water and habitat: public health engineering during armed conflict, 1983-2013

7/29/2019 Water and habitat: Public health engineering during armed conflict, 1983-2013

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WATER AND HABITATPUBLIC HEALTH ENGINEERING DURING ARMED CONFLICT:1983-2013


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International Committee of the Red Cross19, avenue de la Paix1202 Geneva, Switzerland

T +41 22 734 60 01 F +41 22 733 20 57E-mail: [email protected] www.icrc.org ICRC, September 2013

Front cover: Jamil Ahmed/ICRC

WATER AND HABITAT

THE WATER AND HABITAT UNIT AT THE ICRC WAS SET UP IN 1983.IT ASSISTS COMMUNITIES IN NEED AND VULNERABLE GROUPSSUCH AS DISPLACED PEOPLE AND DETAINEES.

WATER, SANITATION, SHELTER, CONSTRUCTION, ESSENTIAL SERVICES

PUBLIC HEALTH ENGINEERING DURING ARMED CONFLICT:1983-2013


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4 5

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

The ICRC was born on the battleeld o Solerino

150 years ago. The nature o warare and the needs o

people aected by it have changed dramatically since

then. And so has the nature o humanitarian work. The

ICRC seeks to be in close contact with the people it tries

to help, and to maintain a dialogue with them. To that

end, it constantly adapts the activities it undertakes

during armed conict and other orms o violence.

Water-and-habitat projects became part o the ICRCs

humanitarian response about 30 years ago. During

a complex large-scale operation along the Thai-

Cambodian border 1979, ICRC delegates, having iden-

tied the diverse needs o more than a million dis-placed people, developed a public-health approach

that included provision o clean water and sanitation

and creation o a health inrastructure.

In the beginning, the ICRCs water-and-habitat activi-

ties mainly took the orm o emergency work in rural

areas rom building small water distribution systems

and latrines in remote Salvadoran villages to major

assis-tance operations during the Ethiopian amine

1985-1987. By the 1990s the ICRC was responding

to situations in Iraq and the ormer Yugoslavia, or

instance where the destruction o inrastructure in

densely populated environments had aected mil-

lions o people. In Baghdad in 1991, many large health-

care acilities and complex water supply systems had

ceased to unction owing to the destruction o elec-

trical power stations. The ICRC made a substantial

commitment to keeping the citys power grid, water

supply and water treatment plants running. And in

Syria in 2012, the ICRC provided water treatment prod-

ucts to ensure that people throughout the country

had access to sae drinking water; the organization also

donated generators to water pumping stations.

The prevalence o protracted conicts has led to the

ICRC taking a longer view and emphasizing sustain-

ability in its approach. Its ocus, within communities,

is on preventing disease through hygiene-awareness

programmes and sanitation management. At the struc-

tural level it concerns itsel with system maintenance

and sewage treatment or evacuation. Both kinds o

work require interaction with a broad range o com-

munity-based groups, partners and authorities.

Over the last 30 years, the ICRCs Water and Habitat

Unit, or WatHab, has also been incorporated in ICRC

activities to benet particularly vulnerable people.

The unit has developed a specic expertise in deten-

tion-related issues: in prisons, overcrowding and poor

sanitation can pose serious health risks. WatHab engi-

neers work at all levels o a prison system to respond to

individual needs and to general structural problems.

The unit has also contributed to the ICRCs physical

rehabilitation programme by constructing or renovat-

ing orthopaedic centres. The longest running o these

centres is in Kabul and over the years it, together with

six other centres in Aghanistan, has enabled 150,000

Aghans to be tted with articial l imbs.

Anticipating needs and managing existing water sup-

plies to ensure their sustain-ability: these are two o

the most crucial challenges conronting WatHab today.

The unit now uses geographic inormation systems to

track population movements and the spread o dis-

ease and to manage water systems. In northern Ethio-

pia, a region particularly vulnerable to environmental

changes, the authorities need rapid and reliable inor-

mation. Technology and training provided by the ICRC

make it possible now or local water boards to monitor

thousands o water points throughout the region.

There are over 500 WatHab engineers at present, with

widely varying proessional backgrounds. In some

50 countries, the unit can draw on the local knowl-

edge and expertise o a large number o locally hired

employees. Together with their expatriate colleagues,

they are one o the ICRCs major assets.

Pierre Krhenbhl

Director o Operations


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1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

www.icrc.org/saewater-30years

ICRC WATER AND HABITAT PROJECTS:1983-2013

Countries in whichWater and Habitat projectswere realized for


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8 9

F.DeBros/ICRC

Uqd, Yemen. Arrival o the clinoboxoperating theatre.

WAR IN THE DESERTIn 1962, war broke out in Yemen. Doctors rom the

International Committee o the Red Cross (ICRC) vis-

ited remote areas o the country in 1962 and 1963;

they sent back reports that were starkly reminiscent

o Henry Dunants account o the suering endured by

wounded soldiers on the battleeld at Solerino in 1859

the events that inspired the creation o the ICRC.

This excerpt rom one o those reports describes the

situation conronting those injured in the remote north,

near the border o Saudi Arabia, where health care or

soldiers and civilians was virtually non-existent:

Transport or the wounded is very long; it happens on

a mans back, or on the back o a donkey, or a camel and

can take eight days beore [the injured person] reaches

a doctor. It is not astonishing thereore that many o the

injured died en route.

These reports led the ICRC in 1963 to send numerous

medical teams and to set up a ully equipped 50-bed

eld hospital in the Uqd desert, near the Saudi bor-

der. It was not an easy task. Hospital equipment had

to be transported by air and then carried by lorry over

unpaved, rutted roadways ull o sand and rocks.

The ty beds were immediately occupied and hos-

pital capacity had to be immediately increased to one

hundred beds, wrote one nurse who was there at the

time and whose reports were published several years

later in the International Review of the Red Cross . The

temperature was high in the tents at midday, partic-

ularly in the summer, when 50 degrees Celsius is normal.

The ICRC teams were sae only at night. They worked

ceaselessly under the cover o darkness, treating and

operating on the wounded, who were lying in heaps

on the ground.

The initial team o thirty people included doctors, sur-

geons, anaesthetists, nurses, mechanics, drivers, radio

technicians, storekeepers and a cook. The scarcity o

water, which made sanitation and maintaining basic

standards o hygiene extremely difcult, was an inescap-

able act o lie. Despite this, there were no water or sani-

tation engineers on the initial team. The need or water,

being paramount, required in the same nurses words

a constant coming and going between the hospital

and the well some twenty kilometres away, across tracks

which were a severe trial or the tank lorries.


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10 11

YvesDebraine/ICRC

ICRC

Protective red crossemblem showinglocation oUqd eld hospital.(Right)

Uqd, Yemen.ICRC eld hospital. THE WAR FOR WATER

Until the mid-1970s, scarcity o water was the main

issue in tribal conicts in northern Yemen. The civil war

that lasted rom 1962 to 1970 had made water even

scarcer or those who had been displaced and or those

involved in the ghting. In this harsh environment, the

ICRCs hospital was something o an oasis.

