The Use of Poo Bags for Safe Excreta Disposal in Emergency Settings

8/6/2019 The Use of Poo Bags for Safe Excreta Disposal in Emergency Settings

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OXFAM Technical Brief Poo bags for Safe Excreta Disposal 1

The Use of Poo Bags for Safe Excreta

Disposal in Emergency SettingsSafe excreta disposal is a top priority in an emergency, but one that takes time and extensive resources toimplement. This Technical Briefing Note examines the use of poo bags for safe excreta containment anddisposal in urban emergency settings. The Brief also explores ways of building more complete excretamanagement systems to ensure not only safe disposal, but also to ensure the dignity and safety of users.

IntroductionSafe excreta containment and disposal are criticalcomponents in an emergency public health response.Safe excreta management is one of the main barriers for

preventing faecal-oral related diseases. From a publichealth perspective, there is little to choose between thevarious emergency sanitation technologies available, aslong as the technology implemented is correctly used,well maintained and that personal hygiene issues areadequately addressed. This is particularly true in highpopulation density urban environments, where the lack ofspace, poor access and cramped conditions limit therange of excreta disposal options that can beimplemented. The use ofPoo bags provides a quick andeffective means of containing both excreta and urine inthe first phases of an emergency.

Safe Excreta ManagementDeciding what technological option to use for containingexcreta in emergencies is not an easy choice foragencies. Each disaster, each affected community, eachsetting is often unique and must be considered on acase-by-case basis. However, the primary goal of anypublic health intervention is to prevent the transmissionof faecal oral diseases caused by inadequate/unsafedefecation practices. Sanitation interventions require notonly good technology, but also a heavy investment in

terms of time and resources. Effective public healthpromotion and community participation are critical keyelements of the sanitation response to be undertakenalongside the technical interventions.

Sustainability is rarely a priority early in the emergency;however, the need to act quickly and decisively is criticalin preventing potential disease outbreaks. Sanitationresponses must be based on detailed needs assessmentsthat identify the key sanitation problems, and the needsarising from these problems. A number of factors shouldbe considered when planning the intervention. TheOxfams TB Notes 1, 2 & 7 give more details on keyfactors to consider when planning a response:

http://www.oxfam.org.uk/resources/learning/humanitarian/index.html

Figure 1: An area used for open defecation by 4,000 plusIDPs for 3 months. Haiti Earthquake, 2009.

Excreta Disposal - Key Concepts

Immediately - 1st Phase Response

Minimize high-risk practices (i.e. indiscriminateopen defecation, flying toilets, etc.)

Reduce the transmission of faecal-oral disease inhigh population density areas

Stabilisation- 2nd Phase Response

Improve technical designs to increase usercomfort, dignity and physical safety

Develop more sustainable excreta disposal

systems that can be managed by the community

Known Bag Usage - Past Emergencies

Anecdotal information from past emergencyresponses highlights a number of situations where

bags of varying types were used as defecationcoping mechanism:

Philippines, 2009 Typhoon response

Haiti, 2008 Hurricane response

Indonesia, 2004 Tsunami response

Bangladesh, 1998 Dhaka flood response

Affected populations either continued their pre-emergency defecation practice (i.e. defecating inbags) or began using bags as a coping mechanismin response to the emergency. Often this was dueto either the breakdown of their previous system orthe inability to access other toilet options.


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The Poo Bag ApproachIn rural emergency settings, land is often available toimplement traditional sanitation approaches such assimple pit latrines. However, men, women and childrenliving in an urban emergency context are often forced toadopt unsafe defecation practices due to the lack space,poor access, cramped conditions, and a whole range of

other factors. As a result, they are left far morevulnerable, not only to potential disease outbreaks, but tophysical dangers and gender based violence.

During and after an emergency, populations will try tocontinue using their traditional defecation practiceswherever possible. When this is not possible, people willadopt new coping mechanisms, and adapt to the newsituation. Often, this will result in inadequate and unsafedefecation practices. When assessing the type ofsanitation intervention needed, peoples previouspractices and their current context must be considered.The opportunities and limitations of working in the newcontext must also be evaluated.

