Wash Assessment at Household Level in the Gaza Strip

WASH ASSESSMENT AT THE HOUSEHOLD LEVEL IN THE GAZA STRIP

June 2017

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

ACKNOWLEDGEMENT The Gaza Strip is facing immense challenges related to water, sanitation and hygiene (WASH), which pose significant health risks to its nearly two million residents and constrain the socioeconomic development of the Palestinian people. Despite the best efforts of the Palestinian Water Authority (PWA) and our many partners, the deteriorating WASH situation has been compounded by the damage caused by 10 years of blockade and three wars. The consequences of the last armed conflict in 2014 are still felt by the WASH sector in direct and indirect ways, limiting the capacity to develop and deliver basic services to children and families in the Gaza Strip, including the key human right of access to safe water and sanitation. Since the last Israeli military operation in 2014, no household assessmentswere carried out that focused on WASH conditions until this greatly appreciated report. PWA is grateful to the financial and technical support providedby UNICEF, which made this vitally important work possible. The main objective of the assessment was to produce grassroots research of WASH conditions at the household level in the Gaza Strip while generating a comparative analysis that informed the identification of critical responses and actions. The field work was exhaustive with 2,382 households reached under a study with 47 indicators. Seventeen interventions have been proposed based on WASH needs identifiedby the assessment. The main water-related interventions will enhance storage capacity, improve quality of both drinking and domestic water, and promote public awareness of the importance of cleaning water storage. PWA thanks the Gaza WASH Cluster, Gruppo di Volontaria to Civile (GVC), the Palestinian Hydrology Group (PHG), UNICEF and other UN partners,the Ministry of Housing and Public Works, and the Ministry of Public Affairs for contributing to this timely and needed assessment.

R. El Sheikh Deputy Head, Palestinian Water Authority

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Safe drinking water and good hygiene practices are essential for the survival and healthy development of children. Without them, the lives of children are at risk because for children under five, water- and sanitation-related diseases are one of the leading causes of death globally. Throughout the West Bank and Gaza, UNICEF works with the Palestinian Water Authority (PWA) to strengthen accountability parameters and capacity to plan, budget, coordinate and promote scaling up of WASH services. Part of our strategy is to support “upstream” work, and this is why we are pleased to be part of this assessment – the first comprehensive household- level WASH survey in Gaza since the 2014 conflict. Palestinian children continue to experience difficulties in realizing their right to safe drinking water. In 2016, UNICEF and our partners provided support to improving the water, sanitation and hygiene conditions of an estimated 536,000 Palestinian children and their families.Our work under the leadership of the PWA and the Coastal Municipalities Water Utilities (CMWU) contributed to the progress Palestine made towards achieving national and global goals for WASH, but serious underlying challenges with infrastructure and wastewater management remain. These obstacles and bottlenecks jeopardize the ability of the affected population to access safe drinking water and sustain a clean, healthy living environment, especially for children. The situation is acute in Gaza, where less than five percent of the water drawn from the coastal aquifer is estimated to be fit for human consumption, and a 2012 UN report projected that if current trends continue, damage to the aquifer will be irreversible by 2020. We are confident national and local authorities will act onthe assessment’s findings and recommendations. UNICEF will do all we can to help the State of Palestine implement the jointly agreedinterventions. In addition to the partners recognized in the forward, namely PWA and CMWU, I would like to express my thanks and gratitude to the Government of Japan for funding this study, to GVC and PHG for conducting the data collection and analysis and to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) for their important contributions to this study.

June Kunugi Special Representative, UNICEF State of Palestine

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

GVC is thankful to the numerous individuals who shared their ideas and experiences and to all partners that contributed to developing and informing this report. It could not have been completed without their commitment and active support. Many thanks to UNICEF, which financially and technically supported this initiative, the Gaza WASH Cluster, which facilitated the information sharing, the Palestinian Water Authority and Coastal Municipalities Water Utilities that chaired the assessment process, and WASH-MWG members (ACF, Oxfam, IRPAL, ISC, and Norwegian Refugee Council), all of which substantially contributed to the assessment’s progress in all stages. GVC is also grateful to the Ministry of Housing and Public Works, Ministry of Social Affairs, United Nations Office for the Coordination of Humanitarian Affairs, United Nations Relief and Works Agency and local municipalities and community-based organizations for providing data for the target groups. Particular thanks go to Giorgio Cancelliere, professor at Bicocca University Milan, for his extremely valuable inputs, comments and suggestions. Last but not least, many special thanks to all GVC-PHG staff for all the great efforts they provided to carry out this assessment, which would not be possible without their hard work.

Yours sincerely,

Luca De Filicaia GVC Country Director oPt

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

EXECUTIVE SUMMARY The Gaza Strip is facing immense challenges related to water, sanitation and hygiene (WASH), which pose significant health risks to its 1.8 million residents and constrain socioeconomic development. Groundwater from the coastal aquifer is the only water resource available in the Gaza Strip. However, abstraction from the aquifer stands at four times the aquifer’s recharge rate at 200 MCM/year, and is expected to rise to 260 MCM/year by 2020. In addition, more than 96 per cent of abstracted water is polluted and not fit for human consumption due to high salinity levels from sea water intrusion and high nitrate levels from excessive use of agrochemicals and wastewater infiltration. The water supply in the Gaza Strip is estimated at 90 l/c/d, below acceptable water quantity standards of 100 l/c/d recommended by the World Health Organization (WHO). Furthermore, the absence of sufficient wastewater treatment facilities results in approximately 35 MCM/year of untreated/partially treated wastewater discharged into the sea along the Gaza coast.

The deteriorated WASH situation has been compounded by nine years of blockade and three consecutive destructive wars. The consequences of the last armed conflict in 2014 are still affecting the WASH sector in direct and indirect ways by limiting the capacity to develop and deliver basic needs and services to people living in the Gaza Strip. Fifty days of continuous attacks caused massive destruction, devastation and displacement. Extensive damage to water and wastewater facilities reported by the Coastal Municipalities Water Utilities (MWU) and the Palestinian Water Authority (PWA) has received a preliminary estimate of around US$ 34 million. The reconstruction process is going slowly.

Since the last Israeli military operation (“Protective Edge”, 2014), there has been no household assessment carried out that focused on the operation’s impact on WASH conditions. In light of this, the WASH Cluster needs to conduct a contextual assessment. As such, GVC and the Palestinian Hydrology Group (PHG) proposed to undertake a thorough assessment with the financial and technical support of UNICEF. They evaluated the WASH conditions in the Gaza Strip at the household level, highlighting the diverse consequences suffered by women, men, girls and boys.

The main objective was to assess WASH conditions at the household level in the Gaza Strip while generating a comparative analysis that informed the identification of critical responses and actions. These, in turn, will contribute positively and efficiently to assuring minimum WASH standards for all Gaza Strip residents and thereby reduce health risks.

Assessment methodology This assessment was conducted from September 2015 to March 2016 under the framework of the WASH monitoring working group (the technical working group that is part of the WASH Cluster), which was established to coordinate the assessment proposed by GVC, PHG and UNICEF. The framework adopted for this assessment consisted of four main consequent stages: 1) preparation, 2) data collection, 3) data analysis, and 4) report writing. The preparation stage included pre-meetings with the WASH monitoring working group to agree on final objectives, structure and required outputs, and also included the selection of a work team. The data collection stage included a field survey conducted through a prepared questionnaire and supported by complementary data; focus group workshops, observatory reports; and secondary

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

data from previous implemented assessments. The data analysis included the elaboration of indicators.

Sample size for the field survey was calculated on a statistical equation for representativeness. According to the defined criteria, 2,382 households is representative of the total of 303,330 households in the Gaza Strip. Considering that 20 per cent of the implemented questionnaires are excluded in the cleaning process, the total minimum sample size was adjusted and rounded to 3,125 households. The sample was stratified based on governorates and localities and classified into four target groups; internally displaced persons, non-affected, war-affected and WASH-affected, of which the last was proposed by WASH-MWG during implementation of the assessment. Data collection was performed in three phases; 3,977 surveys were implemented after carrying out a testing phase including 624 surveys and 3,166 questionnaires were validated during the data cleaning process. The remaining questionnaires were excluded from the data analysis process.

Forty-seven indicators were developed to explain the findings of WASH conditions at the household level over the whole Gaza Strip with a link to the socio-economic situation before and after the 2014 armed conflict. Seven indicators were related to socio-economic conditions, 19 indicators were related to water, six indicators related to sanitation, and 15 indicators related to hygiene.

Main findings Based on key findings of the assessment, results show that interviewed households are spending 33.8 New Israeli Sheqel (NIS)/capita (8.9 United States Dollar (USD)/capita) monthly on the WASH items; 10.6 NIS/capita (2.8 USD/capita) for cleaning supplies, 7.3 NIS/capita (1.9 USD/capita) for hygiene supplies, 5.2 NIS/capita (1.4 USD/capita) for feminine hygiene items, 4.9 NIS/capita (1.3 USD/capita) for drinking water, 4.2 NIS/capita (1.1 USD/capita) for domestic water, and 1.6 NIS/capita (0.4 USD/capita) for solid waste disposal. Additionally, 57 per cent of interviewed households in the Gaza Strip don’t pay for domestic water, Of these, 87 per cent don’t pay because of their economic situation or lack of social responsibility while the remaining households don’t pay because they are not connected to a municipal network or well (they get water from private/illegal wells or public filling points).

Regarding the water situation, results show that the main source of drinking water for interviewed households is desalinated water supplied mainly from water trucks (85 per cent) and public filling points (11 per cent). On the other hand, 84 per cent of interviewed households are supplied by domestic water from municipal networks and 16 per cent from private wells. Around 18 per cent of interviewed households use domestic water sometimes as an alternative source for drinking and cooking. The results show also that 94 per cent of interviewed households in the Gaza Strip are satisfied with the drinking water quality, while only 43 per cent of interviewed households are not satisfied with domestic water quality, mainly because of a salinity issue.

In terms of water storage, eight per cent of interviewed households in the Gaza Strip experienced a decrease in drinking water storage capacity, while 20 per cent of interviewed households described a decrease in domestic water storage facilities after 2014. Ninety-four per cent of interviewed women and 92 per cent of interviewed men were aware of the importance of

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

cleaning drinking water storage, while 76 per cent of interviewed women and 79 per cent of interviewed men don’t recognize the importance of cleaning domestic water storage vessels.

One per cent of interviewed households don’t have toilets; 11 per cent of interviewed households don’t have a sufficient number of toilets. Indictors show that 30 per cent of interviewed households in the Gaza Strip are not connected to wastewater networks and they are using insulated cesspits and small holes that pollute groundwater and the environment. Moreover, 51 per cent of interviewed households have no access to proper drainage systems and are suffering from an accumulation of polluted storm water surrounding their houses during intense rainfalls. The most disturbing sanitation issue relates to solid waste management: around 72 per cent of interviewed households don’t have a safe means of solid waste disposal.

Results of the assessment show that around nine per cent of interviewed households in the Gaza Strip don’t have a hand washing sink, 17 per cent don’t have a shower and 11 per cent don’t have a kitchen sink. The results illustrate poor hygiene practices: 72 per cent of interviewed women and 75 per cent of interviewed men in the Gaza Strip don’t wash their hands properly, while 12 per cent of interviewed women and 15 per cent of interviewed men don’t shower sufficiently. Moreover, 3.7 per cent of reproductive aged women don’t have appropriate materials for menstruation. The percentage of waterborne disease (such as skin disease, diarrhoea and giardiasis) infection is significant. Twenty-five per cent of households with children under five years and 22 per cent of households with members above five years have been infected by waterborne diseases.

Recommended interventions Seventeen interventions have been proposed based on WASH needs illustrated by the assessment. The main water-related interventions will enhance storage capacity, improve quality of both drinking and domestic water, and promote public awareness of the importance of cleaning water storage.

In regard to sanitation, urgent interventions are proposed to protect the surrounding environment and promote good hygiene. Proposed sanitation interventions include installation of new toilets for vulnerable households, installation of wastewater household connections, installation or upgrade of storm water drainage systems and the improvement of solid waste disposal.