I was very surprised, Pascal Gellety, a French doctor

who worked there in 1964, told interviewers. I expected

a little hospital in a tent, but what I ound was a ully

equipped hospital that was unctioning admirably

well in particularly difcult conditions in the middle o

the desert.

But there were problems. Rationing, o water and pro-

visions, was a lingering issue; as was the challenge

or European doctors and nurses rom Zurich, Paris or

Madrid o working in the desert. Nonetheless, between

1963 and 1965, doctors and nurses living in this small

colony o tents saw some 160 patients every day and

carried out more than 2,000 surgical operations.

The Uqd hospital has become emblematic o neutral

humanitarian action and is a symbol o the ICRCs com-

mitment to go wherever help is needed. Yemen might

have been an exceptionally challenging assignment,

but it was ar rom being the only difcult one that ICRC

delegations have had: rom Indo-China to West Arica,

delegates and surgical teams have had to cope with

settings in which lack o water and sanitation, and poor

public health conditions, took as many lives as bombs

and bullets did. As a result o mission reports about the

secondary health eects o conict malaria, diarrhoea

and malnutrition, or instance the ICRC developed the

holistic approach to public health during emergencies

that it employs today.

The ICRC began working in Yemen a little over 50 years

ago. Today, it carries out a wide range o activities in

the country: or instance, providing medical supplies

or hospitals, health-care acilities and physical rehabili-

tation centres in various parts o the country, making

physical improvements to these acilities, and training

local medical personnel. The ICRC has also been able

to ensure that the population aected (some 430,000

people in 2012) has sae drinking water. Ambitious

water and sanitation projects are under way: these

could reduce territorial tensions over water and greatly

improve living conditions or those caught up in the

current crisis.


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1312

GrardLeblanc/ICRC

THE TURNING POINTIn 1979, more than a million people in ight rom

the ghting and violence in Cambodia settled in and

around several massive reugee camps in Thailand, a

short distance rom the Cambodian border.

Needs were great and conditions tough; the humani-

tarian response was many-sided and substantial. The

ICRC had agreed to coordinate the distribution o ood

and medicines, as well as other activities conducted by

the numerous humanitarian organizations working in

the camps. It also helped to build up many essential

elements o the camps inrastructure: rom latrines to

health posts, and then a ull-sized eld hospital.

This swit and unexpected settlement o a large num-

ber o people equivalent to the population o a small

city in a semi-tropical orest posed a serious threat

to public health. At the Mak Moun reugee camp

(above), the ICRC trucked in large quantities o water.

Meanwhile, water engineers rom the ICRC and other

humanitarian organizations worked to nd local

sources that could provide a steady supply o water or

the camps massive population.

As the operation unolded, it quickly became clear

that a greater level o expertise in managing water and

sanitation was needed to keep the camps population

healthy. Rmy Russbach, then the head o the ICRCs

medical division, was impressed by the work o water

and sanitation experts particularly rom the Australian

Red Cross and the New Zealand Red Cross who were

creating systems or pumping clean, sae water and

distributing it to a population already eeling the eects

o water-borne diseases.


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14 15

GrardLeblanc/ICRC

GrardLeblanc/ICRC

V.

Olivier/ICRC

Construction o the hospital (below) is not yet complete, but it has alreadybegun to provide essential services.

Arrival o rst batch o reugees at the ICRC's Khao I Dang camp inThailand. Locally available bamboo was used to build the camp hospital.

At the same time, a French doctor named Pierre Perrin

working in the camps (rst or Mdecins Sans Frontires

and later or the ICRC) was becoming very worried

about the state o his patients health. Increasingly,

medical teams were dealing with diseases or which the

surgeons bench was not the remedy: the solution lay in

improving standards o hygiene within the entire com-

munity. Perrin developed a model he called the health

pyramid. This would change the ICRCs approach, as

well as that o many humanitarian organizations, to

assisting people aected.

At the top o the pyramid is curative care, such as

emergency surgery, which is usually provided only at a

hospital or eld hospital. In the middle is public health

vaccinations, basic medicines: this is a daily concern

and such care is dispensed normally at a health post. At

the bottom are nutrition and sanitation the two key

blocks, Perrin argued.

But the ICRC had no expertise o its own or dealing

with the water and sanitation needs o large popula-

tions. Doctors rom the ICRCs medical division were

asked to direct and oversee the development o water

and sanitation systems while they were setting up and

running eld hospitals such as the one at the Khao

I Dang camp, which was made out o locally available

bamboo. No one would even think o asking a water

engineer to operate on a patient, but doctors are being

asked all the time to do things outside their area o

expertise,Perrin noted.

Rmy Russbach, an early supporter, agreed. A ew

years later, in 1983, he would hire the people needed

to sta the newly created Water and Sanitation Unit.

The work o Perrin, Russbach and others would help

change the delivery o assistance in the decades that

ollowed; it would also make public health a consider-

ation in mounting emergency operations. But all this

did not happen overnight.

During great displacements opopulations, the absence o potablewater and the accumulation ogarbage have a signifcant impacton morbidity and mortality rates,comparable in their destructivenessto the use o weapons.Rmy RussbachHead of the ICRCs medical division (1977-1994)

It makes no sense, he reasoned, to manage the health

o vulnerable people rom the top down with cura-

tive care i their immediate environment and,

crucially, their water supply, is unhealthy. I you put

all your attention at the top o the pyramid, then you

have no oundation the pyramid is inverted and will

topple over,he said.

Perrin was a passionate advocate with a air or draw-

ing cartoons to illustrate his mission reports. He laid

out his case boldly and clearly. It is hopeless to take

care only o the sick people i nothing else is done or

the sanitation in a camp at the same time,he wrote.


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16 17

GrardLeblanc/ICRC

EdouardWiniger/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998

1983

19

Pipes being laid to supply villageswith clean water (let).

Northern El Salvador (below).Equipment, or setting up an ICRC radio aerial,being transported.

THE BIRTH OF WATHABEL SALVADOR 1983Russbach was persuaded by the ICRCs experiences in

the reugee camps on the Thai-Cambodian border that

the organization needed greater technical expertise in

water and sanitation. At the time, he recalls, there was

a prevailing myth that medicine was a kind o saviour

that would cure all ills an idea that was completely

anchored in the habits o donors and victims.

It took considerable energy to change the mind-set,

Russbach says. The rst big step was taken in 1980,

when the ICRCs Assembly reassessed the organiza-

tions medical activities. In principle, the Assembly

agreed to hire a nutritionist and a sanitation engineer

(Alain Mourey and Bob Smyth, respectively). This led

to the establishment, in June 1983, o the ICRCs Water

and Sanitation Unit.

Next came a period o intense activity and numerous

eld missions: newly hired engineers built water and

sanitation systems in various conict zones rom small

water catchment and water distribution systems in

remote villages o war-torn El Salvador to major opera-

tions during the Ethiopian amine o 1985.

The El Salvador operation was humanitarian assistance

in its most concrete orm. Basic materials or construc-

tion, such as wooden beams, planks, sheet metal, nails,

basic tools, sand and cement, were put directly into the

hands o people aected by conict. A new opening

in terms o assistance was created in that era, says

Franois Rue, recalling his rst mission in El Salvador

as a eld delegate.

