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Water and Sanitation Hygiene Sector

In-depth Need Assessment

By WASH Cluster KP and FATA

South Waziristan, Kurram, Orakzai, Bajaur and Mohmand Agency of FATA

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Peshawar, Nowshera, Kohat, Hangu, D.I. Khan and Tank of Khyber Paktunkhwa

Peshawar May 2014

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“The human right to water is indispensable for leading a healthy life in human dignity. It is a pre-requisite to the realization of all other human rights.”(General Comment 15)

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Acknowledgement WASH Cluster Khyber Paktunkhwa and FATA wish to thank the cluster members, implementing partners, government authorities and IDP and returnee communities for making the WASH In-depth Need Assessment Survey a success. We particularly appreciate the commitment, enthusiasm and hard work of the field teams for their outreach in the most challenging circumstances and doing their part at best. UNICEF team deserves a special commendation for taking the lead right from the start till publishing of this report and providing all possible support. Finally, cluster partners express gratitude to UNICEF for financing and guiding the assessments.

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Abbreviations WASH Water Sanitation and Hygiene UNICEF United Nations Children Fund FATA Federally Administered Tribal Areas KP Khyber Paktunkhwa UNHCR United Nations High Commission on Refuges WHO World Health Organization LHW Lady Health Workers HP Hygiene Promoter IDP Internally Displaced Person

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Contents No table of contents entries found.

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Executive Summary According to UNHCR, some one million (157,301 families) IDPs have fled their homes between 2008 and 2013, in wake of insecurity related to conflict and sectarian violence in various parts of FATA and Khyber Paktunkhwa. Over five per cent (7,886 families) of this population is living in camps, and the remaining 95 per cent (149,415 families) are residing in host communities, mostly in the adjoining districts of KP. The deterioration in the humanitarian situation, due to limited local resources, unavailability of basic facilities and services and the resultant burden on host communities has the potential to create a myriad of long-term issues in addition to the immediate emergency. Water and Sanitation is a human rights recognized by global community in its commitment in Item 15 of the United Nations. It is estimated that about ….of Pakistan population do not have access to adequate WASH facilities. According to the research about 40% of the illnesses/diseases are water born in Pakistan. Internally displaced people are more vulnerable to non-availability, short supply or quality issues related to WASH, as they inhabit transitional living mostly in placed outside their areas of origin. To know more specifically about the access to, availability and quality of WASH facilities to the IDPs and returnees of complex emergencies in Pakistan, WASH Clusters in KP and FATA reckoned to carry out an in-depth need assessment of WASH facilities at house hold level in six districts of KP and five agencies of FATA. The assessment was designed, planned and executed by some of the active WASH Cluster member from KP and FATA in coordination with UN-OCHA. A sample of 4269 respondents was selected through stratified random sampling method and was interviewed by team of the cluster members’ organization. District and Agency based teams carried out the survey by visiting house hold through structured interview schedule. Data collected between April…….and May……was entered into excel, analyzed for key findings and is being reported here for wider dissemination and use of humanitarian community. The study has surfaced key and detailed findings related to access, availability and quality of water and sanitation for IDPs and returnee population in the host areas and areas of origin. Key findings reveal that IDPs are mostly using safe sources of water. However situation of access to safe water is worse in FATA than KP. Though most of water sources are available in-house, considerable numbers of IDPs still have to travel 15-30 minutes to collect water. Use of open storage container for water is still was noted in almost one third of the respondents. Responsibility of collecting water still lies with women. It has been learned that IDPs and returnees are not satisfied with the quality of water they get while most of the respondents were found having no knowledge of water purification to them. Major problem with quality of water identified included bad smell, bad test and turbidity. Though latrines are available in most of the respondent’s houses, the distance between latrine and water source is alarmingly less. Stagnant water was reported by most of the respondents. Heath hygiene education and training is hardy available to the respondents due to non-availability of Lady Health Workers or Hygiene Promoters. Health facilities and water in them is not available in the studied area. It is recommended that access to safe water may be increased by minimizing travel time and improving quality of existing water. Awareness regarding safe handling and use of water and sanitation and hygiene practices has also been recommended. Distance between water and sanitation sources is recommended to avoid water borne diseases. Similarly provision of water and sanitation facilities at health and school facilities could also make a difference. It has also been suggested to increase coverage of LHW and Health Promoters for increased awareness and sensitization.

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Introduction The Context Latest estimates of the WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation (JMP), released in early 2013 (collected in 2011), reveals that 36 per cent of the world’s population – 2.5 billion people – lack improved sanitation facilities, and 768 million people still use unsafe drinking water sources. According to Water Aid, 15.9M people in Pakistan don't have access to safe water, Over 93 million people don't have access to adequate sanitation in Pakistan, and over half of the population and Over 40,000 children die every year from diarrhea caused by unsafe water and poor sanitation in Pakistan. The ongoing security operations in the Federally Administered Tribal Areas (FATA) and parts of Khyber Pakhtunkhwa (KP) have led to large scale population displacements across the region since 2008. According to UNHCR Factsheet, one million IDPs (157,301 families), who fled between 2008 and 2013 due to insecurity related to armed non-state entities, security operations and sectarian violence in various Agencies of FATA. Over five per cent (7,886 families) of this population is living in camps, and the remaining 95 per cent (149,415 families) are residing in host communities, mostly in the adjoining districts of KP. The deterioration in the humanitarian situation, due to limited local resources, unavailability of basic facilities and services and the resultant burden on host communities has the potential to create a myriad of long-term issues in addition to the immediate emergency. In the given context, it was deemed important to have comprehensive assessment on the WASH needs of children and women in the IDPS hosting areas and in areas of return. Responding to the need, WASH Cluster KP and FATA decided to conduct in-depth assessment of WASH needs in six (6) Districts and five (5) agencies of Federally Administered Tribal Areas. Objective of the Study This assessment seeks to assess water, sanitation and hygiene (WASH) needs of IDPs in hosting areas and returnees in areas of origin. The study has achieved the specific objective by exploring the status of water, sanitation and hygiene at household level and at schools and health facilities. The study has gathered information on IDPs settled off camps and those returned to the areas of origin separately. Significance of the study The study shall produce in depth understanding of the access, availability and quality of the water, sanitation and hygiene of IDPs and returnees in the target areas. Once identified and classified, the needs analysis shall serve as a base for planning short term, medium term and long term interventions by the cluster members. The cluster will use findings of this study to design program interventions, raise funds and coordinate efforts accordingly. Partners involved in the WASH interventions will have a ready to use needs assessment on critical indicators and would be in a much better position to address them as required. Study Area. The study has been conducted in six (6) districts of Khyber Paktunkhwa namely Peshawar, Kohat, DI. Khan, Tank, Hangu & Nowshera and six agencies of FATA namely Mohamnd, Bajaur, SWA, Khyber, Orakzai & Kurram Agency.

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Description of surveyed Districts and Agencies Kohat district is located at 180km from Islamabad and 65km from Peshawar (the provincial capital. It is bordered by Peshawar district in the north, Hangu and Kurak in the south, Nowshera in the east, and Oarkzai Agency in the west. Military operation in Bajur district and insurgency activity throughout 2011 caused a significant number of displaced persons to Kohat District. The majority of Internally Displaced People (IDP) stays with host communities, stretching the capacity of households who employ distress mechanisms to overcome the additional strain. During 2012 Kohat has received part of the newly displaced population from Khyber Agency, thus the pressure on traditional livelihoods in combination with structural vulnerabilities has had the effect of reducing the overall quality of life and resilience for the region. Hangu district is located at 225 km from Islamabad (the federal capital) and 110 km from Peshawar (the provincial capital). It is bordered by Orakzai Agency in the north, Waziristan Agency and Kurak District in the south, Kohat in the east and Kurum Agency in the west. Military operation in Orakzai, Khyber, Kurum and insurgency activity throughout FATA caused a significant number of displaced persons to Hangu District. During 2012 Hangu has received part of the newly displaced population from Khyber Agency, thus the pressure on traditional livelihoods in combination with structural vulnerabilities has had the effect of reducing the overall quality of life and resilience for the region. The sample clusters were changed by the district administration, EDO health and Security agencies. Six Union councils namely Balyamena, Tora warai, Zargari, Naryab, Darband and Kach were declared as red zones, hence survey team was not advised to carry on the survey practices. Similarly during the survey period, three clusters were re-notified as red zones by the competent authority. Therefore CERD team replaced these three clusters. DI Khan District is the southern district of KP and is bordered by districts of Tank and Lakki Marwat in the north, Dera Ghazi Khan and Bhakkar, both districts of Punjab, in the south and east, respectively. Administratively DI Khan comprises five Tehsils: DI Khan, Paroa, Paharpur, Kulachi and Daraban. Its population is estimated to be 1.3 million out of which nearly 80% is rural based. The social structure is tribal in character and the major tribes are Gandapur, Kundi, Mianhkel, Alizai, and Saddozai. Out of 7000 square kilometres of area, 14, 68,265 acres are under cultivation and 3,359,342 acres is canal fed. It has essentially an agrarian economy. The district is well linked within the province through Indus Highway via Bannu, Kohat to Peshawar, and across Indus to major cities of central Punjab. It is also connected by air to Peshawar, Punjab and to the Federal Capital Peshawar district include the provincial capital also the largest city in the ProvinceThe city district enjoys tremendous historical, military, economic and political importance. The Federally Administered Tribal Areas (FATA) adjoining Peshawar, the Khyber Agency which lies to its West, Mohmand Agency to its North, Frontier Region (Semi-Tribal regions) Kohat to its South. The two settled districts of Charsadda and Nowshera are situated to its North and North-East respectively, whereas the Afghan border is approximately 40 Km to the West. Military operation in Bajur, Khyber & Momend Agency, and insurgency activity throughout 2011 caused a significant number of displaced persons to Peshawar District. Nowshera district is spread over a large area of 1,748 km² with River Kabul bisecting the district. The population density of the district is 608 persons per square kilometre. Until 1988 Nowshera was a Tehsil (sub division) of Peshawar; in 1988 it became a district. It is bordered by Peshawar District to the West, District Mardan to the North, District Charsaada to the North West, District Swabi to the North East, District Kohat (FR KOHAT i.e. Darra Adam Khel) to the South, Orakzai Agency to the South West. While it also makes a boundary with the Punjab province to the East (District Attock). Nowshera District is divided into 47 Union Councils and comprises of many famous Pakhtun tribes including the Khattaks, Babers, Durranis, Kakakhels, Yousafzai & Afridis. It is the only district of Pakistan with three Cantonments namely Nowshera Cantonment, Risalpur Cantonment and Cherat Cantonment. The majority of Internally Displaced People (IDP) stay with host communities at the same time Jalozai IDPs camp in the