In terms of interventions related to hygiene, all of the proposals are very important because they mitigate or solve key public health issues. The proposed interventions include installation and maintenance of sanitation facilities; hand washing sinks, showers and kitchen sinks. Interventions include promotional awareness campaigns about proper hand washing and showering practices, enhancement of menstruation management for vulnerable women, distribution of hygiene kits and identification of ‘hot spots’ of waterborne disease.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

TABLE OF CONTENTS

ACKNOWLEDGEMENT ...... 1 EXECUTIVE SUMMARY ...... 4 Assessment methodology ...... 4

Main findings ...... 5

Recommended interventions ...... 6

TABLE OF CONTENTS ...... 7 LIST OF FIGURES ...... 11 LIST OF TABLES ...... 13 LIST OF MAPS ...... 15 LIST OF ABBREVIATIONS ...... 16 INTRODUCTION ...... 17 Background ...... 17

General socio-economic situation in the Gaza Strip ...... 18

Justifications ...... 19

Goal and objectives ...... 20

Goal ...... 20 Objectives ...... 20

WASH monitoring working group ...... 20

METHODOLOGY ...... 22 Assessment framework ...... 22

Data Collection ...... 22

Questionnaire design ...... 22 Sampling approach ...... 24 Field survey implementation ...... 25 Households selection ...... 27

Complementary data ...... 28

Focus groups ...... 28 Observatory reports ...... 28 Secondary data ...... 28

Data analysis ...... 29

Indicators elaboration ...... 29 Analysis limits ...... 31

FINDINGS AND DISCUSSION ...... 32 General ...... 32

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Socio-economic indicators ...... 34

SE1: Percentage distribution of population based on sex and age ...... 34 SE2: Average housing density ...... 35 SE3: Percentage of households headed by women ...... 36 SE4: Percentage of internally displaced families planning to go back to their homes ...... 36 SE5: Percentage of internally displaced persons and war-affected families with negative variation of income (less purchase power) post-2014 ...... 37 SE6: Percentage of variation of monthly WASH items expenses per household pre- and post-2014 ...... 38 SE7: Average monthly WASH items expenses post-2014 ...... 38

Water indicators ...... 39

W1: Variation of source of drinking water pre- and post-2014 ...... 39 W2: Percentage of women and men who know the origins of safe drinking water ...... 40 W3: Variation of sources of domestic water pre- and post-2014 ...... 41 W4: Variation in capacity of drinking water storage pre- and post-2014 ...... 41 W5: Variation in capacity of the domestic water storage pre- and post-2014 ...... 42 W6: Average storage capacity for drinking water per household member pre- and post-2014 ...... 43 W7: Average of storage capacity of domestic water per household member pre- and post- 2014 ...... 43 W8: Changes in perception about drinking water quality pre- and post-2014 ...... 44 W9: Changes in perception of domestic water quality pre- and post-2014 ...... 45 W10: Percentage of women and men who use drinking water for domestic use ...... 47 W11: Percentage of women and men who use domestic water for drinking and cooking ... 48 W12: Percentage of households engaging children in drinking water collection ...... 49 W13: Percentage of households engaging women in drinking water collection ...... 49 W14: Cleaning of drinking water storage vessels ...... 50 W15: Cleaning conditions of domestic water storage vessels ...... 50 W16: Percentage of households that don’t pay for domestic water ...... 51 W17: Changes in need priorities related to drinking water pre- and post-2014 ...... 52 W18: Changes in need priorities related to domestic water pre- and post-2014 ...... 53 W19: Different coping mechanisms used by women and men related to water problems ... 54

Sanitation indicators ...... 55

S1: Percentage of households without toilets or without sufficient toilets pre- and post-2014 ...... 55 S3: Percentage of households without proper surrounding storm water drainage...... 56 S4: Percentage of households that need access to safe solid waste disposal ...... 57 S5: Changes in need priorities related to sanitation pre- and post-2014 ...... 57 S6: Different coping mechanisms used by women and men to resolve sanitation problems ...... 58

Hygiene indicators ...... 59

H1: Variation of source of water heating pre- and post-2014 ...... 59 H2: Percentage of households entirely without or with poor hand washing facilities post- 2014 ...... 60

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

H3: Percentage of households entirely without or with poor shower facilities post-2014 ..... 61 H4: Percentage of households entirely without or with a poor kitchen sink post-2014 ...... 61 H5: Percentage of people who don’t wash their hands in a timely or proper manner ...... 62 H6: Percentage of people who shower sufficiently ...... 63 H7: Change in hygiene practices post-2014 ...... 64 H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks ...... 65 H9: Percentage of households with members above five years old who were infected by waterborne diseases in the past two weeks ...... 66 H10: Percentage of households that noticed an appearance of new diseases post-2014 ... 66 H11: Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post-2014 ...... 67 H12: Percentage of households that received hygiene kits in the recent period (in 2015) .. 67 H13: Percentage of households with a need for hygiene materials ...... 68 H14: Changes in need priorities for hygiene pre- and post-2014 ...... 69 H15: Different coping mechanisms used by women and men for hygiene ...... 69

Focus group findings ...... 70

POTENTIAL INTERVENTIONS ...... 71 General ...... 71

Water interventions ...... 71

INT1: Enhancing drinking water storage capacity ...... 71 INT2: Enhancing domestic water storage capacity ...... 72 INT3: Improving drinking water quality ...... 73 INT4: Improving domestic water quality ...... 73 INT5: Public awareness campaign about the quality of safe drinking water ...... 74 INT6: Public awareness about the importance of cleaning domestic water storage ...... 75

Sanitation interventions ...... 75

INT7: Installation of toilets for vulnerable households ...... 75 INT8: Installation of household wastewater connections ...... 76 INT9: Installation of storm water drainage systems ...... 77 INT10: Enhancing solid waste management ...... 77

Hygiene interventions ...... 77

INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households ...... 78 INT12: Installation/Rehabilitation of shower facilities for vulnerable households ...... 78 INT13: Installation/Rehabilitation of kitchen sinks (dish washing basins) for vulnerable households ...... 79 INT14: Public awareness about proper hygiene practices ...... 79 INT15: Identification of hot spots of waterborne diseases ...... 80 INT16: Improving the menstrual hygiene management of vulnerable women ...... 80 INT17: Distribution of hygiene kits ...... 81

CONCLUSION AND RECOMMENDATIONS ...... 85 Conclusion ...... 85

General ...... 85

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Methodology ...... 85 Key findings ...... 86 Socio-economic indicators ...... 86 Water indicators ...... 87 Sanitation indicators ...... 88 Hygiene indicators ...... 88 Potential interventions ...... 88

Recommendations ...... 89

Top priorities of interventions ...... 89 Further assessments ...... 90 Suggested approach for interventions ...... 90 Advocacy ...... 91

REFERENCES ...... 92 ANNEX A : WASH-MWG ToR ...... 93 Introduction ...... 93 ANNEX B : LIST OF MEETINGS AND WORKSHOPS ...... 95 ANNEX C : QUESTIONNAIRE TEMPLATE ...... 96 ANNEX D : HOUSEHOLDS SAMPLING ...... 108 ANNEX E : INDICATORS FORMULATION ...... 110 ANNEX F : TABLES OF FINDINGS ...... 116 ANNEX G : MAPS Map 1: War-affected areas ...... 160

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

LIST OF FIGURES

Figure 3.1: Number of the valid questionnaires per governorate based on target group and sex of interviewee ...... 32 Figure 3.2: Number of the valid questionnaires per governorate based on sex and age of the interviewees ...... 33 Figure 3.3: Number of the valid questionnaires per governorate based on average HH monthly income ...... 34 Figure 3.4: Percentage distribution of household members based on age ...... 34 Figure 3.5: Average housing density ...... 35 Figure 3.6: Percentage of households headed by women ...... 36 Figure 3.7: Percentage of internally displaced families going back to their home ...... 37 Figure 3.8: Percentage of IDPs and war-affected families that had negative variation of income ...... 37 Figure 3.9: Percentage of variation of monthly WASH items expenses per household in Gaza Strip ...... 38 Figure 3.10: Average WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month) ...... 39 Figure 3.11: Total WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month) 39 Figure 3.12: Variation of source of drinking water in Gaza Strip pre- and post-2014 ...... 40 Figure 3.13: Percentage of people who know the source of the safe drinking water in Gaza Strip ...... 40 Figure 3.14: Variation of source of domestic water in Gaza Strip pre- and post-2014 ...... 41 Figure 3.15: Variation of capacity of the drinking water storage pre- and post-2014 ...... 42 Figure 3.16: Variation of capacity of the domestic water storage pre- and post-2014 ...... 42 Figure 3.17: Average of storage capacity of drinking water per HH member pre- and post-2014 (litre/capita) ...... 43 Figure 3.18: Average of storage capacity of domestic water per HH member pre- and post-2014 (litre/capita) ...... 44 Figure 3.19: Variation of perception about the drinking water quality pre- and post-2014 ...... 45 Figure 3.20: Aspects of drinking water quality pre- and post-2014 ...... 45 Figure 3.21: Variation of perception about the domestic water quality pre- and post-2014 ...... 46 Figure 3.22: Aspects of domestic water quality pre- and post-2014 ...... 46 Figure 3.23: Percentage of women and men who use drinking water for domestic use ...... 47 Figure 3.24: Domestic uses of drinking water ...... 47 Figure 3.25: Percentage of women and men who use domestic water for drinking and cooking 48 Figure 3.26: Misuses of domestic water ...... 48 Figure 3.27: Percentage of households engaging children in drinking water management ...... 49 Figure 3.28: Percentage of households engaging women in drinking water management ...... 49 Figure 3.29: Cleaning conditions of drinking water storage ...... 50 Figure 3.30: Cleaning conditions of domestic water storage vessels ...... 51 Figure 3.31: Percentage of households that don’t pay fees for domestic water ...... 51 Figure 3.32: Reasons why households don’t pay fees for domestic water ...... 52 Figure 3.33: Variation of needs priorities of the drinking water in Gaza Strip pre- and post-2014 ...... 53 Figure 3.34: Variation of needs priorities of domestic water in Gaza Strip pre- and post-2014 .. 54

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Figure 3.35: Percentage of households without toilets or with no sufficient toilets pre- and post- 2014 ...... 55 Figure 3.36: Percentage of households without access to wastewater networks pre- and post- 2014 ...... 56 Figure 3.37: Percentage of households without proper surrounding drainage...... 56 Figure 3.38: Percentage of households that need access to safe solid waste disposal...... 57 Figure 3.39: Variation of needs priorities of sanitation in Gaza Strip pre- and post-2014 ...... 58 Figure 3.40: Variation of source of water heating pre- and post-2014 ...... 60 Figure 3.41: Percentage of households without or with poor hand washing facility post-2014 ... 60 Figure 3.42: Percentage of households without or with poor shower facility post-2014 ...... 61 Figure 3.43: Percentage of households without or with poor kitchen sink post-2014 ...... 62 Figure 3.44: Percentage of people who don’t wash their hands in a timely manner ...... 63 Figure 3.45: Percentage of people who don’t wash their hands according to each practice ...... 63 Figure 3.46: Percentage of people who do and don’t shower sufficiently ...... 64 Figure 3.47: Percentage of households that changed hygiene practices post-2014 ...... 64 Figure 3.48: Reasons for change in hygiene practices ...... 65 Figure 3.49: Percentage of households with children < five years old infected by waterborne diseases ...... 65 Figure 3.50: Percentage of households with members > five years old infected by waterborne diseases ...... 66 Figure 3.51: Percentage of households that noticed an appearance of new diseases post-2014 ...... 67 Figure 3.52: Percentage of women with no access to appropriate materials for menstruation pre- and post-2014 ...... 67 Figure 3.53: Percentage of households that received hygiene kits in 2015 ...... 68 Figure 3.54: Percentage of households with need for hygiene materials ...... 68 Figure 3.55: Variation of needs priorities of hygiene in Gaza Strip pre- and post-2014 ...... 69

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

LIST OF TABLES

Table 1.1: WASH facilities destroyed during the armed conflict in 2014 ...... 17 Table 2.1: Actual time framework ...... 22 Table 2.2: WASH and socio-economic aspects included in the questionnaire form ...... 23 Table 2.3: Number of the implemented questionnaires and valid questionnaires after cleaning process ...... 27 Table 2.4: Focus groups information ...... 28 Table 2.5: List of indicators ...... 29 Table 3.1 Coping mechanisms used by people related to water problems in Gaza Strip ...... 54 Table 3.2 Coping mechanisms used by people related to sanitation problems in Gaza Strip ..... 59 Table 3.3 Coping mechanisms used by people related to hygiene problems in Gaza Strip ...... 69 Table 4.1: Water interventions ...... 82 Table 4.2: Sanitation interventions ...... 83 Table 4.3: Hygiene interventions ...... 84 Table B.1: List of conducted meetings and workshops ...... 95 Table D.1: Planned minimum number of questionnaires ...... 108 Table E.1: Indicators formulation ...... 110 Table F.1: Total number of implemented and valid questionnaires based on the target group per governorate/locality ...... 116 Table F.2: Number of questionnaires based on sex and age of interviewee ...... 117 Table F.3: Number of questionnaires based on land type ...... 117 Table F.4: Number of questionnaires based on shelter type ...... 118 Table F.5: Number of questionnaires based on average HH monthly income ...... 118 Table F.6: SE1: Percentage distribution of population based on sex and age ...... 118 Table F.7: SE2: Average housing density ...... 118 Table F.8: SE3: Percentage of households headed by women ...... 119 Table F.9: SE4: Percentage of internally diplaced families planning to go back to their home . 119 Table F.10: SE5: Percentage of internally displaced families and war-affected families having negative variation of income post-2014 ...... 119 Table F.11: SE6: Percentage of variation of monthly WASH items expenses per household pre- and post-2014 ...... 119 Table F.12: SE7: Average monthly WASH items expenses post-2014 in NIS/capita/month (USD/capita/month)...... 120 Table F.13: W1: Changes in source of drinking water pre- and post-2014 ...... 121 Table F.14: W2: Percentage of women and men who can/cannot identify safe drinking water resources ...... 121 Table F.15: W3: Variation of source of domestic water pre- and post-2014 ...... 122 Table F.16: W4: Change in capacity of the drinking water storage pre- and post-2014 ...... 123 Table F.17: W5: Changes in capacity of the domestic water storage pre- and post-2014 ...... 124 Table F.18: W6: Average storage capacity of drinking water per household member pre- and post-2014 (litre/capita) ...... 124 Table F.19: W7: Average of storage capacity of domestic water per household member pre- and post-2014 (litre/capita) ...... 125 Table F.20: W8: Changes in perceptions about drinking water quality pre- and post-2014 ...... 125 Table F.21: W9: Variation of perception about the domestic water quality pre- and post-2014 125 Table F.22: W10: Percentage of women and men who use drinking water for domestic use ... 127

