i 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 And Peshawar, Nowshera, Kohat, Hangu, D.I. Khan and Tank of Khyber Paktunkhwa Peshawar May 2014 i ii “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) ii iii 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. iii iv 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 iv v v vi Contents No table of contents entries found. vi 1 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. 2 3 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. 4 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.