NEEDS ASSESSMENT FOR WATER, SANITATION AND Province, HYGIENE

December -2019

NCA Assessment Team Contents 1. Introduction ...... 2 1.1 Background ...... 2 1.2 Assessment Objectives ...... 3 1.3 Approach ...... 4 1.4 Methodology ...... 4 1.5 Sampling ...... 4 1.6 Target population ...... 5 1.7 Selection of Target locations ...... 5 1.8 Respondents ...... 5 1.9 Duration of the survey ...... 5 1.10 Data collection methods and analysis ...... 5 1.11 Questionaire development ...... 5 1.12 Data collection techniques ...... 6 2. Water ...... 6 2.1 Accessibility and Sources of Water ...... 6 2.2 Water Collecting Containers ...... 7 2.3 Sources to filter drinking water ...... 7 2.4 Water quantity used per household in a day ...... 8 3. SAINITATION ...... 8 4. Disease morbidity / mortality and management ...... 10 5. Hand washing practices ...... 11 6. Hygiene messages and sources ...... 13 7. Safety and security ...... 14 8. Nutrition ...... 16 9. Shelter ...... 17 10. Assistance received ...... 17 11. Summary and findings ...... 18 12. Recommendations ...... 19

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1. Introduction

1.1 Background The WASH assessment for , Qalay-I-Zal districts and the City of Kunduz in was carried out by the NCA team. The assessment sought to investigate the humanitarian needs of IDPs and Underserved Host communities in these areas. The assessment survey was conducted in different villages of the province that includes: Ibrahim kheil, Ismail qishlaq , Aqa baie, ortabz , Paeen bala hesar, Baghe zarat, third zone, Toot mazar, Charmgeri third zone , Char taq, Chal dukhtaran, Dehqan qishlaq, Zeer dawra, Sar dawra, kala pazee, Qandak inayat, Kocha adullah, kocha arabha, kocha –e- Mahmal , Miskeen abad, Numra-e- sayaf, Maidan bozkashi, Hawa shanas, Turkmanha and Nawabad. These villages have mixed population i.e. IDPs, refugees and local people. The average family size is quite big (more than 10 people per HH) and are multi-ethnic.

Kunduz city serves as the provincial capital of Kunduz Province. The city has a population of about 161,902 making it about the 6th largest city in Afghanistan, and the largest city in the northeastern part of the country. Kunduz is located near the confluence of Kunduz and Khanabad Rivers. Kunduz is linked by highways with Kabul to the south, Mazar-i-Sharif to the west, and Badakhshan to the east. The land use of the city (within the municipal boundary) is largely agricultural (65.8% of total area). Residential land comprises nearly half of the 'built-up' land area (48.3%) with 29,877 dwellings. Institutional land comprises 17.9% of built-up land use, given that the airport is located within the municipal boundary.

Imam Sahib District is situated in the northern part of Kunduz Province, Afghanistan. It borders with Qalay-I-Zal District to the west, to the north (along the Panj river), with Archi District to the east and to the south. The population is 204,300 (2006) - 25% Pashtun, 25% Tajik, 45% Uzbek and 5% Turkmen. The district centre is the town of Imam Sahib, located in the northern part of the district. The other main town in the district is Sherkhan Bandar, which serves as Afghanistan's main port of entry to Tajikistan.

The district is one of the richest in Afghanistan. The land is very fertile and well irrigated and has not suffered drought. The medical and educational facilities are better than in other districts.

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Qalay-I-Zal District is situated in the western part of Kunduz Province, northern Afghanistan. It borders Province to the west and Tajikistan to the north along the Panj, Vakhsh and Amu Darya rivers. To the east, it borders and to the south Kunduz and Chahar dara districts. Qalay-I-Zal River flows through the district and divides it in two parts. The population is 60,600 (2006) - 90% Turkmen and 10% Pashtun. The district is almost a desert and only the irrigated land is arable. Agriculture and carpet weaving are the main sources of income.

Figure 1: Map showing the three districts that were assessed

1.2 Assessment Objectives The overall objectives of the assessment was to investigate the humanitarian needs of the conflict affected IDPs, Refugees, Returnees and Host Communities in three districts of Kunduz province. The main needs that were identified included WASH, nutrition, health and other cross cutting issues e.g. protection, SGBV.

