Limited access to clean water and sanitation threatens the health of IDPs and returnees (February 2011)
In evacuation centres and relocation sites, limited access to clean water and sanitation facilities and inadequate shelters often combined with poor nutrition to threaten the health of people living there. Most civilian deaths recorded during the 2008-2009 conflict were linked to illnesses while in camps. Access to clean water and sanitation in evacuation centers improved significantly between 2009 and 2010 with problems, however, still reported in relocation sites. The situation also remained highly problematic in return areas where access to clean water and sanitation has traditionally been limited and where the number of water points was further reduced in 2010 by the El Nino phenomenon.
Access to water and sanitation still a challenge in IDP communities and return areas in 2010 and 2011
The already limited access to WASH facilities in many returns areas and in particular to water points was further reduced by the effects of El Nino during 2010. Schools and public facilities were reportedly particularly affected by the lack of water and sanitation facilities. The January 2010 EFSA assessment showed that most returnees were taking their drinking water from unprotected wells, river or lakes, and that the majority of them did not treat the water (WFP and CFSI, 5 March 2010, p.11).
A WASH rapid assessment conducted July 2010 and covering 23 sites, including 17 return areas, 2 evacuation centers and 4 relocation sites in 2 municipalities in North Cotabato and 8 municipalities in Maguindanao, showed that most sites lacked adequate WASH facilities and the situation was often worse in return areas. IDPs also lacked hygiene supplies. Many schools in conflict-affected areas lacked adequate access to safe water and sanitation facilities. As of June 2010, only 61 per cent of the schools had access to working sanitation facilities and 58 per cent had access to water (OCHA, 4 February 2011, p.85).
An assessment conducted by Save the Children among 65 communities, including IDP and host communities, in Maguindanao and North Cotabato in March-April 2010 showed that access to clean water was a major concern in more than a third of the communities (35 per cent) who reported "scarce" or "very limited" access to clean water. The report underlined that "The threat of diarrheal disease on child mortality, morbidity and malnutrition is clearly evident under such conditions" (SCIPHL, 6 August 2010, p. 28).
Previous assessments had already shown very limited access to clean water in Mindanao's conflict-affected areas and pointed to this as a main cause of poor health. A survey conducted in 2004 by ACH in the Liguasan marsch area showed that the health problems most often cited during displacement were hygiene problems relating to overcrowding and poor sanitation. Access to clean and safe water in the conflict-affected areas of the marsh was very limited, with 91% of all water points in use testing positive for bacterial contamination, and 94% of the tested water containers testing positive for bacterial contamination. Water, in particular in remote areas, was mainly accessed through unprotected hand dug open wells. Regular flooding further restricted access to water as open wells get flooded. People are then forced to drink directly from the marsh. The majority of the baranguays within the marsh have very limited access to clean water (ACH, June 2004, p. 22).
Access to water and sanitation in camps and IDP sites improves between 2009 and 2010
In some evacuation centres and relocation sites, access to clean water and sanitation facilities remained a challenge during 2010 although the situation was reported to have significantly improved since 2009. A water, sanitation and hygiene (WASH) assessment conducted in various IDP settings in Maguindanao and Cotabato in July 2009 found that almost 42,000 people had to share 61 water points and 165 latrines, representing one water point for every 680 people and one latrine for every 252 people (Philippines WASH Cluster, August 2009, p.34). Significant efforts by humanitarian agencies between the last quarter of 2009 and March 2010 resulted in the more than doubling of the WASH facilities in IDP camps in Maguindanao.
The number of water facilities increased from 101to 181, the number of latrines from 329 to 816
and the number of bathing cubicles reached 142. The de-sludging of septic tanks remained a challenge limiting the use of latrines. In 2009, it was noted that one in four latrines in the camps could not be used because the tanks needed to be emptied.
While access to WASH facilities has improved in evacuation centres, little progress was noted in 2010 in the relocation sites where water and sanitation conditions continue to be much worse (OCHA, 21 March 2010, p.4). The maintenance and improvement of shelters remained a problem in evacuation sites and relocation sites as more shelter interventions were starting to focus on return areas.
Despite the lack of water points and inadequate sanitation, major disease outbreaks have been avoided since 2009. The most common reason for medical consultation in the IDP sites has been respiratory infections (OCHA, 4 February 2011, p. 59).
Majority of civilian deaths in 2008-2009 conflict linked to illnesses while staying in camps
Unhygienic living conditions and practises and poor nutrition were major causes of health problems in the evacuation centers between 2008 and 2009 with diarrhoea and pneumonia reported as the leading causes of death (ECHO, 4 July 2009, p.2). The most common primary symptoms reported were fever, followed by repeated coughs and colds, and diarrhoea (DOH, UNICEF, WFP, July 2009,
p.35). A WASH assessment conducted in both old and new evacuation centres, relocation sites and house-based settings in Maguindanao and Cotabato in July 2009 showed that a lack of water, latrines and basic materials such as soap combined with the absence of hygiene promotion to undermine personal hygiene levels.
A total of 380 deaths linked to the conflict were officially recorded from August 2008 to July 2009 (NDCC, 14 July 2009). 268 cases, or more than two-thirds of the officially-recognised deaths, were of IDPs who died from causes related to illness while staying in camps. 84 per cent of deaths in camps were in ARMM. The real scale of death in displacement was likely to be higher; however, as casualties among IDPs seeking refuge outside recognised camps were generally excluded from these statistics. According to records which the Municipal Disaster and Coordinating Council in Datu Piang (Maguindanao) shared with IDMC in May 2009, over 100 IDPs died in this municipality alone between August 2008 and May 2009. These findings reflect the greater scale of displacement in ARMM and also that conditions there were probably worse than elsewhere in Mindanao.
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Philippine Department of Health (DOH), UNICEF, WFP, July 2009, Joint Emergency Nutrition and Food Security Assessment of Conflict-Affected Internally Displaced Persons in Mindanao, January-March 2009
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