WASH Sector response to COVID-19 – ver. 02 Cox's Bazar WASH Sector - June 2020

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WASH Sector response to COVID-19

v. 02 – 21st June 2020

Table of Contents WASH Sector response to COVID-19 ............................................................................................... 1

1. Introduction ............................................................................................................................... 2

2. COVID-19 and WASH ............................................................................................................... 2

3. WASH Sector response framework ........................................................................................... 3

3.1 WASH response in camps Hygiene promotion and hygiene items ....................................... 3

3.2 WASH response in Host Communities ................................................................................. 6

3.3 WASH response in health facilities ...................................................................................... 9

4. Coordination ............................................................................................................................ 10

5. Mainstreaming and overarching approaches ........................................................................... 10

6. Inclusion of vulnerable groups ................................................................................................. 10

7. Gender mainstreaming ............................................................................................................ 11

8. WASH Sector Covid-19 monitoring and reporting .................................................................... 12

9. Rumors tracking ...................................................................................................................... 12

Annex 1: COVID-19 specific – Cough diagram (NCA – Sphere) .................................................. 13

Annex 2: Health Sector Information flowchart .............................................................................. 13

Annex 3: WHO guided precautionary health & hygiene measures for non-health field staff and work

premises ..................................................................................................................................... 13

Annex 4: WASH partners stock availability: compiled figures ...................................................... 14

Annex 5: WASH kit in SARI and isolation centers ....................................................................... 15

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1. Introduction

In late 2019, an acute respiratory disease emerged, known as novel coronavirus disease 2019

(COVID-19). On the 30th January 2020, the World Health Organization’s (WHO) Emergency

Committee declared the illness known as Coronavirus Disease 2019 (COVID-19) a Public Health

Emergency of International Concern (PHEIC), and on 11th March declared it a pandemic1.

The pathogen responsible for COVID-19 is severe acute respiratory syndrome coronavirus (SARS-

CoV-2, also referred to as the COVID-19 virus), member of the coronavirus family2.

The first confirmed case in Bangladesh was reported on 8th of March 2020. The Government of

Bangladesh is taking substantial initiatives to limit spread of the disease (i.e. declaration of "national

holiday" and travel restrictions within Bangladesh and also internationally, amongst others). A

National Preparedness and Response Plan for COVID-19 has been consolidated (Version n. 5,

dated 16th March 2020). An addendum to the JRP was finalised by all sectors under the lead of ISCG

early may advocating for 24 million USD for the WASH sector as part of the COVID-19 response.

A first confirmed case of COVID-19 has been registered in Cox’s Bazar district on the 24th of March.

The first COVID-19 confirmed case in Rohingya refugee camps was detected on the 14th of

May3.

As we are learning everyday on COVID-19 and context is always changing, WASH sector decided

to edit a new response plan through this document replacing the one published on 14th of April

2020.

This response plan is intended to cover camp settings and host communities, including locations

targeted by the JRP addendum (meaning, locations situated in Cox’s Bazar district, beyond Teknaf

and Ukhiya, according to partners’ plans and allocated resources).

2. COVID-19 and WASH

There are two main routes of transmission of COVID-19: respiratory droplets and direct contact.

Respiratory droplets are generated when an infected person coughs, sneezes or talk4. Droplets may

be inhaled or may also land on surfaces where the virus could remain viable and thus the immediate

environment of an infected individual can serve as a source of transmission (contact transmission).

The provision of safe water, sanitation, hygienic living and environmental conditions are essential to

protect human health during all infectious disease outbreaks, including the COVID-19 outbreak. Hand

hygiene, personal hygiene and physical distancing are key elements in preventing this disease

to spread.

As of today, a lot of aspects of COVID-19 prevention and control are still partially unclear, including

implications related to WASH interventions (like virus persistence on surfaces or sewage). While

COVID-19 virus persistence in untreated drinking-water is possible, it has not been detected in

1 IOM, COVID-19 Response: Situation Report 2 (20 - 23 March 2020). 2 WHO, UNICEF, Water, sanitation, hygiene and waste management for the COVID-19 virus, Updated technical note, 2nd edition, 6 April 2020. 3 ISCG press release on the first positive case in the Refugee camps - 15.05.2020 4 CDC, How COVID-19 spreads.

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drinking water supplies. Other coronaviruses have not been found in surface or groundwater sources

so the risk of coronaviruses to water supplies is low.

There are no relevant reports of faecal-oral transmission of the COVID-19, however this should

not be excluded and could explain the quick spread of the diseases, as viral RNA fragments of the

virus have been found in feces of infected people, also after their recovery5.

