Yemen: WASH household assessment – Water, Sanitation and Hygiene Assessment (November, 2018)
SUMMARY
The conflict in Yemen strongly intensified after 2015 and deeply affected the humanitarian situation in the country, pushing millions of people to rely on humanitarian assistance. There were over 1 million suspected cholera cases and large areas in state of emergency due to the risk of famine.1 Cholera remains of great concern for Yemen, with the first quarter of 2019 seeing a sharp rise in the number of suspected cases – increasing from 371,323 over the year of 2018 to 214,798 in the first quarter of 2019.2 These outbreaks are further aggravated by widespread food insecurity, with around 360,000 children under five estimated to suffer from severe acute malnutrition.3,4,5 The outbreaks of disease are in part linked to the breakdown of Yemen’s public water and sanitation systems, as well as the failure of the public waste management system.
To improve the humanitarian situation and implement efficient programming, the WASH Cluster worked with partners and technical support from REACH to conduct assessments in 38 districts. Districts prioritized for either cholera, famine, or for both cholera and famine (hereafter referred to as “cholera prioritized districts”; “famine prioritized districts”; or “districts prioritized for both”) that also had a high concentration of Internally Displaced Persons (IDPs)(8% or more) were included for survey. The objective of the survey was to understand the WASH-related needs, coping mechanisms, and hygiene-awareness in the assessed district, disaggregated by IDP or host community (HC). From 4 September to 28 November 2018, 7,609 randomly selected households and 76 Key Informant (KI) interviews were conducted in the 38 districts. This report outlines differences between districts that have been prioritized for famine and/or cholera intervention(s), and with a high concentration of IDPs.
Key Findings
Water
Results show that nearly half of respondents (48%) rely on unimproved sources for drinking water, a dramatic increase compared to 34% in 2006. 7,8 The majority of respondents (56%) report to spend over 30 minutes fetching water, which indicates limited drinking water services, as defined through the Joint Monitoring Programme of UNICEF and the World Health Organization. 9 Distances travelled to fetch water were reported to be abnormally long, as previous functioning water collection points were closed or non-functional.10 In addition, 9% of respondents access less than 15 litres of water per day, the minimum amount of water for basic needs according to the SPHERE Handbook for Humanitarian Standards.11 Compared to respondents from famine prioritized districts and districts prioritized for both, respondents from cholera prioritized districts are more likely to rely on unimproved sources for their water; experience issues related to fetching water (89% in cholera prioritized districts, 72% in famine prioritized districts, and 84% in districts prioritized for both); and were less likely to have their water sources located at their properties. Respondents from cholera prioritized districts had access to the least amount of water per person per day (i.e. 26.7 litres) as compared to respondents from famine prioritized districts (34.2 litres) or respondents from districts prioritized for both (35.4 litres). Clearly, access to clean water remains a major issue for many people in Yemen, but especially in cholera prioritized districts. The poor access to water observed is likely to be contributing to the spread of cholera, as access to water was more constraint in cholera prioritized districts.
In addition, reliance on unimproved water sources was reported to be especially high in rural areas, due to the failure of the public water system and increased costs involved in accessing improved sources12, as fuel became more expensive. Fuel is needed for obtaining water from trucks, bottles or piped networks. The use of unimproved sources is problematic as it can exacerbate the spread of water related, and especially water-borne diseases, including Acute Watery Diarrhoea (ADW)/cholera. Fetching water was particularly problematic for women and children, who are traditionally those collecting water. Problems women faced included having less time to spend on other tasks, and being exposed to harassment. For children, problems included dropping out-ofschool as they spent time fetching water instead, as reported by KIs.
Sanitation
The sanitation situation seems to have been impacted by the conflict as well. Access to improved latrines decreased from 71% in 2006 to 53% in 2012 and 48%, as observed in this assessment.13,14 Also open defecation was widely reported by KIs and 24% of respondents said that none of their household members had access to latrines. Comparing the different types of districts assessed, it seems that the sanitation situation was worse for people living in districts that were prioritized for both. Respondents from those districts least often had access to improved latrines15 (33% versus 34% in cholera prioritized districts and 58% in famine prioritized districts) and likewise were least likely to report that all members had access to latrines (49% versus 59% in cholera prioritized districts and 73% in famine prioritized districts).
Furthermore, the use of unimproved latrines was found to be higher among female respondents and IDPs. Access to latrines was said to be particularly challenging for women and girls in famine prioritized districts and cholera prioritized districts as latrines in these districts less often were gender segregated. Their access was found to be particularly challenging in the districts prioritized for both, as doors and locks were less often in place. Open defecation and the use of unimproved latrines are considered to be problematic as they increase the transmission of faecal-oral diseases through faecal contamination of the environment.
Also waste management seems to have been affected by the conflict in Yemen, as the number of households seeing their waste systematically collected decreased between 2014 and 2018 from 65% to 43% in urban areas and from 5% to 4% in rural areas.16 Most respondents indicated that they burned/buried their garbage (37%), or left it in the street without being picked up (53%). Furthermore, the presence of wastewater in the vicinity of households seems to be a problem across the different types of districts with nearly half of all respondents (45%) reporting to see this near their households. Both the household garbage and wastewater management seem to