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district has remained the epicentre of IDPs registration, basic amenities and instant health care. Apart from the IDPs crisis, in August 2010, monsoons rains caused floods and damaged many areas of Nowshera District leaving many communities inaccessible due to destroyed crops roads, and bridges. Tank District is a southern district in the Khyber Pakhtunkhwa province of Pakistan. There are totally sixteen Union councils with a population of 360124. Tank was formerly part (Tahsil) of Dera Ismail Khan District. Tank is bounded by the districts of Lakki Marwat to the northeast, Dera Ismail Khan to the east and southeast, and South Waziristan to the southwest, west, and northwest. The climate in Tank reaches 110-120 °F. The Total Area of the District is 1679 square kilometres and the average population density is 170.91 per square kilometres. Gomal, Sarangzoona, Dabara Region and UC Mullazai are security risk areas. Tribal alliances run deep and events in SWA tend to have an impact in the District. About 17000 plus IDPs from South Waziristan Agency (SWA) are housed with Mahsud kinsmen in their winter residences or in their permanent residences, some live in hired accommodations. Kurram agency is one of the seven tribal agencies; it was declared as an agency in 1892 and became the part of Pakistan in 1947. The population is divided into three sub-divisions, namely Upper Kurram (almost 80% Shia), Central Kurram (95% Sunni) and Lower Kurram (80% Sunni). Around 935,000 people are living in an area spreading 3,380 square kilometers in the agency which is bordered with the North Waziristan in the South, Hangu, Orakzai and Khyber Agency in the East, whilst it shares its border with Afghanistan’s area of Nangarhar in the North. The sectarian violence remained an issue since long but the sectarian identities as well as hostilities became worse during past few years. Military operation has started in Kurram Agency in July 2011 which resulted in displacement. The displaced persons took refuge in other area of Kurram Agency and New Durrani Camp established by the Government. The Kurram Agency is the most affected Agency which is proven to disasters especially to conflicts. Bajaur Agency was declared a Federally Administered Tribal Agency in December 1973. Geographically, Bajaur Agency adjoins Malakand Agency on the South-East, Dir District on the North-West, Mohmand Agency on the South-West and Afghanistan on the North-West. Bajaur Agency is located at the extreme end of the Himalayan Range which creates variations and uncertainty in the monsoon rains from month to month and year to year. The estimated population of Bajuar Agency is 1,124,141 (1998 census population 595,227 @ 4.33% annual growth rate, with population density of 461 persons/sq.km). The average household consists of 7.19 individuals in the above mentioned three selected tehsils of the Agency. The male and female ratio is 105 males to 100 females. The analysis of the available data shows that 22% out of male population is below 18 years old while 29% of female population is below 18 years indicating a female dominated youth population bulge. Bajaur has been through man mad disaster since 2008 when insurgency stem in the agency and a war against militant started by the state authorities. More than hundred thousand population from the agency were displaced and mostly settled in the adjacent district of Lower Dir, Mardan and Peshawar, till late 2011. South Waziristan Agency is the largest in size of all the other agencies in FATA. It has functioned since 1895. South Waziristan is bounded on the north by North Waziristan Agency, on the north-east by Bannu and Lakki Marwat Districts, on the east by Tribal Area Adjoining Tank, Tank District and Dera Ismail Khan Districts. On the south by Zhob district of Balochistan Province, and the tribal areas adjoining Dera Ismail Khan District; and on the west by Afghanistan. Historically, South Waziristan has been the most volatile tribal Agency of the region of what is today called FATA. South Waziristan has a population of around 0.8 million. South Waziristan is about 6,500 sq kms and is the most sensitive agency of FATA. It is about 500 kms both from Peshawar and Quetta and about 580 kms from Islamabad. Wana is the capital and key city. South Waziristan shares nearly 300 kms of border with Afghanistan. South and North Waziristan Agencies border Afghanistan’s Paktika and Khost provinces.

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Research Design The assessment The study was designed using Creswell’s mix methods of research. The study used house hold data collection method through structured interview schedules and observation for collection information on the access, availability and quality of WASH facilities at house hold level and in the schools and health facilities. The research scheme has been designed by the WASH Cluster in collaboration with UNOCHA. WASH Cluster has explored the possibilities of joint assessment with other clusters where possible. WASH cluster has also worked together with FDMA, PDMA & Government Line agencies. The cluster this way has leveraged combined resources of cluster members for planning, execution and reporting of the assessment. Sampling method The study followed cluster and stratified random sampling method for the study. Clusters of populations were selected on the basis of spread of IDPs and Returnees in the host and areas of origin. This information was taken from the secondary source, mainly UNHCR data base on IDPs. Another characteristic consider in selection of population cluster was homogeneity of population. The population in the given cluster (by UN-OCHA) was then divided into two distinct but related strata’s of IDPs and Returnees. Unit of inquiry was household/family and subject of inquiry has been Head of the Household (HoH) or any responsible adult in case of unavailability of HoH. All efforts have been made to have female respondents where possible, keeping in view the cultural sensitivity of the target areas and security situation. Population Currently 163,102 families are internally displaced in different parts of Khyber Paktunkhwa and Federally Administered Tribal Areas. Out of the total number, 95% families are living in the host areas, outside camp while only 5% families are living inside the IDP Camps established at Jalozai Nowshera, Togh Sarai Hangu and New Durrani Kuram Agency (reference) The 5% IDP living in the camp are further distributed in three main locations. Jalozai is the largest IDPs camp hosting 77% of the in camp population followed by New Durrani with 16% and Togh Sarai having only 7% of the total in-camp population. In Khyber Paktunkhwa, vast majority of IDPs live in the host communities i.e. out of the IDP Camps. Peshawar is hosting the largest chunk of 48% of off camp IDPs. Second largest population of (19%) IDPs is concentrated in D.I.Khan and third largest concentration (18%) is in Kohat. Tank,Kurram and Hangu host 9%, 5% and 1% of off camp IDPs respectively. Sample Size The study was undertaken with sample size of 4269 respondents in the selected districts of Khyber Paktunkhwa and five agencies of Federally Administered Tribal Areas. Sample size for Khyber Paktunkhwa was 2863 (67%) and for FATA sample size was 1406 (33%). The total number of sample both in KP and FATA was further distributed over districts and agencies according to the IDPs population in the host areas and areas of return. This way the sample size per district for both the gender was allocated as per below table.

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Data Management Data Collection WASH Cluster member KP and FATA has jointly done data collection for this assessment in the target districts and agencies. After finalization of the research design, the cluster formed district and agency based team of the local partners. (partners and number of team). For data collection at house hold level, the team visited host communities and returnees at their current location of stay. The teams followed right hand rule and selected every third house hold for inquiry. In case the house was found empty or the inhabitant non cooperative, the adjacent proceeding house hold was interviewed for the purpose. Structured interview schedule having three major sections on Water, Sanitation, and Hygiene was used for data collection. The process of data coaction started on April ………and ended May ………….. Data Analysis & Reporting The data has been analyzed using Meta-Analysis method. Data received from the partners was entered into excel, cleaned for errors and omissions and then analyzed. For analysis purpose, indicators used in the interview schedule were taken as a base. However indicators and questions with similar or close relation were combined for presentation purpose. Analyses extracted are in the form of charts, tables supported by description of the findings and correlation with other indicators in the study. Findings of the study are based on this analysis are being presented here in the form of study report. The report has four major sections Introduction Research Design Findings and Recommendation Annexures

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Findings and Recommendations Summary of Findings Majority (68%) of IDPs and returnees in KP and FATA are using safe sources for drinking water;

however considerable number (32%) is using surface water Both in KP and FATA, 31% of the IDPs in host areas and returnees are using unsafe water sources

including those from river (14%), bore hold and others (14%), open pond (6%) and water channel (5%). Situation of access to safe water in FATA is much worse than in KP. In FATA 53% of the IDPs and 50%

of the IDPs are using unsafe sources of water while in KP the 90% respondent IDPs reported using safe sources of water.

