1. Executive summary
Context:
The unplanned and spontaneous nature of the post-August 2017 Rohingya refugee camps in Cox’s Bazar have combined with high population densities and challenging environmental conditions to produce a crisis with especially acute water, sanitation and hygiene (WASH) needs. A WASH infrastructure was put in place across the camps in Cox’s Bazar to address the large needs of the population, however, the monitoring and maintenance of these infrastructures has proven challenging over the last five years. This challenge of maintaining the WASH infrastructure in the Cox’s Bazar camps was highlighted by a lot quality assurance sampling (LQAS) community feedback mechanism conducted by MSF in 2018. The COVID-19 pandemic further exacerbated this issue due to a reduced focus and funding for WASH activities in the camps leaving the refugee population vulnerable to WASH-related diseases. To gain an understanding of the current WASH situation in Cox’s Bazar, MSF carried out an LQAS across 19 camps in Cox’s Bazar.
Methods:
A cross sectional lot quality assurance sampling (LQAS) community feedback mechanism was conducted from January- March 2022. LQAS uses small sample sizes to identify priority areas for intervention based on existing administrative divisions in camp settings, which are known as supervision areas. Nineteen camps in Cox’s Bazar were considered as the supervision areas. The LQAS were conducted in two phases: (1) in Operational Centre (OC) Amsterdam catchment areas and (2) OC Paris and Brussels catchment areas.
Nineteen households and parents/guardians of children aged under 5 years were interviewed in each of the 19 camps/supervision areas. Block population figures and probability proportional to size (PPS) sampling were used to identify where the 19 households should be distributed in the camps/supervision areas and the households were selected using random sampling using Geographic Positioning System (GPS). Data were collected on the following categories: water supply and storage, sanitation and hygiene practices, solid waste management and WASH and water-related diseases using an electronic method (KoBoCollect). Target values were established for each of the LQAS indicators and the findings were analysed at the camp (supervision area) level as well as overall for the 19 camps combined against those target values. Crude and weighted averages were calculated for each indicator and the results were compared to the 2018 LQAS.
Results:
The LQAS showed that 16 out of 28 indicators did not meet the pre-determined target coverage threshold values and seven of those were particularly low performing with values at least 30% lower than the target values. Low performing indicators were reported in most categories but particularly for solid waste management and sanitation indicators.
At the supervision area or camp level, there has been a significant improvement in the quality of water provision, with improved water source infrastructure becoming available in most areas. However, when compared to the 2018 LQAS, water supply indicators were similar or worse, including some improvements were observed for water storage indicators and availability of consistent water. This corresponds with wide-spread restrictions in the camp regarding water provision, despite the infrastructure improving. Furthermore, sanitation indicators have deteriorated, including the less availability of functioning latrines and availability of soap. All of this corresponds to an increase of skin infections both captured in this assessment, and corresponding to a dramatic increase in scabies cases reported by health facilities in the camps.
Conclusion
In general, the WASH condition in the camp remained hazardous and requires adequate and timely intervention. The finding in this LQAS has shown that some gaps identified in the 2018 LQAS have not changed, where the water storage, sanitation, solid waste management and hygiene indicators have shown the highest gap and are priority for intervention followed by the sanitation indicators. This has created an extended exposure of the camp community to poor WASH situation which is causing health consequences in the camp population, including potential outbreaks of communicable diseases. As a likely consequence of the deterioration in the WASH situation, a high number of waterborne diseases has been reported among children under five years in the LQAS (mainly skin and soft tissue infection and diarrheal diseases. Hence, there is a need for action to improve the WASH situation, in order to prevent and control outbreaks due to water, hygiene and sanitation deterioration.