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Extra-ordinary faecal sludge management in Cox’s Bazar, Bangladesh

12 February 2020 at 11:16
Making the Anaerobic Lagoon at Cox’s Bazar 2017 as the first step in the treatment process Photo: Andy Bastable/Oxfam GB

For the first time in the history of refugee camps there has been a concerted effort across multiple agencies to ensure proper treatment and disposal of faecal waste. Prior to 2017, there has been single unit, single technology attempts to deal with the human waste in refugee camps. This was seen in the Philippines during the cyclone Haiyan Response, and in Myanmar, Iraq and for the Syrian refugees in Jordan.  However, since the Rohingya crisis in 2017, where approximately 800,000 fled from Myanmar into camps around Cox’s Bazar in Bangladesh, there are now at least eight different types of faecal sludge treatment technologies being used in over twenty sites. These figures are unprecedented. 

 Which systems work best? 

Enlisting the support of ARUP, Oxfam saw this as an opportunity to compare the different types of faecal sludge technologies. The aim of the comparison study was to give agencies the tools to quickly decide the most appropriate technology in context and in relation to large scale emergencies. 

A range of criteria was used to compare FSM technologies such as start-up costs verses operation and maintenance costs; land requirement; technical requirements and resilience to disasters. The results show that the easiest option in terms of technical expertise, set up time and cost is Lime Treatment. However, for the long term it is not considered the best option due to the large amount of management involved. A long term, cheaper option where space is limited, is the Up-Flow filter. Where space is not an issue, anaerobic lagoons are a viable option. While there are clear indications about which technology is most suited to which environments, there is no one size fits all. Making the best decision would rely on those who understand the complexities of faecal sludge management to make the most appropriate decision based on the comparison study. Another relevant document when considering the most appropriate faecal sludge management system is The German toilet organisation’s Compendium of Sanitation Technologies in Emergencies

Going forward  

This comparison study is the first step along the way to having predictable faecal sludge treatment in every future emergency. It is only a snap shot of the technologies used at the time of the study, when many other technologies were only just beginning to be used. Therefore, we plan to conduct another faecal sludge comparison in 2020 when the technologies have been running for more than a year. This will more accurately determine the pros and cons of each unit. In addition, the Global WASH Cluster has set up a Technical Working group, led by Oxfam and Solidarite, with support from the Dutch Government and the Netherlands Red Cross. The group has identified gaps in knowledge and practice such as the lack of simple technical guidelines for the different technologies, a decision tree for technology selection and the need for a dedicated FSM Coordinator to go out to the next large emergency. 

We are clear that we do not want this Cox’s Bazar response to be a one off extra-ordinary response in faecal sludge treatment but the start of an approach that will be rolled out in all future emergencies. Thereby, ensuring the safety of people and the environment from disease and contamination.  

Read the full report: Faecal Sludge Management for Disaster Relief: Technology Comparison Study

Andy Bastable

Andy Bastable

Andy took over the leadership of Oxfam GB's Public Health Engineering team in 2002, which became part of the Oxfam Global Humanitarian Team in 2016.

12 tips to sustain hygiene practices now and post coronavirus in emergencies

28 May 2020 at 15:19
Oxfam installed Contactless Handwashing Devices which are activated with a foot peddle to avoid transmission of the virus from touching the soap. Rohingya refugee camp, Cox's Bazar, Bangladesh. Credit: Fabeha Monir/Oxfam
Oxfam installed Contactless Handwashing Devices which are activated with a foot peddle to avoid transmission of the virus from touching the soap. Rohingya refugee camp, Cox’s Bazar, Bangladesh. Credit: Fabeha Monir/Oxfam

Over 20 years ago when I stopped seeking medicinal remedies to prevent and treat diarrhoea and other infectious diseases and moved to population enabling solutions, I have not had cause to look back. Today the coronavirus is having a huge impact, so now more than ever we have better hygiene practices in emergency that not only tackle it now but put in place long term solutions.