Poo bags provide, not only, a flexible excretacontainment option, but they also offer a rapid solutionto problems of open defecation. Especially when othertraditional emergency excreta disposal options are notpossible/viable.

Socio-cultural ConsiderationsEffective excreta disposal systems often depend more onuser perceptions rather than the technology itself.Numerous cases exist where users have rejected soundtechnical solutions due to social, cultural or religiouspreferences/taboos. Excreta disposal technologies workbest when they are fully understood, managed, andsupported by the target communities.

Prior to starting any sanitation intervention, it isimportant to establish a good relationship with targetusers, which may require a competent translators and/orlocal staff. The affected community should beconsulted

to ascertain how women, men and children managedefecation. It will also be necessary to consult the elderlyand those with reduced mobility. The consultationsshould also be cross-referenced with observations in the

field of the context and actual practices (i.e. ditchesused, paths walked to field, etc.). The differing situationsfor men, women, children, elderly, and handicappedindividuals should be analysed, as this is likely to have abig impact on eventual outputs.

To enable poo bags to function successfully, users needto understand why it is important to keep the

environment free of faeces and how the bags can beused as an excreta containment tool. It is important notto focus on the bag, but rather to highlight the benefitsof an effective excreta management system, where thebag plays a vital role in containing and storing peoplesfaeces. Effective public health promotion is crucial inunderstanding current practices and in raising awarenessof the need for safe excreta management. Individualswithin the target communities can be used to championsanitation in their settlements/camps, and to assist inpresenting messages and linking excreta management tobroader health messages.

Overall, agencies must be realistic with their targetgroups, as to if and when it will be possible to provideany bag based facilities. The system for disposing of andreplacing the bags must also be clearly explained and beacceptable to everyone.

Poo Bag SystemsAny Poo bag excreta disposal system must consider all ofthe following elements:

1. Hygiene promotion

2. User interface

3. Poo bag distribution

4. Poo bag deposits and storage

5. Poo bag collection and transport

6. Poo bag treatment and/or disposal

1. Hygiene PromotionFor any sanitation system to impact positively on thehealth and wellbeing of target groups, the system mustbe shown to function correctly and be properlymaintained. Hygiene promotion is an essentialcomponent of the poo bag approach. HP will ensure bagsare used correctly; that they are collected, removed fromthe site, and ultimately, safely disposed of. IEC materialsmust be designed specifically for the bag type, and forthe collection system put in place.

Contexts for the Poo Bag Approach

1st Phase response before emergency or semi-permanent latrines can be constructed

Where latrines/toilets cannot be constructed

Urban settlements or camps with

1. High population density2. Limited open space

3. Inability to excavate

4. Low soil infiltration rate/high water table

5. Landownership issues

6. Insecurity concerns (i.e. night time, women)

7. Inaccessible for latrine emptying services

To fill the gaps in toilet access in consultationwith specific individuals (i.e. women, children,elderly, people with limited mobility)

Figure 2: IEC materials designed for in- home use inHaiti. (Left:normal bags, Right:Peepoo bags).


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Ongoing hygiene promotion messages should includeeducation on the importance of separation of baggedexcreta from general household waste; provision ofseparate facilities for urine and excreta; disposal ofchildrens excreta; and vector control by ensuring bagdeposit drums are correctly closed. In addition,adequate hand-washing facilities, complete with soap,must be provided. Further information on hygiene

promotion approaches can be found in Oxfam TBN ##:http://www.oxfam.org.uk/resources/learning/humanitarian/index.html

Monitoring and evaluation

Ongoing monitoring is necessary to ensure bags arealways disposed of in a suitable container/location and toascertain user perceptions of the system. Sample formswere developed for the poo bag approach in Haiti andare adaptable to other settings.

2. User InterfacePoo bag excreta disposal systems are intended to be low-cost and rapidly implemented, and not labour or resource

intensive. Keep the technology as simple as possible. For in-home only systems (i.e. household level provision),the minimum components are the bag for containing theexcreta and eventually a container to facilitate bag use.