There is a low risk (not proven for COVID-19 but observed for other types of coronavirus) that the

virus could survive up to 2 days in non-chlorinated water so chlorination/water treatment, including

monitoring of FRC, should be particularly encouraged6.

It is not certain how long the COVID-19 virus survives on surfaces, but it seems likely to behave like

other coronaviruses. A recent review of the survival of human coronaviruses on surfaces found large

variability, ranging from 2 hours to 9 days. The survival time depends on a number of factors, including

the type of surface, temperature, relative humidity and specific strain of the virus. The same review

also found that effective inactivation could be achieved within 1 minute exposure time using common

disinfectants, such as 70% ethanol or 0.1% sodium hypochlorite7.

3. WASH Sector response framework

COVID-19 has to be considered a health sector driven response, where WASH Sector has a

supporting role in coordination, preparedness and prevention, mitigation and response. WASH

response has been considered “critical” since the beginning of the emergency and, despite a

reduction of staff visiting affected communities, vast majority of WASH activities have been taking

place since March until now, without major disruptions.

Objective of the WASH response is now to limit the spread of COVID-19 among vulnerable

population in both Cox’s Bazar district and Rohingya Camps via implementation of WASH mitigating

initiatives like disinfection, distribution of hygiene items, awareness raising and community

engagement to induce behaviour change, support health facilities with WASH interventions including

COVID-19 hygiene items, and reinforce Infection Prevention and Control (IPC) measures at camps

“points of entry”. The WASH response targets the 1.42 million beneficiaries as per 2020 JRP

(Joint Response Plan + COVID-19 addendum).

3.1 WASH response in camps

Hygiene promotion and hygiene items

• Formation of communication strategy: This will include training community-based

volunteers, training community stakeholders, adapting and testing visual aids, preparing radio

5 CDC, Water and COVID-19 FAQs, https://www.cdc.gov/coronavirus/2019-ncov/php/water.html and WHO, UNICEF, Water, sanitation, hygiene and waste management for the COVID-19 virus, Updated technical note, 2nd edition, 6 April 2020. COVID-19 has been cultured from stools in one case only: see article from CDC website here. 6 The COVID-19 virus is an enveloped virus, with a fragile outer membrane. Generally, enveloped viruses are less stable in the environment and are more susceptible to oxidants, such as chlorine. While there is no evidence to date about survival of the COVID-19 virus in water or sewage, the virus is likely to become inactivated significantly faster than non-enveloped human enteric viruses with known waterborne transmission (such as adenoviruses, norovirus, rotavirus and hepatitis A). For example, one study found that a surrogate human coronavirus survived only 2 days in dechlorinated tap water and in hospital wastewater at 20° C, from: WHO, UNICEF, Water, sanitation, hygiene and waste management for the COVID-19 virus, Updated technical note, 2nd edition, 6 April 2020.update 7 Kampf G.,Todt D., Pfaender S., Steinmann E., Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents, Journal of Hospital Infection, 2020.

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shows, house-to-house visits, planning small discussion groups with community leaders and

more vulnerable groups in the community. Communication plans should always be based on

two-way dialogue with communities, and not on messaging. Key information for discussion

with communities would be:

o Signs, symptoms and transmission of Covid-19

o Personal and community protection and prevention of spread

o Actions to take if an individual or household suspects someone is ill with Covid-19

Please see the risk communication strategy here.

• Continue the capacity building and information sharing with field staff regarding new

messages, IEC materials, rumors, misconceptions, guidelines developed by WASH or other

relevant sectors.

• Continue hygiene promotion activities focusing on house to house sessions, with maximum

5 persons attending the session each time and with sessions conducted out-doors, keeping

into consideration known physical distancing8 and PPE recommendations9. Hygiene

promotion activities should be inclusive and participatory, going beyond the simple

“messaging”: multiple surveys have found out that older persons and persons with disabilities

and other vulnerable individuals need special support in terms of understanding COVID-19

spread and mitigation measures. Other relevant hygiene promotion topics, like safe water

chain, food hygiene or menstrual hygiene, must continue.

• HP should support in reducing stigma related to COVID-19 and to encourage communities to

seek medical attention without creating shame or panic.

• Focus on older persons as most-at-risk population, according to WASH Sector

recommendations. Specific focus with hygiene messages, soaps and water containers

distribution to the elderly lead family based on the actual needs, household hand-washing

stations. Please see also: May 2020, Cox’s Bazar WASH Sector, Older persons and WASH

response during COVID-19, here.

