Water for Sanitation & Hygiene

In a disaster, most people focus on drinking water — and rightly so. But the diseases that kill most people in displacement and infrastructure failure are spread through hands, waste, and contaminated surfaces, not primarily through drinking water. Cholera, typhoid, hepatitis A, dysentery, and many other illnesses are preventable with basic hygiene. This guide explains how to manage water for sanitation and hygiene when supplies are limited.

⚠️ Diarrhoeal diseases kill approximately 2,200 children per day globally — the vast majority from preventable sanitation failures. In a disaster that degrades sanitation infrastructure, hand hygiene becomes the single most important health intervention available to you.

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Total Water Needs: Beyond Drinking

Many preparedness guides state the minimum drinking water requirement of 2–3 litres per person per day. This is the absolute survival floor. A full picture of water needs is much higher.

Use	Minimum per Person/Day	Comfortable per Person/Day
Drinking	2–3 litres	2–3 litres
Basic food preparation	1–2 litres	2 litres
Basic hand washing (6x/day)	1–2 litres	2–3 litres
Basic facial washing	0.5 litres	1 litre
Oral hygiene	0.2 litres	0.5 litres
Sponge bathing (2–3x/week)	2–4 litres per bath	5–10 litres per bath
Toilet flushing (if available)	6–10 litres per flush	—
Laundry (minimal)	2–4 litres per session	—
Total minimum	~7–12 litres/day	~50 litres/day (WHO standard)

The WHO standard for a dignified quality of life is 50 litres per person per day. In an acute emergency, 7–15 litres per day is the practical minimum that maintains health while conserving supply.

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Hand Hygiene: The Critical Intervention

Handwashing with soap prevents approximately 30–48% of diarrhoeal illness and 16–23% of respiratory infections. It is the most cost-effective public health intervention known.

Critical moments for handwashing

1. Before preparing or handling food
2. Before eating
3. After using the toilet or disposing of human waste
4. After changing nappies or assisting someone with toileting
5. After blowing nose, coughing, or sneezing
6. After touching animals
7. After handling rubbish or waste
8. After treating a wound

Effective handwashing technique

1. Wet hands with clean water
2. Apply soap
3. Lather all surfaces — backs of hands, between fingers, under nails — for at least 20 seconds
4. Rinse thoroughly under running water if available
5. Dry with a clean cloth or air dry

When water is severely limited: sanitiser alternatives

Alcohol-based hand sanitiser (minimum 60% alcohol concentration) is effective against most bacteria and viruses, but NOT against norovirus, Clostridioides difficile, or when hands are visibly soiled.

Soap and minimal water: A 500ml bottle of water poured slowly over soapy hands is sufficient for effective handwashing.

Ash or sand (improvised): In extreme scenarios with no soap, rubbing hands with dry wood ash or fine sand followed by rinse water provides some mechanical removal of contamination. This is a last resort only.

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Improvised Handwashing Stations

When running water is unavailable:

Tippy tap (basic):

1. Suspend a 1.5–2 litre bottle above a washing basin with a stick lever
2. Stepping on the lever tips the bottle, releasing a stream of water
3. Leaves hands free; minimises water contact with the bottle
4. Place soap on a stick or string next to it

Gravity drip station:

1. Punch a small hole in a 5–10 litre container lid
2. Hang from a tree or tripod
3. Water drips slowly when the container is tilted or a tap is opened
4. Pair with a soap solution in a small bottle

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Sponge Bathing

Full bathing without running water is achievable with 2–4 litres of water.

Sponge bath technique

1. Fill a basin with warm water (heated if fuel is available)
2. Add a small amount of soap
3. Use a cloth or sponge to wash the body section by section: face and neck first, then torso, then limbs, then feet, then groin and underarms last
4. Change the cloth or rinse it between sections
5. Use a separate clean basin or cloth for rinsing
6. Prioritise underarms, groin, and feet — where bacterial growth and skin breakdown are most likely

Frequency: In a short emergency (under 7 days), every 2–3 days is sufficient for most people. In extended scenarios, daily attention to high-risk areas (armpits, groin, feet) prevents skin infections that can become serious.

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Improvised Sanitation and Waste Disposal

When flushing toilets are unavailable, human waste management becomes a critical public health issue.

