Bradol, Jean-Hervé; Diaz, Francisco; Léglise Jérome; Le Pape, Marc
Is humanitarian water safe to drink?
Four hepatitis E epidemics have occurred in the areas in which we operate since 2000, prompting a reflection on the quality of the water produced and distributed to their populations by humanitarian organisations. Epicentre's 2004 epidemiological study in the Mornay displaced persons camp in West Darfur state in Sudan (Outbreak of Hepatitis E in Mornay IDP camp, December 2004) highlighted the fact that the correctly chlorinated water distributed by the supply system set up by MSF was one of the means by which hepatitis E was transmitted. The experience of these epidemics led to three conclusions: the frequency of hepatitis E epidemics is not negligible, insofar as they have occurred four times in less than ten years in our areas of operation; in the specific case of this disease our water production procedures, although correctly followed, did not remove the threat; and finally, it is not easy to identify practical alternatives in the situations in which we operate.
Whilst the starting point was a particular disease, hepatitis E, the discussions held at the time showed that the health concerns associated with weaknesses in the water supply procedures used by aid organisations were not confined to this one illness. What are the difficulties we face in producing and distributing sufficient quantities of water that is clear, acceptable in terms of taste, free from faecal germs and correctly chlorinated? What role should the "beneficiaries" play in defining the quality criteria to be met? What are the situations where we think we have achieved this objective and yet a significant health risk remains? What do we know about the relationship between water and health? How do people working in a non-humanitarian context define water as fit for drinking? To what point is people's state of health influenced more by the quantity of water available than its quality? Where do the indicators used by humanitarian organisations to determine whether water is fit for drinking come from, and are they still relevant? Do we need to move away from a culture of complying with the current standard to a culture of managing residual risk, whatever the standards used? Do recent technological developments offer new prospects? Can we hope to improve water quality without making progress in terms of energy consumption, the importance of which is one of the characteristics of drinking water production systems that are more sophisticated than ours?
Aside from medical, scientific and technological considerations, however, access to water is a major social, economic and political issue as well as a local, regional, national and international one. How do consumers perceive the actions of water production and distribution organisations? What are the social, economic and political tensions determining how water is managed and the relationship between users and agencies that deliver water? What are the main areas of focus of national and international public policy in this area?