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.23: W11: Percentage of women and men who use domestic water as an alternative source of drinking water ...... 128 Table F.24: W12: Percentage of households engaging children in drinking water collection .... 128 Table F.25: W13: Percentage of households engaging women in drinking water collection ..... 129 Table F.26: W14: Cleaning conditions for drinking water storage vessels ...... 129 Table F.27: W15: Cleaning conditions for domestic water storage vessels ...... 130 Table F.28: W16: Percentage of households that don’t pay for domestic water ...... 131 Table F.29: W17: Changes in need priorities for drinking water pre- and post-2014 ...... 132 Table F.30: W18: Changes in need priorities of domestic water pre- and post-2014 ...... 134 Table F.31: W19: Different coping mechanisms carried out by women and men related to water problems ...... 135 Table F.32: S1: Percentage of households without toilets or without sufficient toilets pre- and post-2014 ...... 136 Table F.33: S2: Households without access to wastewater networks pre- and post-2014 ...... 137 Table F.34: S3: Percentage of households without proper surrounding storm water drainage . 138 Table F.35: S4: Percentage of households that need access to safe solid waste disposal ...... 139 Table F.36: S5: Change in need priorities in sanitation pre- and post-2014 ...... 140 Table F.37: S6: Different coping mechanisms used by women and men to improve sanitation 141 Table F.38: H1: Changes in source of water heating pre- and post-2014 ...... 142 Table F.39: H2: Percentage of households without or with poor hand washing facilities post-2014 ...... 143 Table F.40: H3: Percentage of households without or with poor shower facility post-2014 ...... 144 Table F.41: H4: Percentage of households without or with poor kitchen sink post-2014 ...... 145 Table F.42: H5: Percentage of people who are untimely in their hand washing practice ...... 146 Table F.43: H6: Percentage of people who do and don’t do sufficient showering ...... 148 Table F.44: H7: Change of hygiene practices post-2014...... 149 Table F.45: H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks ...... 149 Table F.46: H9: Percentage of households with members above five years of age infected by waterborne diseases in the past two weeks ...... 150 Table F.47: H10: Percentage of households that noticed appearance of new diseases post-2014 ...... 151 Table F.48: H11: Percentage of women with no access to appropriate materials for menstruation pre- and post-2014 ...... 152 Table F.49: H12: Percentage of households that received hygiene kits in the last period (2015) ...... 153 Table F.50: H13: Percentage of households with need for hygiene materials ...... 154 Table F.51: H14: Variation of needs priorities of hygiene pre- and post-2014 ...... 155 Table F.52: H15: Different coping mechanisms carried out by women and men related to hygiene problems ...... 155 Table F.53: Focus groups findings and discussion (based on attendee perception) ...... 157

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

LIST OF MAPS

ANNEX G : MAPS Map 1: War-affected areas ...... 160 Map 2: WASH-affected areas...... 161 Map 3: INT1: Enhancing drinking water storage capacity...... 162 Map 4: INT2: Enhancing domestic water storage capacity ...... 163 Map 5: INT3: Improving drinking water quality ...... 164 Map 6: INT4: Improving domestic water quality ...... 165 Map 7: INT5: Public awareness campaign about the quality of safe drinking water (A) ...... 166 Map 8: INT5: Public awareness campaign about the quality of safe drinking water (B) ...... 167 Map 9: INT6: Public awareness about the importance of the cleaning of domestic water storage ...... 168 Map 10: INT7: Installation of toilets for vulnerable households (A) ...... 169 Map 11: INT7: Installation of toilets for vulnerable households (B) ...... 170 Map 12: INT8: Installation of HH wastewater connections ...... 171 Map 13: INT9: Installation of storm water drainage systems ...... 172 Map 14: INT10: Enhancing solid waste management ...... 173 Map 15: INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households (A) ...... 174 Map 16: INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households (B) ...... 175 Map 17: INT12: Installation/Rehabilitation of shower facilities for vulnerable households (A) .. 176 Map 18: INT12: Installation/Rehabilitation of shower facilities for vulnerable households (B) .. 177 Map 19: INT13: Installation/Rehabilitation of kitchen sinks for vulnerable households (A) ...... 178 Map 20: INT13: Installation/Rehabilitation of kitchen sinks for vulnerable households (B) ...... 179 Map 21: INT14: Public awareness about proper hygiene practices (A) ...... 180 Map 22: INT14: Public awareness about proper hygiene practices (B) ...... 181 Map 23: INT15: Identification of the hot spot areas of waterborne diseases (A) ...... 182 Map 24: INT15: Identification of the hot spot areas of waterborne diseases (B) ...... 183 Map 25: INT16: Enhancing the menstrual hygiene management of vulnerable women ...... 184 Map 26: INT17: Distribution of hygiene kits ...... 185

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

LIST OF ABBREVIATIONS

ACF Action Against Hunger (INGO) CMWU Coastal Municipalities Water Utility (water service provider in Gaza) GDP Gross Domestic Product GVC Gruppo di Volontariato Civile (INGO) GRM Gaza Reconstruction Mechanism HH Household HK Hygiene Kit ICRC International Committee of the Red Cross IDP Internal Displaced People INGO International non-governmental organization IRPAL Islamic Relief in Palestine (INGO) ISC Save the Children (INGO) l/c/d litres per capita per day MCM million cubic metres MoHPW Ministry of Housing and Public WorkS MoSA Ministry of Social Affairs NRC Norwegian Refugee Council (INGO) NGO Non-Governmental Organization OCHA Office for Coordination of Humanitarian Affairs (UN agency) OXFAM GB (INGO) PCBS Palestinian Central Bureau of Statistics PHG Palestinian Hydrology Group (local NGO) PWA Palestinian Water Authority RO Reversed Osmosis ToR Term of References UNICEF United Nations Children's Fund (UN agency) UNRWA United Nations Relief and Works Agency for Palestine Refugees (UN agency) UNSCO United Nations Special Coordinator Office (UN agency) WASH Water, Sanitation and Hygiene WASH-MWG WASH monitoring working group WHO World Health Organization

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

INTRODUCTION

Background The Gaza Strip is facing a challenging and precarious situation. Water, sanitation and hygiene (WASH) conditions pose significant health risks for its 1.8 million residents and constrain socioeconomic development. Groundwater from a coastal aquifer is the only water resource available in the Gaza Strip. Abstraction from the aquifer reached four times the recharge rate amounting to 200 MCM/year and is expected to reach 260 MCM/year by 2020. More than 96 per cent of abstracted water is polluted and not fit for human consumption because of high salinity from sea water intrusion due to over-pumping, and high nitrate levels from excessive use of agrochemicals and infiltration of wastewater. Water supply in the Gaza Strip is estimated at 90 l/c/d, below acceptable water quantity standards of 100 l/c/d recommended by WHO 1 . Furthermore, with the absence of sufficient wastewater treatment facilities, approximately 35 MCM/year of untreated/partially treated wastewater is discharged into the sea along the Gaza coast2.

This deteriorated WASH situation has been compounded by nine years of blockade and three consecutive destructive wars. Consequences of the last armed conflict in 2014 (“Protective Edge”) are still affecting the WASH sector in direct and indirect ways, limiting the capacity to develop and deliver basic needs and services to people living in the Gaza Strip. Fifty days of continuous attacks caused large scale destruction, devastation and displacement. Extensive damage to water and wastewater facilities was preliminary reported by CMWU/PWA, estimated at around US$ 34 million, highlighted in Table 1.1.

Table 1.1: WASH facilities destroyed during the armed conflict in 2014

Facility Totally destroyed Partially destroyed Water filtration and treatment plants 10% 19% Water distribution centres 24% 25% Water wells 5% 7% Water pumping stations - 38% Water storage tanks 19% 42% Wastewater treatment - 60% Wastewater disposal systems - 10% Wastewater pumping station - 27%

The damage assessment report further identified over 33,000 metres of damage to the water and wastewater networks. The damage mentioned above does not include unseen damage which can’t be identified until the removal of rubble. Approximately half a million people were directly affected by damage to water facilities and around one million people were affected due to damage to wastewater facilities3.

1 Palestinian Water Authority, ‘Gaza Water Resources Status Report 2013/2014’, 2014. 2 Palestinian Water Authority, ‘Gaza Strip: Water Crisis Deepens: Without Sustainable Solutions, Future at Stake’, 2015. 3 Office for the Coordination of Humanitarian Affairs, ‘Gaza Crises Appeal’,2014.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Moreover, the electrical system was severely damaged when the only power plant in the Gaza Strip was hit during the conflict. Electrical generators supplying water and wastewater facilities are heavily used and overloaded by long hours of operation. Consequently, supplied water is rarely sufficient and most raw sewage collected is being discharged into the environment because of difficulties with proper disposal. During the winter season, intense storms could cause raw sewage trapped under the rubble to mix with rainwater, increasing health risks because of a lack of adequate collectors and drainage infrastructure. As a consequence, repairing and reinforcing WASH conditions at both the municipal and household level is urgently required.

The reconstruction process is slow and restricts a humanitarian response or a development plan. Problems arising from slow implementation of the Gaza Reconstruction Mechanism (GRM), prohibition on entry of dual-use materials, inadequate power supplies and lack of government regulation have seriously worsened the WASH situation in Gaza Strip.

GVC, PHG and UNICEF, supporting the WASH cluster in defining the most appropriate strategic approach for responding to WASH needs in the Gaza Strip, are undertaking an exercise to assess clearly the dimensions and outlines of the problem. This need was recognized by the WASH cluster, and GVC, PHG and UNICEF offered to take the lead on this assessment analysis for the current WASH situation at household level in the Gaza Strip.

General socio-economic situation in the Gaza Strip One million and eight hundred thousand people (896,542 females and 923,438 males) live in the Gaza Strip on 365 km2 of land. They live in poor socio-economic conditions, hampered severely by high population density, limited land access, strict internal and external security controls, Israeli military operations, and restrictions on labour and trade access across the borders. The socio-economic situation in the Gaza Strip has been one of chronic need, de-development and donor dependency. The situation has been worsened by blockades imposed on the Gaza Strip. Since 2007, Israel has imposed a land, sea and air blockade on the territory. Also, Rafah Crossing into Egypt has been continuously closed by the Egyptian government since 2014, including crossings of those needing humanitarian assistance. Farming activities within several hundred meters of the Israeli fence surrounding the Gaza Strip are risky and prohibited. Fishermen are allowed to access less than one-third of the 20 miles allocated to them under Oslo Accords. This total blockade has reduced the Gross Domestic Product (GDP) of the Gaza Strip by 50 per cent, while the unemployment rate has risen to become the highest in the world. On the other hand, most of the funding for the Gaza Strip administration comes from outside in the form of foreign humanitarian aid, and around 80 per cent of the people in Gaza Strip are receiving international assistance4.

UNSCO reports on the socio-economic situation in the Gaza Strip on a quarterly basis. Based on the report of Q3/2015 5, the Gaza Strip economy constituted 23 per cent of the overall

4 Office for the Coordination of Humanitarian Affairs, ‘THE GAZA STRIP: The Humanitarian Impact of the Blockade’ 2015. 5 United Nations Special Coordinator Office, ‘UNSCO Socio-Economic Report: Overview of the Palestinian Economy in Q3/2015’, 2015.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Palestinian economy, whereas the real GDP was $US 445.6 million and the nominal GDP per capita was $US 422.7 and rate of change in real GDP (year-on-year) was 33.3 per cent.

The final consumption in the Gaza Strip in Q3/2015 was 143.1 per cent of GDP. Final household consumption was 79.6 per cent of GDP and the government’s final consumption was 48.4 per cent of GDP. Gross capital formation was negative to the tune of 6.0 per cent of GDP during the Q3/2015, though gross fixed capital formation was positive with 15.2 per cent of GDP. Exports from the Gaza Strip amounted to 3.3 per cent of GDP, while imports amounted to 39.1 per cent, resulting in a trade deficit equal to 35.9 per cent of GDP in Q3/2015.

The business cycle index contracted throughout Q3/2015. The labour force participation rate was 45.3 per cent and was much higher for men than for women. Similarly, 42.7 per cent of the labour force was unemployed in the Gaza Strip in Q3/2015 and the employment rates for women were higher than men, 63.3 per cent of women compared to 37.4 per cent of men. Refugees had a marginally higher unemployment rate than non-refugees in the Gaza Strip.