Option 1: Bucket toilet

1. Line a sturdy bucket with a plastic bag
2. Add a toilet seat ring if available for comfort
3. After each use, add a handful of sawdust, cat litter, or dry soil to absorb moisture and reduce odour
4. Seal bags and dispose of in a designated waste area away from water sources, food preparation areas, and living spaces

Option 2: Cat hole (short-term, outdoor)

1. Dig a hole at least 15–20cm deep, at minimum 60 metres from any water source
2. Cover fully after each use with soil
3. Mark used areas to avoid reuse

Option 3: Pit latrine (extended scenario)

For scenarios lasting weeks or longer:

1. Dig a pit at least 1 metre deep, 30cm wide
2. Site it at least 30 metres from water sources, downhill from them
3. Construct a simple cover to reduce flies and odour
4. Fill and site a new one when the pit reaches within 30cm of the surface

⚠️ Never dispose of human waste near water sources, wells, or low ground that drains to water. Contamination of drinking water with faecal matter is the mechanism of cholera and typhoid — both of which spread explosively in disaster conditions.

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Grey Water Reuse

Grey water is water that has been used for washing (not toilet use). In a water-scarce emergency, it can be reused for:

• Toilet flushing (if the toilet is still functional)
• Watering non-food plants
• Initial cleaning of tools or surfaces (not food preparation surfaces)
• Fire suppression

Grey water should NOT be reused for:

• Drinking
• Food preparation
• Washing food
• Washing dishes or utensils
• Bathing infants

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Menstrual Hygiene

Menstrual hygiene management is often overlooked in preparedness guides. Inadequate management leads to infection, social distress, and physical complications.

Emergency menstrual kit should include:

• Disposable pads or tampons (90-day supply minimum — approximately 100 pads or 50 tampons per person per month)
• Reusable cloth pads (washable alternative — require 1–2 litres of water per wash)
• Menstrual cup (reusable; requires initial sterilisation and basic washing only)
• Unscented mild soap
• Small supply of painkillers (ibuprofen or paracetamol)
• Disposal bags (sealed opaque bags for discreet disposal)

In extended emergencies: A menstrual cup used with basic hygiene reduces water, waste disposal, and supply requirements dramatically. Include one per person of reproductive age in your emergency supplies.

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Oral Hygiene

Oral health deteriorates rapidly under stress and with dietary changes. Tooth infections and abscesses, if untreated, can become life-threatening.

Minimum oral hygiene protocol:

1. Brush teeth twice daily — even 100ml of water per session is sufficient
2. Fluoride toothpaste — a single 100ml tube lasts approximately 3 months for one person
3. If no toothpaste: brush with a small amount of salt or plain water; mechanical cleaning is the primary benefit
4. Floss daily if available — gum disease accelerates under stress
5. Avoid high-sugar foods if possible — reduces cavity risk

If no toothbrush: A clean cloth wrapped around the finger and rubbed across teeth provides basic mechanical cleaning.

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Infant and Nappy Hygiene

Infants in disaster conditions face heightened infection risk.

1. Nappy changing: Always wash hands before and after. Dispose of soiled nappies in sealed bags away from food and water.
2. Formula preparation: Use the cleanest water available, boiled and cooled if possible. Never use untreated water for infant formula if any alternative exists.
3. Bottle washing: Requires boiling water for sterilisation. If unable to sterilise, use a clean cup instead — easier to clean adequately with limited water.
4. Baby wipes: Keep a substantial supply — they enable effective hygiene with minimal water use for infants.
5. Nappy rash: In prolonged situations without adequate changing, barrier cream (zinc oxide) prevents painful skin breakdown. Include in emergency supplies.

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Quick Reference

Situation	Action
Limited water — what to prioritise	Drinking first, then handwashing, then food prep, then bathing
No running water	Set up tippy tap or gravity drip for handwashing station
Toilet unavailable	Use bucket with liner and dry cover material; site away from water
Hands visibly dirty, no water	Use soil or ash as mechanical cleaner; sanitiser alone insufficient
Menstrual supply running low	Shift to reusable cloth pads or menstrual cup to extend supply
Infant formula preparation with questionable water	Boil and cool water before mixing; never use untreated water for infants
Grey water available	Use for toilet flushing and plant watering only — not food or drinking
Outbreak of diarrhoea in group	Intensify hand hygiene immediately; isolate waste; boil all drinking water
Skin breakdown in nappy area	Apply barrier cream; increase change frequency; allow air exposure
Oral health deteriorating	Maintain twice-daily brushing even with minimal water