A Systematic Review of the Amount of Water per Person per Day Needed to Prevent Morbidity and Mortality in (Post-)Disaster Settings

Abstract

BackgroundIn order to improve the effectiveness and efficiency of humanitarian efforts, minimum standards for humanitarian assistance and key indicators, showing whether a standard has been attained, have been developed. However, many of these standards and indicators are based on a consensus on best practices and experiences in humanitarian response, because relevant evidence on the impact of humanitarian interventions is often lacking.ObjectivesOne important example of a standard in humanitarian aid in a disaster setting is “water quantity.” The accompanying indicator states how many litres of water are needed per person per day in a disaster setting. It was our objective to determine the evidence base behind this indicator, in order to improve health outcomes such as morbidity (e.g., diarrhoea) and mortality.MethodsA systematic review was performed searching The Cochrane Library, Medline and Embase. We included studies performed during disasters and in refugee camps that reported a specific water amount and health-related outcomes related to water shortages, including diarrhoea, cholera, and mortality. We used GRADE to determine the quality of evidence.ResultsOut of 3,630 articles, 111 references relevant to our question were selected. Based on our selection criteria, we finally retained 6 observational studies, including 1 study that was performed during the disaster and 5 studies in a post-disaster phase. From two studies there is conclusive evidence on the relationship between the amount of water received and diarrhoea or mortality rates in refugee camps. However, overall, these studies do not contain enough data with relevance to a specific amount of water, and the level of evidence is very low.ConclusionsMore primary research on water amounts in a disaster setting is necessary, so that the humanitarian sector can further professionalise its water-related standards, indicators and interventions.

Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions: A scoping review of current international guidelines

“…Historically, improvements to WASH infrastructure at a population level such as the community-level interventions listed across the included guidelines, have reduced the incidence of cholera, and other diarrhoeal diseases [111,120,[133][134][135][136][137], and eliminated the disease since the time of John Snow [108,109,138]. However, guidelines reviewed offered little specificity on the standards that should be attained for these WASH interventions.…”

Climate Change and Water-Related Infectious Diseases

“…The water needs for disaster recovery identified relations between the amount of water provided and the diarrhoea and mortality rates, but emphasised the inadequacy of the data [91]. As responses to climate related emergencies influence subsequent morbidity and mortality, it is important to understand the impact of water, sanitation and hygiene (WASH) interventions on health outcomes in humanitarian crises.…”

Insecure Security: Emergency Water Supply and Minimum Standards in Countries with a High Supply Reliability

“…This applies to grid-bound and grid-independent supply. The current assessment of water demand in emergencies is predominately based on rough estimates, which diverge regarding the mentioned quantities of drinking water as well as for other water needs [46]. Water demand assessment under normal conditions is based on average supply needs calculated as means from the water consumption of numerous consumer groups.…”

“…To the knowledge of the authors, there are only very few other documents providing quantities for minimum water supply needs per person [16,[46][47][48][49][50], which are less popular and applied than the Sphere Handbook. They provide numbers comparable to the Sphere and UNHCR handbooks.…”