 Hello everyone and good morning, good afternoon or good evening depending on where you're joining us from. Welcome to the Engineering for Change or E4C for short. Today we're very pleased to bring you the latest in E4C's 2014 webinar series. Today's webinar was developed in collaboration with Daniela Lantain from Tafts University. My name is Sean Fury and I will be moderating today's webinar. When I'm not doing this I work for SCAT based in Switzerland, which is a consultancy, knowledge sharing organization and project implementer. My main role is in the secretariat of the Royal Water Supply Network, RWSN, a global network of over 6,000 practitioners in 140 countries. It's a great privilege to be hosting this webinar with our good friends at E4C. We also have our own webinar series happening every Tuesday on rainwater harvesting, water point mapping and groundwater research in Africa. So have a look at our website, rwsn.ch to find out more. Now I'm going to move to the next slide if it works. And I'd like to take a moment now to tell you a bit about today's webinar. Wash in emergencies, lessons learned and the way forward. Water sanitation and hygiene are critical needs worldwide and especially for populations affected by emergencies such as natural disasters, outbreaks and violence. Wash is a key focus area at E4C and we're focused on collecting and sharing information about commonly implemented emergency responses. To treating drinking water and successes and failures and lessons learned as well as the potential new innovations to improve the quality of water and reduce the diarrheal disease burden in emergencies. As part of this effort, we're invited a expert in this field, Daniela Lantane, assistant professor in civil and environmental engineering at Tufts University to share her research. I'm really interested in today's presentation because at SCAT and RWSN we're generally working in development corporation to achieve long term goals. Humanitarian aid people are often different, takes a different skill set and a different attitude to risk and success, but the two disciplines need each other. In Moldova and Rwanda SCAT is patiently building infrastructure and capacity in the wake of emergency situations, but this can unravel at any time. In Ukraine earlier this year we had to abandon one of our project areas in the Crimea for very well publicized reasons. And earlier this year I was in Liberia coaching government staff to write their first ever national wash sector performance report. That was completed just as Ebola crossed over from Guinea and now everything we worked on is on hold and our Liberian colleagues live with day to day fear and uncertainty. This has not been seen since the end of the war a decade ago. So much effort can be undone so quickly, so I have great respect for those who work in emergency response and I'm looking forward to learning through this webinar. We thank you for joining us today, but before we get rolling I'd like to take a moment to recognize the coordinators of the EFC webinar series generally. Yana Aranda at ASME, Holly Schneider-Brown, Michael Maider and Steve Welch of IEEE who work on developing and delivering the webinar series. Thanks team. If anyone out there has any questions about the series or would like to make a recommendation for future topics and speakers we invite you to contact them via the email address visible on the slide webinars at engineeringforchange.org. Before we move on to our presenter, we thought it would be a good idea to remind you about engineering for change, EFC, and who we are. 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So we've currently got around 86 attendees and counting, which is fantastic. And so here is today's presenter, Danielle Latain, who is the Assistant Professor in Civil Engineering at Tufts University. She's an environmental engineer who received her PhD in 2011 from the London School of Hygiene and Tropical Medicine. She completed her postdoctoral work at Harvard Centre for International Development. Between her degrees, she worked at the Centre for Disease Control and Prevention, CDC. And over the past 14 years, she's provided technical assistance and evaluation of chlorination, filtration, and combined treatment of household water implementation in more than 50 countries, both in development and emergency contexts. And she's published over 20 papers. So with no more due, I would like to hand over to Daniela to take us through her presentation. Thank you very much. Thank you so much for that introduction and for the opportunity to be here and to all the attendees. So just a reminder, if you'd like to ask questions, feel free to pop them into the Q&A. I'll be looking at the Q&A and we'll all be reading through it as we present. The timeline is approximately about a 25 to 30 minute presentation. And there'll be 20 minutes for questions afterward. I'd actually like to start the presentation with a little bit of history on emergency response, which I generally find people aren't familiar with and gives a good grounding to people about how we implement an emergency. So the emergency response principles actually come with the establishment of the Red Cross. And the Red Cross was established when a particular individual, Henry Denont, wrote a memory entitled A Memory of Sulfurino, where he described his experiences on a battlefield where he saw all of the wounded on the battlefield left without medical care. And he actually worked in 1863 to establish the predecessor of the International Committee for Red Cross. And their first goal was really to ameliorate the condition of the wounded in armies, to provide medical care irrespective of which side someone on the conflict was, to people impacted, to soldiers impacted by war. The ICRC tenants were actually brought together into the First Geneva Convention, which was agreed to by 12 governments in 1864. The principles that ICRC started with are there's four key principles. The first one is humanity, that you work with the people who need you the most. So you go to the most effective, the