The country was riven by internal conict and grow-

ing numbers o civilians were being displaced by the

conict. The newly created Water and Sanitation Unit

(then part o the Medical Division) provided resh

access to water, in signicant quantities, or 135,000

people displaced by the ghting or trapped in villages

surrounded by it. ICRC activities in El Salvador included

the ollowing: searching or missing persons, visiting

detainees, undertaking eld medical missions, pro-

viding ood assistance and water and sanitation.

It was a period o growth and experimentation, with

engineers learning to adapt to radically dierent envi-

ronments and evolving conicts. It was decided early

on that the ICRCs activities in this connection would

be guided by high levels o technical expertise and

scientic proessionalism. In 1983, Dr Giorgio Nembrini,

a chemist who specialized in water treatment and

environmental analysis, was appointed head o the

Water and Sanitation Unit.

The units activities gradually broadened. For instance,

it began to work in detention acilities (prisons in

Uganda and Zaire were among the rst); this presented

new challenges as well as opportunities or support-

ing the ICRCs protection work. Activities that are

now regarded as comparatively routine aspects o

the ICRCs eorts to improve living conditions or

detainees were pioneered in that era.


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1918

DanyGignoux/ICRC

DanyGignoux/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983

1985

1986 1987

Displaced persons, at the Quiha camp in Ethiopia,waiting or water to be distributed.

Tigray, Mekele.Installation o a sandlter next toa water reservoir.

ETHIOPIA 1985-1987

Civil war, extreme poverty and drought led to a am-

ine that aected millions o people, mainly in Tigray

and Eritrea. The joint response o the Ethiopian Red

Cross Society and the ICRC was o an unprecedented

scale. About a million people were given assistance

in the orm o ood, seed and medical care. Wells and

spring catchments were rehabilitated, ensuring access

to water or villages aected, camps housing internally

displaced persons, and therapeutic eeding centres.

The photograph on the let shows a sand-ltrationsystem being set up.

It was during the Ethiopian am-ine that the engineering approachbegan to receive consideration Suddenly, the head o operations at that time, Jean Pierre Hock was saying, You have to do more.

And small was no longer beautiul.And we did it. In act, we grew withthe needs and we were alwaysready to take up the challenges.Dr Giorgio Nembrini

The team also continued to experiment with new

technology and worked with its colleagues in the ICRCs

assistance division on improving ood security by umi-

gating crops to protect them rom insects such as

locusts. Most o the operations were in rural or remote

areas and the water systems were relatively small-scale.

But there were some notable exceptions: the massive

Ethiopia assistance operation, the restoration o the

power grid and water systems in Monrovia during the

Liberian civil war, and the provision o water to the

besieged population o Beirut.

Gradually, the idea that engineers could also be

humanitarians, like doctors and other conventional

delegates in the eld, gained acceptance. At the same

time, the humanitarian sector as a whole was becom-

ing more proessionalized: many o the ICRCs Water

and Sanitation engineers came rom other areas,

bringing with them technical and proessional skills

o other kinds. Yves Etienne, who had worked or the

World Bank beore joining the ICRC in 1986, was such

an engineer. At the time, Etienne recalls, a rigid distinc-

tion was observed between emergency operations

and development.There was a certain distrust within

the ICRC o diversiying assistance activities, he says.

We noticed, even in the medical sta, a reluctance to

recognize water and sanitation as health activities in

the proper sense.

Formal recognition within the ICRC took shape in

1998, when the Water and Sanitation Unit and the

Construction Unit, then under the assistance division,

were merged and Riccardo Conti a hydrogeologist

and mining engineer who had worked abroad in the

mining sector or ten years beore undertaking mis-

sions in Arica, Asia, Europe and the Middle East or

the ICRC became the rst head o the newly created

Water and Habitat Unit, or WatHab.


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2120

ThierryGassmann/ICRC

FredGrimm/ICRC

1984 1985 1986 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 201303

1986

198919881987

SUDAN 1986-1989

As the civil war in South Sudan worsened, a major

assistance operation was launched, targeting inter-

nally displaced people who had gathered around

government-controlled towns, as well as civilians in

areas held by the Sudan Peoples Liberation Army.

Water projects or internally displaced people, and

or eeding centres and health inrastructure proj-

ects, were an essential aspect o the ICRCs response.

The photograph above shows a woman at an ICRC

water project in Yirol, now in central South Sudan. In

Narus, the ICRC set up a water pump at a spring (above,

right) or people in desperate need o resh, clean

drinking water.


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2322

LuzLuzemo/ICRC

LucChessex/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1990 1991 1992 1993 1994 1995 1996 1997 19981983

1988

1989

MOZAMBIQUE 1989

ANGOLA 1988

In 1988, the ICRC negotiated access to both security

detainees and civilians aected by the conict. Forthe people o Inhaminga (below), as or many others

in Mozambique, access to a reliable supply o water

was oten limited. The ICRC transported spare parts or

water pumps where needed; and a sanitary engineer

worked with the Programa Nacional de Agua Rural, a

government organization, to sink several wells and

repair a number o those already in existence.

Drought and conict had a direct impact on the

harvest and on nutrition. Access to war-aected victims

was not always easy. Ater lengthy negotiations with

all the parties, the ICRC obtained security guarantees

to resume work in the provinces o Huambo, Bi and

Benguela. Here, despite the erce ghting in progress,

ICRC sanitary engineers completed projects in 25 towns

or thousands o internally displaced people and resi-

dents. The ICRCs response also included improving

conditions or patients in health centres and hospitals;

in addition, the ICRC set up nutrition centres, as well as

more health centres.


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2524

SergeCorrieras/ICRC

ThomasPizer/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1991 1992 1993 1994 1995 1996 1997 19981983 1984 1985 1986 1987 1988 1989 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

1990

CAMBODIA 1990

As the ICRCs medical operations grew in the 1990s, its

engineers helped to repair or build acilities or provid-

ing adequate water, heating, cooling and sanitation, as

well as energy efciency and the proper handling o

medical waste oten in very difcult circumstances.

Underground wells were developed to supply the

ICRCs sub-delegation and the surgery hospital in

Mongkolborei in north-western Cambodia. ICRC engi-

neers also built a prosthetic workshop in Battambang

in 1991 to provide low-cost prostheses or amputees;

the workshop is now helping ageing amputees adjust

to their prostheses.


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2726

CarloHeathcote/ICRC

FranoisRuef/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1992 1993 1994 1995 1996 1997 19981983

1991

Kabul, ICRC orthopaedic centre.

KABUL, AFGHANISTAN 1991

In the 1990s, the ICRC expanded its activities in the

area o physical rehabilitation, and WatHab provided

support or that. One example is the construction o

the orthopaedic centre in Kabul. Conceived during the

civil war that broke out ater the Soviet withdrawal, the

centre continues to serve those who have lost limbs

throughout this long and difcult period in Aghani-

stans history. Other centres would ollow in Mazar-

i-Shari, Herat, Jalalabad, Gulbahar, Lashkar Gah and

Faizabad and the WatHab team would play a crucial

role in their construction. Over the years, some 150,000

Aghans have received prostheses at these centres.