Justifications Until September 2015, no household assessment had been carried out assessing the destruction affecting WASH conditions after the last armed conflict in 2014 and consequent impacts. The current situation is similar to the period post- Operation Cast Lead, when a WASH household survey report was elaborated by PHG with the support of UNICEF6. The survey was carried out in all of the Gaza Strip to identify areas requiring critical WASH interventions, thus avoiding potential public health outbreaks. The report was a great support for agencies interested in supporting the urgent WASH needs of the Gaza population and it allowed more strategic, effective and efficient approaches to the response.

The current situation is much more dire than after the “Cast Lead” operation (2009), resulting from a wider amount of destruction of WASH infrastructure and delays in emergency reconstruction response. In light of this, the WASH Cluster expressed the need to carry out a contextual assessment. GVC and PHG, with the support of UNICEF, proposed to undertake a thorough assessment as an urgent need in order to evaluate the WASH conditions in the Gaza Strip at the household level, as well as public health risks. This assessment highlights the diverse consequences suffered by women, men, girls and boys. The proposal is more extensive, however, generating a detailed analysis by comparing three sets of data:

- 2010 post-Cast Lead data included in the PHG report, - New data covering the pre-2014 Protective Edge operation, and - New data on the current situation.

6 Palestinian Hydrology Group and United Nations Children's Emergency Fund, ‘Water, Sanitation and Hygiene Household Survey, Gaza’, 2010.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Goal and objectives

Goal To assess WASH conditions at the household level in Gaza Strip, identifying the real status of drinking water, domestic water, wastewater, solid wastes and hygiene.

Objectives To generate a comparative analysis that informs the identification of critical responses and actions that will contribute positively and efficiently to ensuring minimum WASH standards for the Gaza Strip population, thereby reducing health risks. In addition, the assessment’s purpose emphasizes the insufferable situation that the population of Gaza Strip is compelled to endure because of repeated military activity. These objectives will be achieved through:

a. Identifying WASH needs in the Gaza Strip. b. Designing a framework for data comparison of WASH needs at the household level for the WASH cluster, drawing upon 2010 post-Cast Lead, 2014 pre-Protective Edge and 2015 post-Protective Edge data. c. Distinguishing and suggesting priority lines of actions and responses. d. Expanding the information network related to WASH and gender. e. Contributing to labour market entry by employing fresh graduates, especially women graduates.

WASH monitoring working group The WASH monitoring working group (WASH-MWG) is a Technical Working Group that is part of the WASH Cluster. It was established to harmonize and coordinate the assessment proposed by GVC and PHG. It is supported by UNICEF, using the competences and experiences of the PWA, CMWU and all WASH focal points and key agencies that work in the Gaza Strip. The structure of the group consists of:

- Chair: PWA and CMWU, as they are the WASH sector regulator and service provider respectively in Gaza Strip. - Facilitator: WASH Cluster acts as facilitator towards WASH agencies with the support of GVC and PHG. - Members: WASH Focal Points; Save the Children, Oxfam GB, ACF and IRPAL, UNICEF, UNRWA, NRC with the support of ICRC.

The main tasks and responsibilities of the WASH-MWG are as follows. The complete ToR is detailed in: WASH-MWG ToR.

- Creating an open and accessible database of information gathered through different surveys, based on format and methodologies set up during the assessment carried out by GVC and PHG and supported by UNICEF. - Advising the process of the WASH assessment at the household level, by ensuring that the relevant standards, procedures and approaches are formulated and agreed within all members of the WASH-MWG. - Collecting and addressing information on hazards and risks at each location, and identifying the gaps and priorities of intervention.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

- Providing a link between the infrastructure damage assessment done by CMWU/PWA and the WASH situation at the household level. - Promoting adopted and verified standards to be used in future interventions as part of indication by the Cluster Coordinator. - Ensuring effective and coherent WASH assessment and analysis that is accessible to all relevant partners in order to prevent any overlap with other WASH actors’ activities/assessments. - Promoting information sharing activities both as seminars and documents about results of the assessments and to collect feedback and comments.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

METHODOLOGY

Assessment framework The framework adopted for this assessment consists of four main consequent stages implemented over seven months as shown in Table 2.1: 1) preparation 2) data collection, 3) data analysis and 4) report writing.

The preparation stage included pre-meetings with WASH-MWG to agree on the final objectives, structure and required outputs, and included selection of the work team. On the other hand, the data collection stage included a field survey consisting of three phases, conducted through a prepared questionnaire and supported with other data collection tools, focus groups, observatory reports and secondary data from previous implemented assessments. The data analysis included the elaboration of indicators addressing household socio-economic conditions and the WASH situation. Finally, all methodology steps and output results were elaborated in the final report during the last stage.

All the methodology steps and scope of work (including sampling, data collection, data analysis and findings) were discussed during the WASH-MWG meetings. The methodology was developed and finalized based on recommendations of the WASH-MWG. The key WASH-MWG meetings are listed in Table B.1 in ANNEX B.

Table 2.1: Actual time framework

# Stage Sep Oct Nov Dec Jan Feb Mar 2015 2015 2015 2015 2016 2016 2016

1 Preparation

2 Data collection

3 Data analysis

4 Report writing

Data Collection

Questionnaire design A survey questionnaire was specifically designed for the assessment to tackle different aspects of WASH in the Gaza Strip. The questionnaire is divided into four sections; general information about households including the socio-economic conditions, water, sanitation and hygiene, including the aspects listed in Table 2.2. The questionnaire includes two types of questions; close-ended questions followed by answer options, and open-ended questions to explore answers that better explain the WASH situation in the Gaza Strip.

A discussion workshop was conducted by WASH-MWG during the preparation stage to discuss the questionnaire structure and to plan the work progress and data analysis in all stages. Their purpose was to ensure the highest quality of output data and a fluent exchange of information.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

The final version of the questionnaire was prepared and uploaded on tablet devices. The final version of the questionnaire in English language is shown in ANNEX C.

Table 2.2: WASH and socio-economic aspects included in the questionnaire form

Sector Items

Socio-economic • Target group (internally displaced persons, war-affected, WASH- affected, non-affected) identification • General information (household address, interviewee name, interviewee phone number) • Interviewee sex and age • Interviewee marital status • Interviewee occupation • Family members (number, sex and age) • Family income • Disability (number, sex and age) • Education • Shelter conditions (ownership, type, area, no. of rooms) • Monthly WASH material expenses Water (drinking and • Source of water domestic) • Accessibility (household connection, storage capacity and affordability to pay the fees) • Storage cleaning conditions • Water collection and storage management • Perception about water quality • Perception about water uses • Perception about water needs priorities • Perception about the coping mechanism to alleviate the water issue at the household level Sanitation • Status of wastewater system • Availability of drainage system • Solid waste disposal management • Surrounding cleanliness conditions (garbage, insects, rodents, etc.) • Perception about sanitation needs priorities • Perception about the coping mechanism to alleviate the sanitation issue at the household level Hygiene • Source of water heating • Sanitary facilities conditions • Household cleaning conditions • Availability of hygiene materials • Hygiene practices (hand washing and showering) • Waterborne diseases • Perception about hygiene needs priorities • Perception about coping mechanisms to alleviate the hygiene issue at the household level

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Sampling approach

Sample size Determination of sample size is very important because samples that are too large may waste time and available resources, while samples that are too small may lead to inaccurate results. A correct sample size is necessary to produce results accurate to a specified confidence and margin of error. The following statistical equation7 was used to determine the required minimum sample size that represents households throughout the Gaza Strip. The result was 2,382 households which represents the total of 303,330 Gaza Strip households.

= ( 1) 2 +2 푁휎 푍 푛 2 2 2 Where:푁 − 푒 휎 푍

n= Sample size (using the finite population correction factor)

N Population size = 303,303 households (total population in 2015 = 1,819,9808, household = = 6 members9)

σ Response distribution = 50 per cent =

Z Z-score = 1.96 (confidence level of 95 per cent) =

e= Margin of error = 2 per cent

303,303 × 0.5 × 1.96 = = 2,382 (303,303 1) × 0.022 + 0.5 2× 1.96 푆푎푚푝푙푒 푠푖푧푒 2 2 2 The required minimum sample− size was rounded to 2,500 households. Taking into consideration that 20 per cent of the total questionnaires to be implemented will be excluded in the cleaning process due to bias errors and improper household responses, the appropriate minimum sample size was identified to be 3,125 households.

Sample stratification The selected sample size was stratified based on governorates and localities and classified into four target groups to portray and investigate the socio-economic and WASH conditions in Gaza Strip:

1. Non-affected (normal): households that were not affected by the 2014 armed conflict or were slightly or indirectly affected. 2. Most affected (war-affected): households that were deeply affected by the 2014 armed conflict while their households remained habitable afterwards. The number of war-affected

7 Berenson, M., Levine, D., and Szabat, K., Basic Business Statistics: Concepts and Applications, 13th Ed., Pearson, UK., 2015. 8 Palestinian Central Bureau of Statistics, ‘Population Projections’, http://www.pcbs.gov.ps/site/lang__en/803/default.aspx, 2015. 9 Palestinian Central Bureau of Statistics, ‘Demographic Indicators’, 2015.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

households per governorate was obtained by the Ministry of Housing and Public Work (MoHPW), estimated at 6,205 households in all Gaza Strip. 3. Internally displaced persons: households that were completely destroyed or severely destroyed where residents moved out from their houses or were still living in the location of their destroyed homes inside tents or caravans. The number of internally displaced families was obtained per governorate by the United Nations Office of Coordination and Humanitarian Affairs (OCHA), and was estimated at 17,872 households in all Gaza Strip. 4. WASH-affected: households that were living in very poor WASH conditions. This target group was not in the proposal plan and was adopted by WASH-MWG to replace the non- affected households group in the second phase of the field survey (see sub-section 5. Field survey implementation).

The stratification approach included statistical calculation to stratify the total required number of questionnaires (3,125 households) to each locality and governorate. The calculation determined the percentage of total number of households for each group in each locality in relation to the total number of households in the same governorate. The calculation then applied the percentage to obtain the required number of households of each target group per locality. The minimum representing number of questionnaires for each group per locality is shown in Table D.1 in ANNEX D.

Field survey implementation The time frame of field work was limited by available time and resources. In addition, the initial data analysis was to be submitted to the WASH Cluster for the HNO 2016 process. Due to these constraints, field work was divided into three main phases that began with field training for the work team.

A work team consisting of one coordinator supported by three supervisors and 23 surveyors conducted the assessment with management staff from GVC and PHG. All team members participated in the first and second phase, while only three supervisors and one surveyor continued the work alongside the coordinator in the third phase.

Training phase Three days of training were held before field work commenced to explain the questions included in questionnaires and their related terminologies. Training included the proper way to ask questions and how to use tablets to fill in questionnaires. Subsequently a field test was conducted that included 624 questionnaires targeting only non-affected households. The field team held other meetings to follow-up on the field work and to give feedback and recommendations.

Field work phases Phase 1: The main required output of this phase was to submit initial data to the WASH Cluster as a first estimation of WASH needs in the Gaza Strip, providing a basis for recommendations to the HNO 2016. With available resources, the plan was to implement 1,755 of the required number of questionnaires expected to guarantee a minimum response of 1,404 households. The total number of questionnaires implemented in this phase was 1,343, from 28 September 2015 to 11 October 2015. As shown in Table 2.3, 93 per cent of the total implemented questionnaires in this phase targeted non-affected groups as the coordination was ongoing to

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

get the data of war-affected households from MoHPW and the data of internally displaced persons from OCHA.

Phase 2: The plan was to continue carrying out the assessment with a minimum of 1,370 questionnaires to guarantee a minimum response of 1,096 households, with the goal of reaching 2,500 valid questionnaires as minimum in both the first phase and second phases. In this phase, the planned methodology of the assessment was changed based on the field observations of surveyors and recommendations by UNICEF, the WASH cluster and other WASH-MWG members, to better reflect the WASH situation in Gaza Strip and to avoid any incoherence in identifying the needs of the households most vulnerable in terms of WASH. The changes to the methodology resulted in the following:

1. Surveyors stopped filling out more questionnaires for the non-affected group. 2. Surveyors initiated a new target group, WASH-affected households. 3. Surveyors allocated the remaining number of questionnaires of the non-affected group to WASH affected, war affected and internally displaced person groups.

Due to OCHA’s data sharing protocol, the long process required to get data of new internally displaced persons resulted in numerous nonworking days. Consequently, the number of implemented questionnaires in this phase was 2,634 during the period from 12 October 2015 to 30 November 2015. The total number of implemented questionnaires in both the first phase and second phase reached 3,977 as shown in Table 2.3.

Phase 3: This phase was crucial in order to clean the data and to exclude the surveys where meaningful biases were identified. During the cleaning process, implemented during the period from 1 December 2015 to 11 February 2016, 3,166 questionnaires were cleaned (out of the 3,977 questionnaires total), as shown in Table 2.3. The steps undertaken in the cleaning process, in keeping with the representativeness percentage of each target group per locality were as follows: 1. Highlighting and sorting the questionnaires based on missing answers. 2. Excluding questionnaires with many missing answers. 3. Excluding questionnaires missing answers of observatory questions. 4. Calling interviewees again by phone to get missing answers or to re-correct incoherent answers. 5. Classifying and limiting narrative answers of comprehensive questions (open-ended questions). 6. Translating answers from Arabic to English.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table 2.3: Number of the implemented questionnaires and valid questionnaires after cleaning process

# of implemented # of questionnaires in training questionnaires # of valid Group phase questionnaires Phase 1 Phase 2 Total

Non-affected 624 1,251 215 1,466 780

War-affected 0 42 960 1,002 954

Internally displaced 0 50 579 629 605 persons

WASH-affected 0 0 880 880 827

Total 624 1,343 2,634 3,977 3,166

During implementation of the assessment, several meetings, workshops and other bilateral discussions were conducted with different stakeholders for consultation and to update them on different aspects of the assessment. Five workshops have been conducted with WASH-MWG in order to discuss progress of the assessment. The key meetings and workshops are listed in Table B.1 in ANNEX B.