Handwashing practice with soap and water is a significant solution for reduction of diarrhoea related diseases and respiratory infections. In recent years these solutions have received increased attention globally. Oxfam and partners have made substantial investments  in handwashing research to identify enhanced and innovative approaches which facilitate handwashing, especially among vulnerable population groups affected by crisis (women, girls, men, boys, elderly and persons with different mobilities).

Today, we have a collection of robust handwashing options and a novel low-cost station with over 20 features to increase handwashing practice. There is also a novel promotion approach – “Mums Magic Hands”, which was co-created with Unilever to help increase and reinforce handwashing practice, not just amongst carers, but also with their immediate family and entire community.

Working with different partners, we have harnessed Oxfam’s people centred, gender and vulnerability sensitive experiences with a strong emphasis in different emergencies to develop products which are now needed in one of the biggest disasters of the century.

Since the onset of the outbreak, Oxfam has been working to prepare for the pandemic. In February 2020, the organization formed a taskforce, who pulled together lessons learnt from previous outbreaks (e.g. Ebola, Cholera, Zika) and developed guidelines to help ensure staff safety and implementation of quality responses.

Many countries are now responding to the outbreak with a focus on preventing and reducing the infection risks related to coronavirus. This entails the promotion of handwashing practice with soap and water alongside the training of community-based volunteers to motivate and support their peers in adapting safe behaviours and practices.

So how do we ensure that handwashing and other related hygiene practices are maintained and sustained when the coronavirus may continue for many years? To address the most vulnerable, more efforts will be needed to tackle inequalities. In particular prioritization of programme and policy which look at erasing disparities.

For sustained behaviour change, the following intersectoral recommendations will be crucial:

  1. Ensure access to practical attractive low cost, durable handwashing stations at household and communal levels. For example, Oxfam’s new handwashing station for rapid deployments and other locally made standardised solutions. Latest estimates by WHO/UNICEF show 2 in 5 people globally lack functioning handwashing facilities with soap and water in their home.  
  2. Instilling a sense of ownership and maintenance of WASH facilities amongst the target population.
  3. Provision of continuous access to soap or soapy water (which is cheaper and equally effective option).
  4. Provision of continuous access to safe water for personal, domestic and hand hygiene.
  5. Facilitate continuous well-planned and executed promotion and monitoring of handwashing using interactive activities to remind and reinforce handwashing practices.
  6. Community engagement to help the target population understand better the coronavirus means of transmission and how to prevent the spread. As well as how they can collectively work together to end it through:
    • dialogue
    • joint identification of key risks and debunking rumours
    • interactive age, gender and culturally appropriate communication
    • shielding most vulnerable
    • engaging in other effective action plans including physical distancing.
  7. Supporting government/local administration efforts in referrals, advising on tracing, tracking and WASH provision in treatment and isolation centres.
  8. Different stakeholders working together to ensure joined up efforts to reduce the spread and impact of the different measures introduced since the outbreak impacts on different spheres of life and all groups of people although in different ways.
  9. Sustained financing over time and investments through appropriate resources, new innovations/technologies and their scale up.
  10. Capacity building of different actors and facilitators especially on improved handwashing and hygiene promotion approaches.
  11. Government, NGO communities and others supporting different communities should also endeavour to apply key community engagement principles. These include:
    • building trust
    • collaboration
    • inclusion
    • coordination
    • context analysis
    • use of interactive information, education, communication (IEC) materials
    • accountability (including for service delivery)
    • monitoring and periodic reviews.
  12. Governments should aim to adequately pre-empt, access and address the impact of different preventive measures e.g. impact of lockdowns on access to food, health services for other non-coronavirus ailments including vaccination, gender-based violence, unemployment etc.