• Focus on children: learning centers and schools are closed so children must be targeted at

home (child to child approach to be continued)10.

• Use sector and ISCG endorsed available audio or video messages to reach, also liaising with

CWC/camp-base info hubs. Remote hygiene promotion through mass media campaigns, use

of megaphones, messaging via Imams to be explored (although these methods are largely

used by all sectors and, on the long run, can lead to a loss of interest from communities)11.

• Continue the engagement with key-stakeholders like Imams/Maji, other community leaders,

CiC (Camp in Charge), specifically regarding change in implementation modalities (i.e.

distributions) or regarding communities’ misconceptions and fears about the pandemic.

Provide them correct information to announce and appropriate audio materials to play using

the loudspeakers in the mosques and other facilities. Please see audio/video messages here.

• Continue ensuring regular hygiene items distributions (soap, hygiene kits, menstrual

hygiene kits) according to the regular schedule of each agency, via agreed house to house

adapted modality, as defined here: May 2020, Cox's Bazar WASH Sector technical guidance

on accountability in distribution procedures for COVID-19 response 12.

8 Key messages are focused on: changing sneezing, spitting and coughing behaviors, enhancing systematic hand washing practices with soap, beyond the known "5 critical times" for hand washing. See here complete WASH key-messages. 9 See: Cox's Bazar WASH Sector recommendations on PPE for WASH staff in light of COVID-19, here. 10 See here materials form Clowns Without Borders, adapted to COVID-19 context. 11 Please see also the media resources from BBC Media Action and others, available here.

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• Hygiene promotion during non-WASH distributions, when requested and bilaterally agreed

with other sectors (e.g: hygiene promotion during food distribution). This activity to be

performed only when minimum safety measures of physical distance can be respected.

• Promote shelter hygiene according to these recommended guidelines: “Keep your shelter

clean” and via using these IEC materials on NFI care and maintenance.

Water and sanitation

• WASH partners will continue making sure there’s an appropriate coverage of hand washing

stations (HWS) in camps, specifically in public spaces, at each latrines’ block, at HH level if

the HH hosts one or more elderly or persons with disability and, possibly, at each HH. Food

vendors to be encouraged to install HWS at their stalls. HH level HWS realization to be scaled

up through distribution and promotion of facilities such as tippy-tap or through regular bucket

+ tap + stand installation + bowl as basin. Particular attention to be given to wastewater

management by awareness raising at HH level on proper grey water disposal. The Sector

encourages the piloting of innovative hand washing systems13.

• Ensure maintenance of hand washing stations, engaging WASH committee or neighboring

support system to make water and soap always available. If soap goes missing, soapy water

solution can be used, making sure to ensure a correct concentration14. HWS should have

appropriate drainage system to avoid accumulation of wastewater15.

• Support Health Sector in the installation of HWS at camps’ “points of entry”, as IPC

measure, for mandatory hand washing prior entry to the main gates of the camps16.

• Contribute to a safe, clean, healthy environment through reinforcing regular WASH O&M

and construction work in camps (i.e. maintenance of water supply and water points,

including water usage and increase water quantity provision if possible, desludging etc…), to

prevent and/or mitigate the insurgence of other outbreaks (i.e. AWD). This includes ensuring

enough water provision for drinking, hand washing and hand washing stations maintenance,

chlorination, disinfection (see below details) and regular cleaning activities. In case of water

scarcity or water network breakdowns, specific interventions (like water trucking) have to be

put in place (to be addressed case by case).

13 See, as example, the model designed by OXFAM, here or get inspired by this Wash’Em Webinar here. 14 Recommended quantities are 30 gr. Granular laundry soap for 1.5 liters water; source: Hygiene Hub, Can soapy water be used for handwashing?, here. 15 Use of chlorinated water for handwashing is not recommended as it is difficult to implement at large scale and requires special care in solution preparation and HTH handling. Moreover, correct handwashing with soap is considered sufficient to ensure clean hands and to prevent the spread of germs. However, on specific cases like installation of handwashing station at distribution points, agencies may use chlorinated water for handwashing (0.05%) if no other options are feasible. 16 Health and WASH Sector, Hand washing and temperature screening at camp entry points during COVID-19, (Interim guidance, 16/04/2020), here.

Individuals in home-care: mild and moderate COVID-19 cases might be requested to stay in

home care by health staff, when/if there will be no more beds available in health centers. In this

case, no hygiene promotion is recommended, to avoid putting staff at excessive risk and

contributing the further spread of disease but also considering that HP focusing on COVID-19

happened before the first cases araised. However, discussions with caretakers should happen,

specifically regarding personal support and shelter cleanliness. See here resources on home-care

patients.