people who need the most. Impartiality, that you work irrespective of what side of the conflict, what government, you work with all people who need you. Neutrality, you do not take a side in conflict. And independence, the emergency worker has the ability to make the decisions for themselves as to how to lead to the humanity, impartiality and neutrality principles. Now ICRC also has principles that they have within their own group, which are voluntary nature and the Red Crosses work together across the world. Now to move on to the history of how we start doing emergency response, ICRC was actually crucial in establishing international law in the Geneva Conventions and after World War I and World War II as we see the UN established. The term NGO, non-governmental organization, was actually first used in the UN Charter and organizations can apply to the UN to have what was called consultative status with the UN. So now there's approximately 3,000 NGOs that have consultative status with the UN. Now during the Cold War what happened is it was very difficult to respond to emergencies because of the international politics at the head of the UN level. So what would happen is if an emergency happened in a country associated with the US, the US might go in and if an emergency happened in a country associated with the Soviet Union, the Soviet Union would go in, but it wasn't like we see today where the world responds to emergencies. At the end of the Cold War what we saw was one of the benefits of the peace dividend was an option for really humanitarian aid to be a player for humanitarian organizations to start responding to emergencies and to help. And just to give you a sense of the change there were only 700 NGOs with consultative status at the UN in 1992 and now we have over 3,000. So there's really been a growth in this emergency response field. And so one of the things that I'd like to talk about when I talk about the history is that really emergency response as we know it has only been going on for 20 or 30 years really. It's a relatively new field and I think when people talk about how do we do emergency response we need to keep that in mind that there's a lot of lessons we still need to learn because it's a new field. Now clearly there has been a lot of criticism of various humanitarian response activities particularly in response to the Rwanda genocide where the response itself was actually assisted in continuing the war as some of the food and other aid that went in went straight to the militaries. There was some criticism in Rwanda of poorly treated cholera. And so the emergency response organizations got together after Rwanda to say we need to establish minimum standards for how we respond to emergencies. So when we look at our codes of conduct it was actually Red Cross again that initiated the process to guard the standards of behavior. And again this is voluntary. It's voluntary for an NGO to sign on to this code of contact for emergency response that 433 have. And they're based on the emergency response principles but they also bring in some development principles which are really about gender equality, about cost recovery, about long term sustainability, things that we don't normally see in emergency response principles which are to meet the needs of the most effective person. But we see more when we talk about development context as Sean was mentioning that link between emergency and development. Additionally ICRC led the kind of group that established the SEERS standards. And SEERS is a handbook that establishes minimum standards and key indicators within four sectors, water and sanitation, nutrition and food provision, shelter and health. And so for example, an example standard is that each family should be provided with 15 leaders of drinking water per day. And that should be a minimum standard that we obtain when we're providing emergency response activities. Now these SEERS standards they're not actually evidence based, they're not accepted formally by the United Nations but they are really this kind of minimum standard that's used as a handbook across emergency response to say we as a group say we're going to do this and they're revised on a regular basis so the second SEERS handbook just came out. So as we move on, so this is, that's been really the history of how we do emergency response and what we have now is a whole set of organizations that specialize in responding to emergencies as they pop up. And the type of emergencies that we respond to, natural disasters such as earthquakes, eruptions, landslides, tsunamis, floods, drought. One thing to note is that really we see health impact, we see epidemics after flooding. It's really floods that cause health impact particularly when the floodwater stays, when the floodwater doesn't immediately recede, when it stays in the homes and the people are really exposed to that floodwater. We see a lot of epidemics come up after that. We also see epidemics come up in response to disasters that cause mass displacement. So when people move, we see a lot of health impacts come up. We don't see as many health impacts come up from other types of emergencies. A lot of times it's the initial trauma, like in an earthquake the initial trauma, there might be health impacts but things fairly quickly can recover back to normal after the initial trauma has been dealt with. Now natural disasters are currently increasing both in the amount of population that is affected because there's a lot more urban areas and unplanned settlements and they're also increasing due to climate change effects. Another type of emergency that we talk about is outbreaks. And so we're seeing in particular with diarrheal disease which we look at with water sanitation and hygiene, we're seeing an increase in cholera, particularly in Africa. Something that's very timely that we can talk about in the questions is Ebola. It's ongoing in West Africa and the role of wash in that. And the last type of emergency we talk about is actually something we define at the United Nations level or by the donors. And that's