The above is all encompassing, however, to make handwashing and hygiene a lifestyle, the right enabling environment and adequate resources to fund it will be needed. Globally, only 9% of counties with costed hygiene plans reported are having enough financial resources to achieve national hygiene targets. Ultimately if we are all able to make proper frequent handwashing and always practice good hygiene (including respiratory and surface hygiene) a way of life, some of the losses to coronavirus may turn to gains through significant reduction in some of the other infectious diseases.

Foyeke Tolani

Foyeke Tolani

Dr Foyeke Tolani has over 20 years of Public Health humanitarian and development experience, in more than 20 countries in the world. She is a Public Health Adviser and lead in handwashing research and innovation in Oxfam. She has been involved in six different multi-agency Water, Sanitation and Hygiene (WASH) projects, and is passionate about supporting women and different vulnerable groups in disaster-affected and vulnerable communities.

Top Resources for Global Handwashing Day

14 October 2020 at 14:04
Hafeza* is cleaning her hands by sitting at the doorstep of her tent during Covid19 outbreak in the camp. Rohingya Refugee Camp Cox’s Bazar, Bangladesh (name change to protect identity)
Credit: Fabeha Monir/Oxfam

Global Handwashing Day takes place on the 15th of October. This year it comes with added prominence in our calendar. Coronavirus has heightened the importance of handwashing across the world. In the humanitarian and development sector, handwashing has long been central to disease prevention and programme design.  

In this blog, we’ve compiled some of our most popular resources on everything handwashing. From tools and guidelines for practitioners, blogs for those who want a snapshot of learning and resources for those who want to find out more.


Lest we forget: Why investments in hygiene, sanitation and water are key to fighting COVID-19 is written by Muyatwa Sitali, Head of Country Engagement at Sanitation and Water For All. He shares why investing in public health is key in tackling coronavirus in the long term.

Two blogs by Dr Foyeke Tolani who has 20 years’ experience in public health, humanitarian and development work:
12 tips to sustain hygiene practices now and post coronavirus in emergencies
How to prevent coronavirus through handwashing and working with communities

Recently re-released considering the coronavirus context, Ruth Mayne and Thomas Dunmore Rodriguez share what really influences our behaviour when it comes to handwashing. Check out the beautiful illustration.

Vanita Suneja of WaterAid recently wrote a brief history of handwashing on From Poverty to Power’s blog space.

Tools, Guidelines & Resources

Why is handwashing important? This technical briefing note covers the basics on the relevance of handwashing in disease prevention as well as practicalities around handwashing promotion.

Oxfam’s technical briefing note on a range of different handwashing stations particularly for communal handwashing, including in refugee/IDP settings.

Oxfam has its own handwashing stand. Foyeke Tolani and Mary A Omondi have written the guidelines on how to set up, use and maintain communal handwashing stations.

Mum’s Magic Hands by Oxfam, Unilever’s Lifebuoy soap and Unilever’s Chief Sustainability Officer. Together they have produced Programme Resources which include materials to run meetings with groups (storyboards and images of handwashing with soap) and visuals for making posters.

During the current pandemic, things move fast. This guide from Mum’s Magic Hands is for rapid implementation of handwashing promotion in emergencies.

The Centre for Disease Control and Prevention has a wealth of health promotion materials including stickers, posters and social media graphics to promote handwashing.


How can radio change our behaviour? This case study looks at how the power of radio influenced hygiene and handwashing practice in Turkana in Kenya: SWIFT Story of Sustainable Change: Improving hygiene behaviour through local radio broadcasts in Turkana, Kenya.

Handwashing Compendium for Low Resource Settings: A Living Document: a living publication from the Institute of Development Studies on accessible low-cost handwashing facilities.


The Global Handwashing Partnership is running the Handwashing Thursday Series which will take place between October 22nd and December 17th 2020. The series will present best practices and new concepts to improve the uptake of handwashing.


Beth Donkin

Beth is the Views and Voices Digital Content Editor at Oxfam GB.

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