Water sources to IDPs and returnees are accessible in close proximity in majority of cases; however sizable population still goes out of their homes to fetch water from different sources.

The analysis of data collected shows that (41%) of the IDPs and returnees have water available in-house, 25% travel between 10-30 minutes, while 9% travel more than 30 minutes to collect water

About one tenth of the IDPs and returnees travel more than thirty (30) minutes to collect drinking water. Drinking Water Supply Schemes are predominantly owned by the users themselves Availability of water container is not an issue for the IDPs in the host areas and returnees at the areas of

origin as (84%) of respondents in the assessment reported to have water container at home while only (16%) respondents reported non availability of water container.

The IDPs and returnees are mostly using mix of container for storage of water including water cooler, jerry can, and bucket and others.

Almost one third of the respondents still use open pots i.e. buckets, clay pots and others. Use of unsafe water storage was evident in IDPs at Hangu, Khyber Agency, Kohat, Nowshera, Orakzai Agency and South Waziristan Agencies.

In the areas studies, water is mostly collected by women in the family. Girls also help to considerable extent in collecting water while men and boys has minimum role for collecting water.

The most commonly problem faced while fetching water by IDPs and returnees reported is ‘non-availability of water, followed by ‘difficulty in collecting water’, ‘difficulty in carrying water’ and ‘long distance’. Problem of non-availability of water was reported by IDPs in Tank, Returnees at South Waziristan and Khyber Agency by 69%, 48% and 46% respectively.

vast majority i.e. 77% of the house hold have mug or other utensil available for fetching drinking water while only23% respondents informed of non-availability of mug or other utensils and use of alternate method for fetching of water.

It is encouraging to note that the IDPs and Returnees treat collected water safely by covering it after fetching.

IDPs and returnees both in KP and FATA are not satisfied with the quality of water they get. Majority (59%) of respondents expressed their dissatisfaction with the quality of water while 41% were found satisfied with the quality of water being used.

Users from FATA are relatively more satisfied with the quality of water as compared to KP, except Kurram Agency

IDPs and returnees in KP and FATA are in need of knowledge of the water purification method. Vast majority (83%) of the respondents in the study reported ‘no knowledge’ of any water purification method.

Direct observation of the water at house hold level has revealed problems with the quality of water both in KP and FATA. Major problem with the quality of water is related to bad smell, bad taste and turbidity.

IDPs in D.I.Khan, Hangu, Peshawar and Tank in KP are having most of the quality related problems with significant percentage in drinking water. While in FATA IDPs in Khyber, returnees in Kurram and

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returnees in Mohmand are also facing issues of bad smell, bad taste, turbidity and others with varying ratios.

Majority of IDPs and returnees in KP and FATA have latrines available within their house premises. The data depicts that sixty four (64%) of the respondents have latrines available while thirty six (36%) do not have latrine facility.

In most of the areas, existing latrines are not sufficient to full fill the needs of all IDPs and returnees. Majority (60%) of the respondents are using pour flush with septic tank, twenty percent (20%) use

traditional latrine while nineteen percent (19%) use pour flush with open drain. Most of the latrine being used by the IDPs and returnees are conveniently accessible. Data depicts that distance between latrine and water point in majority (54%) of the household is

alarming i.e. less than 30 feet Majority of the adult male (57%) goes out to agriculture field for defecation while 42% of adult male use

latrine for defecation, 1% uses other options for defecation. Privacy for women is available reportedly in majority of the latrines available. Stagnant water was reported by more than half (66%) of respondents while considerable respondents

maintained that there is no stagnant water around latrine. Sold waste was reported lying around in the house by 64% of the respondents both in KP and FATA.

36% of the respondents however revealed that there is no solid waste around latrine. Vast majority of respondents (81%) wash hands before eating, 47% wash hand after using the latrines,

26% before feeding while only 3% of the respondents told that they do not wash hand on any of the occasion mentioned earlier.

Use of soap while washing hands is much common in IDPs in KP and FATA than returnees. Both in KP and FATA, Lady Heath Workers and Hygiene Promoters are rarely available. Only 15-20%

IDPs and returnees have LHW and HP services available. KP is slightly betters where 20% IDPs have reported presence of LHW/HP as compared to 15% IDPs and returnees who reported availability of LHW or HP.

There seems to be negligible hygiene education both in KP and FATA, IDPs as well as returnees. Meager portion of the respondents (7% overall, 10% in KP and 4% in FATA) reveled that they LHW/HP provide health education

Overall, children under the age of 18 years were reported as most affected by the diarrhea incidents in the family. The status was revealed in KP and FATA and IDPs and returnees alike.

Overall the predominant reason for diarrhea is water. IDP in KP, IDPs and returnees in FATA perceived water as a major reason for diarrhea with 50%, 49% and 33% responses.

Only one third of IDPs and returnees informed the study that they have been provided hygiene kits. Among those who reported receipts of hygiene kits, majority (62%) are returnee while only 18% of IDPs reported to have received hygiene kits.

Considerable number of IDPs from KP and FATA both revealed that they take Oral Rehydration Salt in case of diarrhea.

Majority of IDPs and returnees both in KP and FATA have not received any training on hygiene promotion.

Vast majority (74%) IDPs and 80% returnees confirmed that school exists in their village. Surprisingly IDPs and returnees having school in their village were found higher in number (80%) in FATA as compared to IDPs in KP.

Heath facility at village level in the study area is lacking mostly.

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Overall vast majority (71%) of respondent were of the view that schools don’t have water facility. Situation of availability of water in FATA is much worse than KP.

Water is not available in health facilities at village across KP and FATA Latrine facility is also rare in schools as told by the majority (67%) of respondents both from KP

and FATA Only 21% of the IDPs and returnees in KP and FATA shared that latrine in health facility is

available in the village

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Water: The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses", (UN CESC - General Comment 15, para.2) The right to water to satisfy basic human needs for personal and domestic uses has been protected under international human rights law. When incorporated in national legal frameworks, this right is articulated to other water rights within the broader body of water law. According to United Nations Children's Fund (UNICEF), 20 to 40 % beds are occupied in the hospitals of Pakistan by patients suffering from water related diseases. Unfortunately, most of the water sources are contaminated and there is no proper mechanism exits whereby poor people could get clean water (both biologically and chemically treated). According to a report, in Pakistan one-quarter of all people attending hospitals are ill from water-related diseases as a result of poor sanitation and lack of safe drinking water facilities According to the Pakistan Social And Living Standards Measurement Survey of 2010-11, the main source of drinking water was as follows: 32% tap water, 28% hand pump, 27% motor pump, 4% dug well and 9% others. Primary Source of Drinking Water Majority (68%) of IDPs and returnees in KP and FATA are using safe sources for drinking water; however considerable number (32%) is using surface water. The safe sources of water includes protected and unprotected dug wells, tube wells, hand pumps and tape water while the unsafe sources reported include river, ponds and open water channels and other sources. Among the safe water users, majority of the interviewed respondents (24%) revealed that they use water from hand pump, 21% from dug well, 9% from tube well and 7% use tape Water. Both in KP and FATA, 31% of the IDPs in host areas and returnees are using unsafe water sources including those from river (14%), bore hold and others (14%), open pond (6%) and water channel (5%). Situation of access to safe water in FATA is much worse than in KP. In FATA 53% of the IDPs and 50% of the IDPs are using unsafe sources of water while in KP the 90% respondent IDPs reported using safe sources of water. Worst situation of using unsafe water was reported by (86%) respondents from South Waziristan followed by 65% returnees from Kurram. Ideal situation was reported by IDPs in Peshawar, where all respondents reported safe sources of water, 98% of IDPs respondents from Kohat and 97% from Nowshera revealed that they use safe sources of water.

