To make the spraying efficient, employ a minimum of two people per hand compressed sprayer tank. One
to do the actual spraying. One accompanier, possibly a community health worker, to make sure the
shelters are empty before the actual spraying and to deliver information about disease transmission and
the purpose and benefits of IRS. Potentially also to install a LN and instruct on how to use it.
■ For safety reasons a working day for spray persons will depend on the density of households.
According to the duration of spray person’s exposure, a working day will vary from 4 hours (high
concentration of households) to maximum 6 hours (lower density of households).
■ A team may consist of a team leader and up to 5 spray persons and 5 accompaniers, according to
the specific features of each location to be sprayed. One supervisor can follow-up on a maximum of
4 teams.
■ A storekeeper should be assigned to the IRS campaign to follow-up on the preparation, distribution,
inventory and maintenance of the material.
■ A training should be organized for all the staff involved with the IRS. Often, such a training will last
around two days and should include:
➞ some basic information on the Anopheles mosquito and malaria transmission (T.B.7.01 and section
7.2.3),
➞ delivery of basic messages about the disease addressed, its symptoms and the importance of
seeking early treatment.
➞ the objective of the IRS campaign and the importance of quality work
➞ basic information on public health pesticide (T.Bs. 7.10, 7.11, 7.12),
➞ how to operate, clean and maintain the sprayer (T.B. 7.14),
➞ infrastructure preparation prior to spraying (e.g. food and eating utensils removal).
➞ safety aspects when handling public health pesticides (T.B. 7.13),
➞ diagnostic and treatment of pesticide poisoning (T.B. 7.13),
■ It should be verified that the sprayer persons wear their protective equipment appropriately (T.B.
7.20)
The infrastructure
■ Inform the head of the household of the spraying schedule and the purpose of spraying, giving them
time to prepare and vacate the building.
■ Have the walls, where possible, be cleaned prior to spraying to prevent the removal of the insecticide
residue by cleaning after spraying.
■ Assure that occupants leave the building before spraying. Rooms occupied by sick people who
cannot be moved must not be sprayed.
■ Remove all household items, including water, food, cooking utensils and toys from the building -
protect them against rain. Items that cannot be removed should be well covered. Move and cover,
or take out the furniture to allow easy access for spraying the walls.
Spraying
■ Ceilings must be sprayed with particular attention to all beams. Spraying movement should be as for
walls. Do not stand directly below the spray fallout.
■ Furniture and objects against the wall should, as far as possible, be moved in order to spray behind
them. Cupboards must be emptied so they can be sprayed inside. Tables must be carefully cleaned
of spray fallout.
■ Spray persons must use protective clothing (T.B. 7.20) and use public health pesticides safely (T.B.
7.13). In hot and humid climates the wearing of protective clothing may be uncomfortable. Public
health pesticides should therefore be applied during the cooler hours of the day, to minimize neglect
of the safety rules.
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Procedures after spraying

■ Advice the occupants to stay outside for two hours after spraying.
■ Instruct the hospital staff or the householders to sweep or mop the floor and all flat surfaces to remove
the spray fallout before patients, other persons or items are allowed to re-enter. Instruct them not to
clean the sprayed surfaces.
■ Assure that all empty packaging is returned to the supervisor for safe disposal. Organize appropriate
disposal of remains of insecticide and empty packaging (T.B. 7.12).
■ Never poor the remaining insecticide into drinking water sources or rivers and pools as fish are highly
sensitive to pyrethroids.
Box A
Application of wettable powder/granules: (for use on porous walls like bricks, mud, grass structures,
water based painted walls).
One litre of spray suspension can be prepared using the following formula:
X= S x Y x 100/C
With:
X = weight of water-dispersible powder/granules required to prepare one litre of spray suspension (g)
Y = recommended dosage (g/m²) depends on the insecticide (box C).
C = concentration of active ingredient in formulation as mentioned on the packaging (%)
S = 25 m2 or surface covered by one litre of spray suspension; if standard spraying procedure is
used, spray is applied at 40 ml/m2 or 1L/25m2 (T.B.7.14)
Example: deltamethrin (2.5 % wettable powder ) is to be sprayed at a dosage of 0.025g a.i./m².
X = 25 x 0.025 x 100/2.5 = 25 g
For a 10 litre tank the amount of wettable powder needed is 250 g (calculation: 10 x 25 g)
Example: alphacypermethrin (5 % wettable powder) is to be sprayed at a dosage of 0.03 g a.i./m²
X = 25 x 0.03 x 100/5 = 15 g
For a 10 litre tank the amount of wettable powder needed is 150 g (calculation: 10 x 15g).
Box B
Application of suspension concentrate: (for use on canvas tents, plastic sheeting, oil based painted
walls).
One litre of spray suspension can be prepared using the following formula:
X= S x Y x 100 / C
With:
X = amount of suspension concentrate needed to prepare one litre of spray suspension (ml)
Y = recommended dosage (g/m²) depends on the insecticide (box C).
C = concentration of active ingredient in formulation as mentioned on the packaging
(%weight/volume)
S = 25 m2 or surface covered by one litre of spray suspension; if standard spraying procedure is
used, spray is applied at 40 ml/m2 or 1L/25m2 (T.B.7.14)
Example:
Alfacypermethrin (6 % suspension concentrate) is to be sprayed at a dosage of 0.03g a.i. /m².
X = 25 x 0.03 x 100/6 = 12.5 ml
For a 10 litre tank the amount of suspension concentrate is 125 ml (calculation:12.5 ml x 10).
Pour this in a recipient and top-up with water to 10 litre.

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Box C
(adapted from Whopes list of approved insecticides for IRS – for updates see Whopes website)
Insecticide compounds Class group Dosage Mode of action Duration of effective
and formulations (1) (2) (g a.i./m2) action (months)
Malathion (WP) OP 2 contact 2-3
Fenitrothion (WP) OP 2 contact and airborne 3-6
Pirimiphos-mehthyl OP 1-2 contact and airborne 2-3
(WP and EC)
Bendiocarb (WP) C 0.1 - 0.4 contact and airborne 2-6
Propoxur (WP) C 1-2 contact and airborne 3-6
Alpha-cypermethrin P 0.02 - 0.03 contact 4-6
(WP and SC) P 0.025 – 0.05 contact 3-6
Bifenthrin
Cyfluthrin (WP) P 0.02-0.05 contact 3-6
Deltamethrin (WP, WG) P 0.01-0.025 contact 2-3
Etofenprox (WP) P 01-0.3 contact 3-6
Lamda-cyhalothrin (WP, CS) P 0.02-0.03 contact 3-6
(1) CS: capsule suspension; EC: emulsifiable concentrate; SC: suspension concentrate; WG: wettable granules;
WP: wettable powder; (2) OC : Organochlorines ; OP : Organophosphates ; C : Carbamates ; P : Pyrethroids
Remarks
■ Both the insecticide and the spraying equipment must be WHO Pesticide Evaluation Scheme
(WHOPES) approved. It is strongly recommended to order public health pesticides through your
technical referent. Suitable public health pesticides can possibly be made available locally by the
MoH or national malaria control programs.
■ Respect the precautions during spraying: do not smoke, do not eat, do not drink, avoid touching
other people, wash hands and remove protective equipment after spraying.
■ Insecticides are often classed as “toxic chemicals” and are therefore subject to strict packaging and
shipping certificate requirements for transportation. Packaging requirements for wettable powders
are less strict than for liquid formulations and the wettable powders are normally the most simple
formulations to ship by air transport.
■ Some insecticides can give allergic reactions, such as skin rash. It is therefore important to ventilate
the sprayed surface and try to prevent people entering the infrastructure before the insecticide has
dried. The time needed for the insecticide to dry is context-dependant. A piece of toilet paper applied
on the sprayed surface can be used to confirm if it is dry or not.
■ Before starting up and training a team, find out if suitable people are available in the region (e.g. a
lice control team is not trained to manage a program to control malaria and will need additional
training).
■ IRS is especially recommended in area’s where malaria transmission is largely confined to one
season. IRS can then be very effective when conducted once a year prior to the start of the
transmission season. In area’s where malaria transmission is more or less constant throughout the
year, IRS will need to be repeated every three to eight months (according to local conditions,
habitation types and insecticide used), with both cost and human resource implications.
■ The nature of the sprayable surface plays a major role in the duration of the residual effect of the
insecticide. Surfaces of organic origin (e.g. wood, bamboo, palm leaves or thatch and mud) are
adsorptive and may break down the insecticide chemical structure. They require higher application
rates to achieve satisfactory residual action. Alkaline surfaces such as whitewashed walls affect
insecticides. Do not spray a corrugated iron roof exposed to the sun as the heat that will build up may
rapidly inactivate insecticides or cause it to flake off the sprayed surfaces.
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T.B. 7.16 Long-lasting insecticidal Nets (LN’s)

Long-lasting insecticidal Nets are one of the major ways to control malaria, and they are widely
accepted by communities in areas affected by malaria. They have two kinds of protective effects –
one for the people directly under the nets, and one for the community at large.
Principles
Personal protection and mass effect

The personal protection effect of a Long-lasting insecticidal Net (LN) for the people sleeping under it
operates in three ways. First the insecticide incorporated in the net tissue kills the mosquitoes (and/or
other biting insects) that comes into contact with the net. Second, the LN repels a proportion of the
mosquitoes but this ability depends on the insecticide present in the net. Third, the net acts as a
mechanical barrier to biting. The mechanical barrier provides less protection, which is why nets without
insecticide are less effective than treated ones. A torn and untreated net offers little or no protection
where a torn but treated net still works to some extend.
The mass effect is important but often ignored. It extends the protection beyond that for the individuals
under the net and works in three ways. First, mass coverage by LN’s shortens the lifespan of the
mosquitoes. Second, mass coverage reduces the number of mosquitoes in the community. Apart from
their killing effect, nets will also inhibit mosquitoes feeding, hence reducing their reproductive potential
Third, with some Anopheles species, mass coverage might divert mosquitoes from human to animal
biting, thereby reducing human to human transmission. Taken together, these effects on the vector
population can greatly reduce transmission of disease, but only if the coverage of mosquitoes nets is
sufficiently high.
The personal protection provided by LN’s allows their deployment in a progressive way starting with
low population coverage. Nonetheless rapid scale-up, with a target of complete coverage, is highly
desirable as the mass vector control effects of LN’s becomes more apparent when household coverage
increases. Every LN used thereby contributes not only to the safety of its user(s), but also to the safety
of others.
Characteristics
LN’s are ready-to-use factory pre-treated nets with the insecticide either incorporated or coated around
the fibres. Long-lasting insecticidal Nets retain their insecticidal properties for two to five years, the
physical life span of the net. A LN only needs re-treatment after 20 washes. As a consequence, and if
used in a normal way, they do not require further treatment during their normal life. Polyester and
polyethylene is currently the most common fabric for nets but cotton fibre is also used. A square shaped
net has the least person-to-net contact and is often preferred. An entrance flap is not recommended.
The mesh size indicates the number of openings per square inch in the net; 156 is the most common.
In tropical climates a mesh size higher than 156 may result in insufficient ventilation for comfortable
use. However in desert fringes where it is cold at night, the “demuria”, a non transparent net, might be
the better choice. The “denier” value of a net is an indication of the weight of the fibre and consequently
its strength. Nets with a denier value of less than 100 are not recommended due to the relative ease
of tearing. In practice, the size of the net is a matter of user preference and it is culturally determined.