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2928

PhilippeDutoit/ICRC

MarcBouvier/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1992 1993 1994 1995 1996 1997 19981983 1984 19851983 1987 19881986 1989

1991

Al Musayab, near the city o Karbala (let).Water treatment plant constructedin the 1950s and not used or several years.The ICRC eventually rehabilitated it.

Baghdad, Saddam City Hospital (above).Provision o sae drinking water.

THE NEW URBANBATTLEGROUND

IRAQ 1991

When the coalition o orces led by the United States

launched its attack on Iraq in 1991, it used heavy

aerial bombardment o military and industrial sites as a

means to weaken Iraqs ability to wage war.

Electrical power stations that supplied not only the

countrys military apparatus, but also acilities vital to

the health o the civilian population, were aected.

The outage o power in much o Baghdad aected

hospitals, ood markets and the systems that supplied

the citys seven million people with clean water.

The Geneva Conventions say you cant bomb thewater treatment plants, but there is nothing in the

Conventions that explicitly says you cant bomb the

power plants,says Riccardo Conti, Head o the Water

and Habitat Unit at the time. The problem or the civil-

ian population is that i you bomb the power plants,

you also aect the water treatment plants.

As a consequence, the population in addition to

dealing with the direct eects o bombing, some o

which caused considerable numbers o civilian deaths

and injuries also had to cope with the spread o a

variety o inectious diseases. Outbreaks o cholera,

or example, were linked to the disruption o essen-

tial services over a long period during which hospital

services were overwhelmed and access curtailed.

Civilians were already suering under the sanctions

imposed by the United Nations Security Council

ollowing Iraqs annexation o Kuwait in August 1990.

The military action by coalition orces in January 1991

severely damaged the countrys inrastructure even

urther. The economic sanctions continued, and they

added to the problems o Iraqis. The ICRC maintained

its response throughout this period, by providing

support or hospitals and livelihoods and by repairing

and maintaining electrical power stations damaged

by bombing.


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30 31

MarcBouvier/ICRC

OmarSaad/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

2001

Wasit, near the city o Kut.Water treatment plant completelyrenovated by the ICRC.The plant supplies water to all2,000 inhabitants o the city.

Baghdad.Team o technicians working inAl Wethba pumping station.

IRAQ: TWENTY YEARS LATER,THE WORK GOES ON

For the ICRC engineers who went to Baghdad, the

operation was a turning point. This was the rst time

that they had had to repair a highly developed water

system o this scale. Beore, conicts tended to aect

rural areas,says Conti.

Given the scale and complexity o Iraqs water systems,

the ICRC appointed or the rst time a water and

sanitation coordinator to work with local authorities

and international organizations in what would become

a substantial, long-term commitment to keeping the

citys power grid, water supply and water treatment

plants up and running.

The teams experiences in Beirut and Monrovia in 1989

had prepared them somewhat. There, ICRC engineers

realized the importance o orming partnerships with

local agencies and engineers, many o whom had con-

siderable experience and expertise.

[Beirut in 1989] is where our intervention in urban

centres began, says Nembrini. Under sometimes

heavy shelling we were able to restore the supply o

water in the southern suburbs and on part o the east

side o the town by installing a large generator at a

pumping station.

It was big or us at that time. We were suddenly deal-

ing with thousands o cubic metres or cities with

the related engineering complexity, he recalls. The

people were not in camps but they were living within

the theatre o the operations. They were dened as

the urban trapped,preerring to live where they were

used to, rather than crowding into reugee camps or

some other place that nobody knows.

The team had come a long way since El Salvador in

1983, when some o the relatively small, rural systems

it set up in remote villages were considered the limit o

the ICRCs capacity.

In order to mitigate some o the consequences o the

conict, the ICRC has helped local water boards to

improve the quality and increase the quantity o the

water they supply, as well as to ensure better evacu-

ation o wastewater. These eorts have continued

uninterruptedly since 1995 and have helped to prevent

the spread o water-borne diseases, thus protecting

millions o people. Ater the US invasion and thesubsequent collapse o the government o President

Saddam Hussein in 2003, the ICRC provided substantial

aid in the orm o medical supplies, water and other

essentials to more than 65 urban hospitals, and carried

out emergency repair work on water, sanitation and

power systems in hospitals and maternity and paediatric

centres throughout Iraq. Mobile water-distribution units

were also set up in urban areas suering rom acute

shortages, and regular deliveries made by ICRC water

tankers to regions with no other source o water. The

ICRCs eorts to improve the countrys basic inrastruc-

ture, which has not yet recovered ully, remain in place.


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3332

CdricPiralla/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 201319 84 19 851983 1987 19881986 1989

1992

SOMALIA 1992

When civil war broke out in Somalia in 1991, nearly all

State services collapsed and gaining access to water

became increasingly difcult. Water was also o stra-

tegic importance and water installations, vital to local

populations, were oten destroyed or military purposes.

Hundreds o boreholes along the transhumance route

or nomadic herding communities that relied on animal

production were no longer maintained. For the ICRC, the

rehabilitation o water points like the one shown above

is crucial or the integrated assistance it provides in a

country oten hit by drought, ooding and disease.


18/43

34 35

JolleCome/ICRC

LaurentSazy/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

1993

Split. Water-supply point in ronto a ruined building.

BOSNIA-HERZEGOVINA 1993

The struggle to nd clean water is one o the lesser-

known stories o this protracted conict. In some places,

distribution and treatment plants were destroyed dur-

ing the ghting or ell into disrepair or lack o parts and

chemicals. Elsewhere, they could not be used because

there was no electricity and access to water sources

was restricted, leaving isolated areas with no drinking

water. In addition to negotiating access or civilians

to water supplies, the ICRC worked to ensure that the

water available was sae to drink. The ICRCs water and

sanitation teams worked in some 70 dierent munici-

palities in the coastal city o Split, or instance, where

water was pumped rom in ront o a ruined building.


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3736

GuillaumeBinet/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1995 1996 1997 19981983

1994

A STRONG COMMITMENT

RWANDA 1994

Since 1915, the ICRC has been devising and conducting

activities to protect prisoners, detainees and internees

held in connection with international and non-inter-

national armed conicts.

The ICRCs mandate in this connection was rea-

rmed by the Third Geneva Convention o 1949, which

replaced and signicantly broadened the scope o the

1929 Convention on the Treatment o Prisoners o War.

More than 80 years ater the adoption o the Third

Geneva Convention, which entitles the ICRC to visit

prisoners o war without any restrictions, ICRC dele-

gates continue to monitor conditions o detention.

For the ICRC, the term conditions o detentionincludes

such things as the degree o respect or the detaineesphysical and mental integrity shown by the personnel

in charge o their lives; the material conditions o deten-

tion (ood, accommodation and hygiene); access to

health care and to a certain minimum amount o exer-

cise and leisure; and possibilities or maintaining amily

and social relationships, or working and or receiving

vocational training.