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The objectives of the WASH assessment were:  To identify the basic problems of the affected people and find relevant solutions;  To assess the emergency WASH needs of vulnerable population i.e. IDPs, Returnees and Refugees in the 3 districts of Kunduz province;  To explore ways of assisting the affected people;  To establish the number of the most vulnerable segments of affected population according to gender, age and vulnerability and understand the challenges they are facing;

1.3 Approach The WASH assessment was conducted to establish the basic needs of the affected population of Kunduz in the targeted districts and to find remedies of the same.

1.4 Methodology  Different techniques were used to collect and evaluate the data. Data was collected from multiple sources in the villages of the three mentioned districts of Kunduz province;  Primary data was collected through questionnaires, Focus Group Discussions (FGDs) from households, including structured and unstructured interviews with the people in the three districts.  Participatory techniques such as Household survey, Focus Group Discussions and Key informant survey questionnaires were used to get data from families, male, female, teachers, students, households and community members;  Direct observations, interviews with local authorities using questionnaires.

1.5 Sampling Target Area: Qalay-I-Zal, Imam sahib, Kunduz city Total number of villages: 26 Villages Per District: Qalay-I-Zal = 2, Imam sahib = 7, Kunduz city = 17 Total number of Households: 193 Methodology: Random Sampling

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1.6 Target population Table 1: Map showing the three districts that were assessed

Districts Host IDPs Refugees Returnees Sample size Community Qalay-I-Zal 125 44 18 6 193 Imam sahib 65% 23% 9% 3% 100% Kunduz city

1.7 Selection of Target locations The assessment area was selected based on information gleaned from the HRP. Team focused was on 3 districts where IDPs families are living with host communities and in rented houses.

1.8 Respondents Respondents included children, men, women and the elderly from the local communities and IDPs families. The assessment team managed to visit all members of the selected communities due to its inclusive composition i.e. it comprised of both men and women enumerators.

1.9 Duration of the survey The assessment lasted for 3 days. It ran from 16th – 20th October. Prior to the commencement of the assessment, a planning meeting was convened to pore over the survey instruments and to consider all the likely scenarios that may arise during the assessment and how to mitigate them.

1.10 Data collection methods and analysis A questionnaire survey was deployed to collect data questionnaire which was then analyzed using an excel spreadsheet.

1.11 Questionnaire development The questionnaire was derived from the standard WASH Cluster and was converted into the local language (Pashto) for easier understanding and results accuracy. The survey team covered all important WASH issues.

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1.12 Data collection techniques The following techniques were used to collect relevant data:

 Household survey  Focus Group Discussion  Key Informants

2. Water

2.1 Accessibility and Sources of Water Figure 2: Types of water sources

The survey results show that 35.0% 30.2% there are different types of water 30.0% 27.5% 25.0% 19.2% sources in the targeted areas. 20.0% 15.0% These sources are Pipe Line, 10.9% 9.6% 10.0% Public taps/ tap stand/ 5.0% 1.1% 1.2% 0.2% 0.1% standpipes, protected hand 0.0% pumps/ boreholes/ tube wells, unprotected hand pumps/ boreholes/ tube wells, protected dug well, unprotected/ open dug wells, protected rain catchment, unprotected rain catchment, Bottle/ sachet water, Purchased water, Surface water (river, dam, lake, pond, creeks, canal).

A significant majority of the respondents,89%, reported that the distance to the water point is about 0.5 Km; 7% stated that the distance to reach to the nearest water collection point is between 0.5 Km – 1 Km; 2% pegged the distance that they travel from 1 Km to 3 Km while another 2% estimated their water point to be more than 3 Km away as shown in Figure 3 below.

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Figure 3: Average Distance to safe water point

2% 2%

7%

0.5 Km 0.5 - 1 Km 1 Km - 3 Km More than 3 Km 89%

2.2 Water Collecting Container Figure 4: Kind of specific container used for collecting water

The data reveals that many containers were used to collect / store water as 100% 90% shown in Figure 3. 85% of the 80% 70% households use jerry cans, 14% 60% buckets while only 1% use drums / 50% 85% 14% 1% 40% barrels to store drinking water. 30% However, it was observation that the 20% 10% containers were dirty. 0% 0% 0% 0% 0%

2.3 Purifying drinking water Survey results revealed that 53% of the respondents did not purify water while 47% claimed that they filtered their drinking water.