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Essential conditions for the success of a LN’s distribution are:

■ Ability to asses whether a LN is appropriate for the target group (see Chapter 1 and section 7.2.3).
■ At least some of the vectors bite at hours when and where people are sleeping under the net.
■ There is a potential for behaviour change so that people will use the nets correctly, knowing that the
distribution of nets should be accompanied by clear LN promotion/education messages.
■ The population is willing to and can use the nets (e.g. shelters are large enough to put up a net).
■ The population do not make fire in the sleeping area of the shelter.
■ Ability to organise and implement an effective community promotion campaign prior to distribution.
The information to be disseminated will depend on the outcome of your assessment. Without the
support of the hospital staff and/or the community, its leaders and the authorities, a LN distribution
will most probably not be successful.
■ An adequate delivery system including the acquired information on number and location of houses
and sleeping units requiring nets.
■ LN’s are available or can be made available in time. Long commercial delivery and shipping times
might be experienced with LN’s and this may delay deployment and effective protection.
■ Ability to manage the distribution to targeted groups in the required time frame. The ideal time to
implement the distribution requires a review of previous malaria data. Implementation should be
done preferably before the start of the malaria season in area’s where transmission is seasonal. In
areas of intense all year-round transmission of malaria, distribution will be effective whenever it is
implemented.
■ Distribution of nets will not endanger the population (e.g. risk of theft, looting).
■ The mosquito species is not resistant to the insecticide used to impregnate the LN’s.
Activity plan for LN distribution

■ Define the size, shape and colour of net to be distributed. LN’s are available in rectangular and
circular forms, multiple colours and in transparent or opaque cotton sheet (e.g. the Dumuria).
Distribute in emergency the model available in stock to enable rapid deployment (e.g. rectangular
1.30 m wide individual LN for patients in health centres and rectangular 1.90 m wide LN for families).
■ Define the beneficiaries. A targeted distribution to risk groups (e.g. like pregnant women and children
under 5 in open setting through clinics with antenatal care, immunization programmes, feeding
centres or vaccination campaigns) or a mass distribution, aiming at good household coverage.
■ Define how and where the nets will be distributed. (e.g. mass distribution during a general food
distribution, through local leaders or a house to house distributions installing the LN’s during the
distribution which has a positive impact on their utilisation.).
■ Define a well-prepared LN promotion/education campaign. Contact your technical referent to receive
already existing survey forms that have nevertheless to be adapted to the data collected on the local
context (T.B. 1.01).
■ Define a post-distribution monitoring method to ensure that targeted beneficiaries have actually
received/retained and are using their LN correctly.
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Remarks
■ In refugee or displaced camp settings, Insecticide Residual Spaying (T.B. 7.15) is likely to be
preferable to the distribution of LN’s due to the notoriously poor retention rates for LN’s in the acute
emergency phase. Faced with limited food rations, families will often choose to sell their net as a
means of temporarily increasing the family food intake.
■ LN use can result in rashes or allergic reactions so it is advisable to ventilate the nets 24 hours
before using them. When handling a large number of new nets, protective clothing (gloves and long
sleeves) should be used by staff.
■ To reduce the risk of re-selling of LN’s by the beneficiaries, the nets should be taken out of the
packaging, marked with a number or name and signed for reception by the head of the household.
Some LN’s are already supplied with an individual number printed on them. This can also help with
monitoring of the distribution, and to assess how well predefined targets are reached.
■ In places where a pre-distribution study shows that the nets distributed to pregnant women are largely
used by their husband or other relatives, distribute two nets for each pregnant woman. .
■ Where possible, nets should be ordered well in advance of a planned distribution, to ensure timely
delivery and appropriate transportation costs.
■ The shape and colour are important considerations, as some colours may be refused/misused by
beneficiaries because of the significance of certain colours to that population (e.g. white nets might
be misused to wrap dead bodies or make wedding dresses). White nets may also be washed more
often than coloured nets.
■ A valuable LN’s intervention in malaria endemic countries is allocating one net per bed in dormitory
of schools.
■ Pre-fabricated huts or shelters can be used during promotions campaigns to clearly demonstrate
how to install the LN’s (e.g. to keep the mosquitoes and other insects out, be sure to tuck the bottom
of the net under the mattress or let it hang so that it touches the ground all around).
■ It might be important to provide nails and rope during distribution to facilitate the installation of the
LN’s.
■ It might be important to replace old and damaged nets by new ones during the distribution.
■ In malaria prone areas, make sure the net is used every night, even where mosquitoes are not heard
or seen
■ Avoid using fire near the net or smoking under the net.
■ It is often found that people use mosquito nets for fishing, clothing (wedding dresses) or for crop
protection; be aware of this possibility when distributing nets and include this in the promotion
campaign messages in order to avoid these practices.
■ In case a LN was used by a patient with a highly contagious disease (e.g. ebola), the LN should be
destroyed as it cannot be disinfected; insecticides and chlorine are not compatible.
■ Some bednets (LN’s) need time (up to one week) to recover their insecticidal capacity after washing.
This process can be accelerated with heat (e.g. put LN under a blanket in the sun for a day; the
blanket is required as insecticides break down under UV radiation).

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T.B. 7.17 Impregnation of nets, clothing and curtains

Using a net that is impregnated with public health pesticides is much more effective than using an
untreated net. If a net is not treated, mosquitoes quickly find any body part touching the net or
accidentally left uncovered. Insecticide treated nets inhibit mosquitoes, but also bedbugs, lice, fleas,
sandflies, cockroaches from biting. Clothing and curtains can also be impregnated.
Principles
It is recommended to use a single pre-packed dose required for the impregnation of one net and its
conversion into a Long-lasting insecticidal Net (LN). It is available in kit, containing a single insecticide
dose, a binding agent sachet, gloves, a plastic measuring container (or bag) and the impregnation
instructions. It is usually more efficient to treat several nets at the same time using one dose per net treated.
Used nets should be washed and dried before treatment. The following impregnation procedure can be
applied to curtains and clothes as well. For the impregnation of clothes, the insecticide formulation needs
to be identified with support of your technical referent (e.g. a formulation with deltamethrin as active
ingredient will irritate the skin and is not at all appropriate).
■ Collect the necessary equipment: basin or plastic bag, gloves, soap, net and impregnation kit (insecticide,
binding agent, plastic measuring container (or bag)).
■ Make sure the net is clean. If not, wash with soap and water and dry it before impregnation..
■ Choose an appropriate site to do the impregnation. It is best to treat the net outdoors in the shade. If you
must treat the net indoors, do it in a room with open windows.
■ Put on protective rubber gloves.
■ Measure the correct amount of water in the measuring bag and poor it into the basin or plastic bag: 0.5
litre is required for a synthetic net (e.g. polyester or polyethylene) and 2 litres of water is required for a
cotton net and this independent of the size of the net. If the net is exceptionally large or thick, some
excess water might be required.
■ Add the correct amount of binding agent, when available, to the water and stir to mix thoroughly.
■ Add the correct amount of insecticide to the water. The amount of insecticide or “dose” needed to treat
one net may come as a tablet, small bottle or sachet of liquid.
■ Mix the water and insecticide thoroughly.
■ Unfold the net and put it in the basin or plastic bag with the insecticide solution you have prepared.
■ Soak the net long enough to insure that all parts of the net are impregnated.
■ Lift the net and wring gently. Do not wring too hard - as when washing clothes - or insecticide will be lost.
■ Do not hang the net on a line otherwise the insecticide will be distributed unevenly or even drip out.
Stretch the net out flat in the shade to dry. Do not leave the net in the sun as insecticides break down
under UV radiation. Later it can be hung up to finish drying.
■ Use any leftover mix of water and insecticide to treat curtains. Otherwise, dispose of it in the latrine or in
a specific hole, but away from ponds, rivers, streams, wells, springs, boreholes, the house or animal
shelters. Never store the mix of water and insecticide.
■ Wash the basin with soap and lots of water
■ Dispose of used gloves, plastic bags and empty insecticide containers (T.B. 7.12)
■ Wash your hands with water and soap
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Key
A. Material needed for impregnation
1. Measuring container or bag
2. Clean net
3. Gloves
4. Soap
5. Basin or plastic bag
6. Insecticide formulation
7. Binding agent
B. Impregnating the net
C. Drying the net correctly

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Remarks
■ An untreated mosquito net, if properly used and maintained, can provide a physical barrier to hungry
female mosquitoes. Biting is still possible if there is a small tear in the net, if the net is not covering
the entire bed or if part of the body is touching the net. If treated with insecticide, net effectiveness
is greatly improved, generating a chemical halo that extends beyond the mosquito net. This tends
to repel mosquitoes from biting or shorten their life span and reduce malaria transmission. Even a
treated net with holes will have this impact as the mosquito will have to be in contact with the net to
locate the hole.
■ The use of LN is recommended (T.B. 7.16). LN’s are ready-to-use factory pre-treated nets.
Long-lasting insecticidal Nets retain their insecticidal properties for two to five years, the physical life
span of the net. A LN only needs re-treatment after 20 washes. As a consequence, and if used in a
normal way, they do not require further treatment during their normal life.
■ In health structures, nets should be washed when stained (e.g. blood, excreta, vomit) or at least at
regular intervals (e.g. each month). In this particular case, LN’s will be washed 20 times after almost
two years period, thus before the end of their life span. If the LN’s are still in good condition at this
moment, they need to be re-impregnated prior to being used again (T.B.7.17).
■ Re-impregnation of LN’s is also necessary when information on when they were installed in the
health structures and how many times they were washed is not available (T.B.7.17).
■ Use only public health pesticides that are recommended for mosquito nets impregnation. A wettable
powder formulation cannot be used for net treatment. As the net dries, the wettable powder no longer
adheres to the flexible fibres and falls down. A person using the net risks inhalation and accumulation
of insecticide on the exposed skin during the night.
■ If a concentration exceeding the recommended dosage is used, people may experience eye or skin
irritation when sleeping under the net.
■ Direct skin contact with the insecticide on a net that is still wet may causes a tingling sensation of
the skin and is best avoided.
■ After treatment the net may slightly smell of the insecticide. The smell will go away in a few days and
is not harmful to people who sleep under the net.
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T.B. 7.18 Insecticidal dusting

An insecticidal dust consists of talcum powder, or another inert carrier powder, mixed with
insecticides. They are most useful for the treatment against rat fleas as well as human fleas and
body lice or ticks. They can be applied with dusters between the body and the undewear or in
hollow walls, false ceilings, or other hiding places that cannot easily be reached. The dust disperses
well and can penetrate deep into cracks and crevices.
Principles
Rat fleas
■ Apply insecticidal dust against rat fleas a week earlier than rat poisons during the control of urban
outbreaks of plague. This is to prevent fleas from moving to humans when the rats are killed.
■ Apply insecticidal dust to burrows, runways and other sites where rodents are likely to pick it up. When
the rodents groom themselves they spread the dust on their fur, thus killing the fleas. Before control is
begun, it is important to know where rodent burrows and runways are. To save insecticide, the burrows
should first be closed off; only those that are subsequently re-opened by the rat should be treated.
■ Blow insecticidal dust into each burrow with a duster. A 1 cm thick layer of dusting powder should be
left around the opening.
■ Deposit patches of dust that are 15-30 cm wide and 1 cm thick along runways.
■ Apply dust only where it will remain undisturbed by humans, wind or rain. Insecticidal dust remains
effective for 2-4 months if used in undisturbed dry place.
■ Do not apply dusts to wet surfaces as this reduces their effectiveness.
■ Apply dust only when the sprayed surfaces have dried when used together with residual spraying
(T.B. 7.15).
Human fleas
■ Dust mattresses, beds and crevices in floors where the fleas rest during the day.
■ Use a dust that does not cause irritation when in contact with the body. Dusts with a maximum of 1%
of permethrin, as the active ingredient, are recommended. Ready to use preparations are the safest
and recommended option.
■ Pay attention to the type of talcum used in the formulation; some are only for use on animals and
some are cleared specifically for human use.
■ Do not treat infant bedding with insecticidal dust, but wash them thoroughly and regularly instead.
Human body lice
■ Apply about 30-50 g of powder over the surfaces of clothing that are in close contact with the body for
individual treatment. Powder is applied to the fully clothed subject at the neck, half at the front and half
at the back, then spread by rubbing to ensure complete coverage. Pay specific attention inside the belt
sleeves and socks if these are worn. Make sure the powder is applied in a cultural sensitive manner,
especially between skin and underwear. Leave for 12 to 24 hours. This is the preferred method for mass
treatment.
■ Do not dust open wounds (e.g. scratching related to scabies)
■ Treat headwear, additional clothing, blankets and bedding as well (e.g. add about 30-50 g of powder to
a plastic bag containing the additional set of clothing).
■ Make hand shakers by puncturing one end of a can (approximately 2.6 holes/cm² and of 3 mm diameter).
Application with a soupspoon is also simple and practical; 1 soupspoon is about 15 gram: use one at
the front and one at the back.
■ Only apply dusts with a maximum of 1% of permethrin as active ingredient. Ready to use preparations
are the safest and recommended option.
■ Pay attention to the type of talcum used in the formulation; some are cleared specifically for human use
but some are only for use on animals.
■ Dust patients before being admitted to a health structure as every bout of fever or large drop in
temperature (e.g. death) promotes the movement of lice to a new host.
■ One treatment should be sufficient but re-treatment might be needed at intervals of 8-10 days if
infestations persist.