The all-detainees approach

Ater the Rwandan genocide in 1994, the ICRCs

approach to detention took a major shit. Detention

activities used to be strictly oriented towards prisoners

o war, security detainees or civilian internees; but the

massive increase in the jail population linked to the

Rwandan conict had unprecedented consequences

that led the ICRC to develop sanitation systems and

other health-related programmes aimed at helping

all detainees.

The pri mary objective is saeguarding the health o

detainees: saving lives and reducing rates o mor-

bidity and mortality. Over the past 30 years, WatHab

engineers have acquired specic expertise in the area

o environmental engineering as it relates to places

o detention, in order to improve public health and

ensure dignied living conditions.

ICRC engineers are now members o multidisciplinary

teams composed o protection delegates, health dele-

gates and nutritionists. Their activities are broad in

scope, ranging rom assessing the needs and health

risks associated with individual detainees to addressing

the root causes o deciencies in a given penitentiary

system. Today, the ICRC carries out detention activities

in 101 contexts; there are WatHab programmes in 37 and

they benet over 160,000 detainees each year.

Ater the horriying waves o massacres in which

armed militias wiped out hundreds o thousands o

civilians around two million Rwandan reugees ed

to camps across the borders with Zaire, Tanzania and

Burundi. A urther 500,000 people were displaced

within the country. From the outset, the aims o the

ICRCs water and sanitation programme in Rwanda were

twoold: to curb the outbreak o disease in the camps

and to rehabilitate the countrys main water supply

networks. A total o 10 camps or around 250,000 dis-

placed people were equipped with emergency water-

distribution systems, and materials or the construction

o latrines were provided. The ICRC also launched a

special programme in October 1994 to improve access

to potable water, ood and health care or thousands o

detainees living in squalid, overcrowded prisons.


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3938

EricBouvet/ICRC

PaulGrabhorn/ICRC

PaulGrabhorn/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1997 19981983

1995

1996

Grozny.Water distribution point installedby the ICRC.

Gihanga.Water distribution point beinginstalled by the ICRC.

BURUNDI 1995

CHECHNYA 1996

Political strie that weakened the government, peri-

odic attacks over a long period by rebel groups who

took reuge in urban areas, and large-scale operations

by militias and sections o the army: all these contrib-

uted to the deterioration o social and economic con-

ditions. Some 100,000 residents and displaced people

on the Imbo plain to the north-west o Bujumbura

Renewed ghting between ederal troops and Chechen

separatists impelled successive waves o civilians to

leave or neighbouring republics. Those who did not

ee remained trapped in their homes while their towns

and villages were shelled. Ater a large-scale oensive

by ederal orces in July, about 200,000 civilians ed the

capital city o Grozny. In response, the ICRC rehabili-

tated water and power networks and distributed water

by trucks in uncovered areas in the northern Caucasus.

The ICRC also got Groznys sewage system, including

13 pumping stations, working again.

were deprived o water as a result o violence in the

surrounding hills. As diarrhoea and cholera began to

spread, an emergency plan o action was switly put

into place. By the end o September 1995, in many vil-

lages and camps or displaced people around the coun-

try, the water supply had been secured.


21/43

4140

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1997 19981983 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

1996

1999

EAST TIMOR 1996

The expressions o joy on the aces o these childrenis eloquent proo o the undamental human need or

water. This water tap was installed by the Indonesian

Red Crescent and the ICRC in the village o Riattu dur-

ing a violent chapter in Indonesias history. As ghting

ared up between Indonesian orces and the armed

opposition, the Indonesian Red Crescent and ICRC

water engineers collaborated on a broad range o proj-

ects, including hydrogeological surveys, the sinking o

new wells, and the building o extensive water distri-

bution networks to supply widely dispersed hamlets.


22/43

4342

Je

anNordmann/ICRC

TillMayer/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 19981983

1997

Monrovia.An ICRC team chlorinates arehabilitated well.

ICRC staf helping the LiberianRed Cross clean upthe market-place in Monrovia.

LIBERIA 1997

During times o extreme crisis, maintaining public ser-

vices such as delivering water or removing solid waste

can help prevent the spread o diseases and provide

some order amidst the chaos. Liberia in the late 1990s

was subject to many actors that threatened its stabil-

ity. In 1997, the ICRC supervised maintenance work on

some 500 wells and pumps supplying drinking water

to Monrovia, the capital city. It also built or repaired

sanitation and water-supply acilities in places where

thousands o displaced people had gathered, as well

as in medical acilities in Monrovia and the provinces.


23/43

44 45

PaulGrabhorn/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 19981983

1997

MALI 1997

In northern Mali, as part o a programme called Water,

Spring o Lie, the I CRC rehabilitated water points such

as this one in Haoussa. These water points are critical

to the survival o livestock belonging to pastoralist

Tuareg communities. The situation in northern Mali

was already delicate and the persistent drought ag-

gravated matters: it gave rise to steadily growing

discontent in some sections o the population and

hence to conditions that were more raught with

danger. In 1996, the ICRC carried out environmental

sanitation work and rehabilitated traditional wells as

part o its medical programme in northern Mali.


24/43

4746

MarizildaCruppe/AgenceO

Globo/ICRC

PhilMoore/ICRC

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 19971983

1998

Burungo village, near Goma (above).The ICRC building installations or water distribution.

Volcanodistrict, Goma, North Kivu province (right).A young boy walks between reshly laid water pipes.In 2002, an eruption o the Nyiragongo volcanocompletely destroyed the district.

DEMOCRATIC REPUBLIC OFTHE CONGO 1998

The eastern part o Congo has endured a series o dra-

matic events over the last 20 years, rom the inux o

a million reugees in 1994 to the volcanic eruption in

the town o Goma. In 1998, the people o the Demo-

cratic Republic o the Congo were caught in a proxy

war between a number o neighbouring States. The

ICRC maintained its activities, reurbishing vital water

distribution systems in cities in the ve provinces most

aected by the conict. Improving water systems and

modernizing medical acilities were the ICRCs top

priorities. Over the last two decades, the ICRC has

continued to work with dedicated local operators to

provide water and sanitation acilities or displaced

people and civilians in rural and urban areas.


25/43

48 49

ICRC

BorisHeger/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

1999

ERITREA 1999

KOSOVO 1999

Following the war with Ethiopia in 1998, tens o thou-

sands o Eritreans living on the Ethiopian border

remained displaced or years. In order to help many o

those in displacement camps to return home, the ICRC

provided support or some 50 rural water projects,

donated building materials or the reconstruction

o homes, and helped rehabilitate local health inra-

structure. Given the availability o expertise in it, solar

technology was avoured or water pumping systems.

A series o air strikes on targets by NATO member

countries shattered much o the regions inrastructure

and let it on the verge o economic collapse. Some

800,000 ethnic Albanians ed, mainly to neighbouring

Albania, the ormer Yugoslav Republic o Macedonia,

and Montenegro. ICRC engineers were active through-

out the crisis, providing support or public-health acil-

ities and launching a programme that helped reurbish

wells throughout the country.


26/43

50 51

MarcBleich/ICRC

LucChessex/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

1999

LOKICHOKIO, KENYA 1999

The scale o casualties in the Sudanese civil war, which

broke out in 1986, was such that it necessitated the

establishment o an ICRC eld hospital in Lokichokio,

a village in northern Kenya on the Sudanese border.