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• Chlorination: rise of FRC level in piped network (> 0.5mg/L), bucket chlorination at water

point level or Aquatabs distribution can be evaluated if COVID-19 is rapidly spreading in the

camps or if any suspicious increase of AWD is reported by Health sector. The chlorination

initiatives will be evaluated case by case according to type of water source, IP capacities and

community acceptance. Bucket chlorination or Aquatabs distribution will address, in any case,

only the 40% of the camps not yet covered by chlorinated water or in cases of piped water

breakdowns. Also, it has to be noted that the water needs to be chlorinated through bucket

chlorination or Aquatabs distribution to the families that might still fetch water from some

sources like DTW, canal or pond even if they are residing within the piped network coverage

area (identification via field observation and community discussions).

• Where possible, set up queuing systems at water points, with ground demarcations (>1-

meter distance from one person to another) or other crowd control measures.

• Continuation of operation and maintenance of existing deep tube well. Preposition enough

spare parts and develop a community managed O&M structure so that they can fix the minor

problem themselves even during lockdown.

• Desludging should take place only when the pits are almost full and not in prevention.

Desludging team to be provided with regular PPE (gloves, masks, googles, boots,

coverall/apron, masks). All protective equipment to be properly disposed or disinfected if

reusable (0.5% chlorine solution).

• Disinfection (via spraying of HTH solution) of latrines (slab, internal surfaces, doors locks and

handles), bathing places, tap stands, hand pumps and water reservoir tanks, as regular

preventive/mitigating activity, as per WASH Sector recommendations17. Public buildings may

also be targeted on request from CiC or partners from other sectors, however, capacity

building of those partners should be reinforced so that they can carry-out their own

disinfection.

• Continue regular bacteriological, physical/chemical water testing at source and HH level.

Sanitary inspection as triangulation measure should be implemented. If resources reduction

makes bacteriological analysis a challenge, FRC check can be implemented in the time-being.

• Solid waste management to be continued as regular activity. SWM workers are

recommended to follow WHO and WASH Sector guidelines on PPE. Cleaning campaign

should respect the physical distancing recommendations. Workers to wash hands after

handling waste. To clean and disinfect tools and reusable PPE and to dispose single-use PPE.

• Support other Sectors when needed with provision of handwashing stations, soap, IEC

materials and training of trainers.

3.2 WASH response in Host Communities

Coordination of the humanitarian response in host communities of Ukhya and Teknaf18 is strongly

supported by implementing partners19. Regular host community’s meetings are taking place. WASH

17 See WASH Sector disinfection guidelines here. 18 Lessons learned from Teknaf coordination: the response is focused on suspected cases only. Partners did some blanket distributions of soap and HK in their areas of intervention but, in general, the response targets only suspected cases. SI, as host community coordination NGO, receives line list of suspected cases (cases for which a sample is being tested) from the Union Health Center/General Hospital daily and coordinates response from this list. This list is shared by UHC with SI, WHO, UNO (Union Chairman) and ISCG. A partners mapping showing who is working in each ward and union as well as their response capacity allowed to identify key focal points per union. SI is contacting the focal partner when suspected cases are identified in their areas. A Whatsapp group with those partners alone allows for quick information sharing and follow up. 19 At the moment, NGOF for Ukhiya and Solidarites International for Teknaf. Ask mdadamo@unicef.org for contacts.

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Sector acknowledges that the humanitarian response is taking place in the camps and nearby host

communities. For what concerns the full coverage of all Ukhiya or Teknaf Upazillas, limited resources

are available to cover all WASH gaps. Similarily, for the others Upazillas of Cox’s Bazar district, the

response is at the moment supported by the Government of Bangladesh and NGO partners. A number

of WASH partners have been extending their area of intervention for COVID-19 response (JRP

addendum) also in other upazillas within Cox’s Bazar district. WASH partners are also active in

majority of the upazillas since before the pandemic, involved in development projects.

The WASH Sector recommends the following actions for host communities, according to

implementing partners capacities and plans as per JRP addendum: scale up activities in entire district

by reinforcing and communicating with respective Upazila Officer, DPHE and present NGO partners.

Every activity should be coordinated with Host Community NGO lead and with the WASH sector

(including 4W reporting), to ensure homogeneous support. Specifically, partners are recommended

to share distribution plans and to follow to WASH Sector recommended hygiene items.

Response mechanism should strictly follow equity and inclusion principles. In addition, considering

high natural disaster vulnerability in Cox’s Bazar, responses should integrate DRR and climate

change to minimize repeated loss and optimize the investment.