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Average time required for collecting water Water sources to IDPs and returnees are accessible in close proximity in majority of cases; however sizable population still goes out of their homes to fetch water from different sources. The time consumed on collecting water ranges from less than fifteen minutes to more than thirty minutes. About one tenth of the IDPs and returnees travel more than thirty (30) minutes to collect drinking water. The analysis of data collected shows that (41%) of the IDPs and returnees have water available in-house, 25% travel between 10-30 minutes, while 9% travel more than 30 minutes to collect water. In KP access to water is relatively better than FATA. Majority of KP IDPs (66%) have water facility inside house, while in FATA 16% IDPs and 21% returnees only have in house water source. 25% of IDPs in KP have water source available within 10-30 minutes distance while in FATA 51% IDPs and 42% returnees have water source within house. 9% of IDPs in KP require more than 30 minutes to collect water while in FATA 33% IDPs and 37% returnees required more than 30 minutes to collect water. Area Condition Respondents In-house Less Than 15

minutes 15 to 30 minutes

Total Overall 4797 41% 18% 17% IDPs 2949 54% 19% 12% Returnees 1848 21% 18% 24%

FATA Overall 2553 20% 19% 26% IDPs 705 16% 22% 29% Returnees 1848 21% 18% 24%

KP IDPs 2244 66% 18% 7% Bajaur Returnees 227 63% 16% 9% D.I. Khan IDPs 380 48% 7% 14% Hangu IDPs 311 46% 38% 10% Khyber Overall 300 10% 17% 32%

IDPs 156 3% 23% 37% Returnees 144 19% 10% 28%

Kohat IDPs 372 61% 24% 11% Kurram Overall 1205 17% 20% 26%

IDPs 549 20% 22% 26% Returnees 656 13% 19% 25%

Mohmand Returnees 111 13% 34% 36% Nowshera IDPs 394 66% 25% 6% Orakzai Returnees 378 30% 26% 34% Peshawar IDPs 409 96% 3% 0% SWA Returnees 332 0% 5% 18% Tank IDPs 378 70% 16% 2%

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Ownership of the scheme Drinking Water Supply Schemes are predominantly owned by the users themselves. There exist a strong relationship of these privately owned drinking supply schemes and those provided by the Government. Coverage of the government owned schemes is very low, thus the ownership ultimately rest with the users. However NGOs/Aid Agencies has contributed a lot in terms of increasing access to drinking water by establishing and rehabilitating schemes in these areas. The chart given here depicts that majority (39%) of the drinking water schemes are privately owned by the users. NGOs are the second biggest water scheme providers with ownership of 30% schemes. Government owns only (15%) of the schemes, community 6% and others have 8% share in the schemes ownership. Status of ownership in KP and FATA however is different. In KP most of the schemes (54%) are owned by the users while in FATA, schemes for IDPs majority of schemes are owned by the NGOs. This could be due to the fact that IDPs living in KP are scattered across many geographical areas while in FATA the IDPs are either in camps or in close proximity where the NGOs has focused outreach.

Area Status Respondents Govt Self NGO Community

Others

Bajaur Returnees 226 47% 48% 4% 0% 1% D.I.Khan IDPs 380 29% 46% 25% 0% 0% Hangu IDPs 304 6% 44% 34% 10% 7% Khyber IDPs 155 3% 23% 22% 51% 1% Returnees 141 1% 15% 43% 37% 4% Kohat IDPs 370 11% 51% 30% 5% 4% IDPs 548 3% 17% 66% 9% 4% Kurram Returnees 656 4% 22% 49% 10% 16% Mohmand

Returnees 124 24% 60% 12% 1% 3%

Nowshera

IDPs 393 6% 58% 26% 10% 1%

Orakzai Returnees 378 24% 34% 40% 0% 2% Peshawar

IDPs 408 0% 99% 0% 0% 0%

SWA Returnees 332 12% 15% 8% 0% 65% Tank IDPs 364 64% 20% 10% 0% 6%

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Availability of water container at home Availability of water container is not an issue for the IDPs in the host areas and returnees at the areas of origin. Overwhelming number (84%) of respondents in the assessment reported to have water container at home while only (16%) respondents reported non availability of water container. This further relates to the finding in the preceding section ‘ownership of the scheme’ whereby 39% of the schemes were reported in ownership of the users, as users ownership and those provided by other non-government actors may have contributed in increased availability of water container at house hold level. Almost equal number of IDPs (86%) and returnees (80%) have water container available at home. Higher number of IDPs (88%) in KP however have water container at home as compared to 78% IDPs in FATA. IDPs in Peshawar and D.I Khan in KP and returnees in Khyber and Bajaur represent the highest number of respondents having water container at home, with 100%, 98%, 94% and 91% positive responses respectively. IDPs in Hangu (28%) and Tank districts (19%) have reported non-availability of water containers at home, while 52% IDPs in Mohmand Agency and 25% IDPs in Kurram Agency in FATA reported non availability of water container at home.

Area Status Water Container Available

Water Container Not Available

Bajaur Returnees 91% 9% D.I.Khan IDPs 98% 2% Hangu IDPs 72% 28% Khyber Overall 91% 9% Kohat IDPs 88% 12% Kurram Overall 80% 20% Mohmand Returnees 48% 52% Nowshera IDPs 87% 13% Orakzai Returnees 56% 44% Peshawar IDPs 100% 0% SWA Returnees 99% 1% Tank IDPs 81% 19%

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Type of Water Container Used The IDPs and returnees are mostly using mix of container for storage of water including water cooler, jerry can, and bucket and others. It is evident from the findings that almost one third of the respondents still use open pots i.e. buckets, clay pots and others. Among all the respondents interviewed twenty eight percent (28%) of the IDPs and returnees uses safe storage for water. The data analysis further depicts that 71% of the IDPs and returnees use unsafe water container for storage. Among the unsafe storage users, 41% of the respondents use jerry cans, 28% buckets and only 2% use other pots. Use of unsafe water storage was evident in IDPs at Hangu, Khyber Agency, Kohat, Nowshera, Orakzai Agency and South Waziristan Agencies. Use of relatively safe storage was reported in returnees at Bajaur, IDPs at D.I.Khan, returnees at Khyber Agency, IDPs and returnees at Kurram Agency, returnees at Orakzai Agency and IDPs at Tank Districts. Area Condition Respondents Water

Cooler Jerry can

Bucket Clay Pot Other

Bajaur Returnees 229 69% 24% 22% 23% 3% D.I.Khan IDPs 380 39% 44% 28% 34% 1% Hangu IDPs 311 56% 37% 61% 33% 4% Khyber IDPs 156 59% 16% 15% 63% 15% Returnees 144 11% 59% 6% 58% 0% Kohat IDPs 372 10% 54% 51% 49% 3% Kurram IDPs 549 35% 38% 11% 10% 0% Returnees 657 17% 53% 18% 11% 2% Mohmand Returnees 124 6% 22% 5% 66% 2% Nowshera IDPs 394 83% 20% 25% 69% 0% Orakzai Returnees 378 47% 46% 22% 17% 1% Peshawar IDPs 409 83% 12% 15% 10% 0% SWA Returnees 331 39% 78% 75% 61% 0% Tank IDPs 378 46% 50% 27% 30% 1% Person who collect water In the areas studies, water is mostly collected by women in the family. Girls also help to considerable extent in collecting water while men and boys has minimum role for collecting water. In KP and FATA both, 83% of the respondents informed this study that water is mostly collected by women, only 17% told that water is collected by men. This clearly indicates that women have much greater responsibility in making access to and availability of water for the house hold. This further relates the distance

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covered for collecting water explained in section ‘3.1.2’ whereby 9% of the respondents revealed that they travel for more than 30 minutes to collect water. This means, the women as member of family is investing substantial time and energy to make water available for household consumption Area Status Men Women Boys Girls KP IDPs 19% 75% 8% 18% Bajaur Returnees 6% 63% 1% 19% D.I.Khan IDPs 54% 37% 25% 25% Hangu IDPs 23% 83% 9% 7% Khyber IDPs 8% 92% 0% 43% Returnees 4% 95% 0% 12% Kohat IDPs 3% 96% 2% 3% Kurram IDPs 4% 90% 1% 17% Returnees 2% 89% 4% 15% Mohmand Returnees 11% 84% 11% 6% Nowshera IDPs 3% 95% 6% 18% Orakzai Returnees 1% 97% 0% 4% Peshawar IDPs 3% 96% 3% 7% SWA Returnees 1% 100% 1% 94% Tank IDPs 30% 45% 2% 46% Problem being faced while fetching water IDPs and returnees both in KP and FATA are faced with multiple problems while fetching water. The most commonly problem faced was reported to be ‘non-availability of water’, followed by ‘difficulty in collecting water’, ‘difficulty in carrying water’ and ‘long distance’. More than quarter (27%) of IDPs and returnees complained about non availability, quarter (25%) about problem related to collection, fifteen percent (18%) of issues with carrying water, 15% of long distance and only 2% of cultural constraints while fetching water. This substantiates the role of women member of the family being more demanding in the given circumstances. Area Condition Availability of

Water Difficulty in water collection

Long Distance

Difficulty in carrying water

Cultural Constraints

Bajaur Returnees 27% 57% 13% 0% 0% D.I.Khan IDPs 38% 31% 38% 26% 3% Hangu IDPs 6% 18% 10% 44% 8% Khyber IDPs 42% 28% 23% 23% 6% Returnees 46% 22% 7% 13% 12% Kohat IDPs 29% 44% 16% 22% 1% Kurram IDPs 17% 35% 30% 13% 2% Returnees 12% 25% 43% 17% 2% Mohmand Returnees 23% 31% 27% 5% 2% Nowshera IDPs 18% 15% 13% 9% 1% Orakzai Returnees 18% 17% 20% 37% 19% Peshawar IDPs 0% 3% 0% 4% 0% SWA Returnees 48% 49% 76% 26% 48% Tank IDPs 69% 41% 13% 8% 0%

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Problem of non-availability of water was reported by IDPs in Tank, Returnees at South Waziristan and Khyber Agency by 69%, 48% and 46% respectively. Returnees in Bajaur, IDPs in Kohat and returnees in South Waziristan Agency mentioned difficulty in collecting water as a problem by 57%, 44% and 49% respectively. Long distance was revealed by majority of returnees’ respondents (76%) from South Waziristan, 43% returnees from Kurram Agency and 38% IDPs from D.I.Khan. Respondents also informed the study about problem carrying water by 44% IDPs in Hangu, 37% returnees in Hangu, and 26% IDPs from D.I.Khan and 26% returnees from South Waziristan Agency. In South Waziristan Agency 48% respondents reported cultural constrain as a major problem followed by 19% returnees in Orakzai Agency and 12% returnees in Khyber Agency. Availability of mug/utensil for drinking water It is evident from the study that vast majority i.e. 77% of the house hold have mug or other utensil available for fetching drinking water while only23% respondents informed of non-availability of mug or other utensils and use of alternate method for fetching of water. Non availability of mug or utensil for fetching water is directly related to quality of water discussed in the proceeding section. Sweeping majority of IDPs in Peshawar (100%), returnees of South Waziristan (96%) Agency and Bajaur (95%) reportedly have mug available to fetch water. Districts and agencies where mugs was reported not available by 46% IDPs from D.I.Khan, 44% IDPs from Hangu and 26% returnees from Orakzai Agency.