Households selection The selection process for each target group of households followed specific criteria. Different criteria were identified because of the coordination mechanism related to data sharing protocols and the change in methodology adopted in the second phase.

1. Non-affected: non-affected households were selected randomly in each locality. The selection process involved selecting a certain household and then skipping over the subsequent 20 households before approaching another one. 2. War-affected: a list of households was prepared randomly from the database of the MoHPW of war-affected households from the 2014 armed conflict. Prior to going out in the field, surveyors called selected households to be sure of the data and to arrange for a field visit. In the second phase, because of the change in methodology, specific areas were identified for surveying war-affected households (shown in Error! Reference source not found. in ANNEX G). The areas were different in terms of level of WASH conditions, area size, and number of assigned households. The selection was done at random for 20-30 households. 3. Internally Displaced Persons: all internally displaced households were selected randomly from the OCHA database. Field coordination was done with OCHA to approach the required number of internally displaced persons in each area. While carrying out this assessment, OCHA was also conducting the field assessment. Because of the differing amount of time that the OCHA and GVC-PHG field teams took to fill their questionnaires, a work mechanism for this purpose was agreed on. OCHA and GVC-PHG teams met in household (A), then GVC-PHG team skipped household (B), and then both teams met again in household (C), and so on. At the end of the second phase, when OCHA finished their field survey, this mechanism could not be applied anymore. After a long process of coordination among the WASH Cluster, OCHA and GVC-PHG, OCHA provided the GVC-PHG team with contact information for the remaining required number of internally displaced households that were visited by the GVC-PHG team without being accompanied by an OCHA team.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

4. WASH-affected: specific areas were identified for surveying WASH affected households based on field observations and WASH-MWG recommendations (shown in Map 2 in ANNEX G). Selected areas were different in level of WASH conditions, area size, and number of assigned households. The surveyors used their observations to reach households in specified assigned areas. The selection of a household was made randomly every 20-30 households.

Complementary data In addition to data collected by questionnaires filled out in the field, other data collection tools were applied in order to validate, compile and integrate the whole dataset. Three other tools have been used; conducting focus group sessions, preparing specific reports about the general WASH conditions of households based on the observations of surveyors, and collecting secondary data from previous assessments and researches.

Focus groups Four focus groups were conducted in four different governorates. The selection methodology of these groups was based on the variations of target groups, location and sex of attendees. The four groups were recommended by the WASH-MWG and field team in order to spotlight more of the most affected areas of each target group. The discussion during the sessions was about the general WASH situation at household level. WASH aspects that were discussed included; drinking and domestic water conditions (water quality and accessibility), sanitation conditions (wastewater system, storm water drainage and solid waste management) and hygiene conditions (including diseases that appeared and cleanliness of households). The discussion was based on attendee’s perception and included priorities and solutions required to solve and/or mitigate the WASH problems at household level. Table 2.4 summarizes the general information about each focus group.

Table 2.4: Focus groups information

# Locality/Governorate Target group

1 Ash Shati' Camp - Gaza governorate WASH-affected 2 Beit Hanoun - North governorate Internally Displaced Persons 3 Khuza’a - Khan Younis governorate War-affected 4 An Nuseirat - Middle Area governorate Non-affected

Observatory reports In order to have a clear and consolidated overview of WASH conditions at the household level, it was necessary to understand the whole WASH situation in the community surrounding the households. It was determined that each surveyor should prepare a brief report describing the general WASH conditions in the area that she/he was conducting the survey. In the end, the most WASH affected localities/neighbourhoods were reported and assessed in the second phase (see Map 2 in ANNEX G).

Secondary data To save available resources, time, and to abbreviate the questionnaire, the methodology relied on other data sources for further details. Therefore, some secondary data was collected from

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

other assessments and studies implemented by other agencies that provided additional details not originally obtained during the field survey. The sources of secondary data were:

- PWA: for data on domestic water resources, quality, and public health. - CMWU: for data on domestic water and wastewater networks and drainage system. - NRC: for data on drinking water quality.

Data analysis

Indicators elaboration Forty-seven indicators were developed to capture the socio-economic situation and WASH conditions at the household level for the whole Gaza Strip, before and after the 2014 armed conflict. The indicators were elaborated as follows:

1. Preparing the list of required indicators, and then reviewing and discussing the list with the WASH-MWG. The final list is shown in Table 2.5. 2. Elaborating the indicators based on data collected through questionnaires. Table E.1 in ANNEX E shows question(s) and formulas used to elaborate each indicator. 3. Validating the findings of each indicator by complementary data (see Section Complementary data). 4. Reviewing and discussing the findings of each indicator with the WASH-MWG.

Table 2.5: List of indicators

# Indicator

1 Socio-economic indicators

SE1 Percentage distribution of population based on sex and age

SE2 Average housing density

SE3 Percentage of households headed by women

SE4 Percentage of internally displaced families planning to go back to their homes

SE5 Percentage of internally displaced persons and war-affected families having negative variation of income post-2014

SE6 Percentage of variation of monthly WASH items expenses per household pre- and post- 2014

SE7 Average monthly WASH items expenses post-2014

2 Water indicators

W1 Variation of source of drinking water pre- and post-2014

W2 Percentage of women and men who have/have no knowledge about the origin of the safe drinking water

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W3 Variation of source of domestic water pre- and post-2014

W4 Variation of capacity of the drinking water storage pre- and post-2014

W5 Variation of capacity of the domestic water storage pre- and post-2014

W6 Average of storage capacity of drinking water per household member pre- and post- 2014

W7 Average of storage capacity of domestic water per household member pre- and post- 2014

W8 Variation of perception about the drinking water quality pre- and post-2014

W9 Variation of perception about the domestic water quality pre- and post-2014

W10 Percentage of women and men who use drinking water for domestic use

W11 Percentage of women and men who use domestic water for drinking use

W12 Percentage of households engaging children in drinking water collection

W13 Percentage of households engaging women in drinking water collection

W14 Cleaning conditions of the drinking water storage sites

W15 Cleaning conditions of the domestic water storage sites

W16 Percentage of households that don’t pay for domestic water

W17 Variation of needs priorities of the drinking water pre- and post-2014

W18 Variation of needs priorities of the domestic water pre- and post-2014

W19 Different coping mechanisms used by women and men related to water problems

3 Sanitation indicators

S1 Percentage of households without toilets or without sufficient toilets pre- and post-2014

S2 Households without access to wastewater networks pre- and post-2014

S3 Percentage of households without proper surrounding storm water drainage

S4 Percentage of households that need access to safe solid waste disposal

S5 Variation of needs priorities of the sanitation pre- and post-2014

S6 Different coping mechanisms carried out by women and men related to sanitation problems

4 Hygiene

H1 Variation of source of water heating pre- and post-2014

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

H2 Percentage of households without or with poor hand washing facility post-2014

H3 Percentage of households without or with poor shower facility post-2014

H4 Percentage of households without or with poor kitchen sink post-2014

H5 Percentage of people who do untimely proper hand washing practice

H6 Percentage of people who do and don’t do sufficient showering practice

H7 Change of hygiene practices post-2014

H8 Percentage of households with children under five years old infected by waterborne diseases in the last two weeks

H9 Percentage of households with members above five years old infected by waterborne diseases in the last two weeks

H10 Percentage of households that noticed appearance of new diseases

H11 Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post-2014

H12 Percentage of households that received hygiene kits in the last period (2015)

H13 Percentage of households with need for hygiene materials

H14 Variation of needs priorities of hygiene pre- and post-2014

H15 Different coping mechanisms used by women and men related to hygiene problems

Analysis limits The data was analysed to measure the WASH vulnerability and needs at household levels. The findings were addressed and interpreted in CHAPTER 3 in detail to provide clear and general pictures about the WASH situation. However, further assessments may be needed to explore deeper detail and correlation.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

FINDINGS AND DISCUSSION

General In total, 3,166 valid questionnaires were analysed according to governorates and localities. Figure 3.1 shows the summary, the total number of valid questionnaires per governorate based on the target group and the sex of interviewees, while Table F.1 in ANNEX F shows in detail the total number of implemented and valid questionnaires per governorate and locality based on target group. In addition, the total number of valid questionnaires is disaggregated based on the sex and age of interviewees in Figure 3.2 and in detail in Table F.2 in ANNEX F. All the findings were analysed to furnish an overall representation of WASH conditions in Gaza Strip with a link to the socio-economic situation. Therefore, the findings were not divided based on target group (internally displaced persons, WASH-affected, war-affected and non-affected) since the purpose of sample division, as mentioned in CHAPTER 2, was mainly performed to highlight the most vulnerable areas recommended by the WASH-MWG to better represent the field situation and to avoid any incoherence in final elaboration of WASH assessed needs in the whole Gaza Strip.

Figure 3.1: Number of the valid questionnaires per governorate based on target group and sex of interviewee

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Women Men

<19 19-35 36-60 60+ <19 19-35 36-60 60+

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.2: Number of the valid questionnaires per governorate based on sex and age of the interviewees

Sixty-three per cent of interviewees were men and 37 per cent were women. This difference is significant because in the local culture, families prefer that men meet with outsiders. The age of interviewees ranged from 17-90 years, while the majority (91 per cent) was in the range of 19-60 years. Sixty-nine interviewees had a physical disability (seven women, and 62 men).

The survey considered variations in land types and life levels (type of shelter, income, education, etc). Regarding land type, 2,137 questionnaires (67.5 per cent) out of the total valid questionnaires were implemented in urban areas, while 624 (19.7 per cent) and 405 (12.8 per cent) were implemented in camp and rural areas respectively. The number of valid questionnaires implemented per land type and governorate is detailed in Table F.3 in ANNEX F.

In terms of shelters, 1,562 questionnaires (49.3 per cent) were implemented inside separated houses, 956 (30.2 per cent) inside asbestos/zinco houses, 601 (19.0 per cent) inside apartments in a building/tower and 47 (1.5 per cent) inside tents/caravans. The number of questionnaires implemented per shelter type and governorate is detailed in Table F.4 in ANNEX F.

Income of the interviewed households ranged from 0-9,000 NIS (US$ 0-2,368)10; As such, 86.7 per cent of the interviewed households were under the poverty line, while 91.8 per cent were under the deep poverty line. PCBS guidelines of 2011 indicate that the relative poverty line and the deep poverty line of one household is 2,293 NIS (US$ 603), and 1,832 NIS (US$ 482) respectively11. The average household monthly income in each governorate is shown in Figure 3.3 and detailed in Table F.5 in ANNEX F.

Forty-seven indicators were elaborated and validated by the complementary data; seven indicators related to socio-economic situation, 19 indicators related to water conditions, six indicators related to sanitation conditions, and 15 indicators related to hygiene and public health.

10 Currency rate: USD/NIS = 3.8 11 Palestinian Central Bureau of Statistics, (http://www.pcbs.gov.ps/site/512/default.aspx?tabID=512&lang= en&ItemID=1165&mid=3172&wversion=Staging), 2014.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

<1000 NIS (<263 USD) 1000-1800 NIS (263-474 USD) 1801-2300 NIS (474-605 USD)

2301-4000 NIS (605-1053 USD) >4000 NIS (>1053 USD) 100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.3: Number of the valid questionnaires per governorate based on average HH monthly income

Socio-economic indicators

SE1: Percentage distribution of population based on sex and age This indicator portrays the percentage distribution of interviewed household members based on sex and age. The results show that the sex ratio among interviewees in the Gaza Strip is 105.8 (women is 48.6 per cent and men is 51.4 per cent) which resembles PCBS statistics of 2014 that indicated the sex ratio as 103.3 12. Figure 3.4 shows the percentage distribution of age of interviewed household members per governorate, which is very close in all governorates. In the Gaza Strip, the percentage of children aged 0-5 years is 16.2 per cent and the percentages of people aged 6-18, 19-35, 36-60 and > 60 years is 34.0 per cent, 29.3 per cent, 17.3 per cent and 3.2 per cent respectively. Results related to this indicator are detailed in Table F.6 in ANNEX F.

0-5 yrs 6-18 yrs 19-35 yrs 30-60 yrs >60 yrs

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.4: Percentage distribution of household members based on age

12 Palestinian Central Bureau of Statistics, ‘Demographic Indicators’, (http://www.pcbs.gov.ps/Portals/_Rainbow/Documents/e.htm), 2015.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

SE2: Average housing density This indicator portrays the average housing density of interviewed households in terms of average household area, number of rooms per household, number of persons per room, and average area per person. Figure 3.5 shows that the average household area in Gaza Strip is 126.12 m2, the largest is in the Gaza governorate with 132.39 m2 and the smallest is in the Rafah governorate with 118.12 m2. Governorates did not differ much on the other indicators. In Gaza Strip, the average number of rooms per household is 2.87, the number of persons per room is 2.20, and the average area per person is 20 m2. Results related to this indicator are detailed in Table F.7 in ANNEX F.