Hygiene promotion and hygiene items

• Formation of communication strategy: This will include training community-based

volunteers, training community stakeholders, adapting and testing visual aids, preparing radio

shows, house-to-house visits, planning small discussion groups with community leaders and

more vulnerable groups in the community. Communication plans should always be based on

two-way dialogue with communities, and not on messaging. Key information for discussion

with communities would be:

o Signs, symptoms and transmission of Covid-19

o Personal and community protection and prevention of spread

o Actions to take if an individual or household suspects someone is ill with Covid-19

Please see the risk communication strategy here.

• Continue the capacity building and information sharing with field staff regarding new

messages, IEC materials, rumors, misconceptions, guidelines developed by WASH or other

relevant sectors (same as per camp setting).

• Supporting capacity building of local authorities, including Upazila Administration and Local

Government Institutes (LGIs), concerning COVID-19 causes and WASH mitigation measures.

• Continue interactive hygiene promotion activities followed by follow-up HHs visits/small group

discussions consisting of maximum 5 persons and public mobilization using mass media

awareness campaigns, avoiding gatherings and ensuring physical distance is respected. HP

should support in reducing stigma related to COVID-19 and to encourage communities to seek

medical attention without creating shame or panic. Outdoors house to house sessions can

also be organized, focusing, if possible, on older persons, persons with disability, other

vulnerable population, women, adolescent girls and children.

• Continue the engagement with key-stakeholders like religious leaders, school teachers,

Upazila officials, ward members, community based organizations and volunteers, front line

health workers, NGOs, local sanitation enterprises, community clinics, union health sub-

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centers, Upazila health complex, union Chairmen, regarding communities’ misconceptions

and fears about the pandemic.

• Strengthening women engagement (women as leading community members in hygiene

practices at household level)

• Continue ensuring regular hygiene items distributions (soap, hygiene kits, menstrual

hygiene kits) according to the regular schedule of each agency, via agreed adapted modality20.

Ensure soap distribution as preventive measure in areas of intervention where it is not usually

done, if capacity allows and if this well coordinated with authorities and any other

developmental programs on-going. Strengthen engagement of CVBs trained in HP for the

implementation of regular HP activities such as distributions.

• Exploring options for remote implementation and monitoring of activities if needed.

• Hygiene promotion in schools to be evaluated once the schools will re-open, according to

partners capacities.

Water and sanitation

• Government counterparts and WASH partners to set-up handwashing stations (HWS) with

provision of suitable quantity of running water and the sustainability of the intervention, in:

public places or nearby communal WASH facilities, public locations at unions and Upazila

include bus-station, marketplaces, schools (once opened), health centers, Upazila and Union

Parishad premises. If soap is easily stolen missing, soapy water solution can be used, making

sure to ensure a correct concentration21. HWS should have appropriate drainage system to

avoid accumulation of wastewater22.

• Support host community in the provision of drinking water by O&M of tube wells. Host

community acceptance towards bucket chlorination is low, as reported by some implementing

partners. Chlorination initiatives will be evaluated case by case according to type of water

source and localization of most affected neighborhoods.

• Where possible, set up queuing systems at water points, with ground demarcations (1

meter/3 feet distance from one person to another) or other crowd control measures.

• Disinfection (via spraying of HTH solution) of latrines, bathing places and tap stands, as

regular preventive/mitigating activity, as per WASH Sector recommendations23. Public

buildings may also be targeted on request from community leaders.

• Continue regular bacteriological, physical/chemical water testing at source level, as per

schedule. Testing of drinking water sources in affected communities can be evaluated.

• Liaison with local health center is recommended: WASH agencies can prioritize response

in communities where suspected cases are reported by health staff: distribution of soap,

hygiene items and detergent to clean the house to the affected household and to the

neighboring ones. Hygiene promotion to the same cluster of HH to be organized, together with

20 May 2020, Cox's Bazar WASH Sector technical guidance on accountability in distribution procedures for COVID-19 response - v. 01. 21 Recommended quantities are 30 gr. Granular laundry soap for 1.5 liters water; source: Hygiene Hub, Can soapy water be used for handwashing?, here. 22Use of chlorinated water for handwashing is not recommended as it is difficult to implement at large scale and requires special care in solution preparation and HTH handling. Moreover, correct handwashing with soap is considered sufficient to ensure clean hands and to prevent the spread of germs. However, on specific cases like installation of handwashing station at distribution points, agencies may use chlorinated water for handwashing (0.05%) if no other options are feasible. 23 See WASH Sector disinfection guidelines here.