Area Status Mug for fetching Water is available

Mug for fetching Water is not available

KP IDPs 77% 23% Bajaur Returnees 95% 5% D.I.Khan IDPs 54% 46% Hangu IDPs 56% 44% Khyber IDPs 91% 9% Returnees 85% 15% Kohat IDPs 93% 7% Kurram IDPs 74% 26% Returnees 78% 22% Mohmand Returnees 85% 15% Nowshera IDPs 75% 25% Orakzai Returnees 74% 26% Peshawar IDPs 100% 0% SWA Returnees 96% 4% Tank IDPs 78% 22%

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Safe handling of water container/availability of cover It is encouraging to note that the IDPs and Returnees treat collected water safely by covering it after fetching. Our data shows that vast majority (73%) of the respondents keep water covered after collecting while 27% informed that they do not cover water.

Though vast majority of the respondents confirmed that they cover water after fetching, difference of occurrence across different location is visible in the data collected. Alarming number of returnees (63%) and IDPs (56%) in Kurram Agency and IDPs (52%) at Hangu voiced that they do not cover water after fetching. Satisfaction of users of quality IDPs and returnees both in KP and FATA are not satisfied with the quality of water they get. As indicated in section 3.11, 41% of the respondents reported using unsafe waters either from river, water channel or water pond. While asked about their perception of the water they use, majority (59%) of respondents expressed their dissatisfaction with the quality of water while 41% were found satisfied with the quality of water being used. This call for immediate action to improve the quality of water, helping the IDPs and returnees prevent water borne diseases and related health hazards. Users from FATA are relatively more satisfied with the quality of water as compared to KP, except Kurram Agency. In FATA respondents from Bajaur Agency, Khyber Agency and South Waziristan expressed highest satisfaction with 81%, 76%, 65% respondents in favor of the quality of water, while respondents from Kurram Agency (22%) expressed their dissatisfaction with the quality of water.

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In KP, respondents from Nowshera (82%) Kohat (47%) and Hangu (38%) were found satisfied with the quality of water. Area Status Respondents Satisfied with Quality

of Water Not satisfied with Quality of Water

Bajaur Returnees 225 81% 19% D.I.Khan IDPs 379 17% 83% Hangu IDPs 307 38% 62% Khyber IDPs 155 66% 34% Returnees 144 87% 13% Kohat IDPs 372 47% 53% Kurram IDPs 548 23% 77% Returnees 656 21% 79% Mohmand Returnees 124 60% 40% Nowshera IDPs 385 82% 18% Orakzai Returnees 378 58% 42% Peshawar IDPs 407 32% 68% SWA Returnees 332 65% 35% Tank IDPs 378 32% 68%

Knowledge of water purification method The chart in blow clearly indicates that IDPs and returnees in KP and FATA are in need knowledge of the water purification method. Vast majority (83%) of the respondents in the study reported ‘no knowledge’ of any water purification method while only 17% informed the study to have knowledge of the water purification method.

Type of water purification method used

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As indicated very low number of respondents (17%) of the respondents had any knowledge of water purification method. When asked about type of water purification method, 67% informed that they do not use any purification method at all, 14% boil water for purification, 5% use filtration method, only 1% use chlorination as a method while 3% use other methods.

Observation of quality of water Direct observation of the water at house hold level has revealed problems with the quality of water both in KP and FATA. Major problem with the quality of water is related to bad smell, bad taste and turbidity. In majority (39%) of instances, water had bad taste, in 25% cases water had bad smell, 18% household water had turbidity and in 11% there were other problems related to bad quality. Quality of drinking water observed both in KP and FATA represent almost similar pattern on all the indicators. Water with bad smell was observed in 24% instances in KP and 26% in FATA, bad taste was observed in 41% households in KP and 37% households in FATA, Turbidity however was observed in higher cases in KP (24%) than FATA (12%), while 3% observations in KP and 5% observations in FATA revealed all of the issues in the water. Similarly other issues were found in 7% household in KP and 14% in FATA. As evident from the table below IDPs in D.I.Khan, Hangu, Peshawar and Tank in KP are having most of the quality related problems with significant percentage in drinking water. While in FATA IDPs in Khyber, returnees in Kurram and returnees in Mohmand are also facing issues of bad smell, bad taste, turbidity and others with varying ratios.

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Area Status Respondents Bad Smell Bad Taste Turbidity All of them Others KP and FATA Overall 4661 25% 39% 18% 4% 11% IDPs 2949 25% 43% 22% 3% 7% Returnees 1712 25% 31% 11% 5% 17% FATA Overall 2417 26% 37% 12% 5% 14% IDPs 705 28% 49% 15% 2% 6% Returnees 1712 25% 31% 11% 5% 17% KP IDPs 2244 24% 41% 24% 3% 7% Bajaur Returnees 229 0% 2% 2% 0% 64% D.I.Khan IDPs 380 40% 61% 8% 9% 0% Hangu IDPs 311 14% 47% 32% 1% 12% Khyber Overall 300 16% 18% 36% 4% 24% IDPs 156 20% 19% 46% 4% 22% Returnees 144 12% 17% 24% 4% 26% Kohat IDPs 372 6% 15% 49% 3% 26% Kurram Overall 1206 31% 56% 9% 2% 3% IDPs 549 31% 58% 7% 2% 1% Returnees 657 32% 54% 11% 3% 4% Mohmand Returnees 124 6% 23% 7% 17% 47% Nowshera IDPs 394 9% 18% 2% 1% 0% Orakzai Returnees 378 49% 29% 2% 4% 3% Peshawar IDPs 409 38% 56% 32% 1% 2% SWA Returnees 180 8% 9% 33% 18% 7% Tank IDPs 378 33% 49% 20% 4% 4% Sanitation, According to UN-Water Decade Program on Advocacy and Communication (UNW-DPAC), sanitation is access to, and use of, excreta and wastewater facilities and services that ensure privacy and dignity, ensuring a clean and healthy living environment for all. “Facilities and Services" should include the ‘collection, transport, treatment and disposal of human excreta, domestic wastewater and solid waste and associated hygiene promotion’ to the extent demanded by the particular environment conditions. Status of Latrines Availability Majority of IDPs and returnees in KP and FATA have latrines available within their house premises. The data depicts that sixty four (64%) of the respondents have latrines available while thirty six (36%) do not have latrine facility. Out of the total available latrines eighty three percent (83%) were reported as functional and seventeen percent (17%) as non-functional. Though according to the data majority of the IDPs have latrine available and most of them are functional, the

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respondent however think these are not sufficient to fulfill household needs in most of the cases. Overall, forty one percent (41%) of the IDPs and returnees in the KP and FATA think that the available latrines are sufficient to fulfill the need while majority i.e. fifty nine percent (59%) thinks they do not fulfill the need. IDPs (94%) from D.I.Khan, IDPs (90%) and returnee (85%) from Kurram, IDPs from Kohat (63%), IDPs (84%) and returnees(74%) from Khyber Agency, IDPs from Hangu (79%) and returnees from Bajaur however reported that the latrines available are not sufficient to fulfill their need. Area Status Respondents Available Latrines

are Sufficient Available Latrines are Not Sufficient

Bajaur Returnees 133 26% 74% D.I.Khan IDPs 301 6% 94% Hangu IDPs 282 21% 79% Khyber Overall 161 22% 78% IDPs 63 16% 84% Returnees 98 26% 74% Kohat IDPs 372 37% 63% Kurram Overall 119 13% 87% IDPs 48 10% 90% Returnees 71 15% 85% Mohmand Returnees 124 47% 53% Nowshera IDPs 386 79% 21% Orakzai Returnees 253 39% 61% Peshawar IDPs 382 85% 15% SWA Returnees 319 34% 66% Tank IDPs 317 27% 73% Type of Latrine Majority (60%) of the respondents are using pour flush with septic tank, twenty percent (20%) use traditional latrine while nineteen percent (19%) use pour flush with open drain. Distance of latrine from the house Most of the latrine being used by the IDPs and returnees are conveniently accessible. The data shows that forty six (46%) of the latrines in the studies households are located within the premises of the house, thirty

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percent (30%) of latrines are located in less than 30 feet distance of the house, nineteen percent (19%) latrine exist within 100 feet while only three percent (3%) latrines are in the distance of 10-165 feet distance. Area Status Respondents Less Than