Table 2: respondents answers regarding water purification

Purifying 47% Not Purifying 53%

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Figure 5: different methods used by respondents to filter water

Of the respondents who stated that they 0.7% purify water, a majority, 64.6% stated 0% 10.7% that they use the sedimentation method; 8% 4.7% 8% use solar disinfection; 4.7% use 11.3% chlorine / aqua tab; 11.3% use cloth 64.6% filtration technique; 0.7 % claimed that they use other sources to filter the water while significant minority of 10.7 % do not use any filtration method.

2.4 Water quantity used per not applicable solar disinfaction Chlorine/aquatab Cloth filteration household in a day sedimentation water filter ( biosand/ceramic ) The survey results show that the usage Other of water varies from one household to another. 12% of the respondents said that they use 20- 50l, 46% use 50-80l, 24% use 80-100l while 18% use more than 110L per day.

Figure 6: average quantity of water used per household per day

50% 45% 40% 35% 30% 25% 46% 20% 15% 24% 10% 18% 5% 12% 0% 20 to 50 liters 50 to 80 liters 80 to 110 liters Above 110 liters

3. SANITATION The survey results show that the sanitation facilities in targeted areas were weak. This is demonstrated by the fact that 28% of respondents have no proper latrines; 20% practice open

8 defecation in the fields and open areas. 10% of them use their neighbors’ latrine for defecation, others dig a hole / cat hole and defecate in canals / creeks and rivers.

The households that do not have latrines proffered the following reasons

 Expensiveness  No space for constructing latrines  They think that open defecation is not an issue  They had enough place to defecate therefore they don’t want to construct a proper latrine  Not a priority

On the other hand, 53% of the survey respondents have latrines in their houses which are variants of flush 4%, composting latrine 12%, pit latrine without slab 23%, pit latrine with slab 37%, latrine draining to canal / creek and river 1% and 4% of other types.

Figure 7: Types of latrine facility

40%

35% 37%

30%

25%

20% 23% 20% 15%

10% 12%

5% 4% 1% 4% 0% latrine composting pit latrine draining to pit latrine Flush Other No latrine with slob canal/ without slob creek/river Series1 4% 12% 37% 1% 23% 4% 20%

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Figure 8: Those who don’t have latrine facility, Defecate through

90% 80% 70% 78% 60% 50% 40% 30% 20% 10% 9% 10% 2% 0% 1% 0% General latrine Neighbor’s latrine Fields Kandah Scramble Other 43% of the surveyed households do not have proper bathing facilities in their houses while 57% have. These bathing facilities are made of the following:

 Mud  Local rocks  Brick masonry

4. Disease morbidity / mortality and management The most common diseases in the three districts were attributed to dirty water and unhealthy environment. These diseases are;

 Diarrhea  Malaria  Cough /cold  Skin problems

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Figure 9: Types of Common Diseases in Targeted Areas

Diarrhea is the most common disease 2% according to 69% of the respondents followed by cough/cold with 25%, malaria, 4% and skin 25% Diarrhea problems at 2%. Malaria 69% Cough/Flue 4% The respondents cited a range of treatment Skin problem methods that are available at their disposal to treat the aforementioned diseases such as clinical assistance, herbs, and traditional medicine.

About 46% of people buy medicine for the treatment of diarrhea without prescription and assistance of medical doctor while 37% of them take prescription from medical doctor. (Refer to figure 10)

Figure 10: Treatment Methods for Diarrhea

50% 46% 45%

40% 37% 35% 30% 25% 20% 15%

10% 7% 4% 5% 3% 2% 1% 0% 0% No Action Herbal Buy Medicines Stop Feeding Give ORS/SSS Continue Go to Go to Medication Feeding Clinic/Health Traditional Facilities Healer

5. Hand washing practices Typically, hand washing with soap is a rare culture in Afghanistan, especially in less developed provinces. This was corroborated by the survey results that found out that many health problems

11 were mainly due to lack of hand washing with soap. The survey results suggest that most of the affected families were not washing their hands properly, either before a meal or after defecation.

The survey found that only 2% of residents were washing their hands after handling animals, 8% washed their hands before preparing food; 5% washed their hands before feeding infants which accounts for high number of infant morbidity; 28% stated that they washed their hands before eating or after defecation, which suggests a lack of hygiene education/ awareness.