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the distribution. Disinfection of HH or communal latrines can be organized by the WASH

agency or clear cleaning instructions about latrines cleanliness can be provided to HH, as

alternative24

• Hygiene promotion in schools to be evaluated once the schools will re-open, according to

partners capacities.

• Schools technical assessment (in remote or in presence modalities) to be started, in

agreement with relevant authorities and according to partners capacities, scope of work and

geographical area of intervention.

3.3 WASH response in health facilities

WASH partners are supporting existent, new or reconverted health centers, with provision of a

different range of WASH services. As WASH sector, minimum recommendations for the response in

health centers are as follows:

• Support scaling up of WASH services in quarantine, isolation and SARI facilities

(especially those identified for COVID-19 response) upon request by the GoB/Health Sector

(expected for host communities mainly). This includes provision of water for hand washing,

cleaning, drinking and disinfection purposes, construction or rehabilitation of sanitation

facilities. Of paramount importance is making sure that the plumbing system is not faulty. Fecal

sludge does not need specific treatment before being safely disposed25. Ideally, sanitation

facilities should allow separation between COVID-19 patients and other patients and medical

staff. Gender segregated WASH facilities should be ensured, wherever possible.

• Installation of sustainable hand washing systems at health centers entry points or where

needed. Soap or hand sanitizer (between 60% and 80% of alcohol) can be provided in support

to health centers. Soap is considered the best hand washing option if hands are visibly dirty.

• Support the provision of cleaning materials and products, if gaps are identified.

• Support in solid and/or medical waste management, where gaps are identified. All the

waste produced at health center level, in COVID-19 wards (suspected or confirmed cases),

has to be considered hazardous and, as such, should be segregated as per WHO and GoB

guidelines (infectious, sharps and general waste). Ideally, it should be disposed on site as per

best available treatment options (given the circumstances, although not environmentally

friendly, incineration, like the De Montfort, is the best option). Waste generated in waiting areas

is considered non-hazardous and, as such, can be disposed as municipal waste. However,

acceptance problems can be raised by communities fearing waste being transported and

dumped elsewhere than the health center. Therefore, it is recommended to dispose all kind of

waste onsite treatment facilities.

• Prevision of adequate drainage system for greywater: greywater does not necessarily need

to be treated as the likelihood of pathogens is low, especially if there is chlorine solution used

24 Lessons learned from Teknaf coordination: Each facility and public place in the village where suspected cases (not confirmed) are identified by the UHC and communicated to lead of HC coordination Group (SI in 2020) must be disinfected with 0.1% chlorine solution in 50-meter radius around the affected HH. If no water point/communal place in 50 m, extend to 100m and so on until reaching closest communal places. Distribution of detergent/commercial chlorine based product to affected HH and neighbors will allow beneficiaries to disinfect their HH themselves (limit contact with affected HH). 25 “Chlorine is not effective for disinfecting matter containing large amounts of solid and dissolved organic matter. Therefore, there is limited benefit to adding chlorine solution to fresh excreta and, possibly, such addition can introduce risks associated with splashing”, from: WHO and UNICEF, Water, sanitation, hygiene, and waste management for the COVID-19 virus: interim guidance, 23 April 2020, here.

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for disinfecting. However, it is important that the greywater drains to an uninhabited area and

does not "pool" which could be a site for vectors and other disease. Soak away pit should be

ideally constructed within the health center area and fenced. It is important that greywater is

not mixed with blackwater.

• Provision of hygiene kits for patients in quarantine, isolation or SARI centers. See details in

Annex n. 5.

4. Coordination

WASH sector will regularily update partners about COVID-19 response via emails or meetings. WASH

Sector will continue coordinating with Health Sectors and partners, Risk Communication TWiG, other

Sectors and ISCG. Ad hoc Health-WASH meeting will be organised upon needs.

WASH Sector will make sure partners have access to relevant and updated and endorsed documents

regarding COVID-19, including global publications, crosscutting reports, IEC materials and scientific

evidences.

A folder with relevant documents has been created within the HP TWiG Google Drive and can be

found here.

The WASH Sector will maintain coordination and information exchange with parallel responses such

as cyclone and AWD in order to identify synergies at field level.

5. Mainstreaming and overarching approaches26

In addition to specific WASH related approaches, it is important to strengthen and engage further into

the Accountability to Affected Population (AAP) and mainstreaming of cross-cutting issues. The below

documents provide guidance on the overarching principles to guide WASH response in COVID 19

pandemic context.