what is called a complex emergency or a fragile state. And complex emergencies in fragile states aren't a specific event but they're actually when the state cannot provide for its people. So for example, Somalia is a good example of a complex emergency or a fragile state where the emergency is more political and it's just there's a set of people who are affected by that. There's a number of countries that fall into this. So as we move on, I wanted to give some information on increases in emergencies. You can see the graph on the left from 1975 to 2005. We do see an increase in the number of natural disasters that are occurring each year. As mentioned before, we also see an increase in the affected population because these natural disasters are happening in areas where there's more population as well. And then on the right, I just wanted to talk a bit about the total population of concern to the United Nations High Commissioner for Refugees. And so this goes from 97 to 2006. And as you can see, the number of refugees and refugees are defined as people who are affected by an emergency and then cross an international border in order to seek relief. And that number of refugees has actually stayed pretty constant, but the number of what we call IDPs, which are internally displaced persons. And so these are people impacted by an emergency that leave their home but they don't cross an international border. And so they're within their own country. And that group is called internally displaced persons. And we've seen quite an increase recently and this has continued since this graph in the population of IDPs. Now refugees are formally protected under international law. IDPs are not. The UN is formally responsible for refugees, but IDPs actually, the responsibility still lies with their own government. And in the case where their own government may be part of the reason that they are internally displaced, there's a gap in who provides services to these populations. So I just also wanted to list that humanitarian assistance. This is another chart showing that humanitarian assistance has really increased as well over time. And you see this with the end of the Cold War. There's a great assistance and this comes from both private and public donors. So one thing I do want to highlight is there tends to be a lot of alarmism after emergencies. And this is a World Health Organization staff that after the Indian Ocean tsunami in 2005 stated that unless the necessary funds are urgently mobilized and coordinated in the field, we could see as many fatalities from diseases as we have seen from the actual disaster itself. And actually in the tsunami, the flood waters came up, but then they receded quickly. And so we didn't see huge disease increases. We saw a lot of impact from the trauma. But we didn't see this follow on disease. So I want to highlight that sometimes we don't need to be alarmist. We need to look at the evidence to see when things might be appropriate. And the other quote I wanted to put up is a quote from Deville de Goyer saying, another common myth about disasters is that the affected local population is helplessly waiting for the Western world to save it. Very honestly, especially with trauma, it's the first one to three days where people are being saved. And that's almost always explicitly done at the local level. And so there's a sense of where is emergency response necessary and what is the local population doing that already is very important. So to move on to talking a little bit about the populations, I had mentioned that refugees are formally protected by international law. The UN High Commissioner for Refugees is responsible for these populations. And there's very good literature showing how to reduce crude mortality rate in refugee camps. And essentially what you need to do in refugee camps is to provide food, provide safe water, provide vaccination, particularly measles vaccination, to provide health care and health information. And if you do those five things very quickly, the mortality rate will decline to background normal rates. Now with IDPs, they're not formally protected by international law and you tend to see high crude mortality rate during an increase of background diseases. And we can see this right now in the Ebola affected countries where you simply cannot get health care for normal diseases such as malaria or childbirth. And so we're seeing these increased rates of background diseases such as malaria causing death instead of being treated or childbirth where women can't get access to a C-sex and we're seeing a lot more maternal mortality because the health system is shut down. And then there's also a third type of population I haven't talked about and those are the entrapped populations. And those are people that are stuck. They cannot move. And so a good example in the western world of an entrapped population is people that were trapped in Hurricane Katrina. Do the floodwaters either in the Superdome or in the roofs of their houses? Another example of an entrapped population is some of the populations in the Democratic Republic of Congo where there's quite a bit of violence and they're kind of trapped in their own rural communities. South Sudan is another example of where we see some entrapped populations and there's very little known about their health needs except we know that violence plays a large role in the health needs of these communities. So to move on to prevention in emergencies we really do know what to do in refugee camps. When people go together in camps we know what to do to keep them safe. And this concept is called excess mortality and so normally we want to keep the rate of death to be about 0.5 deaths per 10,000 people per day which is the normal rate of death in Sub-Saharan Africa. And then we consider an emergency situation when you double that rate of death to one death per 10,000 people per day. And so just to highlight this again, that doubling of death normally comes from an increase in background diseases and outbreaks. And so we provide this food, water and sanitation, needle