30 Feet 30 |To 100 Feet

100 to 165 Feet

More Than 165 Feet

Within House

KP and FATA IDPs 2134 31% 12% 2% 1% 55% Returnees 904 28% 34% 6% 5% 27% FATA IDPs 118 59% 14% 1% 6% 19% Returnees 904 28% 34% 6% 5% 27% KP IDPs 2016 29% 12% 2% 0% 57% Bajaur Returnees 105 58% 9% 1% 0% 32% D.I.Khan IDPs 299 35% 57% 2% 0% 6% Hangu IDPs 282 52% 2% 1% 0% 45% Khyber Overall 159 15% 12% 3% 6% 64% IDPs 62 29% 24% 2% 11% 34% Returnees 97 6% 4% 4% 3% 82% Kohat IDPs 342 24% 9% 3% 1% 63% Kurram Overall 134 84% 9% 0% 0% 7% IDPs 56 93% 4% 0% 0% 4% Returnees 78 78% 13% 0% 0% 9% Mohmand Returnees 124 35% 36% 2% 6% 20% Nowshera IDPs 390 61% 3% 0% 0% 36% Orakzai Returnees 181 25% 16% 6% 2% 52% Peshawar IDPs 382 1% 1% 0% 0% 98% SWA Returnees 319 12% 67% 10% 11% 0% Tank IDPs 321 2% 7% 6% 1% 84% As given in the table above sweeping majority (98%) of the respondents in Peshawar district has latrine facility available within house, followed by IDPs in Tank (84%), and returnees in Khyber (82%). IDPs in Khyber Agency and returnees at South Waziristan Agency however reported one tenth (11%) of their latrines available in more than 165 feet distance. Similarly returnees at South Waziristan Agency informed to have latrine available between 100-165 feet. Distance of latrine from the water point Data depicts that distance between latrine and water point in majority (54%) of the household is alarming i.e. less than 30 feet. While it was found between 30-100 feet in 29% households. 100-160 feet distance has been maintained in only 7% households while its 4% beyond 165 feet. This relates to the quality of water revealed as bad smelled (39%), bad taste (25%) and turbidity in 18% instances. The bad quality of drinking water may be attributed to the distance between water and sanitation facilities, besides others. As shown in the chart above and table below, latrines are reportedly located in less than thirty feet (<30ft) distance of water sources for IDPs while for returnees

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situation the distance between latrine and water point is mostly between 30-100 feet. Latrines for IDPs and FATA have also been reported mostly between 30 to 100 feet distance. The district and agency wise status depicts that highest percentage of (87%) respondents from Nowshera indicated that their latrines are between 30-100 feet distance which is alarming, followed by Peshawar (84% ), Hangu (66%) and Orakzai returnee (65%). Contrary to this, returnees from Khyber, IDPs from Khyber and Returnees from Orakzai informed that their latrines are located more than 165 feet of the water points, with 43% respondents from Khyber returnees, 20% Khyber IDPs and 13% Orakzai returnees.

Adult male defecation practice/place According to the data, majority of the adult male (57%) goes out to agriculture field for defecation while 42% of adult male use latrine for defecation, 1% uses other options for defecation. Appropriate privacy of available latrine When asked about privacy of women, most (67%) of the IDP and 51% of returnee respondents both in KP and FATA were of the view that the latrine provides proper privacy to the women.

Area Status Respondents

Less Than 30 Feet

30 to 100 feet 100 to 165 feet

More than 165 feet

Others

KP and FATA

IDPs 2074 62% 28% 3% 4% 3%

Returnees 907 36% 33% 16% 11% 5% FATA IDPs 113 37% 44% 7% 11% 1% Returnees 907 36% 33% 16% 11% 5% KP IDPs 1961 63% 27% 3% 4% 3% Bajaur Returnees 107 51% 32% 6% 5% 7% D.I.Khan IDPs 298 22% 77% 1% 1% 0% Hangu IDPs 279 66% 23% 4% 5% 2% Khyber IDPs 59 51% 17% 10% 20% 2% Returnees 98 31% 10% 12% 43% 4% Kohat IDPs 307 40% 24% 12% 5% 18% Kurram IDPs 54 22% 74% 4% 0% 0% Returnees 87 40% 54% 2% 3% 0% Mohmand Returnees 124 31% 32% 14% 6% 16% Nowshera IDPs 387 87% 6% 1% 5% 0% Orakzai Returnees 172 65% 15% 6% 13% 2% Peshawar IDPs 380 84% 13% 0% 3% 0% SWA Returnees 319 16% 45% 31% 6% 3% Tank IDPs 310 68% 26% 3% 2% 0%

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Among total highest number of respondents whom declared that existing latrines provide proper privacy were IDPs at Peshawar (96%), IDPs at Nowshera (91%) and returnees (72%) from Bajaur Agency. IDPs at Kurram declared that; existing latrines do not have privacy at all, followed by 92% returnees from same agency and 64% returnees at South Waziristan. Area Status Respondents Privacy for Female Available Privacy for Female Not Available

KP and FATA IDPs 2106 67% 33% Returnees 977 51% 49% FATA IDPs 110 34% 66% Returnees 977 51% 49% KP IDPs 1996 69% 31% Bajaur Returnees 111 72% 28% D.I.Khan IDPs 301 50% 50% Hangu IDPs 279 42% 58% Khyber IDPs 62 60% 40% Returnees 98 62% 38% Kohat IDPs 333 59% 41% Kurram IDPs 48 0% 100% Returnees 71 8% 92% Mohmand Returnees 124 63% 37% Nowshera IDPs 387 91% 9% Orakzai Returnees 254 63% 37% Peshawar IDPs 385 97% 3% SWA Returnees 319 36% 64% Tank IDPs 311 61% 39%

Stagnant Water around the house. Majority of the respondents confirmed availability of stagnant water around while 44% maintained that there is no stagnant water around latrine. Ration of respondents who confirmed availability of stagnant water are mostly returnees (63%) than the IDPs (53%) both in KP and FATA. FATA has comparatively more respondents (68%) who reported availability of stagnant water than KP (43%) Districts and Agencies where respondents’ revealed availability of stagnant water in majority includes returnees and IDPs at Kurram Agency (87% and 86%) and IDPs (75%) from Khyber Agency. Area Status Stagnant Water Available Stagnant Water Not

Available KP IDPs 43% 57% Bajaur Returnees 16% 84% D.I.Khan IDPs 49% 51% Hangu IDPs 35% 65% Khyber IDPs 75% 25% Returnees 46% 54% Kohat IDPs 40% 60% Kurram IDPs 86% 14% Returnees 87% 13% Mohmand Returnees 40% 60% Nowshera IDPs 23% 77% Orakzai Returnees 59% 41% Peshawar IDPs 45% 55% SWA Returnees 60% 40% Tank IDPs 64% 36%

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Solid waste lying around the house Sold waste was reported lying around in the house by 64% of the respondents both in KP and FATA. 36% of the respondents however revealed that there is no solid waste around latrine. Availability of solid waste was reported by overwhelming majority (92%) of respondents from Kurram Agency, 83% from D.I.khan and Tank and 81% from Khyber Agency. Respondent from Peshawar district (92%), Nowshera (77%) and Hangu (67%) informed that there is no solid waste lying around in the house. Area Status Solid Waste Available Solid Waste Not Available Total Overall 64% 36% IDPs 61% 39% Returnees 69% 31% FATA Overall 76% 24% IDPs 94% 6% Returnees 69% 31% KP IDPs 50% 50% Bajaur Returnees 55% 45% D.I.Khan IDPs 83% 17% Hangu IDPs 33% 67% Khyber Overall 81% 19% IDPs 92% 8% Returnees 69% 31% Kohat IDPs 73% 27% Kurram Overall 92% 8% IDPs 95% 5% Returnees 89% 11% Mohmand Returnees 55% 45% Nowshera IDPs 23% 77% Orakzai Returnees 47% 53% Peshawar IDPs 8% 92% SWA Returnees 68% 32% Tank IDPs 83% 17%

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Hygiene According to UNICEF, ‘there is now very clear evidence showing the importance of hygienic behavior, in particular hand-washing with soap at critical times: after defecating and before eating or preparing food Practice/frequency of hand washing by family Data depicts that vast majority of respondents (81%) wash hands before eating, 47% wash hand after using the latrines, 26% before feeding while only 3% of the respondents told that they do not wash hand on any of the occasion mentioned earlier. Use of soap for washing hands Use of soap while washing hands is much common in IDPs in KP and FATA than returnees. Data shows that 48% IDPs and 33% returnees use soap during hand wash, while the ratio is much higher in IDPs in KP whereby 52% of the respondents reported use of soap.

Availability of LHW/HP in the area Both in KP and FATA, Lady Heath Workers and Hygiene Promoters are rarely available. Only 15-20% IDPs and returnees have LHW and HP services available. KP is slightly betters where 20% IDPs have reported presence of LHW/HP as compared to 15% IDPs and returnees who reported availability of LHW or HP. Only IDPs in Nowshera and Tank and returnees in South Waziristan Agency reported relatively good coverage of LHW/HP availability with 47%, 46% and 44% responses. Highest number of respondents who reported non availability of LHW/HP availability incudes IDPs from D.I.Khan (100%), returnees from Khyber Agency (98%), IDPs from Peshawar (98%) and IDPs from Khyber Agency (97%).