The hospital grew considerably over the years: its

maximum capacity rose to 500 beds, and at one time

was thought to be the biggest eld hospital in the

world. When it closed in 2006, over 60,000 surgical

procedures had been carried out on 37,905 patients.

Such rapid expansion, accompanied by the exigencies

o adjusting to shiting needs, required a lot o work

behind the scenes.


27/43

52 53

FredClarke/ICRC

FredClarke/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

2000

GEORGIA 2000

It is oten the case during conicts that peoples lives

are dependent on the bravery o certain persons who

dare to go to work. Few people are aware o their

eorts, but water operators such as this control-room

guard at a water pumping station in Sukhumi, in north-

western Georgia, are quietly keeping others alive. War

also orces water engineers rom their posts or destroys

the machinery needed to keep the water owing, as

in this abandoned water pumping station. When that

happens, the ICRC can provide lielines. For example, in

2000, ater an assessment o the water and sanitation

needs o 6,500 Chechen reugees and 8,000 residents

in the Pankisi valley, communal latrines and baths were

built and a water piping system installed.


28/43

54 55

JessicaBarry/ICRC

CarloH

eathcote/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

2002

AFGHANISTAN 2002

Ater the collapse o the Taliban government in late

2001, the people o Aghanistan strove to create a basis

or stability and reconstruction. Hostilities remained

largely dormant, but tensions did are up rom time to

time. By the end o 2001, the ICRC had restored the ull

range o its activities throughout the country. These

were maintained throughout 2002 and the Aghan

operation became the largest mounted by the organi-

zation anywhere. In 2002, the ICRC improved water

supply and sanitation or some 2.7 million people.

In the north, during the winter o 2003-2004, poor

snowall gave rise to worries about drought. The ICRC

worked with the inhabitants o Shaidan village to con-

struct a dam to store water or irrigating the villages

agricultural land.


29/43

56 57

BorisHeger/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2006 2007 2008 2009 2010 2011 2012 2013

2005

DARFUR 2005

As a result o the civil war that broke out in 2003,

over two million civilians were internally displaced or

became reugees in neighbouring Chad, where, oten,

they were housed or sought reuge in urban areas.

The ICRC oered assistance not only in camps such as

the one in Gereida, but also in remote villages cut o

rom most assistance, where water was vital or armers

dependent on livestock. In many o these areas, such

as Al Hosh (let), water points had been destroyed and

needed to be rehabilitated with ICRC help.


30/43

58 59

OlivierMoeckli/ICRC

SarahBaumgartner/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

2005

1999 2000 2001 2002 2003 2004 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983

Muzafarabad.Aerial viewo ICRC eld hospital.

MUZAFFARABAD, PAKISTAN 2005

When an earthquake measuring 7.6 on the Richter scalestruck Pakistan-administered Kashmir on 8 October,

tens o thousands o people were killed and some

3.5 million let homeless. Entire villages were at-

tened, and water and electricity networks, roads,

schools and health acilities suered massive damage.

Many people rom severely aected rural areas

sought assistance in Muzaarabad, the largest city in

the region, even though it had also been badly dam-

aged. Owing to extensive damage in Muzaarabad, a

eld hospital with 100 beds (established jointly with

the Norwegian and Finnish Red Cross Societies) was

set up on the outeld in the citys cricket stadium.

The outeld also served as a h elipad or relie ights,

because the quake had made the roads impassable.


31/43

60 61

BenotSchaefer/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 20131983

2006

1999 2000 2001 2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 20131998

LEBANON 2006

The most intense hostilities since the civil war o

19751991 resulted in more than 1,000 people, mostly

civilians, being killed, thousands wounded and hun-

dreds o thousands displaced. The damage to civilian

inrastructure, including roads, bridges, power plants

and water supply acilities was widespread. Water sup-

ply acilities in the south suered more damage than

those in other parts o the country. The ICRC provided

leadership and coordination or the International Red

Cross and Red Crescent Movements response, which

included relie in the orm o ood, water, basic shelter

equipment and household essentials, as well as sup-

plies or health acilities treating the wounded and the

sick. Along with the Lebanese Water Board, ICRC engi-

neers ocused their eorts on restoring the supply o

electricity, essential or running urban water schemes.


32/43

62 63

ICRC

ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013

20072007

YEMEN 2007

The conict in Yemen had damaged many key water

sites, such as this one (right) in Al-Har. ICRC water

and habitat engineers worked on the restoration

and reconstruction o water supply systems (like the

one below) in many parts o the country, including

Saada, Dahyan and the Marran, to benet bothinternally displaced persons and the resident popu-

lation. The country has had a chronic water shortage

or decades: every year, the quantities o water that

Yemenis pump rom aquiers is greater than that

deposited by the rains; and underground reserves

are shrinking.

Yemen has one o the lowestratios o water to inhabitantsin the world, and the situa-tion is worsening by the day.Countrywide, the water tableis dropping by between oneand seven metres per year.Andres Casal, 2009Then the ICRCs water engineer in Saada


33/43

64 65

Domin

icSansoni/ICRC

ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

2007

2008 2009 2010 2011 2012 20132005 2006

SRI LANKA 2007MYANMAR, CYCLONE NARGIS 2008

In the early months o 2007, thousands o people were

displaced by the ghting in the north o the country.

The ICRC rst distributed tents at the Kiran camp or

displaced persons in Batticaloa. Then it launched a pro-

gramme to construct more durable and permanent

shelters. Because o the number o people aected, and

the speed with which they had been displaced, it was

difcult to obtain building materials in sufcient quan-

Following Cyclone Nargis, which devastated many vil-

lages in Myanmar in May 2008, a team o Myanmar Red

Cross and ICRC engineers took mobile water-treatment

units to two islands in the region o Dedaye. Meanwhile,

assistance in places o detention continued: some 14,000

detainees and sta in 27 dierent prisons received assis-

tance in the orm o water and sanitation.

tities immediately. The number o internally displaced

was estimated to be as high as 300,000. Needs were dire,

among the displaced as well as among the communi-

ties hosting them. The ICRC, sometimes in cooperation

with local branches o the Sri Lanka Red Cross Society,

provided assistance to some 300,000 conict-aected

people in the orm o ood, essential household items,

shelter materials and improved water acilities.


34/43

66 67

MarkoKokic/ICRC

TeriPengilley/ICRC

MarkoKokic/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013

2008

CENTRAL AFRICAN REPUBLIC 2008

Following a decrease in ghting in the north, armed

groups and the government signed a peace agree-

ment in June. In August, conict ared up again,

mainly in the north-west; this time it also involved a

group that had rearmed ater being dormant or some

months. The renewed ghting, combined with wide-

spread lawlessness, displaced more people, hampered

the delivery o aid and prevented the tens o thou-

sands already displaced rom returning home. In 2008,

the ICRC, together with the Central Arican Red Cross

Society, improved hygiene and water acilities or

180,000 people.