vaccination, healthcare and health surveillance and the goal is to reduce this excess mortality by moving from what's called the acute emergency situation where everything is happening to the late emergency situation where things have started to recover to the post-emergency situation where things are back to this normal rate of death. And this scheme is called relief to development and the goal is this very linear process. And I think that's more ideal. The reality is much more complex because we often see emergencies cascading. Haiti is a good example of that. We have the earthquake which we then have cholera after the earthquake. We have political violence after the earthquake. We have a hurricane coming in the middle of all of that. So in November of 2010, Haiti is still recovering from the earthquake 10 months ago. Cholera was introduced one month before. There's political violence going on and there's hurricane Tomas coming through. And that sense of it's not as linear to recover from emergencies as we might think, right? And so this changing framework of emergencies with the refugees constant but the IDPs increasing and with that population harder to access and care for instead of seeing this kind of relief to development goal what we're often seeing is these really complex situations. And Sudan is one example where 68 to 93 percent of the deaths were from violence in the acute emergency and we saw crude mortality rates up to about 10 per 10,000 per day. So that's about 20 times the background rate of death. And again we see that even within the IDP camps we're seeing significant violence causing death. And then we also see entrapped populations like in DRC where there's just ongoing collapse of social structures and so fever, malaria, diarrhea, malnutrition, maternal and child health, childbirth, acute respiratory infection. All of those are accounting for greater than 50 percent of the crude mortality rate. Under five suffer the most from these deaths and account for about half the deaths and of course reductions in crude mortality rate are associated with reductions in violence. And there's estimates that there's been more than four million excess deaths in DRC due to ongoing conflict there. And that's just death that if there had been these systems established there wouldn't have been. There wouldn't have been those deaths. And so to move on to what's really the role for water and sanitation and hygiene and particularly household water treatment which I work a lot on within the emergency context and there's two real spaces where WASH has a role. And the first is in outbreaks related to diarrheal disease, fecal oral transmission such as cholera. Water sanitation and hygiene clearly has a role in those emergencies. And then the other place that WASH really has a role that could impact and prevent the mortality, the deaths is in natural disasters that lead to flooding or displacement because we know that after flooding and displacement we see mortality increase, right? And those, that's where interventions to reduce diarrhea can have a lot of impact. Now in some complex emergencies or fragile states where the state is not providing water and sanitation services, that's another place where water might have a role. And so I want to highlight here it's not that WASH has a role in every emergency. It's not like every person affected by emergency is going to get diarrheal disease or is going to get cholera. There is a strategy for here for how we respond and this is a place for where there might be appropriate responses. So what do we do? In emergencies and in development as well we look at installing water systems and water supplies, we look at providing household water treatment options like this chlorine option, we look at isolating feces from the environment like this latrine and we looked at the promotion of hand washing with soap. Those are the interventions we promote in development and in emergency contexts with water sanitation and hygiene. Within household water treatment specifically point of use water treatment which is what I'll spend the rest of the talk talking about because I've done some research in that area in emergencies. In particular we promote five different household water treatment options. So we have ceramic filters where the water flows through the filter into a container. We have chlorine either liquid tablet form, we have solar disinfection where we put water in the roof in the combined synergistic effects of sunlight and UV and activate the bacteria viruses in protozoa. We have sand filters and we have a flocculant disinfectant that's a commercial product that includes both a flock and a disinfectant. So we generally have these options and these options are used in both development but they're often also handed out in emergencies. So the first project that we did at the London School of Hygiene and Tropical Medicine is we looked at a literature review funded by USA and CDC on point of use water treatment and emergency response. And the goals were to document the recent experiments of point of use water treatment and emergencies and to identify lessons learned to guide operational research. And these goals were completed by conducting a literature review and an e-survey of implementers. And so one of the things I want to point out of the literature review when we look at a variety of different products you see really that there's 37, there's 40 total documents identified looking at either household water treatment, point of use water treatment and emergencies and 20 of those were on one commercial product, the commercial flocculant disinfectant. So there's not a lot of research on household water treatment in the emergency context and I particularly want to point out aqua tabs which are chlorine tablets which are very widely distributed and there's almost no research on the time of this review, there was no studies on aqua tabs in emergencies. And so some of the things that are most provided are not actually well researched, there's a gap there whereas some of the things that are funded by