Types of Bags Available

A wide range of bags are available on the market, witheach type having specific advantages and disadvantages.Bag degradability will on depend on UV light, moisture,and oxygen availability. Globally, bag degradabilityterminology is not yet fully standardized. Table 1 (below),highlights the key parameters to be considered whendesigning a poo bag excreta disposal programme.

Polyethylene Oxodegradable Biodegradable Peepoo

Cost

$ $$ $$-$$$ $$$ (?)

Size

Varies Varies Varies small

Procurement

Easy Moderate ModerateNot massproduced

Envir

on

impa

ct Polluting/

nondegrading

Degrades, butvariable safety Degrades, noimpact

Degrades

noimpact

Degradation

None

FragmentableAerobic oranaerobic(landfill)

Completedegradation,can be rapid.May requirecomposting

Rapid,complete

degradation

Health

impact

None None NonePathogen

breakdown

Table 1: Criteria for Selecting a Poo Bag Type

The choice on bag type will depend on a number offactors including what is available locally and the costper unit. Ordinary plastic non-degradable bags can be

used in the absence of other options, particularly at thestart. As the response develops, other more sustainableoptions can be developed through the use ofbiodegradable bags, etc. However, a number of factors,including: user preference, impact on local markets,availability and cost per unit, etc. should all be

considered. Independently of the bag type used,darker coloured bags are recommended for obscuring

the contents, and decreasing the potential forshame/offence amongst users.

Note:Various powder and gel coagulants are available tosolidify excreta by absorbing moisture. Handling anddisposal is easier. However, the products are expensiveand not recommended for large-scale emergencies.

Containers (bag supports)

Where possible, a container should be used to supportthe bag for ease of use. Locally available containers,such as those recycled from food or drink packaging, canbe used. Ensure the container is both clean and intact(i.e. will not cause bags to tear). Containers must alsobe sized correctly according to the volume of the bagbeing used (i.e. stretching bags will cause them to tear).

Urinals

Where possible, the provision of male and female urinalsis recommended as an effective way of reducing overalloperating costs. Providing urinals will decrease overallbag consumption, and ultimately facilitate handling bagcontents, as they are likely to be less wet. A number ofurinal designs are available using simple plumbingmaterials or by using recycled materials. The use ofurinals will also decrease waiting time at cabins(especially for women).

When soak-aways are built for urinals, one upgradingoption to consider is the use of urine diversion (UD) bagtoilets. This is particularly appropriate in smallersettlements/camps where PHP is feasible.

Further details of urinal designs can be found in OxfamGB fact sheets:

LINK: Under construction

Figure 3: In-home provision of locally available, recycledcontainer with bag used in Port-au-Prince, Haiti


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Communal Facilities and Commodes

Where feasible, communal facilities for bag use shouldalso provided. As a minimum package, an in-homesystem (bags + basic container) can be provided inside abasic superstructure at a communal location. Such astructure offers privacy and comfort for users, and iseasy to manage through community toilet attendants.Improved options could include a simple commodesystem.

3. Poo Bag DistributionFor in-home bag distributions, enlist the help ofcommunity leaders and volunteers from the targetcommunity. This is particularly relevant in largesettlements/camps where programme teams may nothave the capacity to reach the entire population. Whenbiodegradable or Peepoo bags are being distributed, it isimportant to ensure 100% coverage and usage amongstthe target groups, if the full environmental/healthbenefits are to be obtained. In the case of the Peepoo,no benefits will be obtained from the pathogen die off ifcoverage in not universal. In-home usage bags shouldbe provided on a ratio of1 bag/person/day.

Where in-home bag distributions are not feasible (i.e.high risk bags will not be collected and properly disposedof), bags should be provided directly at communalfacilities. Communal bag usage should be providedbased on a ratio of1 bag/person/day. However, extraprovision should be made assuming a certain percentageof the population having diarrhoea. Extra bags can beprovided at a ratio of 3 bags/person/day for thispercentage.