35/43

68 69

AlBaba/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983

2009

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 20131983

GAZA 2009

Developing water delivery systems in the densely

populated Gaza Strip is a ormidable task. Access to

surace water is almost non-existent and ground-

water resources are limited. Restrictions on the import

o building materials and lack o unding and space

are other obstacles. Wastewater treatment is a vital

public health issue. In 2009, construction o the Raah

wastewater treatment plant three years in the plan-

ning got under way. The builders relied as much as

possible on materials that could be ound or manuac-

tured locally, including piping and even cement blocks

recovered rom the remnants o the old Raah wall. The

plant, which was inaugurated in 2011, treats 20,000

cubic metres o wastewater a day or 175,000 inhabi-

tants. During the three-week Israeli military operation

in the Gaza Strip in 2009, the ICRC with the consento both sides continued to carry out its activities: it

was able to assist authorities in maintaining essential

inrastructure or health care and access to water.

Its a great challengeto carry out construction

projects in the Strip, asbuilding materials cannot beimported. Humanitarianorganizations such as theICRC are orced eitherto come up with alternativeand creative ways o pro-ceeding, or to put essentialprojects on hold.Marek Komarzynski

An ICRC engineer in Gaza


36/43

70 71

GettyImages/ICRC

SamuelBonnet/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983

2009

JUBA, SOUTH SUDAN 2009

The ICRC eld hospital in Lokichokio, a village in north-

ern Kenya on the Sudanese border, had been set up

to deal with the mounting casualties o the Sudanese

civil war. In 2006, when ICRC operations at the hospital,

where amputees had been treated, were shut down, the

organization saw the need or an equivalent in South

Sudan to ensure adequate ollow-up or patients. For the

estimated 35,000 amputees in South Sudan, the physical

rehabilitation centre built by the ICRC in Juba over a two-

year period was an immensely signicant development.

The centre, including a workshop or manuacturing and

repairing prostheses, was handed over to the health

authorities in 2009. Staed by 26 technicians, the centre

has a yearly capacity o 1,200 patients and can house up

to 100 patients at a time. It reects the ICRCs long-term

engagement in South Sudan with those who have lost

limbs during the conict.


37/43

72 73

NormandBlouin/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 20131987 1988 1989 1990 1991 1992

2009

SENEGAL 2009

In the Casamance region o Senegal, the long-standing

conrontation between government orces and armed

opposition remained unresolved. Uncertain security

conditions, coupled with the presence o mines, pre-

vented displaced people including those who had

sought reuge across the border in Guinea-Bissau

rom returning home. In Casamance and in Guinea-

Bissau, the ICRC worked with National Societies to

improve community health through hygiene promo-

tion and the installation o public water points and

latrines. As women played a crucial role in managing

the daily lives and preserving the economic security

o amilies, the ICRC worked to improve their access to

clean water and provided support or market garden-

ing projects.


38/43

74 75

MarkoKokic/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2011 2012 2013

2010

2010 AND BEYONDIn 2012, WatHab conducted activities in 50 countries,

with the direct involvement o over 500 people. It is

now an essential part o the ICRCs operations, as

inseparable rom the humanitarian response as health-

related activities curative and preventive the provi-

sion o access to ood, and the ensuring o protection,

in accordance with the Geneva Conventions, or civil-

ians and people engaged in conict.

Today, WatHab has become a natural part o the ICRC

and is present in all situations where its needed,notes

Pierre Perrin, one o the doctors who laid the ounda-

tions or the units creation 30 years ago.

No one knows what challenges or opportunities the

next 30 years will bring, but everything suggests thatthe issues will become more complex, that public

health risks are growing, and that the solutions that

are developed will have to be continuously adapted to

new realities. One major trend is population growth in

cities, which are increasingly becoming battlegrounds

and where civilians are trapped without coping

mechanisms like those available to people in rural

areas. Another is the growing complexity and inter-

dependence o the technological aspects o essential

urban inrastructure: electricity, water, and medical

acilities. Access and proximity are essential or build-

ing up our understanding, not only o the people

aected, but also o the technical issues involved. This

is by no means a given in conict areas today: there are

many more actors on the scene and conicts are oten

unstructured. These constraints notwithstanding, the

authorities and the people aected remain an integral

part o any response. The scope o engineering skills

must be expanded to develop suitable solutions that

make use o new technology and approaches, and o

ideas and innovations rom the people who manage

and benet rom these systems over the long term.

I remain condent that challenges will produce solu-

tions as long as we can count on our imagination and

sense o humanity. Over the last 30 years, we have

constantly, within the organization and beyond, been

exible and open to change, and we will persevere

with that approach, says Philippe Dross, the current

head o WatHab.

In some conict zones, when humanitarian personnel

become targets, the ICRC is able, or a while, to develop

and manage projects remotely: it works with what is

available locally to deliver water or expand hospital ser-

vices. This has been a trend in several countries over the

last decade; it should not become a xed practice over

time, but it does provide positive results when access

is wholly unavailable. Weapon bearers throughoutthe world should be persuaded to respect the ICRCs

humanitarian mandate and the rights o civilians.

The good news is that in most conict zones, the ICRC

and other humanitarian organizations, particularly

the local networks provided by National Societies,

are able to obtain access to the people aected. As a

consequence, over the past three decades, millions o

people at risk have been able to evade the bullets and

the bombs; they have also been able to evade disease

and malnutrition, through access to clean water, basic

sanitation and adequate health-care acilities.


39/43

76 77

ICRC

ICRC

SamuelBonnet/ICRC

AlexanderHumbert/ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 20132002 2003 2004 2005 2006 2007 2008

2010

2011

HAITI 2010

KYRGYZSTAN 2010

CTE DIVOIRE 2011

The devastating earthquake that struck Haiti on

12 January killed more than 230,000 people and let

over a million others homeless. It also inicted heavy

damage on the countrys inrastructure, including water

systems, roads, hospitals, and schools and other build-

ings. The ICRC responded by acilitating amily contacts

and by providing rst aid, hospital care, access to clean

water, and management o dead bodies. The Special

Fund or the Disabled, which had been providing sup-

port beore the earthquake or Healing Hands or Haiti,

a local oundation, mobilized the American, Australian,

Canadian and Norwegian Red Cross Societies to jointly

und a new building (above) on a privately donated plot

o land. Construction, supervised by the ICRC, began in

March 2011 and the building was ormally handed over

to Healing Hands or Haiti in March 2012.

Serious political tensions, ollowed by clashes between

young people o Kyrgyz and Uzbek origin, led to

the deaths o almost 400 people. Many others were

wounded and houses and public buildings burnt

down. Tens o thousands o people were internally

displaced and some 100,000 others ed to Uzbekistan;

a ew hundred crossed over into Tajikistan. The ICRC,

working with the National Societies concerned, pro-

vided ood, essential household items and clean water

to almost 400,000 people. By means o a cash-or-work

programme, the ICRC reconstructed 317 homes in

Kyrgyzstan, enabling people to have shelter beore

the onset o winter.

The wave o violence that swept Cte dIvoire severely

restricted local production o drinking water, as the

authorities were unable to import chemicals essential

or treating potable water. The ICRCs representations

to diplomatic authorities enabled an ICRC-chartered

ship to deliver 4,000 tonnes o lime (calcium oxide) to

the country. As a result, the ve million inhabitants o

Abidjan, the capital city, had water to drink.