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Key
A. Devices used for insecticidal dusting
1. Hand shaker
2. Puff dusters
3. Plunger type duster
B. Treatment of human body lice with insecticidal dust
Remarks
■ Take care not to apply public health pesticides where they can contaminate food or where children
might be playing.
■ When dusting people, be sure to explain the purpose since the insecticidal powder leaves visible
traces on the clothing
■ Ready to use dusting formulations are the safest and recommended option. Contact your technical
referent in case other options are considered.
■ A combined rodent and flea control, using baited traps is possible using baits that combine insecticide
and rodenticide characteristics. After bait ingestion, the flea will die first due to the insecticide that
will diffuse through the rodents ski; the rodent will die later due to the rodenticide. This strategy can
be interesting in case of plague or murine typhus outbreak. Contact your technical referent in case
this option is considered.
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T.B. 7.19 Rodent control

The most important methods to reduce the rodent population are mechanical protection, sanitation,
traps and poison. Often a combination of these methods is needed to achieve a significant decrease
of the rodent population. Complete eradication remains very difficult as only a limited area is
targeted with rodent control. The control campaign should be accompanied by health promotion.
Principles
Mechanical protection
The aim is to prevent access by rodents to important or vulnerable area’s
■ Block or protect all openings greater than 6 mm with cement or metal netting (1mm wire , mesh
less than 6 mm diameter).
■ Fit barrier (e.g. discs) on cables that join roofs.
■ Paint a smooth band (oil painting) of at least 30 cm wide on walls, at 1 m from the ground, to
prevent passage on rough vertical surfaces
■ Fix galvanized sheets (1 mm thick) at the bottom of doors and on skirting.
■ Pay particular attention to warehouse management (e.g. recondition where required, clean
regularly)
General environmental sanitation
The presence of food sources and shelter in areas of human habitation attracts rodents and could
be associated with outbreaks of plague. General environmental sanitation and proper household
hygiene can do much to reduce any type of rodent infestation, more specifically:
■ Limit access of rodents to food supply (e.g; harvest fruit in a timely manner, make it possible to
store all food in rat-proof containers)
■ Install a proper disposal of food residues and refuse.
■ Eliminate or at least reduce the protective vegetation cover that is crucial to the rodents. Prune
shrubs so that the ground below them is clearly visible. Mow, trim or remove ground cover plants.
Stack firewood, lumber and other materials at least 30 cm away from walls and fences and at
least half a meter above the ground.
■ Keep irrigation and drainage canals clean.
■ Avoid, where possible, access to any source of water during hot dry weather. This unless you
want to attract and trap them.
Traps
■ Traps can be divided into three types:
➞ Spring traps: can be efficient but not to be used in the vicinity of children or non-targeted animals.
➞ Cage traps: allow to catch the rodents (alive for observation or examination if needed).
➞ Rat glue is available in tubes and should be put on a piece of cardboard with some bait in the
middle.
■ Keep in mind that rodents are very suspicious, always use the same runs and learn very quickly. This
means that traps should be used in large numbers, over a short period, on carefully chosen sites,
perpendicularly to rodents runs. It is also best to leave the traps not set for a few days after installation
to reduce trap shyness.
■ Check traps twice a day to remove captured rats and replenish bait if required.
■ Do not place glue boards where children, or other non-targeted animals might be in contact with
them. Replace glue boards often; they lose their effectiveness when covered by dust or insects.
Effectiveness is also reduced by heat and moisture, therefore it is recommended that glue boards
be used only indoors.
Rodenticides
Rodenticides can be divided in two classes:
■ Chronic or slow-acting rodenticides: referred to as multiple dose anti-coagulants that are the safest
for user and generally require several doses (e.g. Difenacoum Brodifacoum, Bromadiolone,

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Difethialone). They are normally the first choice rodenticides and exisist in different formulations
(e.g. grains, blocks, paste, gel), their advantages being: they don’t cause bait-shyness and accidental
poisoning of people or animals is unlikely to happen. Some formulations are weather resistant.
However, rodents can become resistant to them and before selecting the rodenticide, information on
local resistance should be collected.
■ Acute rodenticides such as zinc phosphate, arsenic oxide and Fluoroacetamide are mainly for
industrial applications (e.g. ships). They are too toxic for human beings and are not recommended
for general use. They are effective in situations where anticoagulant resistance exists and where the
dead bodies can easily be found and disposed off. However, it is advised to use these products only
if you have no other option because of the health risks that they represent to man and non-targeted
animals. Such intervention can only be envisaged after discussion with your technical referent.
Key
A. Temper resistant bait box with key and bait
B. Metallic cage trap
1. bait
2. key
3. entry / exit
4. trapdoor
5. spring
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Remarks
■ Against a flea-born disease (e.g. plague or murine typhus) the flea control must precede rodent
control to prevent fleas from moving to humans when the rats are killed. If not, the spread of these
flea-born diseases can be encouraged (T.B. 7.18).
■ All rodenticide containers should be clearly marked with warning labels and stored securely.
■ A health promotion campaign to enlist the help of the community groups and individuals is probably
the most essential component of the rodents control activities.
■ Rodenticides can be very effective, but their use requires supervision and follow-up by well-trained
staff.
■ Before placing any bait, check that rats are not a supplement to the diet of the population/refugees.
If this is the case contact your technical referent. In any case, inform the population about the control
campaign and the risks of the rodenticides.
■ Temper resistant bait boxes are bait boxes that can be closed with a key. These boxes should be
secured to the ground so the population cannot take and use them for other purposes like storage
of food. They represent a safe way to place baits, in opposition to PVC or bamboo that are commonly
used but that still allows access to the bait by children.
■ Prior to embarking on a rodenticide campaign, limit the rodent access to food supply and nesting
places. As long as this is not taken care off the rodent population will grow and quickly reach its
former population level. The impact of a rodenticide campaign will in this case be negligible.
■ Rat control activities using ultrasonic sounds to scare the rats away are not recommended.
■ Offering rewards to bring in rat tails as proof for each killed rat has previously shown to be contra
productive as it resulted in people breeding rats.
■ Particular attention should be paid to protecting vulnerable refugees (such as the old and the sick)
from being bitten by rats. Those suffering from leprosy may be especially defenceless when sleeping
due to their lack of sensations in fingers and toes.
■ Rodenticides can be used in health structures and warehouses but are generally not recommended
for use in refugee camps. The large number of children, having little to do and few things to play with,
make it risky to place poison bait traps around the camp environment.
■ For safety reasons, utilise pre-packed ready to use rodenticides already mixed with baits.
■ Bait must not be placed haphazardly. Care must be taken to place the bait where the rodent will find
it, but children and animals cannot.
■ Check baits twice a day for replenishing of bait.
■ Care has to be given to correct collection and disposal of carcasses: put dead rats safely in a plastic
bag and bury them in a deep pit.
■ Caution to safe handling of trapped rodents (e.g. the multi-mammate rat is the natural reservoir for
the Lassa fever virus; the virus is spread through the urine of the rats; if trapped these rats
urinate wildly and become covered with the virus; their corpse must be disposed of without direct
contact).
■ Impact of rat control can be observed after 3 weeks for the brown rat, and 4 to 5 weeks for the black
rat/mouse.

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T.B. 7.20 Protective Clothing

All public health pesticides are toxic to some degree. Absorption can occur through contact (skin),
inhalation (lungs) and/or ingestion (mouth). Specific protective clothing must be worn in accordance
with the safety instructions on the product label.
Principles
General Insecticide Use
Even for apparently straightforward application of public health pesticides (e.g. placement of cockroach
poison, impregnation of fabrics) a minimum of protective clothing is required.
Spraying/Dusting/Packing
During spraying, dusting or packing activities, absorption of insecticide can occur through contact,
inhalation and/or ingestion. Therefore specific protective clothing must be worn, covering all parts of
the body.
Care and Use of Protective Clothing
■ Wash clothing daily. Keep it in good state of repair, and inspect it regularly for tears or worn areas.
Keep clothing in a closed, ventilated place, out of the reach of children
■ Take the clothes off immediately after the work is finished and do not taken them home. Protective
clothing should be changed if it becomes wet. As such, a spare set of protective clothing is useful
on the field.
■ Change the respirator every day. The respirator prevents exposure of the face (protects nose and
mouth from airborne particles of the spray) and inhalation of vapour.
■ Protect head, face and neck from spray droplets by a broad rim hat.
■ Wash face shield or goggles regularly to maintain visibility. Face shield or goggles protect the eyes
from drops of insecticide.
■ Wear overalls, even when hot, to protect the body and wash it regularly. Wear clothing under it
(e.g. underwear, T-shirt).
■ Wear boots to protect the lower legs. The overall pants should be tugged over the boots.
■ Wear plastic gloves to protect the hands when handling and spraying the insecticide. The sleeves
of the overall should be tugged within the gloves. After use, the gloves should be rinsed with
water before they are taken off. They should be washed daily with soap, separately from other
clothing. Gloves should be washed on the inside as well. Be careful when re-using gloves not to
wear them inside-out.
■ Provide access to good washing facilities after the job is done to personnel involved in chemical
vector control.
Key
A. Protective clothing for insecticidal residual spraying
B. Face/eye protection
1. Broad rim hat
2. Face shield
3. Face respirator
4. Long sleeved overalls (keep overalls outside of boots).
5. Long rubber gloves (keep overalls inside of gloves)
6. Rubber or plastic apron.
7. Boots.
8. Safety glasses
7 60
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TECH-SAN-160_CH7 22/03/10 10:12 Page 62
Remarks
■ Use public health pesticides safely (T.B. 7.13).
■ The quality of the respirator should be adapted to the public health pesticide and formulation used,
and needs to be verified with your technical referent (e.g. minimum FFP2 for pyrethroids, minimum
FFP3 for carbamates).
■ Depending on the situation, a centralized system of storage and care may be the best option with
protective clothing handed out prior to the control activity and collected and cleaned afterwards.
This ensures better control and care of the equipment.
■ A face shield is the preferred option for full face and eye protection. They are less hot to wear and
do not mist over as easily as goggles. If no face shield is available, a pair of safety glasses is an
acceptable alternative.
■ Protective clothing can be a mayor source of exposure to operators if it is not either carefully washed
or disposed after use.
■ In hot and humid climates the wearing of protective clothing may be uncomfortable and the sweat
generated increases absorption of insecticide. Public health pesticides should therefore be applied
during the cooler hours of the day, to minimize neglect of the safety rules and assure use of protective
clothing. It is the responsibility of supervisory staff to ensure that the appropriate protective clothing
is worn, no matter what the circumstances.
■ If poisoning is suspected, medical help must be sought immediately. Some indications of insecticide
poisoning are: extreme weakness and fatigue, skin irritation or burning sensation, itching eyes,
nausea, vomiting, diarrhoea, headache, cough, chest pain, unconsciousness (T.B. 7.13).
■ Overalls should be available in two samples to allow a daily washing and drying, even in tree samples
in particular circumstances like during rainy season or under humid climates where it takes more than
one day to dry.
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Disposing
of Dead Bodies
Narrative
Technical briefs
T.B. 8.01 Special precautions when disposing of dead bodies
T.B. 8.02 Morgue
T.B. 8.03 Cemetery
T.B. 8.04. Cremation
Chapter 8
Disposing of Dead Bodies - draft 8 1

TECH-SAN-160_CH8 22/03/10 10:13 Page 2
8 2
Disposing of Dead Bodies - draft
TECH-SAN-160_CH8 22/03/10 10:13 Page 3
8.1 Why disposing of dead bodies?

