An estimated 4 billion cases of diarrhea each year, causing 1.8 million deaths mainly among children under five years of age, are caused by unsafe drinking water, poor sanitation, and poor hygiene. In the development context, five point-of-use water treatment (PoUWT) options - chlorination, flocculant/disinfectant powder, solar disinfection, ceramic filtration, and biosand filtration – have been shown to improve household water microbiological quality and reduce diarrheal disease in users, and another, boiling, is widely promoted. Based on this evidence, the World Health Organization (WHO) promotes PoUWT to provide safe drinking water for the 884 million people without access to improved water supplies and the millions more drinking microbiologically unsafe water.
Safe drinking water is also an immediate priority in most emergencies. When normal water supplies are interrupted or compromised due to natural disasters, complex emergencies, or outbreaks, responders often encourage affected populations to boil or disinfect their drinking water to ensure its microbiological integrity. Recently, PoUWT options verified in the development context have been recommended for use in emergencies.
As an intervention that reduces diarrheal disease burden, PoUWT could potentially be an effective emergency response intervention: 1) after flooding events or natural disasters that lead to displacement; 2) in some complex emergency settings when relief cannot progress to development; and, 3) in response to outbreaks caused by untreated drinking water. PoUWT may be especially effective during the initial phase of an emergency when responders cannot yet reach the affected population with longer-term solutions. However, differences between the emergency and development contexts may affect PoUWT effectiveness, and raise questions about generalizability of PoUWT results from development into emergency contexts.
The objectives of writing this report are to: 1) document the recent experience in PoUWT use in emergency response; and, 2) identify the lessons learned from that experience and develop a set of recommendations to guide operational research on PoUWT in emergencies and identify the most effective deployment. To complete these objectives, we completed a literature review and implementer survey on PoUWT in emergencies. We then summarized the results into lessons learned and research indicated