companies are very well researched. And so there are huge research gaps in emergency response work. And then I just want to summarize very quickly the results of this, the report I can provide the source file for this report but the lessons learned that came out in this report were that household water treatment, point of use water treatment can be effective sometimes in emergencies but not always. The currently point of use water treatment projects do target high risk emergencies, ones where diarrheal disease risk is increased such as flooding or displacement but the products and not users dominate the option selection. People are, they have a product and they just give it out. They're not talking to users about whether the users want it, know how to use it, receive sufficient training or it's appropriate for the local water quality. And that training is crucial to update, that you can't just hand these products out, you need to hand them out with appropriate training in order for them to work and that logistics are super important. Things are distributed that are available in country before the emergency, that are registered in country and that people have the materials to use. And the last thing we learned in this review was that chlorine dosage, which varies quite significantly and needs to be considered and appropriate for the water quality. So there was a lot of research that was indicated from this review, including looking at the acute emergency situation right after emergency onset, looking at all household water treatment options, not just commercial ones, looking at behavioral determinants of adoption, looking at the relation to other water sanitation hygiene programs, looking at organizational decision making and seeing if the emergency really did lead to development use, longer term use. And just to highlight here, this is a kind of fact sheet brochure manual that I developed with the Red Cross and then talking about how to do option selection, it provides very simple information on the options available in emergencies and then when you might select them based on water quality, what you have access to, etc. And I can also provide the original file for this document which is in multiple languages and available on the Red Cross website. So then after we'd completed this literature review, we really wanted to move on to do the research that was needed. And we decided to have two research questions and we were funded by UNICEF and Oxfam to answer what role, if any, should household water treatment, point-of-use water treatment, play an emergency response particularly in the acute emergency context and what are the factors associated with feasible and potentially sustained implementation of point-of-use water treatment in response to emergencies. And so what we did is we had an open protocol where we actually went into four emergency situations and in each of those emergency situations we evaluated, we went to households of people who received household water treatment products from any organization. So for example, we'd go into an emergency funded by UNICEF and Oxfam, but we'd find out who had distributed household water treatment options within that emergency and we would get the household or geographical information and we would go to those households to see how they used or didn't use those water treatment products. And so it was an open protocol, it was open for a year, we didn't know what emergencies we were going to go to and in the end, the four emergencies we went to, where we went to Nepal for the cholera in August of 2009. This is an image from Nepal in the rural areas and this is the cholera outbreak. We went to Pariamon, Indonesia for the earthquake that occurred in 2009, October. This is an image of a household that came down in the earthquake. We went to Turkana, Kenya where there was flooding and this is the flooding that occurred, but there was also a cholera outbreak in January, February 2010. Just to give you a sense of the area, this is a home in that area, it's on the border of Sudan, it's quite remote. And then lastly, the Haiti earthquake in February, March 2010, we went in and looked at all the household water treatment options that have been distributed in the Haiti earthquake. Now we did a mixed method, we did household surveys, we did key informant interviews, we did water quality testing at the household level. We looked at costing and logistics. We looked at GIS mapping, so there's quite a bit of information that was gained. In each of these four emergencies, we looked at 400 households. So we looked at 400 households, so a total of 1600 households that had received product were evaluated. Now this is all the information, let me get to the right side here. This is all the information we gained from all four emergencies in one slide, and I'm going to kind of walk through this slide. The emergencies are on the first column, so the Nepal, Indonesia, Turkana, Kenya, and Haiti, and then the actual household water treatment options that have been distributed by any NGO or in the second column. So in Nepal, various forms of chlorine, either tablet and liquid, were distributed and they were distributed by an NGO who stationed people in the affected cholera communities, and then they handed out these products, and one day you might get water guard or one day you might get pH, UNICEF was providing the products so they could get them there, and so it wasn't like, it was where you could get a product for four weeks you ran out, you might get a different product, but you had training on that from the people that were living in your community, helping you use these products to prevent, to improve your water quality, to prevent cholera. So we need to add these numbers together because we visited households, and so about 30% of households we visited reported that they use the household water treatment option. They said, yes, in the water I have today, it is treated with these chlorine options. So about one-third of households reported using it, and I'm going to skip the confirmed numbers in this