If Poo bag approach is to be used for longer periods, thecommunity should be empowered to take on the functionof supplying themselves from commercial sources. Toprevent the misuse of Poo bags, people should also bemade aware of the importance and value of safe excretadisposal in their community. In Haiti, beneficiaries werefound using bags for selling charcoal and vegetables.

4. Poo Bag Deposits and StorageTo ensure the safe management of excreta, Poo bags willrequire a collection and storage system. The use of adesignated deposit container will ensure the bags arecollected at specific locations, and stored prior to removaloff-site. Suitable storage facilities are essential to preventthe flying toilet phenomenon, which commonly occursbecause there is no deposit system in place. The

availability of storage containers can vary in post-emergency context. However, at minimum, depositcontainers should have tight fitting lids for smell andvector control, and can be upgraded as the emergency

Figure 4:Rapid, low-cost toilet construction (left) by MSF-Bfor bag (right) used post-EQ in Cit Solil, Haiti

Figure 5:Existing commode with low-cost modification ofwelded bucket that was the appropriate size of the Peepoo,

Port-au-Prince, Haiti

Figure 6:Prefabricated commode (often available in Westernnations) requires larger bags; used with a grocery-style bag

in Port-au-Prince Haiti

Figure 6: Community-assisted distributions of in-homePoo bags. Port-au-Prince, Haiti


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stabilises. If possible, the container should have a handleon the lid, to minimise contact with the container. The lidshould also be tight fitting to prevent vermin and othervectors from entering. Also, in the event container fallsover, the lid will prevent the contents from spilling.

In flood emergencies where populations may beinaccessible, it may not be possible to establish a deposit

and storage system. Further research is required into thevarious bag options in such settings. One option is tobury the bags on-site, providing suitable bag buriallocations are available at a suitable distance frompeoples dwellings (smell) and from water sources (> 30m). However, this is only recommended forbiodegradable bags and is not appropriate in flood proneareas or on land with a high water table.

5. Poo Bag Collection & TransportA number of options exist to transport storage containerssafely and effectively. The choice of option will depend

on the volume and weight of the containers to betransported; access to the collection site; distance to thefinal disposal site; and cost of operation for the collectionservice. Options include wheelbarrows, handcarts,bicycles with trailers, horse and carts, pick-up trucks, andshoulder carried containers.

Depending on the distance to the final disposal site, thesystem put in place may require transfer stations, werethe contents from many smaller containers are depositedand then collected by larger sized transport option suchas a large truck. Vacuum operated sewerage trucks maybe appropriate vehicles to use at such transfer stations.

In flood situations, it may be necessary to use boats or

other aquatic transport to collect Poo bag containers. Abell or whistle can be used to warn the community thatthe boat is approaching and that containers should beplaced outside for emptying/collection.

6. Poo Bag Treatment/Disposal

After collection and transport, the excreta filled bagsmust be handled in such that any potential tocontaminate the environment or harm public health ismitigated. The options for treating or disposing of thebags will depend on the context. Specific examples arediscussed in the following case study section.

Contingency Bag StocksIn disaster-prone urban areas, there is potential to designand stock appropriate poo bag sanitation systems, whichcan be deployed rapidly and scaled as required in theevent of an emergency. With forward planning, it ispossible to identify to raise awareness amongst potentialfuture users on the options, and to stock moreenvironmentally friendly materials, which may notnormally be available locally. Depending on the type ofbag kept, it may be necessary to work in some form ofstock rotation, to ensure the shelf life of the bags is notexceeded.

Various containers for bag support and deposits will alsobe necessary, but it may be prohibitively expensive tostock these due to the large volumes. In this event,suitably commercially available drums/containers can beidentified locally, and pre-agreements set-up with localsuppliers to deliver specified quantities ofdrums/containers rapidly in the event of a rapid on-setemergency.

Poo bag kits can be designed for rapid distribution. As aminimum, a kit should have an appropriately sizedcontainer to support the bag, and contain thecorresponding IEC materials with instructions onknotting, disposal, and the collection scheme to be put in

place. Ideally, the kits should fit into the container and befitted with a lid.

