Vulnerability and Socio-Cultural Considerations for PHE in Emergencies | Sanitation | Hygiene

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One size does not always fit all. A toilet design which suits one community may be rejected by another. Superstitions over particular water sources can add complications to the selection and development of sources. Water supply facilities inappropriately sited can leave women at increased risk of rape or attack. Use of water resources in semi-arid or arid conflict affected areas can be politically sensitive and risk causing an escalation of conflicts. This Technical Brief highlights a range of vulnerability and socio-cultural related considerations for the PHE/PHP teams and identifies a number of ways in which they can respond in the field. For example there is a need to try to understand the power dynamics of the environment in which you are working
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   Vulnerability and socio-cultural considerations for PHE in emergencies One size does not always fit all. A toilet design which suits one community may be rejected by another. Superstitions over particular water sources can add complications to the selection and development of sources. Water supply facilities inappropriately sited can leave women at increased risk of rape or attack. Use of water resources in semi-arid or arid conflict affected areas can be politically sensitive and risk causing an escalation of conflicts. This Technical Brief highlights a range of vulnerability and socio-cultural related considerations for the PHE/PHP teams and identifies a number of ways in which they can respond in the field. For example there is a need to try to understand the power dynamics of the environment in which you are working; ask the people themselves what is suitable for facility provision making sure that you ask each of the key groups of people within the affected or host community. If men are unable to speak to women because of the cultural practices of the affected community, then ensure that female staff are available to discuss with women – which is also good practice in most situations. And where privacy is a particular issue, such as where women usually live in Purdah   , then ensure that privacy is a feature of the technical designs. Useful questions  Are our technical assessment teams / implementation teams well balanced in terms of gender and representation of minority groups? Who are the most powerful and least powerful people in this humanitarian context? What steps do we need to take to be able to listen to and speak freely with the least powerful people?  Are there any protection considerations for the location of facilities for any particular group? What level of privacy is required for the various groups in this environment vs socio-cultural norms / needs and dignity? What particular practical facilities do the women need to deal with menstruation? Will issues such as caste, gender, social-norms, lead to any groups being excluded from using the facilities? If so, what needs to be done to ensure they will be able to access facilities (promotion, discussions with users, additional facilities)?  Are there any cultural beliefs which would lead to people rejecting the use of particular water sources or excreta disposal systems? What will the likely impacts of developing this water source be? Could local resource based conflicts be worsened? What steps need to be taken with both the affected and host communities to minimise this risk? Hearing the voice of the vulnerable People may be differentiated by many factors such as their age, gender, caste, class, wealth, ethnic group, religion or disability. In many situations, although not all, women will be less powerful than men, the poor will be less powerful than the rich, people with disabilities will be less powerful than those without, female-headed households poorer than male headed households, and people from minority groups may have less voice than those from majority groups. If somebody fits into a number of these groups, for example a widowed elderly woman who is disabled and comes from a minority ethnic group, then the likelihood that she will be poor, marginalised and will have less voice in the community will be high. It would also be likely that a child or grandmother heading a family of children because the parents have died from the complications of HIV/AIDS, would also have less voice and likely to be particularly vulnerable. Children using a clothes and pot washing slab   OXFAM Technical Brief – Vulnerability and socio-cultural considerations for PHE in emergencies 1  Whilst it would be impossible to consult with every different group of people in an affected or host community, it is still important for the PHE and PHP teams to understand the power relationships within and between communities and to make a particular effort to consult with those they understand to have ‘less voice’, or may have particular needs within this given context. The amount of consultation and the amount of participation of the affected communities which will be possible will depend partly on the immediacy of the risk to life and the stage of the emergency and whether it is fast or slow onset. The little extra time and care taken to involve women and men can have a big impact on accuracy and the potential benefits from the response. However, if it is only possible for limited consultation or involvement in the first few days following a fast on-set emergency event, further consultation and participation should be undertaken or encouraged as soon as possible. For slow on-set or chronic emergencies there is more time to consider the response and these steps should not be omitted. Be aware that the poorest and most vulnerable will also often be the most difficult to reach. Gender and equity Within every community there will be inter-relationships and power differences between men and women, which will form the norms of how men and women relate to each other in that particular community and at that particular period of time. Most of these norms will be socially constructed, they will vary community to community, and will vary over time and in response to the changing economic situation and sometimes also to the impact of the emergencies themselves. ‘Gender’ refers to the roles and responsibilities which society has determined for men and women and within given communities. The gender roles and relationships can also vary with the age of the person and also between people of different ethnic groups or wealth or poverty levels. There are a number of