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Area Status Respondents LHW/HP Available LHW/HP Not Available

Bajaur Returnees 224 30% 70% D.I.Khan IDPs 379 0% 100% Hangu IDPs 310 24% 76% Khyber IDPs 156 3% 97% Returnees 143 2% 98% Kohat IDPs 372 0% 100% Kurram IDPs 545 17% 83% Returnees 654 0% 100% Mohmand Returnees 123 16% 84% Nowshera IDPs 384 47% 53% Orakzai Returnees 378 12% 88% Peshawar IDPs 408 2% 98% SWA Returnees 332 44% 56% Tank IDPs 376 46% 54% Hygiene education by LHW/HP There seems to be negligible hygiene education both in KP and FATA, IDPs as well as returnees. Meager portion of the respondents (7% overall, 10% in KP and 4% in FATA) reveled that they LHW/HP provide health education Mohmand Agency in FATA and Nowshera and Hangu Districts in KP scored notably with regard to provision of hygiene education by 37%, 35% and 16% respectively. Districts and Agencies which reported negligible hygiene education available to them incudes IDPs from Khyber, Peshawar and returnees in South Waziristan with a score of 1%, 2% and 2% respectively. Diarrhea illness incident in last two months in the family Area Status Respondents Diarrhea Illness in the family Occurred No Diarrhea Case Occurred in

the family

D.I.Khan IDPs 379 68% 32% Hangu IDPs 304 68% 32% Khyber Overall 276 72% 28% IDPs 153 75% 25% Returnees 123 69% 31% Kohat IDPs 372 86% 14% Kurram Overall 1194 79% 21% IDPs 540 76% 24% Returnees 652 82% 18% Mohmand Returnees 123 47% 53% Nowshera IDPs 377 58% 42% Orakzai Returnees 366 56% 44% Peshawar IDPs 408 18% 82% SWA Returnees 332 70% 30% Tank IDPs 358 58% 42%

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Most affected family member from diarrhea Overall, children under the age of 18 years were reported as most affected by the diarrhea incidents in the family. The status was revealed in KP and FATA and IDPs and returnees alike. In FATA however the incidents of diarrhea in women is a bit higher (26%) than the overall average of (20%). Similarly in KP the ratio of children affected by diarrhea was reported a little higher (82%) than the average of 77% overall District who reported children as most affected by the diarrhea includes Tank (99%), South Waziristan Agency (96%), Peshawar (91%), Kohat (90%), and Hangu (86%). Women were reported second largest population most affected by diarrhea by IDP from Khyber (41%), IDPs from Kurram (36%) and returnees from in Khyber (34%). Area Status Respondents Men Women Elderly

People Children <18

Bajaur Returnees 216 9% 27% 8% 74%

D.I.Khan IDPs 379 17% 13% 32% 58%

Hangu IDPs 242 6% 20% 17% 86%

Khyber Overall 299 6% 38% 2% 75%

IDPs 156 8% 41% 3% 76%

Returnees 143 3% 34% 1% 73%

Kohat IDPs 372 1% 10% 12% 90%

Kurram Overall 1074 4% 33% 9% 63%

IDPs 486 5% 36% 11% 59%

Returnees 586 4% 31% 9% 67%

Mohmand Returnees 119 10% 16% 3% 71%

Nowshera IDPs 262 21% 23% 10% 75%

Orakzai Returnees 264 3% 9% 3% 84%

Peshawar IDPs 77 4% 16% 0% 91%

SWA Returnees 332 5% 10% 52% 96%

Tank IDPs 333 4% 3% 5% 99%

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Perceived reason for diarrhea Overall the predominant reason for diarrhea is water. IDP in KP, IDPs and returnees in FATA perceived water as a major reason for diarrhea with 50%, 49% and 33% responses.

Highest rate of incidents due to dirty water was revealed by IDP (89%) in Tank, (78%) in D.I.Khan, 54% IDPs in Kohat, 51% returnees at Kurram Agency. Contaminated food was declared as second largest category with 62% IDP respondents from Nowshera, 83% respondents from South Waziristan Agency, 58% respondent in Bajaur, and 25% respondents from Kohat. Area Status Respondents Dirty water Dirty hands Flies Contaminated

Food Bajaur Returnees 219 26% 32% 24% 58% D.I.Khan IDPs 378 78% 35% 19% 15% Hangu IDPs 234 27% 33% 37% 9% Khyber Overall 280 26% 53% 15% 9% IDPs 138 25% 54% 9% 12% Returnees 142 28% 52% 21% 6% Kohat IDPs 372 54% 23% 52% 25% Kurram Overall 1075 44% 25% 19% 7% IDPs 489 35% 23% 27% 5% Returnees 584 51% 26% 13% 8% Mohmand Returnees 124 29% 40% 3% 16% Nowshera IDPs 302 26% 32% 14% 62% Orakzai Returnees 262 31% 24% 28% 18% Peshawar IDPs 72 85% 6% 6% 14% SWA Returnees 331 89% 21% 8% 83% Tank IDPs 342 43% 11% 13% 38%

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Provision of hygiene kits Only one third of IDPs and returnees informed the study that they have been provided hygiene kits. Among those who reported receipts of hygiene kits, majority (62%) are returnee while only 18% of IDPs reported to have received hygiene kits. The ration of hygiene kits distribution was recorded higher (46%) tin FATA than in KP. In FATA, returnees at South Waziristan, Khyber Agency and Kurram confirmed receipt of hygiene kits with 78%, 65% and 60% positive responses respectively. Locations where highest number of respondents told that they haven’t been provided hygiene kits includes IDPs at Kohat (100%), IDPs of Kurram Agency (95%), IDPs in D.I.Khan(94%), IDPs of Khyber Agency (97%), IDPs at Hangu (89%) and IDPs at Tank (81%). Area Status Respondents Hygiene Kit

Provided Hygiene Kit Not Provided

Bajaur Returnees 224 40% 60% D.I.Khan IDPs 379 6% 94% Hangu IDPs 273 11% 89% Khyber Overall 300 33% 67% IDPs 156 3% 97% Returnees 144 65% 35% Kohat IDPs 95 0% 100% Kurram Overall 1203 35% 65% IDPs 546 5% 95% Returnees 655 60% 40% Mohmand Returnees 121 58% 42% Nowshera IDPs 387 43% 57% Orakzai Returnees 378 65% 35% Peshawar IDPs 409 38% 62% SWA Returnees 332 78% 22% Tank IDPs 378 19% 81% Treatment given to the diarrhea patient When asked about treatment given in case of diarrhea, considerable number of IDPs from KP and FATA both revealed that they take Oral Rehydration Salt in case of diarrhea. Overall percentage of respondents who reported ORS were 46% IDPs and 40% returnees, those who take rice soups are 22%, those whom don’t do anything in case of diarrhea are 18% while 20% go for other options.

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Status of hygiene training received by family member The data analysis shows that majority of IDPs and returnees both in KP and FATA have not received any training on hygiene promotion. Overall an average of only 17% respondent informed that they have received hygiene training. Ratio of IDPs whom received hygiene training was noted higher (23%) in IDPs in KP as compared to other categories. Area Status Respondents Hygiene promotion training

received Hygiene promotion training not received

Bajaur Returnees 224 2% 98% D.I.Khan IDPs 379 5% 95% Hangu IDPs 309 6% 94% Khyber Overall 298 21% 79% IDPs 156 9% 91% Returnees 142 34% 66% Kohat IDPs 372 52% 48% Kurram Overall 1201 2% 98% IDPs 544 1% 99% Returnees 655 3% 97% Mohmand Returnees 124 19% 81% Nowshera IDPs 392 41% 59% Orakzai Returnees 375 29% 71% Peshawar IDPs 408 28% 72% SWA Returnees 332 32% 68% Tank IDPs 378 1% 99% There are districts and agencies where the reasonable numbers of respondents or their family members have received training on hygiene promotion. These respondents’ incudes IDPs at Kohat (52%), IDPs at Nowshera (41%), returnees in South Waziristan Agency (32%), returnees in Khyber Agency (34%) and returnees of Orakzai Agency (29%). While sweeping majority of IDPs of Kurram Agency, Tank and returnees at Bajaur, revealed no hygiene promotion training received. Health and Education Facilities Existence of school in the village Vast majority (74%) IDPs and 80% returnees confirmed that school exists in their village. Surprisingly IDPs and returnees having school in their village were found higher in number (80%) in FATA as compared to IDPs in KP.

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Detail analysis of the data further present that sweeping majority of returnees at South Waziristan Agency, IDPs in Kohat (98%), IDPs and returnees at Kurrram (86%) and returnees at Orakzai Agency reported presence of school in their village. While IDPs in D.I.Khan (47%), Nowshera (40%) and IDPs of Khyber Agency (39%) shared that there is no school in their village. Area Status School exist in the village School does not exist in

the village Bajaur Returnees 66% 34% D.I.Khan IDPs 53% 47% Hangu IDPs 73% 27% Khyber Overall 63% 37% IDPs 61% 39% Returnees 65% 35% Kohat IDPs 98% 2% Kurram Overall 86% 14% IDPs 86% 14% Returnees 85% 15% Mohmand Returnees 47% 53% Nowshera IDPs 60% 40% Orakzai Returnees 78% 22% Peshawar IDPs 64% 36% SWA Returnees 99% 1% Tank IDPs 83% 17% Existence of health center in the village Heath facility in the study area is lacking mostly. Overall about 70% of the respondents informed that there exist no health facilities in their village. Area wise difference however exists. KP has more (45%) responses in favor or having a heath facility while in FATA only 16% respondents uncovered that there is a health facility in the village. In FATA 85% of the respondents admitted that there is no heath facility in the village, which is quite higher. Availability of water facility in the school Overall vast majority (71%) of respondent were of the view that schools don’t have water facility. Situation in FATA is much worse than KP. In FATA only 16% of the respondent informed that water facility is available in school while in KP almost half (45%) of the respondent reported availability of water facility in schools.