It’s a common misbelieve that dead bodies who are not or cannot immediately dealt with would lead to
epidemics. Dead bodies related to war, famine or natural disasters do not form a direct and immediate public
health risk. This misbelieve should not be transmitted to the affected population because it will only increase
their traumatic experience. Still, it’s advisable to deal with the corpses as soon as possible because of:
■ The respect that should be paid to the population’s culture regarding the deceased.
■ The proximity of the dead bodies, often after a traumatic experience, can lead to mental health problems
of the survivors. But the unceremonious disposal of the corpses, can have the same impact as well.
■ The nuisances such as the odours.
■ The scavengers and vectors that will be attracted and can represent an indirect health hazard.
However, deceased victims of cholera, plague, typhus and viral haemorrhagic fevers (e.g. Ebola, Marburg),
can have an impact on the spreading of the respective disease to a wider population and thus can represent
a direct health risk. Rapid and special precautions have to be taken when disposing of these kinds of dead
bodies. An in-depth description of how to deal with deceased victims of these diseases can be found in the
respective guidelines (section 8.5 Further reading).
8.2 What is disposing of dead bodies?

Disposing of dead bodies can include locating the deceased, collection, preparing the body for viewing (with
possible disinfection of the body and the living environment of the deceased; TB 8.01), registration, body
dressing (e.g. putting body in a coffin), transport (with potential disinfection of the means) and burial or
cremation.
In general, the culture and wishes of the relatives should be respected as much as possible, as this helps
the survivors in their mourning process. But particular rules (e.g. rapid burial) have to be respected for the
casualties of specific diseases as described hereunder (T.B. 8.01 and section 8.5 Further reading) as they
can lead to epidemics. It is of utmost importance that correct information concerning the risk of being in
contact with deceased of highly infectious diseases is well explained to the relatives and the neighbours,
otherwise they might be reluctant to bring the sick people to the health centres.
8.3 Where and When should dead bodies be disposed of and by Who?
It is obvious that dead bodies should always be dealt with, as soon as possible. It should be strongly
encouraged that the relatives take responsibility themselves of the dead body, in case the deceased is a
victim of war, famine or a natural disaster. This can be done according to their usual cultural and religious
procedures, such as the preparation for viewing of the deceased and body dressing. Those steps are often
done at home. They have a positive influence on the psychological and emotional effects of the relatives, as
they are essential steps in the mourning process.
However, the aid-agencies will often have to provide adapted funeral areas:
■ Morgue (should be available in all in-patient health structures, and sometimes there is a need for additional
ones after natural or man-made disasters (e.g. war) due to the high number of casualties, or in isolation
centres dealing with specific diseases; TB 8.02).
■ Cemetery (TB 8.03) or cremation site (see TB 8.04).
These facilities have to correspond to certain specifications. The sites need to be chosen in collaboration with
the local authorities and preferably as well with the affected community.
The aid-agencies can also help the affected population in providing shrouds and/or transport if necessary.
In particular contexts (e.g. high number of dead bodies after a natural disaster), the aid-agencies might have
to collect and dispose of the deceased.
The role of the (medical) aid-agencies in disposing of dead bodies increases in importance during the control
of an epidemic of highly infectious diseases. For viral haemorrhagic fevers for instance, the preparation of
the dead body (e.g. disinfection of the body and leak proof body bag) has to be taken in charge by a trained
team (T.B. 8.01) in order to avoid further spreading of the epidemic. In such a context, it is important to
promote and supervise safe burial, and to disinfect the living environment of the deceased.

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8.4 How to dispose of dead bodies?

Follow up on identification of the deceased, information towards their relatives, human rights and legal issues are
very important, but fall outside the scope of these guidelines (section 8.5 Further reading).
During epidemics of highly infectious diseases, the dead bodies will have to be disposed of with specific
precautions. In all other cases, it isn’t necessary and even not advised to disinfect the corpses. Dead bodies that
can’t be removed immediately (e.g. corpses left on the street due to insecurity conditions) can be covered with
lime. Since the high pH of the lime “disinfects” to a certain extent the dead body superficially, but doesn’t affect
internal pathogens, its effectiveness is limited. However, lime can reduce the odour of the corpses that start to
decompose.
Special attention should be paid to the protective clothing of people coming in contact with dead bodies having
open wounds, or deceased victims of highly infectious diseases as described in the respective guidelines. In all
other cases, the relatives that deal with the dead bodies don’t require any specific protective clothing. However,
it is recommended that all people that have been in contact with dead bodies do wash themselves thoroughly
with water and (preferably antiseptic) soap.
Whereas the traditional funeral rites and practices are important for the relatives (e.g. mourning process), they
should be adapted for victims of highly infectious diseases as they could lead to the further spreading of an
epidemic. Supervised funerals together with other safety procedures to avoid further spreading of the specific
disease should also be addressed in the obligatory health promotion campaign.
Besides cloths, coffins are often used as well to bury the dead bodies. In case of acute emergencies, those items
are often not available in sufficient numbers, thus blankets or mats or preferably appropriate body bags can be
used as an alternative. In epidemics of highly infectious diseases, it is strongly recommended to use leak proof
body bags (in addition to a coffin).
In most cases, the body is carried by the relatives in procession to its final resting place. However, in epidemic
situations, it might be necessary for the aid-agency to do the transport of the deceased person. It is very important
to disinfect properly the vehicles used for transporting the infectious corpses, according to the existing standards
per specific disease (section 8.5 Further reading).
In general, the preferred final step is burial in a cemetery as it is simple and cheap. However it does require a lot
of space (foresee about 1500 m² for a population of 10.000 persons; T.B. 8.03). If possible, individual burial
should be chosen over mass graves, to allow the relatives to visit the actual tomb of the deceased person. In
certain cultures, the corpses are embalmed before they are transported to their final resting place.
If not specifically demanded by the relatives, it is strongly advised not to cremate the dead bodies, and certainly
to avoid mass cremation (T.B. 8.04), not even the corpses of highly infectious diseases. Cremation will require
enormous amounts of fuel. Often, the cremation will succeed only partially, especially if experienced and skilled
personnel is lacking to perform this task. The smoke generated during the cremation can be hazardous to health
as it contains dioxins and possibly thermo-resistant pathogens.
8.5 Further reading

Cholera guidelines
PAHO/WHO/IFRC/ICRC, Geneva
Management of dead bodies after disasters: a field manual for first responders
ICRC Publication, 2006
Water, Engineering & Development Centre (WEDC), 2002
Filovirus Haemorrhagic Fever
8 4
T.B. 8.01 Special precautions when disposing of dead bodies
In most cases, no special precautions beyond normal hygiene practices are required when disposing of dead bodies. However, specific precautions are
required if people died from highly infectious diseases. These precautions may include amongst others the wearing of protective equipment, the
TECH-SAN-160_CH8
disinfection of the dead body and the restriction of traditional funeral practices. Nevertheless, in every circumstance all efforts must be made to ensure
that the body is treated with respect and in a dignified manner.
The following table shows precautions recommended for the highly infectious diseases likely to be encountered in the field.
Precaution Cholera Ebola SARS Typhus Tuberculosis HIV/AIDS
22/03/10
Marburg Plague
Wearing of specific protective equipment Yes Yes Yes Yes Yes Yes
• rubber gloves • respirator • respirator • rubber gloves • rubber gloves • rubber
• overall FFP2 FFP2 overall gloves
10:13
• • respirator
• apron • goggles • goggles • apron FFP2
• (rubber boots) • double rubber • rubber gloves • respirator
• goggles gloves • gown FFP2 (if
(protection • gown • head cover pneumonic
Page 5
against chlorine • head cover • rubber boots plague)

splashes) • rubber boots
• apron
Body disinfection (with chlorine solution) 2% 0.5% 0.5% No No No
Insecticide dusting of body and clothing No No No Yes No No
Blocking body orifices Yes No No No No No
Body bag (or similar) Yes Yes Yes Yes Yes Yes
Immediate burial (within 12 hours) Yes Yes No No No No
Limitation of funeral gatherings Yes Yes Yes No No No
Promotion of safe funeral practices Yes Yes Yes Yes No No
Supervised funerals Yes Yes No No No No

Disinfection of the living environment of the Yes Yes Yes No No No
deceased
Remarks
■ In the case of body disinfection, it can not be considered as a complete disinfection of the body because it still contains pathogens. Nevertheless, it
temporarily improves safety when transferring the body to the (leak proof) body bag or while wrapping it in plastic sheeting.
■ It is recommended that blocking the orifices in the case of cholera is performed by a (para-) medical person.
■ Use of (leak proof) body bags is recommended for all infectious diseases.
■ Supervised funerals have to be considered when traditional funeral practices are particularly risky for the health of the family, the neighbours and the
community.
8
■ When bodies that have started to decompose must be collected, spraying an insecticide and chlorine solution around the body and on surrounding
leachates (if present) might be useful. It can be done inside a house or a building, but also outside, in an open place.
5
■ To avoid the occurrence of rigor mortis in an undignified position, always dress the body properly as soon as it is noticed that the person passed away.
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T.B. 8.02 Morgue