Figure 8: Ideal deposit container- 32-gallon, lightweighwith handle, lockable lid and attached wheels

Figure 10:Distribution of household kits for in-homePeepoo use in Port-au-Prince, Haiti


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Use of the Poo Bag Approach -Case Studies

1st Phase Response

Bags can be deployed rapidly deployed to an affectedcommunity and require minimal education. However,

prior to any bag distribution, a suitable bag collection,storage and disposal system must be put in place and beeffectively maintained over time.

In-home only provision

Bags, containers, and IEC materials can be distributedimmediately so that beneficiaries can begin to use thebags in their home or in a place where they feel secure.However, proper receptacles or designated burial spotsto deposit used bags must be provided. Acceptance ofthe system by users is also important. From a publichealth perspective, urine has minimal associated with it,and it is unnecessary to use bags for urine only. Userscan be encouraged to use specific urinals.

On-site bag storage and/or burialProlonged storage can limit the collection and transportcosts. For example, if Peepoos are properly used (i.e. noexcreta outside of the bag and no leaks) they can bestored for 4 weeks then simply discarded. However, thelength of time between collections or burials must beacceptable to the population.On-site burial may be the most rapid and logisticallyfeasible option available until off-site transport can bearranged. If biodegradable bags are used, it must beensured that the pit remain undisturbed for at least 12-months to allow pathogens to degrade. Care must be

taken to ensure groundwater is not polluted due toleaching from the burial pit.

Off-site bag disposal

When biodegradable bags are used and on-site burial isnot possible or not acceptable, deposit drums can betransported off-site to disposal sites or alternatively tocomposting facilities (see below). When ordinary plasticbags are used, off-site disposal by landfilling orincineration is the only viable option to remove excretafrom the immediate living environment (refer to Oxfam

GB TBN no. 15).http://www.oxfam.org.uk/resources/learning/humanitarian/index.html

When excreta filled bags filled with excreta are disposedof in a landfill or dump site, special areas should beprepared for the bags, especially if there are people livingin the vicinity or if there is a practice of scavengingrefuse at the site. This area should preferably becordoned off.

Upgrading options

Community level provision

When space is available, superstructures can be erected

to offer additional privacy and comfort for users, which isparticularly important for women. Various toilet designscan be used inside the superstructure, depending on thepreferences of the intended users.

In-home Bag Provision in Port-au-Prince

Camp Maranatha, a spontaneous IDP settlementisolated on a mountainside. It was considered thatOxfam GB would not be able to provide traditionallatrines, as the nearest road access is 15 minutes walkover unstable terrain. There was also a land dispute.People were either defecating in the open around thecamp, or into plastic bags that were thrown into anearby ravine.

Figure 11: Camp Maranatha, surrounded by a riverbed thatexperiences flash floods during the summer rains

In-home Bag Provision (continued)

Buckets were distributed to each household along withweekly supplies of biodegradable bags. One small pitwas excavated at the bottom of the hill (public land)

and the population were instructed to deposit used bagsthere. Community mobilisers raised awareness aboutcovering the pit daily with soil and/or ash.

Figure 12: IEC specific to carrying bag from usage point to pitfor burial

After 2-weeks, an agreement was reached with thelandowner to build pit latrines in the camp. In-home bagusage continued for over one month to fill the gap untilthe pit latrines were completed.


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For users accustomed to squatting, a simple bucket tohold the bag, with footrests, may be appropriate. Forusers accustomed to sitting or for the physically disabledand elderly, various chair/commode like structures can bemade, modified, or purchased prefabricated. More detailsfor adapting facilities for disabled can be found in:

Water and sanitation for disabled people and other vulnerablegroups: Designing services to improve accessibility.

Space permitting, simple urinals for men and women canbe installed to limit the number of bags used anddecrease waiting times at cabins.

Composting Bags

Composting is the biological decomposition of organic

material under aerobic conditions (in the presence ofoxygen). With proper management, biological heat isgenerated and composting takes place followed by aperiod of stabilisation to produce a final product suitablefor application to the land without adverse environmentalor health effects.