Figure 11: Timing of Hand wash of respondents after activities

30%

25%

20%

15% 28% 27% 23% 10%

5% 8% 5% 3% 4% 2% 0% Before After eating After Before after Changing Before food after Eating defecation feeding this handling pamper of prepration handling infant rubbish infant animals

Figure 12: Hand wash prectices

The respondents who said that they wash their hands before a meal or after 4% defecation stated that they use only 12% water, sand and water, water and ashes 45% as shown in Figure 12.

 12% of the respondents said they 39% wash their hands with soap. Respondents ascribed the low use of soap in hand washing to Only water Water and sand Water and soap Other the following reasons: Think that water is enough to clean hands  Unavailability of soap in the area  Washing hands with soap is time consuming

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 Cannot afford to buy soap

6. Hygiene messages and sources The survey results show that hygiene is a big problem in the three districts. A whopping 94% of the respondents stated that they lacked hygiene awareness especially personal hygiene while only 6% said they were aware of hygiene in general and personal hygiene in particular (Table 2).

Table 2: Hygiene Awareness

Hygiene message %age received Yes 6% No 94% The respondents who were aware about hygiene attributed their knowledge to a number of sources: 1.88% from NGOs, 1.13% from volunteer social workers, 7.14% from posters, 9.40% from Community Health Workers (CHWs). Health clinics and hospitals which have a crucial role in hygiene promotion were cited by 10.16% as shown in Figure 12 below. The survey participants complained about not receiving hygiene kits from organizations working in the WASH, GBV and ES – NFI sectors.

Figure 13 Awareness sourcves of hygiene

46.24%

7.14% 10.16% 9.40% 1.88% 7.89% 12.78% 1.13% 3.38%

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7. Safety and security Figure 14: Respondents feelings regarding security

The survey data shows that a significant majority of the respondents, 84%do not feel secure in their localities compared to 16% 16% who felt secure. This was cited by all categories of the respondents; IDPs, returnees, refugees and host communities 84% (Figure 14).

The reasons advanced for feeling insecure Feeling Secure Feeling Insecure due to the fighting between the government and armed opposition groups (AOG), intra armed group fighting was cited by 44% of the respondents,14% of respondents said they are facing bad behavior of Host communities, 8% of respondents said they are feeling insecure due to existence of armed groups, 15% of respondents are feeling insecure due to Irresponsible armed groups, while 16% of respondents said they are feeling secure in targeted area.

Figure 15 Reason of security issues in targeted area

45% 40% 35% 30%

25% 44% 20% 15%

10% 17% 15% 16% 5% 8% 0% Due to war Bad behavior of Availability of Irresponsible Feeling secure Host communities armed group armed groups

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Local authorities have an important role in solving problems of the residents and most people are satisfied with them. The survey results show that 47.7% of the respondents have approached the police for help in resolving wrangles; 37% have been assisted by local Shuras (elders council) and they are satisfied with their quick response; 11.7% have sought recourse from the Human Rights Commission and 3% have approached NGOs for help to solve their social problems.

Table 3: Taking assistance to solve social problems

Source %age Local Shura 37.6% Police 47.7% Human rights 11.7% NGO 3%

Furthermore, 74% of IDPs and refugees mentioned that they have good relations with the host communities. Some of the respondents mentioned that they have psychological problems and worry about the pervasive insecurity in their neighborhoods. The IDPs and refugees’ claim of peaceful coexistence does not appear to be shared by host communities as 60% accused the IDPs and refugees of destroying their cultivated lands.

Figure 16: Physical threads for children in targeted area

Children living in the three districts are 14% exposed to a myriad of physical threats as 31% 13% shown in Figure 15, opposite. Parents were concerned about the influence that the 13% 29% AOGs have on their children as evidenced by 29% of the respondents expressing fears that the AOGs influence their children to join Existence of land mines Uncovered wells armed groups. Damage houses Distance to school Others

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8. Nutrition Figure 17: malnutrition awareness

Survey results suggest that most 35% 30% respondents do not have awareness 31% 25% 30% about malnutrition. About 30% of 20% 22% 15% 16% people consider children with obesity 10% to be malnourished, 31% said that 5% 1% 0% Sick with they do not have information about Healthy Weak child lose child losing Anorexia motion No malnutrition, while 39% mentioned gaining weight and weight that weak children losing weight, vomiting Series1 30% 22% 16% 1% 31% anorexia, and diarrhea, vomiting were symptoms of malnutrition.