6. Inclusion of vulnerable groups

Please note this resource on referral pathways: Protection Working Group Cox's Bazar,

Bangladesh: Referral Pathway for different services (As of February 2020) -

https://reliefweb.int/report/bangladesh/protection-working-group-coxs-bazar-bangladesh-referral-

pathway-different-2

26 From GWC response to COVID-19 here.

Disinfection tunnels: this technology, widely available in Bangladesh, is not recommended under

any circumstance. Spraying an individual or group with chemical disinfectants or detergents is

physically and psychologically harmful and does not limit the spread of COVID-19 and it can, on

the contrary, give a false perception of protection. In particular, spraying of chlorine on individuals

can lead to irritation of eyes and skin, bronchospasm due to inhalation, and potentially

gastrointestinal effects such as nausea and vomiting. Even if a person is infected with the COVID-

19 virus, spraying the external part of the body does not kill the virus inside the body and may

worsen the clinical condition of the individual.

See also: 20 May 2020, Legal notice served to stop use of disinfectants on human body, Dhaka Tribune, here and WHO, 15 May 2020, Cleaning and disinfection of environmental surfaces in the context of COVID-19, here.

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Persons with disabilities

• UNICEF – 19/03/20, COVID-19 response: Considerations for Children and Adults with

Disabilities, http://www.internationaldisabilityalliance.org/sites/default/files/covid-

19_response_considerations_for_people_with_disabilities_190320.pdf

• WHO, March 2020, Disability considerations during the COVID-19 outbreak,

https://rb.gy/icc9to

Older persons

• Cox’s Bazar WASH Sector, May 2020, Older persons and WASH response during COVID-

19,

https://drive.google.com/file/d/1HFuMszy2pPDqscpVxXhzYlgKrbp9Ct1s/view?usp=sharing

• International resources from HelpAge on Protecting older people during the coronavirus

COVID-19 pandemic: https://www.helpage.org/what-we-do/protecting-older-people-during-

the-coronavirus-covid19-pandemic/

• Health Sector and GoB, Advice for vulnerable populations, including people over 60 years

old, and those with co-morbidities during the COVID-19 pandemic in the forcibly displaced

Myanmar national (FDMN) / Rohingya refugee setting:

https://drive.google.com/open?id=1ApT7FZ1Syt-XfHK-Yrpyi7zbvrmmPiII

Marginalized groups

• COVID-19: How to include marginalized and vulnerable people in risk communication and

community engagement - Inter-Agency - 13/03/2020,

https://drive.google.com/file/d/1i70kI__NfC7MzLQ-KRfwTs6t-X-nWOzA/view

7. Gender mainstreaming

Gender equality should be promoted also throughout the COVID-19 response. Female should be

provided with the possibility to speak, influence and decide on strategic issues, at all level. Women,

men, girls and boys should be consulted and engaged separately regarding COVID-19 WASH

programming.

The development of Call for Gender Actions for COVID-19 Preparedness and Response was led by

Cox's Bazar UN Women and the ISCG Gender Hub with inputs and endorsement by the GIHA WG

Co-Chair, UNHCR, and GIHA WG members. The purpose of the call for action is to make the

gender concerns explicit and provide recommendations to Sectors and their partners. These

recall the SEG endorsed Key Action for Gender Equality and Empowerment of Women and Girls in

Humanitarian Action in line with IASC Gender Policy, and further reflect evidence from the field, as

Additional relevant resources on Gender and COVID-19:

• UN Women & Gender Hub, Rohingya Women Speak Up About COVID-19, April 2020,

https://www.humanitarianresponse.info/en/operations/bangladesh/document/rohingya-

women-speak-about-covid-19

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• Gender Hub, UN Women, CARE & Oxfam, COVID-19 Outbreak: Cox’s Bazar Rapid Gender

Analysis, May 2020,

https://www.humanitarianresponse.info/en/operations/bangladesh/document/covid-19-

outbreak-rapid-gender-analysis

• GIHA WG, Protection Sector, Child Protection Sub-Sector, GBV Sub-Sector and PSEA Network, Guidance for Creating and Managing Safe Quarantine, Isolation and Shielding Centers for Women and Girls, April 2020, https://www.humanitarianresponse.info/en/operations/bangladesh/document/gendered-protection-guidance-quarantine-isolation-and-shielding-0

8. WASH Sector Covid-19 monitoring and reporting

WASH Sector is requesting to AFAs to report key-COVID-19 related activities on a weekly bases. At

the moment, the Sector is requested to report, with the same frequency, to ISCG.