presentation, but if you go to the effective numbers, about 18%, that's 8 plus 7 plus 3, actually we're using that option to take their water from dirty to clean, meant they had dirty water and they were making it clean with this option. So about one in three that were given these options in Nepal were reported using it, about one in five were using it correctly to make their water safe. Now if we go to Indonesia, we see a slightly different story, they were handing out liquid and tablet chlorine, well people really didn't like the taste of chlorine in Indonesia, the directions on the tablets were written in English, there was no one to follow up and people just didn't like it and as you can see there's very low reported use and no effective use. Now boiling is widely used in Indonesia just regularly and while it wasn't promoted by emergency response organizations, 88% of our respondents said they were using it and 27% of respondents had been moving their water from dirty to clean with boiling. And so what I want to highlight here is that what should have happened in this emergency is that the emergency response organization should have helped people boil better, providing them safe boiling containers, providing them a safe storage container, but instead they were promoting chlorine which people didn't want to use. Turkana, aqua tabs, chlorine tablets and pure were handed out in an emergency response non-food item kit distribution. So essentially a car came, you got a big box, it had some pans and some crayons for your kids and some blankets and some chlorine tablets and some pure, but you received a very cursory training on these products and then there was no one in the community to ask about afterwards and so as you can see 6 to 13% of people reported using these products but very few people were using them correctly. Less than 1% could tell us how to use pure correctly and they were actually using it incorrectly and just not seeing effective use. So this non-food item kit distribution led to very low use and the last thing I'll talk about and this is, and then I just have two more slides and I'll finish up, is in Haiti which was a much more complex situation where we had lots of different distributions and we see filters distributed for the first time. In Haiti, aqua tabs were distributed in one program where they were just handed out no follow-up and we see about 24% reported use and 15% effective use in that but in another program, aqua tabs were handed out via a community health worker program to rural areas that didn't have access to clean water and had follow-up from local community health workers and this was done by an organization that was in Haiti before the emergency and who had Creole materials and this is where we see our incredibly high use like 75 to 92% of people reported use and over half to 2 thirds of people improved the water quality here. They got the training. The materials were in Creole. They had follow-up from local community health workers. Now with the filters that were distributed we see very high reported use 53 and 72% but the effective use was lower and that's partly because with the ceramic filters they were actually handed out to people who already had clean water. They were handed out to people living next to an airstrip and those weren't really the people that needed it and with the biosand filters we see a lower effective use because the people installing biosand filters were affected by the earthquake and they made mistakes in their job afterwards. They were impacted. They were not able to perform their job as well because of that impact and they installed the biosand filters incorrectly so they didn't work and so this is a very complex set of information but what I want to boil this down to is one slide which is if you provide an effective option that actually works to a population with actually unsafe water we can't assume everyone with safe water and that population wants to use the product is familiar with it it's the materials are appropriate they have the right training that's when we see our effective use that's when we see emergency response working really well and so I think that we've done additional research and emergencies this time and I think this graphic remains true I'm going to have one more slide here which is essentially some thought questions about research and emergencies which is what research is ethical to conduct in the emergency context is one in two enough is one in five enough how should money be tracked how do you balance the ethic of humanitarianism which has reached the most needy with scaling up how do we better apply lessons under the development context into emergencies and how do we link emergencies and development and I think these are questions that we still really are working on today and this is where things are moving forward and I'd like to end this presentation which is the notion that being humanitarian and doing good or somehow inevitably the same is a hard one to shake off and I'd like to comment that the doing ethical research can help us align being humanitarian and doing good thank you so much for your attention it's been great to speak and I'm happy to take questions I see a few questions here that I will go through and feel free to type up your questions which is fantastic really, really good very, very thought provoking and I'd just like to invite everyone to just we've got some time about 10 minutes or so to ask some questions so please type some questions into the Q&A box we've got a couple arriving already but I had a couple of thoughts on that because it was very thought provoking and it really for me raised all sorts of issues around communication and how communication and scaling up and promoting technology is very difficult in a normal situation so in a humanitarian situation it becomes 10 times harder and I think the points you've made at the end there are really, really powerful because the number of organisations plus with what I call the magic boxes these little things that can treat water to 0.000 nanograms per litre or whatever