All health structures who have patients staying overnight should possess a morgue. But it might also be
necessary to set up a morgue in case of an emergency like an epidemic, a natural or a man-made disaster
(e.g. war) where a lot of people have died or will die. When needed, a morgue has to be foreseen from
the beginning (e.g. onset of an emergency).
Construction
■ Inform yourself well with the local population and medical staff on the customs and cultural aspects related
to death. They will be able to give you information on how a morgue should look like, how long the deceased
will stay in a morgue, how the relatives will collect the dead body.
■ Look for a place within the “technical” zone of the health structure, close to the fence with a specific exit
for the morgue. This enables the relatives to view and collect discretely the deceased person, without
creating an uneasy feeling for other patients and visitors of the health structure.
■ Fence the area well to avoid unauthorised people to enter. Foresee also some additional space for potential
(temporary) extension of the morgue (e.g. during emergencies).
■ Include within the morgue facility:
➞ a space (quite and peaceful) where relatives can wait and mourn (this can be outside the morgue, but
preferably shaded in hot countries).
➞ some space where the register files and personal belongings of the deceased can be stored.
➞ a room where the deceased can be prepared and possibly be viewed by the relatives. For small health
structures (e.g. about 20 beds), a capacity for 1 or maximum 2 dead bodies is sufficient. For bigger health
structures, the capacity should be determined with the medical staff.
■ Avoid windows in the actual morgue building. Ventilation holes in the upper part of the walls protected by
grills to avoid rodents to enter are more appropriate.
■ Cover the floor with smooth concrete in such a way that it has a slope of 1% leading towards a drain. This
enables the evacuation of wastewater and body fluids via a grease trap towards an infiltration system (see
chapter 4). Make sure that small animals can’t enter the drain pipe that leads the wastewater outside.
■ Provide masonry tables in chronic emergencies and stabilised situations to avoid having to put corpses on
the ground. To keep these tables clean and hygienic, it’s recommended to cover them with ceramic tiles.
The tables should present a gentle slope towards their centre and a channel allowing to drain body fluids
and wastewater in a bucket.
■ Foresee a plastic curtain in between the tables to permit some privacy when relatives come to view the
deceased.
■ Install a light inside the morgue for safety / security reasons.
■ Provide a water point close to the morgue (< than 20 m) for body disinfection and washing, according to
local customs.
Remarks
■ In the very first phase of an emergency, a tent is often used as a morgue. It should be replaced as soon
as possible with a temporary semi-hard structure to better protect the dead bodies against the adverse
climatologic conditions, vectors such as rats, scavengers and looters. The lower part of the building should
be in bricks or reinforced with metal plates when the structure is completely in wood. The floor should be
in concrete.
■ The morgue should be part of the whole health care infrastructure, in order to be guarded as the rest of
the facilities.
■ Only authorised persons should have access to the morgue.
■ The morgue should be kept clean and be disinfected regularly with a chlorine solution (T.B. 2.20).
■ In case storage is essential, the dead bodies should ideally be kept at a temperature of 4°C, but this is
hardly possible in a lot of low-income countries as it creates a lot of logistical constraints.
■ In hot / low-income countries, dead bodies will often be buried / cremated within 24 hours, therefore special
rooms to store the deceased are mostly not needed.
■ In case there isn’t a cold storage place and the family or the caretaker has not collected the deceased after
more than a day, the body should preferably be buried / cremated promptly by trained staff, according to
the specific context (e.g. special precautions in case of an infectious disease, otherwise according to the
normal funeral rites). However, the identity of the deceased should be known, or at least a picture should
be taken before the funeral takes place, in order to provide information towards the relatives.
8 6
Disposing of Dead Bodies
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T.B. 8.03 Cemetery

Unless another solution / procedure is specifically requested by the relatives, burial is the preferred method
of final disposal of dead bodies. A cemetery has to be foreseen from the beginning (e.g. onset of an
emergency). However, burial requires sufficient land surface that has to respond to specific criteria.
Construction
■ Calculate the minimum cemetery surface needed based on the population data:
about 1500 m² for a population of 10.000 persons
■ Choose an area at least 500 m away from the dwellings. Take care about the distance from water points,
which should never be less than 50 m and which should be uphill from the burial site. The water table at
its highest level (at the end of the rainy season) should be at least 3 m deep. The selection of the site has
to be done in collaboration with the local authorities and preferably also with the host and the affected
population.
■ Fence the area well to avoid people to install their dwelling within.
■ Make a central alley and potentially pathways in between the rows of the (future) tombs.
■ Dig a drainage ditch around the whole area to avoid runoff water eroding the soil away from the graves.
This ditch should lead towards a drainage canal to evacuate runoff water that doesn’t infiltrate during heavy
rainfall.
■ Construct a ditch crossing at the entrance of the cemetery for easy access.
Operation
■ Dig preferably individual graves for the relatives to be able to visit the tomb of the deceased person. The
grave should be about 1.5 m deep, and the bottom should be at least 1.5 m above the highest water table
to avoid its biological contamination (at least if the soil is homogenous).
■ Leave the burial ceremony up to the relatives according to the local cultural and religious rituals as this helps
them in their mourning process, unless the deceased was victim of a highly infectious disease. In the latter
case, the burial has to be supervised by trained and experienced personnel, complying as much as safely
possible with the local cultural and religious rituals.
■ Make sure that the dead body is covered with at least 1 m of soil. This depth is important to avoid bad
odours and dogs or other carrion-feeders digging out the corpses.
■ Keep the cemetery tidy (no waste laying around, vegetation kept under control) and dignified.

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8 8
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Key Input
A. Cemetery
B. Minimal safety distances
1. Fence Construction
2. Used graves - Land (1500 m²/population of 10.000 persons)
3. Reserve graves - Stakes and fencing material
4. Alley - Poles or tree trunks to build a bridge over the drainage ditch
5. Drainage ditch - Shovels, hoes and pick axes to construct the ditch
6. Ditch crossing
7. Lowest corner towards infiltration Operation
facility with overflow - Mechanical shovel or numerous workers
8. Runoff direction - Shovels, hoes and pick axes
9. Dwellings - Trained personnel, permanently at the cemetery
10.Well - Protective clothing for the personnel
Remarks
■ Burial needs a lot of land but is otherwise rather simple and cheap.
■ It might be necessary to foresee several cemeteries, or at least split up the graveyard in different zones when
different religions and/or ethnic groups are living together.
■ The bottom of the graves must be more than 1.5 m from the aquifer to avoid microbiological pollution of the
groundwater by the corpses. The depth of the water table can be estimated by verifying its level in nearby
wells. Another option is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe
into the ground, as deep as 1.5 m beneath the required depth of the grave. When pulled out, the rod or (the
earth inside) the pipe should be dry. Soil saturated with water after heavy rainfall might give a false impression
of the actual water table level.
■ Normally, it isn’t necessary to line the graves. However in unstable undergrounds, it is recommended to install
a removable (wooden) rectangular support until the body is lowered in the pit. This support which should avoid
collapse of the upper soil layer should have the size of the hole and a height of at least 0.5 m within the edge
of the grave.
■ It’s recommended to always have some graves dug in reserve but not too many at once because they will
collapse over time. The Crude Mortality Rate indicates how many graves per day should be available.
■ In acute emergencies when the Crude Mortality Rate is high, it might take too long to dig individual graves. Long
trenches (possibly made with a mechanical shovel) where the dead bodies are put head to toe can be a
solution, as it still permits to put an identification on each grave and thus the relatives visiting their deceased
family member. However, try to avoid as much as possible mass graves with different bodies being pilled up
on top of each other, because visiting a deceased person is part of the mourning process for the relatives.
■ Be assured that the coffin is well closed (and the lid well fixed) so that an accidental event during transportation
or burial doesn’t result in the body dropping out.
■ Provide the possibility for the relatives to collect a piece of (white) cloth to cover the deceased person.
■ Be aware that in some cultures the dead bodies are buried in a standing up or sitting position. Get information
on the practices prior to the ceremony.
■ In big catastrophes, with lots of dead people, it might be up to the aid-agency to do the burial of the dead
bodies. Also in epidemics such as cholera, Ebola or Marburg, it is recommended to have a trained team who
can do the (supervision of the) burial after the disinfection of the corpse and laying it in a leak proof / sealed
body bag, in order to contain the disease.
■ A fence and preferably guards are strongly recommended to guarantee the correct use of the cemetery. During
emergencies, the guards should also act as graveyard watchers who count and report every day the new
tombs.
■ A maintenance team will be needed to dig new tombs and to keep the cemetery tidy. Depending on the size of
the graveyard, this task can also be done by the guards.
■ Make sure that the potential gate of the cemetery is open when a corpse arrives.
■ Protective clothing should be available for the staff working at the burial site.
■ Washing (at least water and soap) and related wastewater facilities should always be available onsite.

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T.B. 8.04. Cremation

Cremation should only be considered if it is specifically requested by the relatives, because it’s their
tradition or preferred option. This technique is difficult and expensive and may cause health hazards. If
this is a common option, a cremation site has to be foreseen from the beginning (e.g. onset of an
emergency).
Construction
■ Inform yourself well with local people experienced in cremation. They will be able to give you detailed
information on cremation, the site, the facilities and the equipment that are needed.
■ Choose an area at least 800 m away and downwind from the dwellings. Take care about the distances from
water points, which should never be less than 50 m away. The selection of the site has to be done with the
local authorities, the people experienced in cremation and preferably with the host and the affected
population as well.
■ Fence the area well to avoid unauthorised people to enter or to install their dwelling. A guard is
recommended who can also register the number of people that are cremated.
■ Dig a drainage ditch around the whole area to evacuate runoff water towards a drainage canal.
■ Construct a ditch crossing at the entrance of the cremation site for easy access.
■ Foresee a potential disposal area for the ashes, according the local customs (e.g. spreading the ashes on
a well identified area). In case (unburned) residues need to be buried, the bottom of the residues pits or
trenches must be more than 1.5 m above the water table to avoid microbiological pollution of the
groundwater. The depth of the water table can be estimated by verifying its level in nearby wells. Another
option is to drive a metal bar such as a reinforcing rod or (several pieces of) ½” galvanized pipe into the
ground, as deep as 1.5 m beneath the required depth of the grave. When pulled out, the rod or (the earth
inside) the pipe should be dry. Soil saturated with water after heavy rainfall might give a false impression
of the actual water table level.
Operation
■ Leave the cremation process, according to the local cultural rituals, completely over to experienced local
people.
■ Make sure that when potential unburned residues are buried, they are covered with at least 1 m of soil and
respect the recommendations as described in the T.B. 8.03.
■ Keep the cremation site tidy and dignified.
Remarks
■ Cremation is NOT required to dispose of deceased victims of highly infectious diseases. When cremation
is not specifically requested by the relatives, burial is still preferred.
■ This technique needs a lot of fuel and is thus expensive. To cremate one body, at least 300 kilogram of
firewood is required, which leaves a big strain on the local environment. If cremation is the chosen option
when a lot of bodies need to be cremated (e.g. after natural catastrophe), it is recommended to bring in
the wood from another place where industrial “wood chopping” is done, or to choose another combustible
if possible. This will allow to decrease the strain on the environment.
■ As traditional cremation is done with limited means, potential thermo-resistant pathogens and hazardous
gases containing toxic components such as dioxins will escape as well. The more bodies are cremated at
the same time, the higher the concentration of hazardous gases. So mass cremation should always be
avoided.
■ It might be necessary to foresee several cremation sites, or at least split up the site in different zones when
different religions and/or ethnic groups are living together.
■ A fence and preferably guards are strongly recommended to guarantee the correct use of the cremation
site.
■ Washing (at least water and soap) and related wastewater facilities should be available onsite.
■ Burial sites for the unburned residues might be needed.
■ Only specialised staff should perform this task.
■ A maintenance team is essential to keep the cremation side tidy.
8 10
TECH-SAN-160_CH8 22/03/10 10:13 Page 11

CONVERSION TABLES 29/03/10 16:09 Page 1
Conversion tables
Distances Surface
1 km = 0.6214 miles 1 km² = .386 miles = 100 ha
1m = 1.0936 yards 1 ha = 2.471 acres = 10000 m²
1 cm = 0.394 inches 1 m² = 1.196 yd² = 10000
cm²
1 mile = 1.609 km = 10.76 in²
1 yard = 0.914 m 1 mile² = 2.59 km² = 240 acres
1 foot = 0.305 m 259 ha
= 30.48 cm 1 acre = 0.405 ha = 4.840 yd²
1 inch = 2.54 cm 1 yd² = 0.836 m² = 9 ft²
1 ft² = 0.09 m² = 144 inch²
= 930 cm²
1 inch² = 6.54 cm²
Volume Capacity
1 m³ = 1.307 yd³ = 1000 1 litre = 0.22 UK Gal
litres = 1.76 UK Pints
= 35.32 ft³ = 0.26 US Gal
1 cm³ = 0.061 in³ = 2.11 US Pints
1 yd³ = 0.765 m³ = 27 ft³ 1 ml = 0.0675 fluid ounces (fl.oz)
1 ft³ = 28.32 litres = 1728 1 UK Gal = 4.55 litres = 8 UK Pints
in³ = 1.20 US Gal
1 in³ = 16.39 ml 1 US Gal = 3.791 litres = 8 UK Pints
= 0.83 UK Gal
Weight Temperatures
1 tonne = 0.984 long (UK) tons From Centigrade to Fahrenheit:

= 1.102 short(US) tons multiply by (9/5) and subtract 32
= 2204 pounds (lb)
1 kg = 2.205 lb From Fahrenheit to Centigrade:
= 35.27 oz add 32 and multiply by (5/9)
1g = 0.03 oz
1 UK ton = 1016 kg = 2240 lb
1 US ton = 907.01 kg
1UK ton = 1.1 US ton
1 lb = 0.4 kg = 16 oz
= 453.6 g
1 oz = 28.35 g
1
Conversion tables - draft
Material and work estimated

(adapted from: A Handbook of Gravity-Flow Water Systems)
EXCAVATIONS Per m³ BRICK MASSONRY (1:4 mortar) Per m³

Ordinary soil 0.55 man-day (m-d) Bricks 75 %
Gravely soil 0.77 m-d Cement 0.063 m³
Boulder mix 1.10 m-d Sand 0.25 m³
Medium rock cutting 1.60 m-d Mason labour 1.4 m-d
Hard rock cutting 2.50 m-d Unskilled labour 2.8 m-d
WOOD WORKING Per m³ RUBBLE-STONE MASONRY

of finished wood (1:4 mortar) Per m³
Skilled labour 18 m-d Cement 0.089 m³
Unskilled labour 18 m-d Sand 0.35 m³
Mason labour 1.4 m-d
Unskilled labour 3.2 m-d
STONE AGGREGATE
PRODUCTION Per m³ of crushed rock
DRESSED-STONE MASSONRY
Unskilled labour 14 men-day (1:4 mortar) Per m³
Cement 0.075 m³
CONCRETE Per m³: Sand 0.30 m³
1:2:4 mix 1:1:3 mix Mason labour 2.8 m-d
Unskilled labour 5.0 m-d
Cement 0.25 m³ 0.33 m³
Sand 0.50 m³ 0.50 m³
Aggregate 1.00 m³ 1.00 m³
Mason labour 1.1 m-d 1.1 m-d
Unskilled labour 4.0 m-d 4.0 m-d
PLASTER* Per m³:1:4mix 1:3 mix

1:2mix
Cement 0.0025 m³ 0.0030 m³ 0.0050 m³
Sand 0.01 m³ 0.01 m³ 0.01 m³
Mason labour0.14 m-d 0.14 m-d 0.14 m-d
Unskilled labour 0.22 m-d 0.22 m-d 0.22 m-d
* Each coat of plaster 1 cm thick
SPECIFIC WEIGHTS kg / m³
Portland cement: 1.440
Brick masonry : 2.120
Stone masonry : 2.450
Concrete : 2.409
Seasoned wood : 650
Water : 1.000
Dry-stone masonry : 2.000
2
Material and work estimated - draft
Perimeter
Square: Circle
Perimeter = 4a Perimeter = 2 pi r
Rectangle: Parallelogram:
Perimeter = 2a + 2b Perimeter = 2a + 2b
Triangle: Trapezoid:
Perimeter = a + b + c Perimeter = a + b + c + d = 2m + c + d
Rhombus: Regular N-gon:
Perimeter = 4a Perimeter = ns, n = # of sides

Ellipse:
3
Perimeter - draft
Area
Square: Circle:
Area = s2 Area = pi r2
Rectangle: Ellipse:
Area = a b Area = pi r1 r2
Parallelogram: Equilateral Triangle:
Area = b h Area =
Triangle: Triangle given SAS (two sides and the opposite angle):
Area = 1/2(b h) Area = 1/2 a b sin C

Trapezoid: Rhombus:
Area = 1/2h(b1 + b2) Area = 1/2 d1 d2

Regular Polygon:
4
Area - draft
Volume
Cube: Sphere:
Volume = a3 Volume = (4/3) pi r3

Rectangular Prism: Pyramid:
Volume = a b c Volume = (1/3) b h

Cone: Cylinder:
Volume = (1/3) pi r2 h Volume = pi r2 h
5
Volume - draft
Trigonometric Formula
Given Triangle abc, with angles A,B,C; a is opposite to A, b opposite B, c opposite C:
a/sin(A) = b/sin(B) = c/sin(C) (Law of Sines)
c^2 = a^2 + b^2 - 2ab cos(C)
b^2 = a^2 + c^2 - 2ac cos(B) (Law of Cosines)

^2 ^2 ^2
a = b + c - 2bc cos(A)
(a - b)/(a + b) = tan [(A-B)/2] / tan [(A+B)/2] (Law of Tangents)
6
Trigonometric Formula - draft
DICTIONNARY 17/05/10 11:28 Page 1
Dictionary
Absorption Incorporation of one substance by another (e.g.:of gas by a liquid, of

a liquid by the soil)
Accumulation rate Rate at which decomposed faecal matter builds up in a pit of a
latrine, expressed in m3 per person per year, and used for the
calculation of effective pit volume.
Activated carbon Specially prepared powdered or granulated carbon, used in final
treatment of drinking water by absorption, particularly for the
removal of dissolved organic polluntants which impart taste and
odours to water.
Adsorbent Solid particle (e.g:activated carbon) of very large surface compered
to polutens with the property of collecting dissolved solids and
colloids in water. See activated carbon.
Aerobic Micro-organism living or taking place in the presence of oxygen.
A IDS Aquired Immunodeficiency Syndrom. Terminal phase of the disease
caused by the Human Immunodeficiency Virus (HIV).
Ampoule Glass container containing medicinal solution.
Amputed limbs Accidentally or surgically removed human body parts.
Anaerobic Micro-organism living or taking place without oxygen.
Antiseptic Chemical substance that kills or inhibit germs development and is
harmless when applied to living tissues (skin, mucous membranes).
Aquatic Living in water, or related to water
Aquifer Porous, water-saturated layers of sand, gravel or rock that can store
water and are permeable enough to allow water to flow through
them in useable quantites.
Arbovirose Arbovirus caused disease. The most importants arboviroses are:
yellow fever, dengue, Rift-Valley fever and certain encephalitis.
Arboviru s Any group of pathogenic viruses borne transmitted to vertebrates
by arthropods blood suckers ( mosquitoes, ticks, etc...),
responsible of producing arboviroses.
Arthropod A jointed-limbed, with a segmented body and external skeleton
invertebrate animal belonging to the phylum Arthropoda, wich
includes the insects, crustaceans and spiders.
Autoblock s yringe (= A specially modified disposable syringe with a fixed needle which is
auto-disable s yringe) automatically disabled by plunger bloking after a single use. Used in
mass vaccination campaign.
Autoclave Hermetically sealed apparatus for sterilisation by steam under
pressure, allowing the sterilisation of all kind of material. The
autoclave is the most reliable sterilisation method, when done at 121
ºC for 20 min (1bar).
A vailable chlorine Pure chlorine content of a chlorine-generating product, expressed as
a percentage, or in chlorometric degrees(e.g.:70% for calcium
hypochlorite, 1º =15 %).
Bacteria Unicellular prokaryotic microorganism that usually multiplies by cell
division and that can aid in pollution control by metabolizing
organic matter in sewage, oil spills or other pollutants. However,
bacteria in soil, water or air can also cause human, an
1
Dictionary - draft
Biodegration see Biological decomposition

Biological cycle Developement stages or phases through which an organism passes
in one generation
Biological Breakdown of active organic matter into more stable forms by the
decomposition action of aerobic or anaerobic micro-organisms
(degradation)
Bleach Chlorine-generating product (NaOCI) in a liquid form containing 5
to 15% of available chlorine. Less stable than the solid formulations.
Breeding site or The place where insects proliferate, where they lay the eggs and
grounds where the eggs hatch
Burial Action of covering with earth (e.g:refuse). See controlled tipping,
dead body.
Calcium hypochlorite Chlorine-generating product in powder form containing 65 to 70%
(Ca(ClO)2 ) available chlorine, made by reacting chlorine with calcium hydroxide.
Candle filter Candle shapped ceramic filter element (pore size: 0,45 um), works by
osmosis principle.
Carbon monoxid (CO ) A colorless, practically odorless and poisonous gas formed by the
incomplete combustion, its toxic action is due to its strong affinity
for hemoglobin, myoglobin, and cytochromes, reducing oxygen
transport and blocking oxygen utilization.
Catchment 1.Part of the well below the static level of the water table which
allows water to flow into the well, or 2. the emergence zone of a
spring where safe water may be collected.
Cavitation The formation and collapse of gas pockets or bubbles on the blade
of an impeller or the gate of a valve; collapse of these pockets or
bubbles drives water with such force that it can cause pitting of the
gate or valve surface.
Chemical analy si s Tests for the identification of undesirable or toxic chemical
substances whose maximum permissible concentrations determine
the potability of water, according to scientifically pre determined
levels.
Chemical wa s te Residuals or remains that contains substances that can react, affect
or interfere, chemically, with the environment (eg.: laboratory
reagents, film developer, expired disinfectants, solvents, etc...)
Chloramine See Combined residual chlorine.
Chlorine Reactive element (Cl) with strong oxidizing power, used for water
disinfection ( destruction of organic matter and biocidal action).
Chlorine compound Reactive element (Cl2) with strong oxidising power, used for the
desinfection of water, destruction of organic material and biocidal
action.
Chlorine demand Difference between the amount of chlorine added to water and total
residual chlorine level after 30 mins (=chlorine consumed during the
disinfection process)
Cholera Intestinal toxi-infection, strictly human, due to Vibrio cholerae.
Extremely contagious. Contamination is produced through contact
with affected people (hands, beddings, dead corps) and by ingestion
of contaminated water or food.
Cement Cohesive substance used in mortars due to its strong adhesive
properties.
2
Dictionary - draft
Combined residual The fraction of chlorine added to water which is not consumed, but
chlorine combined with certain substances (with lesser disinfectant power,
than free residual chlorine).
Compost Humus-like product produced by the controlled decomposition of
organic matter; either nightsoil or sludge mixed with organic
material rich in carbon (such as refuse or sawdust); and valued as
fertilizer or soil conditioner.
Concrete ring/rin Short concrete cylinder shell for supporting and lining the sides of a
well to make them impermeable and stable.
Contact time Period necessary for the reaction of a substance (eg:chlorine) with
organic matter contained in water (at least 30 minutes for chlorine).
Contamination Entrance of potentially pathogenic micro-organisms or chemical
substances presenting health risks into any environmental medium.
See pollution.
Controlled tipping Method of disposal of solid wastes by burial in successive layers in
ground exclusively reserved for this purpose. See Sanitary landfill.
Cytotoxic wa st e Possessing a specific destructive action on certain cells.