In an emergency or post emergency setting, thecomposting of excreta (combined faeces and urine orsource separated) should only be considered if there issufficient technical expertise, space and trained staff tolimit potential risks to health and safety. In the earlystages of an emergency, establishing a new compostingsystem is unlikely to be appropriate, and emphasis should

be placed on removing bags from high population densityareas.

Community level bag provisionPort-au-Prince, Haiti

At Cit aux Cayes camp, in-home bag provision wasstarted 2-days after an assessment. During this time,superstructures for commodes and urinals were beingbuilt, with construction taking around one week.Following this, camp residents were given the choice toeither use in-home bags or to use communal cabins.

Cit aux Cayes was not accessible by road. Awheelbarrow was used to transport excreta depositdrums and solid waste to the nearest road for pick up.

Figure 13: Bag commodes with superstructures

Post-trial data collected from household questionnairesfound 94% of cabin users were very satisfied orsatisfied with the community toilets. Additionally, 65%of households highlighted in-home bags were used byone or more members of the family.

Figure 14: Solid waste and excreta deposit drums being takento the nearest road for pick up.

Case Example UD-bag toilets,

Port-au-Prince, Haiti

Instead of providing separate urinals, to maximize thspace available and minimize the number of bagused, Oxfam GB developed Urine Diversion (UD)-batoilets. The urine was diverted to a soak pit and th

back bucket style was used as with other basystems, to contain faeces.

Figure 15:Low-cost, locally produced UD toilets (Left,fibreglass, right recycled materials)

Figure 16: IEC used to explain proper removal of bag fromUD toilet and deposit for collection and disposal


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If and when the decision is taken to develop composting,it is important to involve communities from thebeginning, especially when excreta re-use is not taboo.Composting can be used to treat raw excreta and renderit safe, providing this is done in a systematic way.Composting processes are discussed more in depth inOxfam GB TBN 16.

http://www.oxfam.org.uk/resources/learning/humanitarian/index.html

Composting in a 1st Phase EmergencyPort-au-Prince, Haiti

Two months after the earthquake, the New DirectionsFoundation set up a pilot-composting project. Thesystem used fungal inoculation in small compost pileson wooden crate-platforms.

Figure 18: A New Directions Foundation composting site in

Port-au-Prince

Further Information

Ferron, S. Morgan, J. and OReilly, M. (2007)Hygiene Promotion: a practical guide for relief anddevelopment. -Practical Action, Rugby, UK.

Harvey, P. Baghri, S. and Reed, R. (2002)Emergency Sanitation Assessment & programmedesign. -WEDC Loughborough University UKhttp://wedc.lboro.ac.uk/knowledge/bookshop_results.html?s=ful

Harvey, P. (2007)Excreta Disposal in Emergencies a field manual. -WEDC Loughborough University, UKhttp://wedc.lboro.ac.uk/knowledge/bookshop_results.html?s=ful

Jones, H. and Reed, R. (2005). -WEDC Loughborough University, UKhttp://wedc.lboro.ac.uk/knowledge/bookshop_results.html?s=full

Patel, D., Brooks, N. and Bastable, A. (2010)Coping mechanisms for urban emergencsanitation: bag and Peepoo trials with internalldisplaced people in spontaneous settlements inPort-au-Prince, Haiti.

Oxfam GB TBN no. 1Excreta disposal for people with physical disabilitiesin emergencies

Oxfam GB TBN no. 2Vulnerability and socio-cultural considerations forPHE in emergencies

Oxfam GB TBN no. 7UD Toilets and Composting Toilets in EmergencSettings

Oxfam GB TBN no. 15Domestic and Refugee Camp Waste ManagemenCollection & Disposal

Oxfam GB TBN no. 16Composting of Organic Materials and Recycling

Oxfam GB TBN no. XXHygiene Promotion

www.biodeg.org

www.peepoople.com

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The Use of Poo Bags for Safe Excreta Disposal in Emergency Settings