and they're so fixated on the treatment side that they haven't really understood the human dimensions and I think that's come out really, really strongly I guess one question I'd like to pose before I pick out some that have come in is in the development context household water treatment is struggling to scale up in many regions of the world there are lots of different organisations trying lots of different ways but there is a consensus around sort of a market based approaches about no subsidies it should be a desirable product so how does that square with a humanitarian situation or a complex situation where it's kind of like South Sudan where it's kind of humanitarian working alongside long-term development where you have some organisations trying to market based approaches and then you have humanitarian organisations giving stuff out for free what's your experience with that tension? Yeah and that's a great question so humanitarian responses is almost by definition for free very, very few people think it's ethical to charge for any distribution in humanitarian response but I would actually challenge a little bit your statement that there's a consensus around market based approaches for household water treatment I think that there's a consensus around you need to look at the socioeconomic status of your recipient and determining which approach you use so for example if we're looking at middle income or higher income for their water treatment but I think when we look at the lowest quintile the bottom 20% in developing countries I also think there's a consensus that the provision can either be highly subsidised or it can be provided for free and so I think it's a more complex story of you're looking at the economic status of your user a middle income person in an urban area in India is going to be able to afford something quite different than as you say someone in DRC or Sudan and so it's a more complex picture and as you say I think we need to look at we need to really look at our end user in terms of what program we develop to reach them and I don't see in humanitarian response attention like if you get something for free in an emergency but there is attention in places like Haiti where there's been so much emergency response people aren't willing to pay for anything anymore even though they might be able to afford it because they're just all wait for the next person to give me free aqua tabs does that make sense and I just wanted to say I've seen a bunch of questions about if you'd like to send me this I'm happy to send the presentation I'm also happy to send research so I see a ton of questions on can you send me this or can you send me this literature all of those questions I think are probably not best to answer in this forum but just have me send an email to this and I'll send this off to you yeah I have the sphere standards not being endorsed by the UN they're so prolific even by UNHCR in its work so this actually is a fantastic question and the reason is the sphere standards are everyone uses them we all know everyone uses them but they are consensus based standards they are not evidence based standards and as such the UN does not formally endorse them it doesn't success the greater of populations for prepared and instructed in advance rather than reacting afterwards exactly disaster risk reduction preparing in advance we see that in Indonesia that would be the ideal is to have people know an option beforehand and then be able to use it afterwards that's what we saw in Indonesia with Boiling and Haiti with the chlorine program that worked really well with community health workers to emergencies happening unfortunately that's not how the funding is allocated funding comes after an emergency with the response pouring in there's not as much funding for risk reduction and I think we do need risk reduction and what's your experiences with how successful risk reduction has been outside these examples you know I think in Indonesia which clearly sees and Indonesia sees emergency after emergency it's right on the ring of fire there's a lot going on in that country and they've been able to establish long term emergency response cluster meetings and working groups and so for example Indonesia has a document these are the types of latrines we recommend that organizations coming in after an emergency build in Indonesia and so they have fantastic preparation fantastic planning it's clearly because they're so often impacted a challenge of course is there's these long-term working groups that make these documents what latrines they recommend for Indonesia don't come in with your latrine from Rwanda use the ones that are appropriate for the toileting practices here but then sometimes an organization will come in and they won't look at what's on the ground they call them cowboys we have cowboys dropping in and they do whatever they did in the last emergency whether or not that's appropriate for where they are and don't look at what's on the ground because I think when you look at what's on the ground is when you have the most impactful programs and that might require a little bit of culture shift in both the emergency and development response organization but that's when we see impact of volunteering because as you've put in the last slide there's tension between doing good and also do good as you end up getting in the way and actually causing a lot of headaches later on and Haiti is a great example of where everyone piled in and ended up in some cases doing more harm than good so what advice can you give on how people can volunteer in a useful practical way? Right and I think one thing and you raised really good points with Haiti where there was an expression in Haiti blondes falling out of the sky foreigners white people falling out after the earthquake was the expression in Creole and a lot of people did not help and there were people who flew in to help build fences and I'm like in a sense one you can find an organization you trust that does work that you know whether it be a local organization through your church or community