Dead body / corps The remains of an expired living being (human), characterised by the
signs of death.
Decontamination Action to reduce contamination, mainly radioactive, risks to
harmless levels to people or the environment. See radioactive
waste.
Defecation Passage of waste matter from the bowels.
Density Concentraton of matter within a certain volume.
Detergence Physic-chemical action of product combined with a mechanical
brushing and rinsing action.
Detergent Compound used in cleaning (e.g.: washing soap), often found grey or
wastewater.
Dioxin Any of a family of compounds known chemically as dibenzo-p-
dioxins. Concern about them arises from their potential toxicity as
contaminants in commercial products. Tests on laboratory animals
indicate that it is one of the more toxic anthropogenic (man-ma
Disinfectant Chemical agent that is able to reduce the viability of
microorganisms, on surfaces or objects. See antiseptic.
Disinfection Treatment aimed at reducing the number of vegetative
microorganisms to safe or relatively safe levels on surfaces or
objects.
Disposable s yringe An all-plastic syringe designed for a single and used with a separate,
steel needle.
Disposal Intentional burial, deposit, discharge, dumping, placing or release of
any waste material into or on any land sites, air medium, or water
bodies as final destination.
Distribution box Construction for collecting effluent from a septic tank and
distributing it equally among drains in a multiple trench infiltration
system. In a water drainage system it is represented as a man-hole
juncture where effluents are dispersed to a predetermined
3
Dictionary - draft
Domestic wa ste Putrescible (organic) or non-putrescible solid waste material from

household activities. See solid waste.
DPD1 Diethyl-p-phenyline diamine. Used in tablet form with a colorimetric
comparator to measure free residual chlorine.
Drainage Removal of liquid (wastewater) by ditches "open" system or pipes
"closed"system.
Drum Any large (eg: 200 liters) cilindrical shaped container.
Dumping site A site used to dispose of solid waste without environmental
controls. See disposal.
Dwelling Utilised living space, within or nearby a settlement.
E f fective grain size Range and average dimensions of sand or other material used as a
filtration medium material.
E f fluent Partially or totally treated wastewater coming from a treatment unit
and going to secondary treatment or disposal in the environment.
Emergence e ye Place where spring water appears at the surface. See spring and
catchment.
E n capsulation Waste treatment method used to isolate expired drugs or unwanted
pharmaceuticals by containment with an immobilizing material
(cemente 50 %, lime 50 %, water 5% by weight) in a sealed drum.
E n vironmental impact The positive and negative effects on the surrounding mediums
(climate, air, water) and population of a certain action.
E v apotranspiration The loss of water from the soil both by evaporation and by
transpiration due to plants growing in the soil.
E x creta Human wastes, particularly faeces and urine. See defecation.

Faecal oral Transmission of pathogens from faecal matter to the digestive
transmission system via the mouth (faecal contamination of water, food, hands,
etc...). See cholera.
Ferrocement Technique of constructing walls by applying layers of cement mortar
to a framework of wire/mesh. Construction of iron and cement.
Fertilizer Substance (chemical or organic) used in agriculture to improve soil
fertility. See compost.
Filtration A treatment process, under the control of qualified operators, for
removing solid (particulate) matter from water by means of porous
media such as sand or a man-made filter; often used to remove
particles that contain pathogens. See candle filter and effe
Final disposal Disposal that is undertaken without the intention of retrieval. See
disposal.
Floc A clump of solids formed in water by biological or chemical action.
See floculation and sedimentation.
Floculation Process by which clumps of solids in water are aggregated through
biological or chemical action so they can be separated from water
by sedimentation or filtration.
Flowrate The rate at which a fluid escapes from a hole or fissure in a fluid
container. Expressed as volume per unit time (eg: gallons or liters
per hour).
4
Dictionary - draft
Free residual chlorine The amount of chlorine remaining in a treated (chlorinated) water
that is allowed to combat expected future contaminations. Usually
0,3-0,5 mg/l.
Furan Substance, contaminant, found in engine exhausts, wood smoke and
tobacco smoke. Furan is carcinogenic to humans and its primary
exposure route is inhalation.
Germ General term that refers to microorganisms such as bacteria,
protozoa, virus, funghi.
Gra vel Some small river stones found naturally or mechanically produced
by crushing larger stones, used in construction.
Grea se trap Special construction for separating fatty material from wastewater
before disposal in a septic tank, soakaway pit or infiltration field.
Gre y water/sullage Domestic dirty water not containing excreta, also called sullage.
Groundwater Infiltrated water contained in underground porous layers, forming a
body of water.The supply of fresh water found beneath the Earth's
surface, usually in aquifers, which supply wells and springs. Because
ground water is a major source of drinking water, t
Hazardiou s Intrinsic potential property or ability to cause harm.
Health care wa ste Waste generated by all kind of medical activity.
( se e medical wa ste )
Heavy metal Metallic elements with high atomic weights; (e.g., mercury,
chromium, cadmium, arsenic, and lead); can damage living things at
low concentrations and tend to accumulate in the food chain. See
pollution.
Helmints Scientific name of worms, there are different types: 1. Plathelmints,
or flat worms ( trematodes and cestodes, 2. Neáthelmints or round
worms (filarias, ascaris, oxyures). 3.Leeches
Hepatitis B Inflammation of the liver , caused by hepatitis virus type B (HBV).
Transmitted by exposure to contaminated blood or sharps and
sexual intercourse with an infected partner. See sharp and
Nosocomial infection.
Hepatitis C Hepatitis caused by hepatitis virus type C and transmitted by
exposure to contaminated blood or during sexual intercourse with
infected person. Hepatitis C is usually chronic and can cause
cirrhosis and primary liver cancer.
HI V Abbreviation for human immunodeficiency virus. AIDS virus. See
sharps and Nosocomial infection.
Host A living organism that mantains or harbours an infectious agent
(virus, bacteria or parasite). Considered a potential initial point for
diseas transmission.
Hygiene Practises that improve life conditions ( cleanliness) and prevent the
dispersion of diseases. See sanitation.
In cineration A waste treatment process involving destruction of waste by
controlled burning at high temperatures (>850 ºC), resulting in
significant reduction of volumenous waste into ashes. See
incinerator, health care waste, solid waste.
In cinerator A furnace for burning medical waste under controlled conditions,
utilised in health facilities as a waste treatment tool. See incinerator,
health care waste.
5
Dictionary - draft
In ertization Waste treatment process that involves inactivation, in order to

minimize the risk, of toxic substances contained in the waste to
migrate into the environment, used for disposal of pharmaceutical
waste, reduced (by crushing) and encapsulated. See encapsula
In filtration (rate) The quantity of water that can enter the soil in a specified time
interval, normally measured as m3/h/m2.
In filtration trench Structure for disposing of wastewater by underground drainage,
unsing trenches and drains. See drainage.
In sect An arthropod belonging to the class Insecta. Insects have three
distinct body regions (head, thorax and abdomen), three pairs of
legs, one pair of antennae, and usually one or two pairs of wings in
the adult.
Larva The intermediary stage between the egg and the pupa, in the
development of an arthropod. See arthropod
Larvicide A chemical or biological compound which specifically kills insect
larva.
Latrine An external defecation area for deposition, retention and sometimes
decomposition of excreta. See biological decomposition.
Leachate Water that collects contaminants as it trickles through wastes,
pesticides or fertilizers. Leaching may occur in farming areas,
feedlots, and landfills, and may result in hazardous substances
entering surface water, ground water, or soil.
Lime Ca(OH)2. Yellowish white stone or powder. Can be found freely in

the environment and has various industrial uses, contruction, water
treatment, etc...
Line / lining The process strenghtening, sleeving, supporting an underground
structure.
L y s ol Solution of cresol and soap (powerful disinfectant used for floors
and other surfaces). See disinfection.
M a nure Animal excreta, normally faecal matter from livestock.
M edical wa st e See Health Care waste.
Micro-organism Any microbiological entity, cellular or non-cellular, capable of
replication or of transferring genetic material under certain
environmental variables. It includes bacteria, virus, protozoa and
micoscopic funghi.
M otorpump Pump powered by an electric motor or combustion engine.
NaDcc Chlorine-generating product found in tablets form, usually
containing 1,5 g available chlorine per tablet.
Needle Hollowed and pointed steel stem used for puncturing or injecting.
See sharp
Needle stick injury Harm caused by unintentional needle puncture. See for nosocomial
infection, hepatitis B, hepatitis C, AIDS.
Nitrate s (NO3 ) A plant nutrient and inorganic fertilizer, nitrate is found in septic
systems, animal feed lots, agricultural fertilizers, manure, industrial
waste waters, sanitary landfills, and garbage dumps.Nitrates in
water can cause severe illness in infants and dom
6
Dictionary - draft
Non return valve Valve allowing water to flow in one direction only, installed at the
start of a delivery pipe from a motorpump to stop backflow when
pumping stops, usually an arrow indicates direction of flow.
Nosocomial infection Infection contracted by the patients or the medical staff while
(= hospital infection) medical care is being given.
Organic matter Carbon based substances.
Organic wa st e Residuals of carbon containing materials, biodegradable waste.
Organic waste generated in health care facilities such as amputed
limbs, placenta, fetus and food residuals.
O xidize To transform by combination with oxygen.Normally signifies the
chemical addition of oxygen to break down pollutants or organic
wastes. See Biological decomposition or degradation, also chlorine
Parasite An organism which, for all or part of its life, lives in or on the body of
another organism (the host), and obtains nourishment from it,
without causing the death of the host. Parasites can be funghi,
arthropods, protozoa, helminths, etc...
Pathogen Any disease causing organism or substance.
Percolation The movement of water downward and radially through subsurface
soil layers, usually continuing downward to ground water. Slow
seepage of water through a filter
Permeability The characteristic or the measure of the ease with which water can
flow through a solid media, soil. See infiltration rate.
Pe st An inconvenient insect, rodent, nematode, fungus, weed or other
form of terrestrial or aquatic plant or animal life that is injurious to
health or the environment
Pe sticide Substances or mixture that of intended for preventing, destroying,
repelling, or mitigating any pest.
pH An expression of the intensity of the basic or acid condition of a

liquid; may range from 0 to 14, where 0 is the most acid and 7 is
neutral. Natural waters usually have a pH between 6.5 and 8.5.
Pharmaceutical wa s te Residuals or remains of any subtance or product used in a medical

care or prevention activity. (e.g: expired and unwanted drugs or
vaccines). See encapsulation and inertization
Phenol Red Chemical compound used to measure pH by colorimetric
comparison, normally in tablet form.
Pie zometric line Confined groundwater is usually under pressure because of the
weight of the overburden and the hydrostatic head. If a well
penetrates the confining layer, water will rise to this level, the
piezometric level, the artesian equivalent of the water table. If
Pit latrine Confined defecation with a single pit dug in the ground. See latrine.
7
Dictionary - draft
Pollution Generally, the presence of a substance in the environment that