Average HH area (m2) Average # of rooms per HH

135 3.00

133 2.95

130 2.90 128 2.85 125 2.80 123 2.75 120 118 2.70 2.65 Average HH area (m2) 115

113 of Average#rooms per HH 2.60 110 2.55 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

# of persons per room Average area per person (m2)

2.35 21.50

) ) 2 2.30 21.00 20.50 2.25 20.00 2.20 19.50 2.15 19.00 # of personof #Per Room 2.10 18.50 Average area Per Person (m 2.05 18.00 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.5: Average housing density

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

SE3: Percentage of households headed by women This indicator shows the percentage of interviewed households headed by women. Figure 3.6 shows the percentage of households headed by women per governorate, all hovering around 8.7 per cent as an average for the whole Gaza Strip. The percentage in Khan Younis is the highest at 10.7 per cent of female-headed households, due to the presence of rural areas where women usually are the heads of the household, while Rafah is the lowest at 5.8 per cent. The average according to the PCBS was 8.4 per cent in 201513. Results related to this indicator are detailed in Table F.8 in ANNEX F.

% of HHs headed by women

12 10

8 6 4 Percentage (%) 2 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.6: Percentage of households headed by women

SE4: Percentage of internally displaced families planning to go back to their homes Figure 3.7 portrays that almost all interviewed internally displaced families in all governorates (99 per cent) are planning to go back to their houses and they are just waiting until the reconstruction process is finished. Most remaining interviewed families who preferred not to return (one per cent) mentioned that they can’t go back because they were living in hot spot zones (mainly at the border) and there is a high risk that their houses will be targeted again. Results related to this indicator are detailed in Table F.9 in ANNEX F.

13 Palestinian Central Bureau of Statistics, (http://www.pcbs.gov.ps/site/512/default.aspx?tabID=512&lang=en&ItemID =1441&mid=3171&wversion=Staging), 2015.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

% of families coming back

100

Percentage (%) 92

90 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.7: Percentage of internally displaced families going back to their home

SE5: Percentage of internally displaced persons and war-affected families with negative variation of income (less purchase power) post-2014 This indicator shows the percentage of interviewed internally displaced persons and war- affected families who had a negative variation of income due to the 2014 armed conflict. Figure 3.8 illustrates that the average percentage of affected families that had a negative income variation in the Gaza Strip is 45 per cent, while the percentage living in the Middle Area is highest with value of 61 per cent. The proportion with a negative variation in Rafah was at 29 per cent. Results related to this indicator are detailed in Table F.10 in ANNEX F.

% of IDPs and war-affected families having negative variation of income

80.00

60.00

40.00

Percentage (%) 20.00

0.00 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.8: Percentage of IDPs and war-affected families that had negative variation of income

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

SE6: Percentage of variation of monthly WASH items expenses per household pre- and post-2014 This indicator shows variations in monthly WASH expenses of interviewed households before and after 2014. Figure 3.9 indicates that the WASH expenses of most interviewed households in the Gaza Strip were not affected by the 2014 armed conflict, as their needs remained the same. The trend in variation was almost the same in all governorates. Results related to this indicator are detailed in Table F.11 in ANNEX F.

% of HHs with no paying variation % of HHs paying less % of HHs paying more

100

60 Percentage (%)

40 Drinking water Domestic water Hygiene materials Female hygiene Cleaning materials Solid waste items disposal WASH items

Figure 3.9: Percentage of variation of monthly WASH items expenses per household in Gaza Strip

SE7: Average monthly WASH items expenses post-2014 This indicator shows the monthly WASH item expenses of interviewed households after 2014. Figure 3.10 shows the results (in NIS and US$ 14), reflecting the expense amounts of each item as nearly the same across governorates. The highest portion of WASH expenses (around 2/3) is spent on cleaning materials at a rate of 9.1-11.3 NIS/C/M (2.4-3.0 USD/C/M) and the lowest part is spent for solid waste disposal with rate of 1.3-1.9 NIS/C/M (0.3-0.5 USD/C/M), while the other expenses are in between; 4.3-5.5 NIS/C/M (1.1-1.4 US$/C/M), 2.9-5.2 NIS/C/M (0.8-1.4 USD/C/M), 5.6-8.1 NIS/C/M (1.5-2.1 US$/C/M) and 4.8-5.8 NIS/C/M (1.3-1.5 USD/C/M) for drinking water, domestic water, hygiene materials and feminine hygiene items respectively. Figure 3.11 shows the total WASH expenses across governorates in the range of 30.4-36.4 NIS/C/M (8.0-9.6 US$/C/M) with an average value of 33.8 NIS/C/M (8.9 US$/C/M) for the whole Gaza Strip. The amount of each WASH item refers to the cost of the WASH item in the local market and the practices of the household. Results related to this indicator are detailed in Table F.12 in ANNEX F.

14 Currency rate: USD/NIS = 3.8

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

North Gaza Middle Area Khan Younis Rafah Gaza Strip

12.0 3.0 10.0 2.5 8.0 2.0

6.0 NIS 1.5 USD 4.0 1.0 2.0 0.5 0.0 0.0 Drinking water Domestic water Solid waste Hygiene Female hygiene Cleaning materials items materials WASH item

Figure 3.10: Average WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month)

Total WASH expenses

40.0 10.0 35.0 30.0 8.0 25.0 6.0 20.0 NIS USD 15.0 4.0 10.0 2.0 5.0 0.0 0.0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.11: Total WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month)

Water indicators

W1: Variation of source of drinking water pre- and post-2014 This indicator describes the sources of drinking water for the interviewed households before and after the 2014 armed conflict. Figure 3.12 shows the source of drinking water of interviewed households in Gaza Strip, illustrating no considerable change due to the 2014 conflict. The results show that around 85 per cent of interviewed households are dependent mainly on water vendors to get their drinking water, while public filling points are the second most used drinking source with 11 per cent. The manner is almost the same across governorates, where percentages of households dependent on water vendors and public filling points are (79.4 per cent, 9.8 per cent in the North), (90.4 per cent, 6.3 per cent in Gaza), (95.6 per cent, 3.5 per cent in the Middle Area), (78.8 per cent, 18.0 per cent in Khan Younis) and (78.8 per cent, 17.5 per cent in Rafah). The remaining households are getting drinking water from other sources; public filling points, private wells, municipal networks, RO home filters and bottled water. The average percentage of interviewed households who obtain their drinking water from municipal or private

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

wells is very low (less than three per cent) since more than 96 per cent of groundwater is contaminated 15. Some households are obtaining drinking water from more than one source. Results related to this indicator are detailed in Table F.13 in ANNEX F.

Pre 2014 Post 2014

100 85.53 84.55

Percentage (%) 20 8.15 10.8 0.54 0.82 3.57 2.56 3.03 2.68 0.92 0.76 0 Bottling RO home filters Municipal Private well Public filling Water truck network points Water Source

Figure 3.12: Variation of source of drinking water in Gaza Strip pre- and post-2014

W2: Percentage of women and men who know the origins of safe drinking water This indicator measures the perception of interviewed people about safe sources of drinking water. Figure 3.13 shows the results according to the sex of interviewees. Taking into consideration that bottled water, RO filters, water trucks and public filling points are safe sources for drinking water, while water coming from municipal networks and private wells is not safe, the results show that the percentage of interviewed people who don’t know which are sources of safe drinking water is 7.7 per cent of women and 6.4 per cent of men. The highest percentage of interviewees who don’t know is in the North governorate, where 13.3 per cent of women and 17.5 per cent of men did not indicate safe sources of drinking water. This is because the quality of domestic water coming from municipal and private wells in the North governorate is better than other governorates (see indicator W9), and so the answers there are in fact different. The perception of women and men is similar across governorates. Results related to this indicator are detailed in Table F.14 in ANNEX F.

Have no knowledge Have knowledge

100

80 60 40 20 Percentage (%) 0 Women Men Sex

Figure 3.13: Percentage of people who know the source of the safe drinking water in Gaza Strip

15 Palestinian Water Authority, ‘Gaza Water Resources Status Report 2013/2014’, 2014.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W3: Variation of sources of domestic water pre- and post-2014 This indicator shows the variation in sources of domestic water of interviewed households before and after the 2014 armed conflict. Figure 3.14 shows the source of domestic water of interviewed households in Gaza Strip and reflects no considerable change due to the 2014 conflict. The results show that around 84 per cent of interviewed households are dependent on the municipal network and 16 per cent are dependent on their own private wells, while less than two per cent of households are dependent on other sources such as water trucks and public filling points which are used mainly as a domestic water source in case the municipal water is unavailable due to power outage. Some households are getting domestic water from more than one resource—mainly those that have a connection to both a municipal network and a private well at the same time. This manner is almost the same for all governorates. The main anomaly was in the Middle Area governorate, where the percentage of households that use municipal networks and private wells is 63.6 per cent and 37.1 per cent respectively, i.e. with significantly less network use. For the other governorates, the percentage of households using municipal networks and private wells are (90.2 per cent, 8.3 per cent), (88.2 per cent, 11.7 per cent), (93.4 per cent, 7.0 per cent) and (74.7 per cent, 26.1 per cent) for the North, Gaza, Khan Younis and Rafah governorate respectively. Results related to this indicator are detailed in Table F.15 in ANNEX F.

Pre 2014 Post 2014

100 83.26 83.99

Percentage (%) 16.08 15.95 20 0.16 0.16 1.93 1.48 0 Municipal network Private well Public filling points Water truck Water Source

Figure 3.14: Variation of source of domestic water in Gaza Strip pre- and post-2014

W4: Variation in capacity of drinking water storage pre- and post-2014 This indicator shows the variation in the capacity of drinking water storage of interviewed households before and after the 2014 armed conflict. Figure 3.15 describes results in each governorate, where most interviewed households in Gaza Strip had no change in the storage capacity of drinking water (85 per cent). Some households had an increase in storage capacity due to tank distribution interventions carried out after the 2014 conflict or for indirect reasons (such as moving to another place or increase in family members). The situation is similar across all governorates. In some localities, the percentage of households that faced a decrease in the storage capacity of drinking water is a bit higher than the others, mainly in Al Nasser, Al Maghazi Camp and An Nuseirat Camp where the percentage was 30.8 per cent, 21.4 per cent and 19.3 per cent respectively. Results related to governorates/localities for this indicator are detailed in Table F.16 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

No Change Decreased Increased

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.15: Variation of capacity of the drinking water storage pre- and post-2014

W5: Variation in capacity of the domestic water storage pre- and post-2014 This indicator protrays the variation in domestic water storage capacity of interviewed households before and after the 2014 armed conflict. Figure 3.16 shows results in each governorate, where most interviewed households in Gaza Strip had no change in storage capacity for domestic water (74 per cent). Some households had increases in storage capacity due to tank distribution interventions carried out after the 2014 conflict or for indirect reasons (such moving to another place or increase of family members). On the other hand, the percentage of households that faced a decrease in storage capacity of domestic water is highest in Khan Younis and Gaza governorates with a value of 31.3 per cent and 24.9 per cent respectively. In some localities the percentage of households that had reduced storage capacity of domestic water was more than one-third of interviewed households, mainly in Khuza’a, Abasan al Kabira and Juhor ad Dik where the percentages were 67.2 per cent, 45.7 per cent and 33.3 per cent respectively. Results related to this indicator for all governorates/localities are detailed in Table F.17 in ANNEX F.

No Change Decreased Increased

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.16: Variation of capacity of the domestic water storage pre- and post-2014

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W6: Average storage capacity for drinking water per household member pre- and post- 2014 This indicator shows the average capacity of drinking water storage of interviewed households per household member before and after the 2014 armed conflict. Figure 3.17 describes the results; the difference in storage capacity before and after the 2014 conflict is not significant as already explained for indicator W4, except in Rafah governorate where there was a considerable variation before and after 2014 in the rural areas. The average storage capacity per capita in the Middle Area is highest for all land types while it is lowest in Khan Younis for all land types. The current average capacity of drinking water storage of interviewed households in Gaza Strip is 56.5 l/capita in the urban areas (the lowest is in Khan Younis with 41.5 l/capita and the highest is in Middle Area with 65.6 l/capita), 49.9 l/capita in the rural areas (the lowest is in Khan Younis with 12.0 l/capita and the highest is in Middle Area with 157.5 l/capita) and 37.8 l/capita in the camp areas (the lowest is in Khan Younis with 16.4 l/capita and the highest is in the Middle Area with 50.9 l/capita). The high value in rural areas in the Middle Area governorate results from the low number of carried questionnaires. Results related to this indicator are detailed in Table F.3 and Table F.18 in ANNEX F.