reasons why gender and equity should be considered in technical projects, but as the bare minimum, if gender relationships in a community are not understood and technical projects are not designed accordingly, it can reduce the effectiveness of a programme and can in some cases lead to vulnerable people becoming more vulnerable. Other reasons for considering gender and equity include a commitment to equity of involvement and provision, or to support the empowerment of marginalised groups and a belief that it is the right of people to be involved in decisions which affect their own lives. OXFAM has a policy on gender equality and has developed short booklet covering the main issues to be aware of in relation to gender -  ‘A Little Gender Handbook for Emergencies or Just Plain Common Sense’  . Within this booklet it notes that emergency response is always conducted with the long term goal of gender equity and recommends using participatory approaches throughout the project cycle. Examples of gender related considerations for PHE include: 1.The privacy needs for women, men and children forpersonal hygiene / bathing. In camp situationsseparate and private bathing areas or units must beprovided, for both men and women. In cold climates,warm water for bathing should also be provided or ameans and fuel for people to warm their own bathingwater.2.The location of the water and sanitation facilitiesshould be appropriate to ensure that women andchildren will not be vulnerable to harassment orattack. In Albania women had to go to the toilet inpairs as the units had no locks on them. In Bangladeshin the camps for Burmese refugees, tapstands weremoved to reduce harassment of women by thesecurity forces. The facilities should also be lit at night.3.Consider the location of shelters for female- or child- headed households or particularly vulnerable groups toensure that they are secure.4.Specific considerations for women living in seclusion(see below for further details).5.Consider the needs of women in terms of dealing withmenstruation (this consideration is related to abiological need rather than a gender related need).6.Making sure that both men and women gain thebenefit of the water, sanitation and hygieneinterventions by understanding and ‘rules’ that applyto their particular gender in relation to these services.For example, some communities have specific culturalrelated rules such as daughter-in-laws cannot use thesame toilets as mother-in laws and in others womenhygiene promoters may not be able to speak withmen. In this second case, it would be important toensure that both men and women hygiene promotersand community facilitators are trained.7.Both women and men should have the opportunity forpaid employment as part of the PHE/PHP programme.8.Make sure that meetings, discussions etc tie in withthe availability of both women and men and do notclash for example with the times when women arepreparing the family’s meals.9.Women and men may have different knowledge onwater sources.10.Women and men may have different preferences forconstruction tools, for example headpans versuswheelbarrows for earth moving. Women living in seclusion Women living in seclusion / Purdah   pose additional challenges for the PHE / PHP teams. Seclusion is sometimes practiced by women who are Muslim in a number of countries and also by some women who are Hindu in communities in India, although different communities practice it in different ways and to different degrees. It is possible that the women previously living in seclusion will have more freedom to leave their living areas in emergency situations. However, if they are unable to leave their living areas then female PHE / PHP staff will OXFAM Technical Brief – Vulnerability and socio-cultural considerations for PHE in emergencies 2  need to negotiate access to their living areas and undertake individual discussions with the women, to find out their needs and problems. If the provision of communal facilities is not appropriate, then in some instances household facilities (and particularly latrines) will need to be considered. Where communal facilities are possible, then particular care should be made to ensure the privacy of the users, for example, by providing additional screening around toilet and bathing areas (see below). Women living in seclusion may also have difficulty accessing relief supplies. In some of the rural villages in northern Pakistan, women from female-headed households were unable to come down the mountainside to collect relief supplies and tents. Therefore OXFAM’s partner staff from Sungi Development Foundation made additional visits into the mountains to collect information on the needs of women headed-households and then to arrange delivery by mule. Refer to the case study at the end of this Technical Brief for the layout of a screened block as used in Pakistan in response to the October 2005 earthquake. This particular block was provided separately for both women and men. For occasional women’s units a menstruation or ‘hygiene unit’ was also included inside, or was attached to the outside of the units for the women to be able to use for washing and drying their menstrual cloths. Screened latrine and bathing unit Menstruation Girls and women of child-bearing age have to deal with menstruation, a natural bodily process which occurs on a monthly basis when their bodies release un-required blood from their reproductive systems. In most cultures menstruation is a taboo subject and many women do not discuss the issue very often, even with other women. Women and girls use a variety of ways to cope with the loss of menstrual blood. Some use products such as sanitary towels / pads, but many use cloth which may be re-used. Some women bleed into boxer shorts or saris and some use plastic or natural materials to catch and soak up the blood. Younger and older women from the same communities may use different methods. Dealing with menstruation needs a significant degree of privacy. This is less available in the context of an IDP or refugee camp, particularly where the girl or women’s shelter space may be limited to a one room tent or a self built shelter which is shared with her family. Issues to consider when supporting women and girls with dealing with their menstruation needs: 1.What do women and girls usually use for dealing withtheir menstruation – cloths, sanitary pads etc? Makesure the required materials are provided with oralongside hygiene kits (if cloth is provided this shouldbe of a dark colour and never white).2.What do the women and girls want in terms of facilities for dealing with menstruation? Note