that you know their work they're doing and donate money or an international organization for example it's very clear if you're interested in Ebola response MSS and IMC and Red Cross are doing fantastic care and treatment work is develop a skill that you offer in collaboration with an organization that can place you such that that skill can be used so if you're a doctor and you can provide medical care and you want to work with MSS or if you're an accountant and you want to help you know manage the money because when these huge influxes of money come in it's crazy to manage it all right so can you work with the NGO design or repair buildings or can you help train people or write manuals and I think one of the things I would say is always work with a reputable organization be that the local government or the international government or your own government or a reputable non-governmental organization and bring a skill because often if and I don't mean to sound rude who needs that money more and have them use their hands does that make sense and feel free to tell me I'm a little bit rude and I just more gently but I think it's really the skills that are often needed and can we transfer those skills locally yeah I guess yeah spot on I'll certainly back you up on that one yeah very much very useful okay we've got time for maybe one or two more questions and who asks can you tell a bit more why exactly the biosand filters in Haiti have failed to verify clean water is it more to to do the technical lack of training or was it the yeah was it was it this was actually they were literally installed incorrectly they were installed if you know biosand filters you're supposed to have a standing literally the the people installing the filters were really emergency affected and they they didn't have that that standing water layer the water came below the level of the sand was where the spout was put and so it was literally a technical error in installation by emergency affected workers that led to the biosand filters not affect you need that standing water layer to establish the Smith's Deca and in emergencies everyone around is affected and that impacts the work that you can do yeah great okay so I would just pick up one last question what it's kind of two related ones about from Steve asking do you see large centralized purification systems being effective in emergencies and are other methods of treatment like reverse osmosis and quite more technically advanced methods than the household water treatment right and exactly this raises a good point because I only talked about household water treatment here but there's I could do equivalent presentations for sanitation for hygiene for large water treatment and yes people do tend to bring in there's a huge movement to bring in what we call mobile water units that are removed at point zero zero one micro and blah blah and I think there's a great paper and I can send it on if you email me I can send it on to people that review some of these water treatment units these mobile water treatment units and the end result is if they are complicated which they most often are they have a lot of filters they have a lot of this you need to send someone who's trained to both install it and operate it so actually some countries have set like Indonesia literally said please do not send us any more mobile water treatments we will not accept them in the country through customs because people want to send these large units and they don't often provide the necessary training follow up equipment and maintenance now if you provide that necessary training follow up equipment and maintenance you can have a lot of high quality water treatment units and they're a little bit they're a little bit dinosaurs that break down very quickly and so there's a good paper from responders talking about which ones have worked well and which ones haven't that I can send on to people who are interested. Brilliant thank you and yeah so I think we're coming up to the top of the hour now so thank you very thank you very much. I've got no question for one more question so I'll pick out one more question. Yeah what do you see as the future for emergency response let's go for that from Robin. I think there is a huge push and this is coming from USAID it's coming from DFID the UK equivalent of USAID it's coming from all of these organizations to get more evidence and there's a couple of questions I'm seeing on evidence to start doing the research necessary in emergencies to understand what is used how people use it what reduces the burden what reduces risks and doing research and emergencies to understand right now there's a lot of perceived wisdom if you hand this out people will recognize them and put data on it like I presented here and it's it's very simple research but the conclusions are very solid and generalizable and so there's a lot more work to do that research that's necessary and there's some things like R2HC the research for Humanitarian Contacts all this is coming out and I think it's important that we get that evidence base and then I think we will that's a mix of local governments international governments UN NGOs there's a lot of push toward coordination which is the cluster systems of coordination is moving forward but yeah it's about how do we do better selection of what we do in emergencies Brilliant. Okay well thank you Diana that's a fantastic presentation and really insightful responses to all those great great range of questions so thank you very much for your time and thank you to everyone that's attended this webinar and put in a very thoughtful questions we didn't get to all the questions but we'll respond to those and thank you very much to engineers for change for giving this opportunity to host this just a reminder that next week's RWSN webinar will be on rainwater harvesting but otherwise I'm looking forward to the next DFC webinar because if they're all as good as this one then I will definitely be logging on regularly so thank you very much for attending and I'll sign off Thank you. Okay thank you everyone