Figure 18: Treatment for malnutrition according to respondents

Survey participants gave the causes of 35% 31% 30% malnutrition as dirty water, dirty food, 25% 21% diarrhea and unbalanced diet (Figure 18). 20% 17% 15% 10% 12% The respondents mentioned that 10% 7% malnourished children with complications 5% 3% 0% need clinical assistance (referral to TFUs), Dirty Dirty Lose Un Lack of Other Don't water food motion balance fruit Know giving them less food and more fluids, nutrition complete and proper nutritious food and taking assistance from traditional healers (Figure 19).

Figure 19: Causes of malnutrition according to respondents 60% 50% 40% 30% 53% 20% 37% 10% 0% 7% 4% Clinical consultancy Less foods much water Complete and proper food Going to religious leader (Imam)

Clinical consultancy Less foods much water Complete and proper food Going to religious leader (Imam)

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Survey participants suggested that colostrum milk should be given to newborn babies to have better health and that infants should be breastfed until they are 2 years old.

9. Shelter Figure 20: Types of shelter

The survey found out that the targeted some of the respondents do not have their own houses and depend on host communities for 9% shelter. The majority of the respondents, 62% 28% live in temporary structures and 28% live in 62% public buildings such as mosques, schools, clinics etc. Others who could not find shelter live in open areas. These people are not able to build houses for themselves because of poverty. Furthermore, they do not have land on Temporary shelter Open vicinity (Mosque) No shelter which to construct houses. Typically, more than 10 people live in one house.

Figure 21 Sources of income

Interview participants explained that they have 40% 32% 30% limited income and resources 30% e.g. personal assets, small 20% 8% 8% 10% 8% business, livestock etc. Most 10% 5% of the survey participants 0% stated that go to market to meet their daily needs such as food items, clothes, home appliances etc.

10. Assistance received 75% of the families have received mosquito nets from NGOs and they use them for protection from mosquitoes.

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74% of respondents mentioned that they have not received any non-food items and other home appliances. They said they need items for such as water tanks, kitchen equipment, home construction materials, blankets, soap and others.

11. Summary and findings  Majority of the population living in 26 villages assessed, have been displaced from the neighboring districts affected by conflict. A large proportion of vulnerable local population is also living in the areas assessed.  According to NCA baseline study, access to safe drinking water is a problem for the local population in Qalay-I-Zal district, Imam Sahib district and Kunduz city.  Water with turbidity is found in some places that needs treatment before usage.  In the areas assessed, fetching of water is the duty of women, therefore it is an additional burden for the women.  Lack of awareness on the importance and techniques of water treatment, poor hygienic conditions and absence of sanitation facilities may increase the spread of diarrhea, skin diseases due to contaminated drinking water or food, or poor sanitation.  Safe, lockable and well-lit latrines are not available for women and children in the villages assessed.  Open defecation is not considered a problem, as many of the respondents said that, they have enough space for open defecation.  The survey found some of the most common diseases in targeted areas were diarrhea, Malaria, Cough and Skin problems.  People do not practice hand washing because they were not giving it priority due to lack of knowledge about hygiene awareness.  Safety and security loomed large in the minds of the conflict affected families.  Malnutrition and knowledge about it is a key finding of this survey.  IDPs do not have shelter because they do not have their own land on which to construct homes.

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12. Recommendations  Environmental sanitation and hygiene awareness campaign is essential in all the 26 villages surveyed. It is also important to launch awareness raising campaigns on hygiene, sanitation, emergency health, malnutrition and safe water in the same villages. For immediate solution, awareness raising on appropriate household water treatment technology is essential.  Carry out water quality testing of all water sources in 26 villages on a monthly basis and of village water sources to understand the existing situation and prepare an action plan. Drinking water supply through installation of hand pumps is needed in 26 villages of (Qalay-I-Zal district, Imam Sahib district and Kunduz city). In addition to this, water quality testing is also necessary for the water to be provided.  Construction of emergency latrines with hand washing spaces and bathing facilities for target population (especially for women and children) is essential in the surveyed areas.  Installation of hand pumps in (Qalay-I-Zal district, Imam Sahib district and Kunduz city) for increasing quantity of clean drinking water for the population.  Provision of hygiene kits and minimum WASH package to the registered cases of malnutrition.  Hygiene promotion using participatory approach in sanitation transformation (PHAST) in communities and health centers.  As per their basic needs required items to be provided such as water tanks, shelters, blankets and other home appliances.

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