Pre-2014 Post-2014

Urban Rural Camp Urban Rural Camp

175 175 150 150 125 125 100 100 75 75 50 50 25 25 0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Averageof storage capacity (l/capita) Area Younis Strip Averageof storage capacity (l/capita) Area Younis Strip Governorate Governorate

Figure 3.17: Average of storage capacity of drinking water per HH member pre- and post-2014 (litre/capita)

W7: Average of storage capacity of domestic water per household member pre- and post- 2014 This indicator shows the average capacity of domestic water storage of interviewed households per household member before and after the 2014 armed conflict. Figure 3.18 illustrates the results, where the difference in storage capacity before and after the 2014 conflict was not high, except in rural areas (especially Khan Younis governorate). The current average capacity of domestic water storage of interviewed households in Gaza Strip is 282.8 l/capita in urban areas (the lowest is in Khan Younis with 234.2 l/capita and the highest is in Gaza with 330 l/capita), 253.9 l/capita in rural areas (the lowest is in Rafah with 180.7 l/capita and the highest is in Middle Area with 315 l/capita) and 237.4 l/capita in the camp areas (the lowest is in Khan Younis with 167.9 l/capita and the highest is in Rafah with 284 l/capita). Results related to this indicator are detailed in Table F.3 and Table F.19 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Pre-2014 Post-2014

Urban Rural Camp Urban Rural Camp

400 400 350 350 300 300 250 250 200 200 150 150 100 100 50 50 0 0

North Gaza Middle Khan Rafah Gaza Average of storage capacity(l/capita) North Gaza Middle Khan Rafah Gaza Average of storage capacity(l/capita) Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.18: Average of storage capacity of domestic water per HH member pre- and post-2014 (litre/capita)

W8: Changes in perception about drinking water quality pre- and post-2014 This indicator shows the perception of interviewed people about their drinking water quality before and after the 2014 armed conflict. Figure 3.19 shows whether interviewed people perceive the drinking water quality as acceptable or not. There was no considerable difference in people’s perception of water quality before and after 2014, and the perception was similar across governorates. About 94.2 per cent of interviewed households in Gaza Strip were satisfied with the quality of their drinking water while the remaining percentage complained from one or more problems shown in Figure 3.20. The main problem of quality was salinity and taste which resulted from post-treatment processing.

NRC in cooperation with PWA conducted an assessment to evaluate the drinking water quality based on lab analysis, rather than on people’s perception16. Based on that assessment, 68 per cent of drinking water at the household level is biologically contaminated. Results related to this indicator are detailed in Table F.20 in ANNEX F.

16 Norwegian Refugee Council, “Desalinated Water Chain in the Gaza Strip ‘From Source to Mouth'”, 2015.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Pre-2014 Post-2014

Acceptable Not Acceptable Acceptable Not Acceptable

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.19: Variation of perception about the drinking water quality pre- and post-2014

Pre-2014 Post-2014

Salinity Odour Turbidity Taste Salinity Odour Turbidity Taste

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.20: Aspects of drinking water quality pre- and post-2014

W9: Changes in perception of domestic water quality pre- and post-2014 This indicator protrays the perception of interviewed people about domestic water quality before and after the 2014 armed conflict. Figure 3.21 illustrates whether interviewed people perceived the quality of domestic water as acceptable or not. There is no large difference in people’s perception before and after 2014 except in the Khan Younis governorate where water quality became much worse after 2014. Overall, 56.7 per cent of interviewed households in Gaza Strip are not satisfied with the quality of supplied domestic water, while the worst situation is in Khan Younis governorate where 82.8 per cent of interviewed households viewed the supplied water as being of unacceptable quality. Negative perceptions were lowest in the North governorate (27.7 per cent of the households) where the quality of the groundwater is better. In general, the

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

unsatisfactory percentage is high in most of the localities. On the other hand, Figure 3.22 describes interviewed people’s perception about aspects of the unacceptable domestic water quality. Salinity is the main problem, and in some localities the percentage reaches 100 per cent. The water taste is also a considerable problem resulting mainly from the infiltration of wastewater, excessive chlorine doses, rusted pipes and the rancidity of the intruded seawater. Results related to this indicator for all governorates/localities are detailed in Table F.21 in ANNEX F.

Pre-2014 Post-2014

Acceptable Not Acceptable Acceptable Not Acceptable

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.21: Variation of perception about the domestic water quality pre- and post-2014

Pre-2014 Post-2014

Salinity Odour Turbidity Taste Salinity Odour Turbidity Taste

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.22: Aspects of domestic water quality pre- and post-2014

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W10: Percentage of women and men who use drinking water for domestic use This indicator portrays the percentage of interviewed women and men who use drinking water for domestic purposes. Figure 3.23 shows that five per cent of women and 6.2 per cent of men in the Gaza Strip reported using drinking water for domestic purposes. In Figure 3.24, the highest percentage of those who use drinking water for domestic use is in Rafah and Khan Younis governorates with a value of 10.3 per cent and 8.1 per cent respectively for both women and men. The main reason is because the salinity of drinking water in most places makes the water inappropriate for domestic purposes (see indicator W9). Results related to this indicator are detailed in Table F.22 in ANNEX F.

Women Men Women+Men

12 10

8 6 4 Percentage (%) 2 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.23: Percentage of women and men who use drinking water for domestic use

Bathing Cleaning Washing Dishes Ablution Showering the children

6 5

4 3 2 Percentage (%) 1 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.24: Domestic uses of drinking water

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W11: Percentage of women and men who use domestic water for drinking and cooking This indicator shows the percentage of interviewed women and men who use domestic water as an alternative source for drinking and cooking purposes. Figure 3.25 shows that 19.9 per cent of women and 16.7 per cent of men in Gaza Strip mentioned that they use domestic water for drinking and cooking purposes as shown in Figure 3.26. The highest percentage of interviewees who use domestic water for both drinking and cooking is in Khan Younis governorate with a value of 25.5 per cent for both sexes. In the North governorate, the highest percentage (11.4 per cent of the interviewed households) of interviewed people who use domestic water for drinking when it should not be can be explained because the quality of groundwater there is better (see indicator W9). Results related to this indicator are detailed in Table F.23 in ANNEX F.

Women Men Women+Men

30 25

20 15 10 Percentage (%) 5 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.25: Percentage of women and men who use domestic water for drinking and cooking

Drinking Cooking

30 25

20 15 10 Percentage (%) 5 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.26: Misuses of domestic water

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W12: Percentage of households engaging children in drinking water collection This indicator shows the percentage of interviewed households that engage children in the drinking water collection process. Figure 3.27 indicates that 10.9 per cent of interviewed households in Gaza Strip engage children in drinking water handling. The highest percentage is in Gaza governorate at 14.1 per cent, and the lowest percentage is in the Middle Area governorate with three per cent. It is fairly common in the the Gaza Strip for households to engage children in some logistics, especially simple ones like drinking water handling. Results related to this indicator are detailed in Table F.24 in ANNEX F.

% of HHs

Percentage (%) 3

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.27: Percentage of households engaging children in drinking water management

W13: Percentage of households engaging women in drinking water collection This indicator shows the percentage of interviewed households that engage women in drinking water collection. Figure 3.28 illustrates results which indicate that only 2.3 per cent of households in all Gaza Strip engage women in drinking water handling. This is also not surprising, given that Gaza Strip households prefer men or children conduct such outdoor logistics. All the results related to this indicator are detailed in Table F.25 in ANNEX F.

% of HHs

Percentage (%) 1

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.28: Percentage of households engaging women in drinking water management

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

W14: Cleaning of drinking water storage vessels This indicator portrays perceptions of interviewed women and men regarding cleaning drinking water storage vessels, i.e. the frequency of cleaning processes and the existence of a tight cover. Figure 3.29 describes results which indicate good awareness among interviewed women (94.1 per cent) and men (91.9 per cent) in the Gaza Strip regarding the importance of cleaning drinking water storage vessels. The highest percentage of poor perceptions about drinking water storage vessels is found in Rafah governorate where 11.1 per cent of interviewed women and 13 per cent of interviewed men responded with improper cleaning. In some specific localities, this percentage is even higher, mainly in Beit Lahia, Wadi as Salqa, Al Naser and Shokat as Sufi. On the other hand, there is no significant difference between the perceptions of women and men across governorates. Results related to this indicator for all governorates/localities are detailed in Table F.26 in ANNEX F.

Women Men

Bad Good Bad Good

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.29: Cleaning conditions of drinking water storage

W15: Cleaning conditions of domestic water storage vessels This indicator shows the perception of interviewed women and men regarding the importance of cleaning domestic water storage, as per the frequency of the cleaning process and the existence of a tight cover. Figure 3.30 shows that the percentage of interviewed households that don’t clean their domestic water storage vessels properly is high in all governorates/localities. In some localities, this percentage reaches 100 per cent. Likewise, 76 per cent of interviewed women and 79 per cent of interviewed men described poor cleaning of domestic water storage vessels; there is no significant difference between the perception of men and women across all governorates. Results related to this indicator for all governorates/localities are detailed in Table F.27 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Women Men

Bad Good Bad Good

100 100

80 80

60 60

40 40 Percentage (%) 20 Percentage (%) 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.30: Cleaning conditions of domestic water storage vessels

W16: Percentage of households that don’t pay for domestic water This indicator shows the percentage of interviewed households that don’t pay for domestic water. Figure 3.31 shows the percentage of interviewed households that don’t pay while Figure 3.32 shows the reasons why they don’t pay. The reasons could be a result of the household’s economic situation or lack of social responsibility, or because the household is not connected to a municipal network/well (getting water from private/illegal wells or public filling points). The percentage of interviewed households in Gaza Strip who don’t pay is 57 per cent, of which 87 per cent don’t pay because of their economic situation or lack of social responsibility. However, the data obtained from CMWU shows even higher percentages of non-payment. This is mainly because it was collected based on registration and not based on people’s perception. Results related to this indicator for all governorates/localities are detailed in Table F.28 in ANNEX F.

HHs that don't pay

70 60

50 40 30 20 Percentage (%) 10 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.31: Percentage of households that don’t pay fees for domestic water

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Don’t pay because of economic situation or lack of social responsibility Don’t pay because they are not connected to municipal network/well 100

80 60 40

Percentage (%) 20 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.32: Reasons why households don’t pay fees for domestic water

W17: Changes in need priorities related to drinking water pre- and post-2014 This indicator shows the perception of interviewed women and men regarding priorities related to drinking water before and after the 2014 armed conflict. Figure 3.33 shows that there has been no significant change in interviewed people’s perception before and after 2014. The highest priority needs for interviewed people are providing additional tanks (35.5 per cent of women and 25.9 per cent of men), rehabilitating water pipelines (21.2 per cent of women and 28 per cent of men), building more desalination plants (18.8 per cent of women and 26 per cent of men) and distributing home RO filters (16.4 per cent of women and 13.8 per cent of men). The results also show that the majority of interviewed people are satisfied with the cost of drinking water as only three per cent prioritized the need for low-cost water. On the other hand, interviewed people didn’t prioritize the need for public awareness (only 3.5 per cent prioritized this need) although the above indicators clearly show the need to conduct awareness-raising campaigns. The results of all governorates are detailed in Table F.29 in ANNEX F.

Pre-2014

Women Men Women+ Men

35 30 25 20 15 10 Percentage (%) 5 0 Distributing Extra water Low cost water Public Rehabilitation Building more No priority home tanks awareness on of water desalination desalination potable water pipelines plants filters Priority

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Post-2014

Women Men Women+ Men

Figure 3.33: Variation of needs priorities of the drinking water in Gaza Strip pre- and post-2014

W18: Changes in need priorities related to domestic water pre- and post-2014 This indicator reflects changes in need priorities related to domestic water before and after the 2014 armed conflict. Figure 3.34 describes the results, which indicate that there has been no significant change in interviewed people’s perception before and after 2014. The priorities for interviewed people are rehabilitating water pipelines (36.7 per cent of women and 61.3 per cent of men), providing additional tanks (40.5 per cent of women and 20.3 per cent of men) and building more desalination plants (17.3 per cent of women and 12.5 per cent of men). On the other hand, interviewed people did not prioritize the need for public awareness (only 2.4 per cent prioritized this need) although the above indicators show the need for awareness raising campaigns. The results of all governorates are detailed in Table F.30 in ANNEX F.

Pre-2014

Women Men Women+ Men

60 50 40 30 20 Percentage(%) 10 0 Distributing Extra water Low cost water Public Rehabilitation Building more No priority home tanks awareness on of water desalination desalination non-potable pipelines plants filters water Priority

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Post-2014

Women Men Women+ Men

Figure 3.34: Variation of needs priorities of domestic water in Gaza Strip pre- and post-2014

W19: Different coping mechanisms used by women and men related to water problems This indicator presents the coping mechanisms used by interviewed households to mitigate or to solve problems related to water. Table 3.1 shows the key results in Gaza Strip which are ordered according to the perceptions of interviewed women and men together. The results show that around 8.6 per cent of interviewed people are doing nothing to mitigate the problems related to water, and this may be because they have no problem with their water or because they don’t care about problems with water. Results related to this indicator are in detailed in Table F.31 in ANNEX F.