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Non availability of water facility from FATA was reported by vast majority of respondents from Kurram (91%), Orakzai and South Waziristan (83%), Khyber (82%) and Tank (81%). In KP water facility is not available in view of majority of respondents from D.I.Khan (84%), Hangu (69%) and Nowshera (44%). Availability of water facility in the health center As revealed by the respondents, non-availability of water in health facilities at village prevails across KP and FATA. Overall only 11% of the respondents informed that water is available while in 89% instances respondents shared that water facility is not available in the health center.

Availability of latrine in the school Latrine facility is also rare in schools as told by the majority (67%) of respondents both from KP and FATA. There however exist a marginal difference between responses from IDPs and returnees. 47% of IDPs and 12% of returnees confirmed availability of adequate latrine facility in schools. Similarly the difference of opinion about availability between FATA and KP also varies widely. 57% of respondents from KP and 13% from FATA informed that adequate latrine facilities are available in schools. Sweeping majority of IDPs and returnees from South Waziristan, and Kurram reported non availability of adequate latrine facilities with 96%, 94% and 82% responses respectively, followed by returnees at Orakzai (82%), returnees from Khyber Agency (87%) and Bajaur (75%). Area Status Respondents Adequate Latrine Facility

Available Adequate Latrine Facility Not Available

KP and FATA Overall 4616 33% 67% IDPs 2790 47% 53% Returnees 1824 12% 88% FATA Overall 2517 13% 87% IDPs 691 15% 85% Returnees 1824 12% 88% KP IDPs 2099 57% 43% Bajaur Returnees 224 25% 75% D.I.Khan IDPs 379 49% 51%

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Hangu IDPs 280 35% 65% Khyber Overall 263 21% 79% IDPs 144 27% 73% Returnees 119 13% 87% Kohat IDPs 370 89% 11% Kurram Overall 1203 8% 92% IDPs 547 12% 88% Returnees 654 6% 94% Mohmand Returnees 117 20% 80% Nowshera IDPs 355 64% 36% Orakzai Returnees 378 18% 82% Peshawar IDPs 338 75% 25% SWA Returnees 332 4% 96% Tank IDPs 377 29% 71% Availability of latrine in the health center Only 21% of the IDPs and returnees in KP and FATA shared that latrine in health facility is available in the village. The difference of opinion between KP and FATA and IDPs and returnees however is negligible. Respondents from Nowshera Tank, and Hangu however informed about existence of latrine in health centers with 40%, 38% and 25% responses respectively. Non availability of latrine in health facility was noted from all respondents from Peshawar (100%), D.I.Khan (97%), Kohat (88%), Kurram Agency (82%), and Mohmand (78%).

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Recommendations

1. Intervention for increasing access to safe water sources may be increased in FATA including rehabilitation of existing schemes and establishment of new ones.

2. Covered storage container should be encouraged to ensure safe storage of water. 3. Efforts should be made to improve quality of the drinking water, particularly taste, smell and

decreasing turbidity. 4. Number of latrines both in KP and FATA and IDPs and Host must be increased to fulfill he needs. 5. Awareness and motivation should improve regarding stagnant water and resulting health risks. 6. Awareness and training on solid waste disposal and management must increase so as solid waste

is not dumped inside the house or around water or sanitation facilities. 7. Coverage of LHW and Hygiene Promoter should be increased to improve awareness and prevent

water borne diseases. 8. Hygiene promotion trainings should increase, especially for women and mothers to prevent

diarrhea in children under 18 years. 9. Water facilities in health and educational facilities at village level should be provided.

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Annexure Annexure 1. Consolidate Number of IDPs

IDPs in the Camp

Camp Families % Jalozai Camp 12442 77 New Durrani 2513 16 Togh Serai 1159 7 Total Families in Camps 16114 100

IDPs off-camp

Annexure 2: Ownership of Water and Sanitation Schemes Area Status Government Self NGO Community Others

S.No IDPs Status Families % 1 IDPs living Off-camps 146,988 90% 2 IDPs living in camps 16,114 10% 3 Total IDPs 163,102 100%

S.No Districts/ Agency Families (%) 1 Peshawar 70113 48 2 D.I. Khan 28195 19 3 Kohat 26122 18 4 Tank 13517 9 5 Kurram 7981 5 6 Hangu 1060 1 146988 100

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Total Overall 15% 39% 30% 7% 9% IDPs 15% 46% 29% 7% 3% Returnees 16% 28% 32% 6% 18% FATA Overall 12% 26% 39% 10% 14% IDPs 3% 18% 57% 18% 3% Returnees 16% 28% 32% 6% 18%

KP IDPs 19% 54% 20% 4% 3% Bajaur Returnees 47% 48% 4% 0% 1% D.I.Khan IDPs 29% 46% 25% 0% 0% Hangu IDPs 6% 44% 34% 10% 7% Khyber Overall 2% 19% 32% 44% 2% IDPs 3% 23% 22% 51% 1% Returnees 1% 15% 43% 37% 4% Kohat IDPs 11% 51% 30% 5% 4% Kurram Overall 3% 20% 57% 9% 10% IDPs 3% 17% 66% 9% 4% Returnees 4% 22% 49% 10% 16% Mohmand Returnees 24% 60% 12% 1% 3% Nowshera IDPs 6% 58% 26% 10% 1% Orakzai Returnees 24% 34% 40% 0% 2% Peshawar IDPs 0% 99% 0% 0% 0% SWA Returnees 12% 15% 8% 0% 65% Tank IDPs 64% 20% 10% 0% 6%

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Annexure: Users Knowledge of Water Purification Method

Area Status Know about Water Purification Method

Don't Know About Water Purification Method

KP and FATA Overall 17% 83% IDPs 20% 80% Returnees 14% 86% FATA Overall 11% 89% IDPs 2% 98% Returnees 14% 86% KP IDPs 25% 75% Bajaur Returnees 38% 62% D.I.Khan IDPs 22% 78% Hangu IDPs 7% 93% Khyber Overall 6% 94% IDPs 2% 98% Returnees 11% 89% Kohat IDPs 25% 75% Kurram Overall 2% 98% IDPs 2% 98% Returnees 3% 97% Mohmand Returnees 24% 76% Nowshera IDPs 28% 72% Orakzai Returnees 20% 80% Peshawar IDPs 50% 50% SWA Returnees 10% 90% Tank IDPs 12% 88%

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Annexure: Availability of Latrine Area Status Respondents Latrine Available Latrine Not

Available

Bajaur Returnees 229 49% 51% D.I.Khan IDPs 380 79% 21% Hangu IDPs 311 91% 9% Khyber OverAll 300 53% 47% IDPs 156 40% 60% Returnees 144 67% 33% Kohat IDPs 372 94% 6% Kurram OverAll 1206 11% 89% IDPs 549 9% 91% Returnees 657 13% 87% Mohmand Returnees 124 100% 0% Nowshera IDPs 394 99% 1% Orakzai Returnees 378 51% 49% Peshawar IDPs 409 94% 6% SWA Returnees 332 96% 4% Tank IDPs 378 85% 15% Annexure: Type of Latrine in Use Area Status Respondent

s Pour Flash with septic tank

Pour Flash with open drain

Traditional Latrine

VIP Latrine

Others

Total OverAll 3003 118% 38% 39% 3% 3% IDPs 2123 114% 42% 39% 2% 2% Returnees 880 127% 29% 40% 3% 4%

FATA OverAll 989 120% 32% 44% 3% 4% IDPs 109 61% 61% 74% 1% 5% Returnees 880 127% 29% 40% 3% 4%

KP IDPs 2014 116% 41% 37% 3% 2% Bajaur Returnees 83 153% 28% 47% 0% 0% D.I.Khan IDPs 299 108% 34% 56% 2% 0% Hangu IDPs 276 95% 53% 36% 17% 2% Khyber OverAll 158 58% 61% 66% 7% 6%

IDPs 63 40% 92% 62% 2% 5% Returnees 95 71% 41% 69% 11% 7%

Kohat IDPs 344 99% 31% 69% 0% 0% Kurram OverAll 118 84% 31% 81% 0% 8%

IDPs 46 91% 17% 91% 0% 4% Returnees 72 79% 39% 75% 0% 10%

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Mohmand Returnees 122 72% 85% 25% 2% 18% Nowshera IDPs 390 109% 65% 25% 0% 1% Orakzai Returnees 189 88% 28% 67% 6% 1% Peshawar IDPs 382 172% 10% 11% 0% 7% SWA Returnees 319 193% 2% 11% 0% 0% Tank IDPs 323 104% 54% 34% 0% 0%