because of its chemical composition or quantity prevents the
functioning of natural processes and produces undesirable
environmental and health effects. Under the Clean Water Act, for
example
Pond Small water body.
Porosity The ratio of volume of open space of the total volume. Ability of a
medium to transpass fluids through it.
Poupinel (Hot air Equipment for sterilisation by hot air (dry heat). MSF does not
st erilizer) recomend this method of sterilisatin due to its need for powerful
and uniterruptible power source, high level of user knowledge and
care. It doen'st allow to sterilise all kind of material (
Pour flush latrine Latrine in which the slab has a pan and water trap which is flushed
manually.
Precipitation Water in form of rain, sleet, hail and snow that falls from the
atmosphere onto the land and bodies of water.
Prion Non conventional transmissible agent poorly characterized. Prions
are believed to be the cause of a number of neurodegenerative
diseases in humans and animals. Very resistant to conventional
sterilisation methods. See nosocomial infection.
Proto zoa One-celled organisms that are larger and more complex than
bacteria. May cause disease in humans. amoeba)
Pupa The intermediate stage between the larva and the adult , in the
development of an insect.
Radioactive wa ste Material that contains, or is contaminated with, radionuclides at
concentrations or activities greater than clearance levels. See
radionucleid.
Radionucleid An atom (nucleide) that exhibits properties of spontaneous
disintegration, liberating energy and accompanied by the emission
of different types of (very harmful) radiation.
Rain water Run-off originated by rainwater and collected separatly to formal
(h arve sting) water sources. See rain water
Rainfall pattern s Historical records of the distribution and quantity of rainfall for a
certain area.
Rainwater Water from atmospheric precipitation which may collect and form
or contribute to a water body.
Retention time Time during which wastewater is held in a tank to undergo treatment
(e.g:1 to 3 days in a septic tank).
Risk Probability that a hazard will cause harm, and the severity of that
harm.
Rodent A mammal belonging to the order Rodentia, which includes rats,
mice, squirrels, muskrats, beavers and others. Our concern is due to
their high infestation rate and potential to health risks. See pest.
Run-off ( water) That part of precipitation, snow melt, or irrigation water that flows
into streams or other surface-water bodies. It can carry pollutants
from the air and land into receiving waters. See rain water.
8
Dictionary - draft
Safe injection An injection that does not harm to the recipient, does not expose
the health worker to any risk, and does not result in waste that puts
the community at risk. See sharps, sharp container.
Sand Granular silica compound which is found naturally and used as
building material and filtration medium in water treatment plants.
Sanitary landfill Sanitary landfills are disposal sites for non-hazardous solid wastes
spread in layers, compacted to the smallest practical volume, and
covered by soil applied at the end of each operating day. See
leachate, controlled tipping.
Sanitation Health related activities which are dealing with elimination or
reduction of harmful waste to the human inmediate environment. See
Hygiene, waste management.
Scalpel Medical instrument consists of a handle and a sharp disposable
blade used in surgical dissection.
Sca v engers Human or animal which depends on refuse from waste dumps for
survival.
Schmutzdecke Biological layer (biofilm) playing a purifying role, at the surface of a
slow sand filter. See slow sand filter.
Sedimentation The process of complete submergence of impurities to the bottom
( Settling) part of a liquid due to gravity. See floculation
Segregation Separation of waste materials (medical wastes) into different
categories such as sharps, solid, organic. It is desired to take place
at source. See sharp container.
Septic tank An intermediate installation in an evacution system which serves as
wastewater collection and treatment site, in which organic matter is
degraded to more stable forms, forming a sediment or slurry. See
Biological Degradation.
Se wage The waste and wastewater produced by residential and commercial
sources and discharged into a sewage system. A sewage system is
a design arrangement of channels or conduits that carries
wastewater and storm-water runoff from the source to a treatment
pla
Shallow trench Surface excavations used for defecation during early stages of
latrines certain emergency settlements ( camps, etc...)
Sharp container Segregation tool used in health facilities for handling,
transportation, storage, and/or eventual disposal of sharp wastes.
See Sharps and segregation.
Sharps Medical instruments and objects such as needles, scalpel blades,
ampoules and broken glass that can cause injuries, considered, after
used, as a separate category of medical waste. See needle stick
injury, sharp container and segregation.
Slow sand filter An installation in which raw water passes through a bed of sand at
low velocity, resulting in substantial removal of chemical and
biological contaminants, by combination of mechanical filtration
(sand) and biological purification. See Schmutzedcke.
Slurry A watery mixture of insoluble matter resulting from some pollution

control techniques and installations. See septic tank.
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Dictionary - draft
Soaka wa y pit The construction or a device used to dispers excess waters, it

constitutes of a sizeable hole filled with stones, to increase porosity
and facilitate water infiltration. See infiltration rate.
Sodium thiosulphate Crystalline chemical substance used for dechlorinating drinking
water.
Soil A complex mixture of inorganic materials (clay, silt, gravel and sand),
decaying organic matter, water, air and living organisms, which
covers the earth surface.
Solid wa ste Volumenous residuals representing the final non-useful or harmful
by-product, which require final treatment or processing, to further
reduce its volume before final disposal. Related to health care
medical waste it constitutes: syringes, gauze, cotton, pa
Spring Ground water seeping out of the earth where the water table
intersects the ground surface. Spring can be seasonal or permanent
water sources. See emergence eye.
Stakeholders Any organization, governmental entity, or individual that has a stake

in or may be impacted by a given approach to environmental
regulation, pollution prevention, energy conservation, etc.
Standing/stagnant Water from rain or human activities which remain static on the
water ground surface. Remaining run-off water. See run off
Sterile Any object or media that does not contain germs or any other form
of life.
Sterilisation Elimination of all microorganisms ( virus, bacteria and microscopic
funghi) from water or from a surface. See autoclave.
Stock solution Concentrated chlorine solution, 1% ( 10 g/l), used for chlorinating a
"mother solution" known volume of water.
Strainer Filter at the bottom of a motorpump suction pipe to keep back
large impurities. Often used with a non-return foot valve.
Submersible pump Pump with the pumping part under the water (delivery only).
Subsoil A complete mixture of inorganic minerals (clay, silt, gravel, sand)
under the ground level and above the bedrock. See soil.
Subsurface drainage Treatment and elimination of wastewater by infiltration into the
subsoil. See infiltration trench.
Sub- surface water All the water which is underground, wether in the saturated or
unsaturated zone.
Sulphur dioxide (S O2 ) A pungeont, colorless, gas formed primarily by the combustion of
fossil fuels; becomes a pollutant when present in large amounts.
Surface pump Handpump or motorpump with the pumping part above the water
level and a suction part under the water level (suction head limited to
7 m).
Surface water Water from precipitation, making streams, rivers, lakes, ponds.
Su spended solids Small particles of pollutants that float on the surface of or hanging
within a fluid (water). See turbid water.
Turbid water Water containing fine particles in suspension which give it a cloudy
appearence (turbidity is expressed in NTU units).
10
Dictionary - draft
V e ctor An organism, often an arthropod or rodent, that carries disease.

V e ctor control Mesures used to contain the population of pests below certain
levels by chemical, biological and environmental methods or
technics.
V e ctor-borne Disease which are transmitted by vectors. See vector.
(disea s e )
V e ntilated improved Pit latrine, where the pit is equipped with a ventilation pipe to
pit latrine( V I P ) reduce flies and odour, with a fly screen at the top.
Viral haemorrhagic Name given to different types of arboviruses that produce an
fe v ers hemorrhagic syndrom (Ebola, dengue, Rift-Valley fever). See
arboviruses.
Virus A sub-microscopic agent that can only multiply inside living cells.
Usually very harmful to health. See AIDS, hepatitis B and hepatitis C.
Wa s hing area Place or structure design for cleaning clothes and for personal
hygiene (washing slab, wash tub, etc...)
Wa ste Refuse from places of human or animal habitation.
Wa ste area Refuse collection place, where refuse is contained and either treated
or transfered to a treatment or disposal place.
Wa ste management All the activities, administrative and operational, involved in the
handling, treatment, conditioning, storage, and disposal of waste
(including transportation).
Wa ste s torage The placement of waste in a suitable location where isolation,
environmental and health protection and human control are
provided.
Wa ste water Sewage and sullage.The spent or used water from a home,
community, farm, or industry that contains dissolved or suspended
matter.
Water table Surface level or depth of ground water. See aquiffer.
Watercourse Bed of stream or river. With direction of flow from upstream to
downstream.
Weir 1. A wall or plate placed in an open channel to measure the flow of
water. 2. A wall or obstruction used to control flow from settling
tanks and clarifiers to ensure a uniform flow rate and avoid short-
circuiting.
Well Hole in the ground which enters an underground body of water (
water table) to allow its abstraction. A bored, drilled, or driven
shaft, or a dug hole whose depth is greater than the largest surface
dimension and whose purpose is to reach underground wate
11
Dictionary - draft
BACK COVER 22/03/10 10:25 Page 1
his is an invaluable reference manual for engineers, logisticians, medical officers and all those
T concerned with environmental health in humanitarian relief operations associated with natural
disasters or conflicts. A huge amount of literature and practical experience has been drawn upon and
digested to produce this handy textbook for use in the field.
The chapters on Water Supply and on Sanitation are followed by further ones on Drainage,
Management of Solid Wastes and of Medical Waste, Vector Control and even on the Disposal of Dead
Bodies. Each chapter begins with a succinct narrative addressing the questions why? what?
where/when? how? This is followed by a list of 3 to 4 books for further reading, and a series of technical
briefs on specific topics. The range of each chapter is quite wide; for example, the chapter on Drainage
includes guidance on the design and construction of shower blocks. The focus is on engineering and
hardware; this book does not cover hygiene promotion, but gives the details of other books which do.
MSF are to be congratulated on this excellent guide, which will be of help to many beyond their own
staff. More than 20 years ago, another international humanitarian relief agency had a similar manual,
but found to their dismay that only 3% of their staff had read it. The challenge now for MSF is to
encourage relief workers around the world to get their own copies of this book and use them. They will
have my full support in that endeavour.
Sandy Cairncross
Professor of Environmental Health
London School of Hygiene & Tropical Medicine

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COVER+FOREWORD 17/05/10 11:23 Page 2

© Médecins Sans Frontières - 2010

Public Health Engineering

Public Health Engineering

Additional authors (in alphabetical order):

Using this guide

Please send comments to:

Watsan unit/Médecins Sans Frontières

T.B. 1.01 Data collection methods

Management of Water, Hygiene and Sanitation activities - draft 1 1

1.1 Why are water, hygiene and sanitation activities important?

1.2 What are water, hygiene and sanitation activities?

1.3 Where/when should water, hygiene and sanitation activities

Management of Water, Hygiene and Sanitation activities - draft 1 3

1.4 How should water, hygiene and sanitation activities be managed?

1.4.1 Assessment and analysis

1.4.2 Strategy planning

Management of Water, Hygiene and Sanitation activities - draft 1 5

1.5 Further reading

A.S. Benenson (Editor)

S. Ferron, J. Morgan, M. O’Reilly

R. Sawyer, M. Simpson-Hébert, S. Wood

T.B. 1.01 Data collection methods

Management of Water, Hygiene and Sanitation activities - draft 1 7

Name Description Purpose Material / Tools

water, hygiene and sanitation matters.

Management of Water, Hygiene and Sanitation activities - draft

Name Description Purpose Material / Tools

-books -Books / guidelines

on the sheet) or in their working environment, in health structures. -Ticketing schedule

Management of Water, Hygiene and Sanitation activities - draft

Description Purpose Material / Tools

Management of Water, Hygiene and Sanitation activities - draft

T.B. 1.02 Mapping

Management of Water, Hygiene and Sanitation activities - draft 1 11

Management of Water, Hygiene and Sanitation activities - draft 1 13

T.B. 1.03 Area sampling

Management of Water, Hygiene and Sanitation activities - draft 1 15

Management of Water, Hygiene and Sanitation activities - draft 1 17

T.B. 1.04 Health structure checklist

Management of Water, Hygiene and Sanitation activities - draft 1 19

T.B. 1.05 Camp checklist

Management of Water, Hygiene and Sanitation activities - draft 1 21

T.B. 1.06 Water, Hygiene and Sanitation checklist

Management of Water, Hygiene and Sanitation activities - draft 1 23

Check if water treatment is being done:

Operation and maintenance:

Operation and maintenance:

Management of Water, Hygiene and Sanitation activities - draft 1 25

Runoff and wastewater

Operation and Maintenance:

Operation and maintenance:

Management of Water, Hygiene and Sanitation activities - draft 1 27

Operation and maintenance:

Operation and maintenance:

Management of Water, Hygiene and Sanitation activities - draft 1 29

T.B. 1.07 Basic Survey Form

Surveyor: ........................................................................Date: .............................................................

General impression (e.g. open defecation / presence of livestock):