that it isessential that the women and girls are asked, as if thefacility is not exactly what they feel they want andwould feel secure to use, then it is unlikely that it willbe used.3.If disposable sanitary pads are to be provided thenfacilities for effective collection and disposal areessential. Where waste disposal is not effective therewill always be the risk that used sanitary pads will endup on piles of refuse thrown into the road or publicareas. This is unhygienic, unsightly, and could pose arisk to health. Washing slab for menstrual cloths inside a screened block and washing lines for drying the cloths  It may be that the women and girls will be happy simply with the supply of cloth or sanitary pads, but it may be that they need specific areas to be able to wash and dry their cloths, as they may be unable to dry them in the confined spaces of their shelter where other family members could see them. Whatever is provided for the women and girls, it should be of an acceptable privacy level for their needs and other people should not be able to see any blood coloured water coming from the unit when the cloths are washed, or see the towels being dried. OXFAM Technical Brief – Vulnerability and socio-cultural considerations for PHE in emergencies 3  Menstruation / ‘hygiene’ units in Pakistan In Pakistan, in Jabba camp the women appreciated having separate units within the latrine blocks to wash and in some cases dry their menstruation cloths. The separate units were constructed inside the existing screened latrine and bathing block structures. In Havelian camp however, where the additional units were added on the outside of the standardised toilet and bathroom blocks, but with the door entering from inside the block, the women would not use the units even though they had requested them. They rejected them as both men and women became curious as to what was inside the extended blocks and as their walls were made of tarpaulin they could be easily punctured. This made women feel insecure. These women reported that instead they washed their cloths in the bathing units and then hung them up to dry with their clothes, but covered them with another item so that they could not be seen. Children Children may have specific needs and small children may not be able to use the latrines or may be frightened of doing so. Programme design considerations in relation to children: 1.Potties can be provided for parents of smallchildren and / or scoops for picking up children’sfaeces. For both of these items the users will needadequate facilities to be able to wash the itemsafter use.2.If slabs are not pre-formed and are beingconstructed on site, then smaller holes for childrencan be designed into a proportion of slabs.3.Child friendly designs for latrines can also includelatrines without a superstructure, where the childcan defecate as though they were in the open,such as were used in Rwanda, but where they areactually defecating into a latrine pit.4.Provision of cloth nappies. Care would also beneeded to ensure effective disposal if disposablenappies are provided. Disposable nappies can block pour flush latrines if the users do not understandtheir correct disposal. Caste The caste system operates a strong hierarchy within some Asian societies. People from the lower castes are sometimes excluded from using the same water sources as people from the higher castes. Unless the people from the lower castes are particularly targeted to be involved in discussions in areas where the caste system is particularly strong, it would be unlikely that lower cast people would be able to sit together with, or speak in the presence of higher caste people. In Pakistan where a form of caste system exists, but is not as strong as in neighbouring countries, such as in Nepal or India, it proved difficult to engage the general population in the clearing of refuse. The clearing of refuse as well as the cleaning of public toilets are tasks assigned by society to a group of people who are considered at the bottom of the social scale and known as  ‘sweepers’. The people whose job means that they were known as ‘sweepers’ did an excellent job in response to the emergency, but it meant that involving volunteers in the cleaning of communal refuse or latrines proved difficult. Other cultural / tradition / religious related considerations For PHE/PHP it is also important to be aware that sometimes there may also be specific cultural, traditional, or religious related beliefs or needs with respect to water, hygiene or sanitation. These may vary widely. The way to find out about them is to ask the people themselves or people who are likely to know, such as the OXFAM local staff (not just PHE or PHP) that may have inside knowledge of the practices and beliefs of people from particular ethnic groups. Examples of cultural, traditional or religious beliefs and needs which affect PHE / PHP programmes 1.That particular water source types (springs whichnever dry up, high yielding wells etc) havesupernatural powers. This may affect whether theexisting users of the source will allow them to befurther developed.2.In the Islamic faith, good hygiene is very importantbefore prayer. Therefore wherever there is a Mosque,the provision of an adequate water source or supplywill help the people who utilise the Mosque to be ableto fulfil their religious needs effectively.3.For Muslim communities, latrines should be placed sothat the user is not facing Mecca when he or she usesthe latrine. An acceptable direction for the latrineshould be confirmed through discussion with theusers.4.There may be particular traditions which it would beappropriate to follow when utilising a new watersource, such as the slaughtering of a goat before itsuse.5.The use of chlorine may be rejected by some peoplewho are not used to the taste. Particular effort onpromotion will be needed with the water users if this isthe case, to ensure that they do not revert back tousing unsafe sources.6.In Indonesia in response to the Tsunami in 2004,people who were used to pour-flush latrines rejectedthe use of direct drop latrines.7.Some cultures may find the handling of excretaoffensive. In such cultures the use of ecologicalsanitation may be inappropriate as people will notwant to handle the waste after it has decomposed andwould not want it used on their fields as a fertiliser. Itmay also cause problems with finding people who areprepared to repair damaged latrines, or emptying thelatrines. OXFAM Technical Brief – Vulnerability and socio-cultural considerations for PHE in emergencies 4
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