A monitoring template has been shared with Area Focal Agencies, for them to capture the progress

of implementing partners in respective areas. Reporting template can be found here27. AFAs are

expected to share key updates with the Sector every Tuesday.

4W monthly report is not replaced by this specific COVID-19 template and all COVID-19 related

achievements have to be reported in the 4W.

9. Rumors tracking

In a disease outbreak rumors and misconception of the disease and/or how it is coordinated and responded to can have serious consequences (fuel mistrust, cause panic, prompt irrational behavior). It is therefore important and within our remit to find out what people are saying and address those rumors and misconceptions quickly. Use the data to inform programming, information for communities, and advocacy at cluster level. A Lot of implementing partner have their own feedback mechanism in place, that can continue to be used, with specific recommendations for the feedbacks to be closed in an efficient and resolutive way. Moreover, all Sectors/WG are asked to collect rumors/misinformations related to COVID-19 via a

specific template. BBC Media Action will analyze this information and share the recommendations

to the Sectors. This will be useful for reinforcing positive messaging and to dispel rumors that are

circulating and to ensure accurate and timely information is shared with persons of concern.

The template can be found here, to be sent to: cxbfeedback@bd.bbcmediaaction.org.

27 A specific report template for Teknaf Upazilla has been tailored by Solidarités International and can be found: here.

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Annex 1: COVID-19 specific – Cough diagram (NCA – Sphere)

28

Annex 2: Health Sector Information flowchart

See: Streamlining Information related to COVID-19 case notification, lab results and control measures in camps, here

Annex 3: WHO guided precautionary health & hygiene

measures for non-health field staff and work premises

• Regarding PPE use for non-Health staff please see this guideline: here

• Regarding general behavior guidelines for staff travelling to the camps see this document from

Health Sector Cox’s Bazar: here.

• Performing hand hygiene frequently with soap and running water, especially before going

to the field, performing an activity (water treatment, hygiene promotion sessions…) and after

coming back from the field or performing sanitation related activity (latrine rehabilitation or

maintenance, desludging); increase hand washing stations presence in office spaces if

needed; if alcohol-based sanitizers are provided, the percentage of alcohol should be of at

least 70%.

• Avoiding touching face (eyes, nose and mouth especially);

28 GLOBAL WASH CLUSTER – COVID 19 RESPONSE GUIDANCE NOTE #02 – Update 15 April 2020, here.

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• Practicing respiratory hygiene by coughing or sneezing into a tissue or bent elbow and then

immediately washing hands with soap and running water; dispose used tissue immediately in

closed waste bin. Remind employees to avoid spitting in public

• Maintain physical distance (minimum of 1 m/3 feet) from person to person. Staff to avoid

hand shaking, sharing food, sharing phones, water bottles and other kitchen utensils.

• Ensure safety conditions are met for contractors as well (hand washing facilities, PPE, soap);

• Staff not in good health should not go to field or to any workplace, especially if having fever,

cough and respiratory illness

• In office place: make sure relevant IEC materials are displayed; permanent hand washing

facilities, closed waste bins to be provided for hygienical disposal of tissues.

• Display posters demonstrating hand hygiene procedures in all places with hand hygiene

facilities

• Surfaces (e.g. desks, tables, door handles, handrails) and objects (e.g. telephones,

keyboards) need to be wiped with disinfectant regularly. Use 0.1% chlorine solution to disinfect

floors, and other surfaces.

• Teleworking to be ensured as much as possible.

Annex 4: WASH partners stock availability: compiled figures

Updated: 5th of May 2020

IEC materials Posters Pieces - 100, FaQ in English - 100 posters in English - 500 posters in Bangla

HTH, 65-70% (kg)

Calcium hypochlorite Kg. 12.690

Chlorine NaDCC (tablet form) for water disinfection at HH level

Piece 107.142.000

Plastic Jerrycan 10 L Flexible and good quality; made of plastic

Piece 322.724

Plastic Bucket 10 L with Lid Piece 155.677

Soap for laundry Piece 2.789.135

Soap for hand washing Piece

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Annex 5: WASH kit in SARI and isolation centers

WASH and Health Sector recommended kit composition for SARI centres

• 1 laundry soap and 1 bathing soap • 1 toothpaste • 1 toothbrush • 2 cotton towels (approx. size 0.5*1 meter) • 1 bucket with lid • 1 pc. of plastic sheet (approx. size 1*2 meters)

WASH and Health Sector recommended kit composition for isolation centres

• 1 laundry soap and 1 bathing soap • 1 toothpaste • 1 toothbrush • 1 MHM kit (reusable cloth/pad OR disposable if needed) • 1 bucket with lid