40/43

395E

3910E

1425N

1420N

ZibanGuyla

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KhilMilo

DzhilChe

Mizbar

ImbaburTerara

IlaShet

IlaShet

MayAwehi

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AdiChiana

UokhabitMarYam

BetGebet

DebreAnbesa

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AddiKelKel2

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Mezbir

InineMaryam Bete

Kristiyan

Irar

HarmetDakEyano

Dubere

Cheguoro

AdiAbiy

Inine

Inine

Mezbir

E T H I O P I AE T H I O P I A

Tigray Water Resource authorities have

set themselves a goal: no village in Tigray willbe farther than 1.5 kilometres away from a

source of water.

The map above was created by the Tigray

Water Resource Bureau after an inventory of all

the water points in Woreda Ahferom in 2011.

It shows which villages have access to water

within 1.5 kilometres and which do not,

thereby indicating where water points have

to be repaired or constructed.

Hand pumps

Working

Broken

Served by functioning water points

within 1.5 km

Served by partially functioning water points

within 1.5 km Repairs are needed

Served by broken water point within 1.5 km

Repairs are urgently needed

Not served by a water point within 1.5 km

Additional water points are needed

Areas and villages

78 79

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2013

2011

PUTTINGTHE ICRC ON THE MAPLITERALLYThe whereo humanitarian aid has always been a matter o much

importance to water and sanitation engineers: Where are the

people in need o water? Where can a reliable water source be

ound? Where should we lay the pipeline to bring water to the

people in need?

It is no surprise, thereore, that making maps and managing

geographic inormation systems (GIS) are key skills or water

and sanitation engineers. Consider, or example, one early GIS

project in the Somali capital o Mogadishu, where much o the

water supply is pumped rom hand-dug wells and distributed by

private vendors who carry the water by donkey cart or other smallvehicles. In 1997, the ICRC used GIS to study whether, as a result

o many o the wells being overused, the water in Mogadishu and

the surrounding areas had become too salty. Tests showed that

underground water containing sea salt was indeed moving inland

rom the coast had moved close to two kilometres since the last

measurements in the 1980s.

This type o analysis is important because understanding local

water tables and markets can be critical in deciding when, where,

how and with whom to drill a new borehole. These decisions could

alter not only water ows and aquier replenishment, but also

the local market system in which competition could easily lead to

conict or exacerbate tensions.

Now widely used in responding to conicts and natural disasters,

GIS allow humanitarian workers to track everything rom popula-

tion movements and water use to the spread o disease. According

to Robert Mardini, a ormer head o WatHab, early versions o such

systems have been in use within the unit since the 1990s. Today, a

more user-riendly, web-based programme, the ICRC Geoportal, is

used to map ICRC operations, activities and inrastructure such as

warehouses and other acilities.

A current ICRC project in Ethiopia oers another example o the

way GIS can be used to help local water boards to maintain water

systems. In this case, water technicians returning rom a water-

point maintenance tour can upload data to a new cloud-based

database that charts the unctional status o over 10,000 rural water

points. Thus the central water boards ofces are kept inormed o

where repairs are needed, saving time and resources. Such systems

have also been used to share vital inormation (about water points

or medical care) during rapid emergency response: the conict

in Libya, the oods in Pakistan and the 2010 earthquake in Haiti,

among many other examples.


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80 81

ICRC

ICRC

ICRC

1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

2011

2012 2013

SOUTH SUDAN 2012

KEYSANEY HOSPITAL,MOGADISHU 2011

SYRIA 2013

As a consequence o border clashes and civil war in

South Kordoan and Blue Nile states, over 170,000 reu-

gees entered South Sudan. The ICRC provided support

or United Nations agencies in two camps or displaced

persons by upgrading water systems and providing

essential household items or 37,000 reugees.

Despite harsh security conditions and limited access,

the ICRC succeeded in constructing a new 400-square-metre operating theatre in Keysaney Hospital, a ormer

prison building where, in the last 20 years, more than

216,000 patients, including 30,000 war-wounded, have

received treatment.

Since the onset o the violence in Syria in March 2011,

the ICRC has been doing its utmost to respond to the

needs o those aected by the ghting. Together with

the Syrian Arab Red Crescent, the ICRC has been provid-

ing water, ood, medical supplies and other items to the

people aected, namely displaced persons.

In 2013, Peter Maurer, the president o the ICRC, said

that the ICRC was convinced that humanitarian orga-

nizations should provide support or governments

who were the rst responders in any crisis and not

act in their stead. He said that in 2012, the ICRC, act-

ing on this principle, was able to provide more than

1.5 million people with ood and household items;

and, in terms o water and sanitation, aided more than

12 million people in all.


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82

OUR HEARTFELT THANKS

MISSION

The International Committee o the Red Cross (ICRC)

is an impartial, neutral and independent organization

whose exclusively humanitarian mission is to protect

the lives and dignity o victims o armed conict and

other situations o violence and to provide them with

assistance. The ICRC also endeavours to prevent suering

by promoting and strengthening humanitarian law and

universal humanitarian principles. Established in 1863,

the ICRC is at the origin o the Geneva Conventions and

the International Red Cross and Red Crescent Movement.

It directs and coordinates the international activities

conducted by the Movement in armed conicts and other

situations o violence.

It has been close to hal a century since ICRC delegates

and surgeons set up a eld hospital in a remote part

o the Yemeni desert. On the Thai-Cambodian border,

20 years later, one o the rst complex, large-scale

ICRC operations took place. It marked the birth o the

public-health approach, which takes into account the

needs o communities living in complex environments

and ensures sae living conditions or individuals. It

also made possible the shit rom individual medical

care towards all-inclusive community support in

rural and urban settings and or the short as well as the

long term.

Civilians are the primary, and by ar the most numer-ous, victims o conict not always as a direct conse-

quence o the ghting, but because entire communities

are woundedwhen their habitual living environment

is disrupted. Their basic rights are oten disregarded

and their access to water, health, ood production and

essential services jeopardized. This can be seen at its

most dramatic in Syria today: hundreds o thousands

o people in the cities are enduring the grim conse-

quences o the ghting and are without access to

essential services and resources.

Each person is unique; as is each situation, requiring its

own proper solution. We learn rom our experiences,

rom all the persons we meet, rom technicians, host

communities and authorities. They help us towards di-

erent sorts o understanding: social, political or tech-

nical; without them, we would not be able to develop

solutions or the problems that we conront. Without

this human actor we would not be able to move or-

ward. Technical obstacles are seldom insuperable.

At present, the ICRC employs approximately 450 water,

sanitation and habitat specialists. They have one objec-

tive: to serve each individual and his or her community

as eectively as possible, mindul o their particularneeds and with respect or their dignity.

To all those who have supported our eorts to restore

or maintain peoples dignity over the last 30 years, we

oer our heartelt thanks.

And to all those who ought or and won institutional

support and created the Water and Sanitation Unit in

1983, we oer our most sincere gratitude.

Jean-Philippe Dross

Head, Water and Habitat Unit


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water and habitat: public health engineering during armed conflict, 1983-2013

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