Water, Sanitation and Hygiene Assessment at the Household Level in Gaza – UNICEF Report

31 July 2017

EXECUTIVE SUMMARY

The Gaza Strip is facing immense challenges related to water, sanitation and hygiene (WASH), which pose significant health risks to its 1.8 million residents and constrain socioeconomic development. Groundwater from the coastal aquifer is the only water resource available in the Gaza Strip. However, abstraction from the aquifer stands at four times the aquifer’s recharge rate at 200 MCM/year, and is expected to rise to 260 MCM/year by 2020. In addition, more than 96 per cent of abstracted water is polluted and not fit for human consumption due to high salinity levels from sea water intrusion and high nitrate levels from excessive use of agrochemicals and wastewater infiltration. The water supply in the Gaza Strip is estimated at 90 I/c/d, below acceptable water quantity standards of 100 I/c/d recommended by the World Health Organization (WHO). Furthermore, the absence of sufficient wastewater treatment facilities results in approximately 35 MCM/year of untreated/partially treated wastewater discharged into the sea along the Gaza coast.

The deteriorated WASH situation has been compounded by nine years of blockade and three consecutive destructive wars. The consequences of the last armed conflict in 2014 are still affecting the WASH sector in direct and indirect ways by limiting the capacity to develop and deliver basic needs and services to people living in the Gaza Strip. Fifty days of continuous attacks caused massive destruction, devastation and displacement. Extensive damage to water and wastewater facilities reported by the Coastal Municipalities Water Utilities (MWU) and the Palestinian Water Authority (PWA) has received a preliminary estimate of around US$ 34 million. The reconstruction process is going slowly.

Since the last Israeli military operation (“Protective Edge”, 2014), there has been no household assessment carried out that focused on the operation’s impact on WASH conditions. In light of this, the WASH Cluster needs to conduct a contextual assessment. As such, GVC and the Palestinian Hydrology Group (PHG) proposed to undertake a thorough assessment with the financial and technical support of UNICEF. They evaluated the WASH conditions in the Gaza Strip at the household level, highlighting the diverse consequences suffered by women, men, girls and boys.

The main objective was to assess WASH conditions at the household level in the Gaza Strip while generating a comparative analysis that informed the identification of critical responses and actions. These, in turn, will contribute positively and efficiently to assuring minimum WASH standards for all Gaza Strip residents and thereby reduce health risks.

Assessment methodology

This assessment was conducted from September 2015 to March 2016 under the framework of the WASH monitoring working group (the technical working group that is part of the WASH Cluster), which was established to coordinate the assessment proposed by GVC, PHG and UNICEF. The framework adopted for this assessment consisted of four main consequent stages: 1) preparation, 2) data collection, 3) data analysis, and 4) report writing. The preparation stage included pre-meetings with the WASH monitoring working group to agree on final objectives, structure and required outputs, and also included the selection of a work team. The data collection stage included a field survey conducted through a prepared questionnaire and supported by complementary data; focus group workshops, observatory reports; and secondary data from previous implemented assessments. The data analysis included the elaboration of indicators.

Sample size for the field survey was calculated on a statistical equation for representativeness. According to the defined criteria, 2,382 households is representative of the total of 303,330 households in the Gaza Strip. Considering that 20 per cent of the implemented questionnaires are excluded in the cleaning process, the total minimum sample size was adjusted and rounded to 3,125 households. The sample was stratified based on governorates and localities and classified into four target groups; internally displaced persons, non-affected, war-affected and WASH-affected, of which the last was proposed by WASH-MWG during implementation of the assessment. Data collection was performed in three phases; 3,977 surveys were implemented after carrying out a testing phase including 624 surveys and 3,166 questionnaires were validated during the data cleaning process. The remaining questionnaires were excluded from the data analysis process.

Forty-seven indicators were developed to explain the findings of WASH conditions at the household level over the whole Gaza Strip with a link to the socio-economic situation before and after the 2014 armed conflict. Seven indicators were related to socio-economic conditions, 19 indicators were related to water, six indicators related to sanitation, and 15 indicators related to hygiene.

