Abstract
Water chlorination is widely used in emergency responses to reduce diarrheal diseases, although communities with no prior exposure to chlorinated drinking water can have low acceptability. To better inform water treatment interventions, the study explored acceptability, barriers, and motivating-factors of a piped water chlorination program, and household level chlorine-tablet distribution, in place for four months in Rohingya refugee camps, Cox’s Bazar, Bangladesh. We collected data from June to August 2018 from four purposively selected refugee camps using structured observation, key-informant-interviews, transect-walks, group discussions, focus-group discussions, and in-depth-interviews with males, females, adolescent girls, and community leaders. Smell and taste of chlorinated water were commonly reported barriers among the population that had previously consumed groundwater. Poor quality source-water and suboptimal resultant treated-water, and long-queues for water collection were common complaints. Chlorine-tablet users reported inadequate and interrupted tablet supply, and inconsistent information delivered by different organisations caused confusion. Respondents reported fear of adverse-effects of "chemicals/medicine" used to treat water, especially fear of religious conversion. Water treatment options were reported as easy-to-use, and perceived health-benefits were motivating-factors. In vulnerable refugee communities, community and religious-leaders can formulate and deliver messages to address water taste and smell, instil trust, allay fears, and address rumours/misinformation to maximise early uptake.
Highlights
Amidst the myriad of health issues for which Rohingya refugees in Bangladesh are at risk, waterborne illness is one of the most common [1,2]
Water points were installed in the Rohingya camps, but the water was not safe to drink; approximately 28% of the source water was contaminated with faecal coliforms, and 10.5% with E. coli among 3186 tubewells tested [1]
The early stages of this emergency were tackled by humanitarian actors stepping up to ensure basic WASH infrastructure, where quantity was prioritised but facilities were temporary in nature, often overlooking quality in terms of water point depth, location, and functionality
Summary
Amidst the myriad of health issues for which Rohingya refugees in Bangladesh are at risk, waterborne illness is one of the most common [1,2]. Contaminated water, lack of safely managed sanitation, and inadequate hygiene facilities are a concern for diarrheal disease transmission among the community [3,4]. In this emergency context, the provision of safe drinking water is crucial to reduce and control diarrhoea and other waterborne diseases [5]. Water 2020, 12, 3149 emerged after August 2017, there were no pre-existing water, sanitation, and hygiene (WASH) facilities including toilets, water points, or bathing places, and some people reported collecting water from the paddy fields for drinking [6]. Ensuring safe drinking water management at the household level remains challenging, and household level water contamination remains high [1]
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