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Uganda: Responding to cholera during a refugee emergency

19 Oct 2018

In February 2018, in the space of a few weeks, over 40,000 refugees fled violence in the Democratic Republic of Congo (DRC) to seek refuge on the shores of Lake Albert in neighbouring Uganda. They crossed the lake in overcrowded and rickety fishing boats in search of safety but instead found dire living conditions, and an outbreak of cholera that was rapidly escalating out of control. In response, we’ve sent emergency teams to both sides of the lake, offering medical humanitarian assistance to those in need. Australian engineer Rosie Sanderson was part of the emergency team in Kyangwali, Uganda. She provides some insight into the role of a water and sanitation specialist (WatSan) in MSF's emergency cholera response.  

What is the role of a WatSan team in an emergency like this?

Our MSF WatSan team had two main responsibilities: to work alongside the medical teams to set up, maintain and manage cholera treatment units and oral rehydration points; and to prevent the spread of cholera around the camp by providing clean, safe water to the refugees. My role focused on the latter.

"Working with the emergency team usually means the only thing you can expect is that each day will be different."

What was a typical day like for you?

Working with the emergency team usually means the only thing you can expect is that each day will be different. A typical day might see me up at 6am, checking over a design for the next groundwater borehole that we were to drill and trying to decide again, based on the limited information I had, if the location we had chosen was going to yield water.

A quick breakfast of rolex (chapatti and egg rolled into a burrito) then I would usually head off to the camps to check on our pipes and tanks and that people were using the water taps around the camp. Later in the day I might go down to our Water Treatment Plant - located about 30 minutes away from the camps on the shores of Lake Albert - to help our supervisor with a malfunctioning pump or perform some water quality testing. Then in the evening before the work day finished I had to review how much water we had trucked in that day and make sure our 45-strong team of water chlorinators had enough chlorine supply for the next few days to continue to treat all the water that came into the camp, no matter which source it came from. 

What were some of the challenges you faced and how did you cope?

From a technical perspective, it was quite hard to identify reliable water sources as the ground was so fractured and rocky, and the existing information was pretty patchy. Finding underground water was often more a case of luck than expertise, even after conducting geophysical surveys of the target locations.

Water trucking to distribute water around the refugee camp was not a long-term, sustainable solution and sometimes simply the terrible access and wet conditions meant we physically couldn’t get water to people. And even with all the work we did, there were still shortages and large distances for people to go to collect water. I had to continually remind myself and my team that there was no one perfect solution, and that we needed to work in phases. On a personal note, it was challenging to see how difficult the conditions of the camps were for an otherwise resilient and strong group of people, particularly women and children.

“I’m proud of the work the MSF team did in Kyangwali – running the cholera treatment units, providing clean drinking water, chlorinating water tanks, and undertaking a massive cholera vaccination campaign all contributed to the outbreak being declared over by May.”

Can you share a highlight from your time working in Kyangwali?

One of my proudest achievements was a collaborative effort. The Ugandan Red Cross had found a natural stream behind the refugee camp, and had set up a very small, simple but elegant physical/chemical treatment plant to supply water to the families in that immediate area. But they faced severe funding and material constraints. By putting our heads together, and with MSF providing technical, material and man power support, we were able to go from providing 500 people with water to 10,000 every day.

I’m proud of the work the MSF team did in Kyangwali – running the cholera treatment units, providing clean drinking water, chlorinating water tanks, and undertaking a massive cholera vaccination campaign all contributed to the outbreak being declared over by May.”

WORKING AS AN ENGINEER FOR MSF

Water and sanitation specialists working for MSF are responsible for the planning, coordination, implementation and monitoring of all water, health and sanitation (WHS) activities in the project, including, but not limited to: water supply, excreta disposal, waste management, hygiene, and infection control. MSF also employs engineers in other non-medical roles such as construction managers and general logisticians. For more information about working for MSF, visit: https://www.msf.org.au/join-our-team/work-overseas/who-we-need/non-medic...