Main findings

Based on key findings of the assessment, results show that interviewed households are spending 33.8 New Israeli Sheqel (NIS)/capita (8.9 United States Dollar (USD)/capita) monthly on the WASH items; 10.6 NIS/capita (2.8 USD/capita) for cleaning supplies, 7.3 NIS/capita (1.9 USD/capita) for hygiene supplies, 5.2 NIS/capita (1.4 USD/capita) for feminine hygiene items, 4.9 NIS/capita (1.3 USD/capita) for drinking water, 4.2 NIS/capita (1.1 USD/capita) for domestic water, and 1.6 NIS/capita (0.4 USD/capita) for solid waste disposal. Additionally, 57 per cent of interviewed households in the Gaza Strip don’t pay for domestic water, Of these, 87 per cent don’t pay because of their economic situation or lack of social responsibility while the remaining households don’t pay because they are not connected to a municipal network or well (they get water from private/illegal wells or public filling points).

Regarding the water situation, results show that the main source of drinking water for interviewed households is desalinated water supplied mainly from water trucks (85 per cent) and public filling points (11 per cent). On the other hand, 84 per cent of interviewed households are supplied by domestic water from municipal networks and 16 per cent from private wells. Around 18 per cent of interviewed households use domestic water sometimes as an alternative source for drinking and cooking. The results show also that 94 per cent of interviewed households in the Gaza Strip are satisfied with the drinking water quality, while only 43 per cent of interviewed households are not satisfied with domestic water quality, mainly because of a salinity issue.

In terms of water storage, eight per cent of interviewed households in the Gaza Strip experienced a decrease in drinking water storage capacity, while 20 per cent of interviewed households described a decrease in domestic water storage facilities after 2014. Ninety-four per cent of interviewed women and 92 per cent of interviewed men were aware of the importance of cleaning drinking water storage, while 76 per cent of interviewed women and 79 per cent of interviewed men don’t recognize the importance of cleaning domestic water storage vessels.

WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

One per cent of interviewed households don’t have toilets; 11 per cent of interviewed households don’t have a sufficient number of toilets. Indictors show that 30 per cent of interviewed households in the Gaza Strip are not connected to wastewater networks and they are using insulated cesspits and small holes that pollute groundwater and the environment. Moreover, 51 per cent of interviewed households have no access to proper drainage systems and are suffering from an accumulation of polluted storm water surrounding their houses during intense rainfalls. The most disturbing sanitation issue relates to solid waste management: around 72 per cent of interviewed households don’t have a safe means of solid waste disposal.

Results of the assessment show that around nine per cent of interviewed households in the Gaza Strip don’t have a hand washing sink, 17 per cent don’t have a shower and 11 per cent don’t have a kitchen sink. The results illustrate poor hygiene practices: 72 per cent of interviewed women and 75 per cent of interviewed men in the Gaza Strip don’t wash their hands properly, while 12 per cent of interviewed women and 15 per cent of interviewed men don’t shower sufficiently. Moreover, 3.7 per cent of reproductive aged women don’t have appropriate materials for menstruation. The percentage of waterborne disease (such as skin disease, diarrhoea and giardiasis) infection is significant. Twenty-five per cent of households with children under five years and 22 per cent of households with members above five years have been infected by waterborne diseases.

Recommended interventions

Seventeen interventions have been proposed based on WASH needs illustrated by the assessment. The main water-related interventions will enhance storage capacity, improve quality of both drinking and domestic water, and promote public awareness of the importance of cleaning water storage.

In regards to sanitation, urgent interventions are proposed to protect the surrounding environment and promote good hygiene. Proposed sanitation interventions include installation of new toilets for vulnerable households, installation of wastewater household connections, installation or upgrade of storm water drainage systems and the improvement of solid waste disposal.

In terms of interventions related to hygiene, all of the proposals are very important because they mitigate or solve key public health issues. The proposed interventions include installation and maintenance of sanitation facilities; hand washing sinks, showers and kitchen sinks. Interventions include promotional awareness campaigns about proper hand washing and showering practices, enhancement of menstruation management for vulnerable women, distribution of hygiene kits and identification of ‘hot spots’ of waterborne disease.

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