Essential services: Water supply

Information sheet for Health Facilities in Emergencies

Without water a health care setting cannot safely operate. A health care setting not only represents a concentrated area of patients but also a concentrated area of germs.  

To maintain an optimum level of safety, in disaster situations health care settings should be able to maintain essential environmental health services such as, a reliable supply of good quality water, facilities to provide access to safe hygiene, sanitation and health care waste management, this to control the spread of health care settings associated infections which are a major causes of morbidity and mortality.   

These measures are priority in health care settings and should be integrated as key components in the initial development phase of a health care structure in natural disaster prone areas, and globally secured for all buildings where health care is provided.   

A safe water supply will rely on a number of factors such as agreements with water authorities to prioritize supplies provided to health structures and, alternatively in emergency, to quickly provide the necessary water resources. This also relies on functioning power supply to operate pumping systems to maintain enough pressure in the water network or to fill up emergency buffer storages.  

Actions which can be taken  

Within the health care setting, the presence of well trained environmental health technicians is fundamental to ensure that water, sanitation and hygiene facilities are designed based on potential or prevailing risks and ensure that in all contexts safety standards are maintained.  

Whenever services are disrupted, this should be reported to agencies identified in the pre-planning phase and responsible for restoring services or to provide alternative options. In such an extreme scenario, the accuracy of the information, based on a pre-defined assessment tool, is fundamental and requires the service of a competent environmental health staff.   

Microbial water quality as well as minimum water quantity are of overriding importance for drinking and for infection control in health care settings. In practice, this means that a safe water supply should be secured from a protected source which ensures an uninterrupted supply. A two-day buffer storage would be the minimum required considering that emergency contexts mean increased health care activities and safety should not be compromised because of water usage restrictions.  

Essential standards defined by WHO and SPHERE recommend 40 to 60 litres for in patients per day in hospitals. This quantity can go up to above 100 litres per patient per day when surgical procedures are performed or in isolation centres and covers the needs for drinking, cooking and hygiene.

Hygiene facilities should be operational all times in all services where health care is provided with a priority on hand hygiene. Alternatively, in case of emergency, simple improved water containers equipped with a tap can be safely used if the network is disrupted and there is no water running out of taps. Those should be stored as safety alternative options.  

Sources of water should be also secured to flush toilets or for washing and hygienic purpose. The wastewater produced should be drained through the main sewerage if still operational or alternatively treated on site if space permit or stored and emptied by vacuum tankers for safe treatment off site. This also requires pre agreement with competent agencies.  

The safe management of Infectious health care waste is crucial to prevent the transmission of diseases and particularly blood borne pathogens. Proper segregation and storage of waste should be maintained and additional containers available. Waste should be treated and disposed safely in the existing system in place on site or off site. Alternatively a fenced disposal site where infectious waste will be burned and buried need to be part of a pre-agreed scenario with local competent agencies if the existing facilities are disrupted.  

WHO activities   

In emergency contexts WHO leads the health cluster and has the responsibility to ensure that safe water, access to sanitation and hygiene facilities and safe waste management measures are in place in health care facilities. WHO played an active role in the safety of Cholera Treatment Centres during the past cholera outbreaks by ensuring that those centres were operating according to safety environmental health standards.

Reference documents:  

Guidelines for drinking-water quality, third edition, incorporating first

Environmental health in emergencies and disasters: a practical guide

WHO Technical notes for emergencies

Frequently asked questions in case of emergencies

Four steps for the sound management of health-care waste in emergencies

Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies (WHO, 1999)  

Essential Environmental Health Standards in Health Care