Table 3.1 Coping mechanisms used by people related to water problems in Gaza Strip

% of % of % of women and # Mechanism women men men 1 Saving water through reducing the water consumption 35.64 47.5 43.08 2 Increasing the storage capacity of domestic water though using enough tanks 17.15 20.4 19.2 3 Using small tanks and jerry cans to store water for emergencies 17.82 9.543 12.63 4 Purchasing drinking water for domestic use when the domestic water is not 13.26 7.11 9.41 5 Doingil blno action 8.95 8.38 8.59 6 Others 7.18 7.01 7.09

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Sanitation indicators

S1: Percentage of households without toilets or without sufficient toilets pre- and post- 2014 This indicator describes the interviewed households that have no toilet or without sufficient toilets before and after the 2014 armed conflict. Based on local experience and recommendations of WASH-MWG, the household does not have sufficient toilets if there are more than eight family members per one toilet . Figure 3.35 shows the results, indicating no significant difference before and after the 2014 conflict. There has been a small increase in the percentage of interviewed households that don’t have any toilet after 2014, however the percentage is very small and does not exceed one per cent in the whole Gaza Strip. On the other hand, the percentage of interviewed households without sufficient toilets is 11 per cent. Results related to this indicator for all governorates/localities are detailed in Table F.32 in ANNEX F.

Pre-2014 Post-2014

No toilets Not sufficient toilets No toilets Not sufficient toilets

14 14 12 12

10 10 8 8 6 6

Percentage (%) 4 Percentage (%) 4 2 2 0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.35: Percentage of households without toilets or with no sufficient toilets pre- and post-2014

S2: Variation in households without access to wastewater networks pre- and post-2014 This indicator shows the difference in interviewed households without access to wastewater networks before and after the 2014 armed conflict. Figure 3.36 shows that there is no considerable variation before and after 2014. However, there is a small increase in household connections after 2014 due to implemented interventions that followed the conflict. The present average wastewater coverage in Gaza Strip, based on households interviewed, is 70.3 per cent. Khan Younis is the governorate covered by the fewest wastewater networks where 53.5 per cent of interviewed households are connected to conventional cesspits. The best situation is in the North governorate where 87.4 per cent of interviewed households are connected to a wastewater network. The results were checked against data obtained from CMWU and few differences were found. Results related to this indicator for all governorates/localities are detailed in Table F.33 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Pre 2014 Post 2014

60 50

40 30 20 Percentage (%) 10 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.36: Percentage of households without access to wastewater networks pre- and post-2014

S3: Percentage of households without proper surrounding storm water drainage This indicator shows the availability of proper drainage surrounding interviewed households. Improper drainage depends mainly on the size and conditions of urban (if existing) surroundings of the household, and could be caused by bad conditions of roads (presence of many holes), a type of soil that doesn’t allow storm water to infiltrate, or topography that allows storm water to accumulate around households. Figure 3.37 describes the results: 51 per cent of interviewed households in Gaza Strip suffer from poorly drained storm water. The best situation (which is also bad) is in Gaza governorate where 38.4 per cent of interviewed households are without proper storm water drainage. The worst situation is in Rafah governorate where 67.4 per cent of interviewed households don’t have access to proper surrounding storm water drainage. In some localities, especially rural ones, the situation is much worse (see Table F.3 in ANNEX F). Results related to this indicator for all governorates/localities are detailed in Table F.34 in ANNEX F.

% of HHs

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.37: Percentage of households without proper surrounding drainage

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

S4: Percentage of households that need access to safe solid waste disposal This indicator shows the percentage of interviewed households that don’t have access to safe solid waste disposal. Most households in Gaza don’t have safe means to dispose of solid waste and have to burn, bury or leave the garbage outside a proper container. Figure 3.38 describes a situation that is universally bad across governorates. The average percentage of interviewed households in Gaza Strip that don’t have safe means of solid waste disposal is 71.5 per cent. Results related to this indicator for all governorates/localities are detailed in Table F.35 in ANNEX F.

% of HHs

100

Percentage (%) 20

0 North Gaza Middle Area Rafah Khan Younis Gaza Strip Governorate

Figure 3.38: Percentage of households that need access to safe solid waste disposal

S5: Changes in need priorities related to sanitation pre- and post-2014 This indicator describes changes in the perception of interviewed women and men regarding need priorities related to sanitation before and after the 2014 armed conflict. Figure 3.39 indicates no considerable variation in need priorities before and after the 2014 conflict. The highest priority for interviewed people is to extend or install wastewater networks (48.4 per cent), while 23.8 per cent of interviewed households prioritizing the need to increase toilets units. On the other hand, interviewed people saw as unimportant the need for public awareness related to sanitation, despite that previous indicators show great need for increased awareness. The results for all governorates are detailed in Table F.36 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Pre-2014

Women Men Women+Men

60 50 40 30 20 10 Percentage (%) 0

…

Other up and - No priority sion of Building network. of the local Increase the the Increase wastewater wastewater Increase the the Increase check quality of of toilets quality municipalities in in municipalities Activate the rule treatment plants Sewege disposal of the risk of bad Installation/exten quantity of toilets Awareness raising Priority

Post-2014

Women Men Women+Men

60 50 40 30 20 10 Percentage (%) 0

…

Figure 3.39: Variation of needs priorities of sanitation in Gaza Strip pre- and post-2014

S6: Different coping mechanisms used by women and men to resolve sanitation problems This indicator presents the coping mechanism used by interviewed households to mitigate or solve problems related to sanitation. Table 3.2 shows the key results in the Gaza Strip, which were ordered according to the perception of interviewed women and men together. The results show that around 12.5 per cent of interviewees are doing nothing to mitigate problems related to sanitation, and this may refer to the fact that they don’t face any problem or they don’t care about the problem. All results related to this indicator are detailed in Table F.37 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table 3.2 Coping mechanisms used by people related to sanitation problems in Gaza Strip

% of % of % of # Mechanism women women men and men Cleaning and maintaining the household internal wastewater pipes and 1 35.22 38.8 37.46 strainers Avoid throwing solid wastes, cooking oil and sands inside the 2 22.55 20.08 21 wastewater strainers 3 Doing no action 15.79 10.54 12.51 4 Covering the household wastewater strainers very well 11.82 7.21 8.94 5 Vacuuming the cesspits regularly 3.72 11.1 8.34 Connecting only the toilets to the cesspits to avoid cesspit overflow (the 6 5.49 6.1 5.87 grey water is used for irrigation or discharged into the street) 7 Drilling new cesspits when the existing one is full 1.77 2.22 2.05 Reducing water consumption to decease wastewater quantity to avoid 8 1.1 1.87 1.58 cesspits overflow 9 NA (no Knowledge about the required coping mechanisms) 1.52 1.11 1.26 10 Using insecticide to combat the insects available due to the wastewater 1.01 0.96 0.98

Hygiene indicators

H1: Variation of source of water heating pre- and post-2014 This indicator shows changes in water heating sources among the interviewed households before and after the 2014 armed conflict. Figure 3.40 shows that the proportion for each source is almost the same in each governorate. There is no significant difference before and after 2014. However, the percentage of interviewed households that were using solar heating decreased after 2014, while the percentage of interviewed households that were using gas heating increased after 2014. There are some households using more than one heating source at the same time. Electricity is the main source of water heating, in spite of an electricity deficit, with 61.5 per cent in Gaza Strip after 2014. The reason may refer to the high capital cost of a solar heating system, which can be unaffordable. Gas is more risky than electricity for water heating and is not available all the time. Some interviewed households are still using wood to heat water (15.2 per cent of the households in Gaza Strip). Results related to this indicator for all governorates/localities are detailed in Table F.38 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Pre-2014 Post-2014

Solar heating Electrical heating Solar heating Electrical heating Gas heating Wood Gas heating Wood 70 70 60

50 50 40 40 30 30 20 20 Percentage (%) Percentage (%) 10 10 0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governortae Governorate

Figure 3.40: Variation of source of water heating pre- and post-2014

H2: Percentage of households entirely without or with poor hand washing facilities post- 2014 This indicator shows the availability and conditions of hand washing facilities in interviewed households after the 2014 armed conflict. Figure 3.41 illustrates the results, in which the percentage of interviewed households in Gaza Strip without hand washing facilities is 8.8 per cent, while the highest percentage is in Khan Younis governorate with 14.8 per cent. The percentage is higher in specific localities, mainly Omm Al Nasser (39.6 per cent), Al Qarara (36.8 per cent) and Bani Suheila (25.8 per cent). On the other hand, the percentage of interviewed households in Gaza Strip that have poor hand washing facilities is 27.9 per cent, which is higher in some localities such as Khan Younis Camp (54.3 per cent), An Nuseirat Camp (46.2 per cent), Omm Al Nasser (45.3 per cent), Ash Shati' Camp (44.6 per cent) and Khuza'a (40.9 per cent). Results related to this indicator for all governorates/localities are detailed in Table F.39 in ANNEX F.

Not available Available with poor conditions Available with good conditions

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.41: Percentage of households without or with poor hand washing facility post-2014

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

H3: Percentage of households entirely without or with poor shower facilities post-2014 This indicator shows the availability and condition of shower facilities in interviewed households after the 2014 armed conflict. Figure 3.42 describes the results: the percentage of interviewed households in the Gaza Strip without shower facilities is 16.6 per cent, while in Omm Al Nasser locality, 88.7 per cent of interviewed households don’t have shower facilities. On the other hand, the percentage of interviewed households in Gaza Strip that have poor shower facilities is 23.7 per cent, which is higher in some localities such as Al Qarara (44.7 per cent), Ash Shati' Camp (44.6 per cent), Khuza'a (44.5 per cent) and Khan Younis Camp (40.7 per cent). Results related to this indicator for all governorates/localities are detailed in Table F.40 in ANNEX F.

Not available Available with poor conditions Available with good conditions

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.42: Percentage of households without or with poor shower facility post-2014

H4: Percentage of households entirely without or with a poor kitchen sink post-2014 This indicator shows the availability and condition of kitchen sinks in interviewed households after the 2014 armed conflict. Figure 3.43 describes the results: the percentage of interviewed households in Gaza Strip without kitchen sinks is 10.6 per cent. The percentage is higher in specific localities, mainly Omm Al Nasser (56.6 per cent) and Juhor ad Dik (28.9 per cent). On the other hand, the percentage of interviewed households in the Gaza Strip that have poor shower facilities is 27.3 per cent, which is higher in some localities such as Khan Younis (55.0 per cent), Ash Shati' Camp (54.4 per cent), Al Qarara (50.0 per cent), Khuza'a (46.7 per cent) and An Nuseirat Camp (42.3 per cent). Results related to this indicator for all governorates/localities are detailed in Table F.41 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Not available Available with good conditions Available with poor conditions

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.43: Percentage of households without or with poor kitchen sink post-2014

H5: Percentage of people who don’t wash their hands in a timely or proper manner This indicator portrays the percentage of interviewed women and men who don’t wash their hands in a timely manner—mainly after using the toilet, after changing diapers, before eating and before cooking. The indicator was measured based on the perception of interviewed women and men. Figure 3.44 illustrates the percentage of interviewed women and men who don’t wash their hands properly; the situation is similar across all governorates and for both women and men. In general, the situation is bad across all the Gaza Strip in terms of hand washing practices. The results show that 72.2 per cent of interviewed women and 74.7 per cent of interviewed men in Gaza Strip don’t wash their hands properly, while this percentage reaches 100 per cent or close to it in some localities. On the other hand, Figure 3.45 shows the percentage of interviewed women and men who don’t wash their hands according to each practice. The perceptions of women and men are similar regarding hand washing practices, except a lack of hand washing before cooking is higher for men than women, since cooking is usually a task carried out by women. The percentage of those who do not wash their hands after changing diapers is the highest for both women and men (in Gaza Strip: 64.7 per cent and 66.9 per cent respectively), while the lowest percentage is the lack of hand washing after using the toilet (in Gaza Strip: 0.65 per cent and 2.6 per cent respectively). The other practices fall in between: lack of hand washing before cooking (10.8 per cent of women and 28.6 per cent of men) and before eating (5.8 per cent of women and 9.7 per cent of men). Results related to this indicator for all governorates/localities are detailed in Table F.42 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Women Men

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.44: Percentage of people who don’t wash their hands in a timely manner

Men

After using toilet After changing diapers Before cooking Before eating 100.00

80.00

60.00

40.00

Percentage (%) 20.00

0.00 North Gaza Middle Khan Rafah Gaza Area Younis Strip Governorate

Figure 3.45: Percentage of people who don’t wash their hands according to each practice

H6: Percentage of people who shower sufficiently This indicator portrays the percentage of interviewed women and men who do and don’t shower sufficiently, i.e. less than four times per week. The indicator was measured based on the perceptions of interviewed women and men. Figure 3.46 shows no significant difference between the perceptions of women and men across governorates. The percentage of interviewed women and men in the Gaza Strip who don’t shower adequately is 12.3 per cent and 15 per cent respectively, while the highest percentage is in Rafah with 23.9 per cent and 34.9 per cent respectively. Results related to this indicator for all governorates/localities are detailed in Table F.43 in ANNEX F.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Women Men

Do enough practice Don’t do enough practice Do enough practice Don’t do enough practice

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.46: Percentage of people who do and don’t shower sufficiently

H7: Change in hygiene practices post-2014 This indicator shows the percentage of interviewed households reported a change in hygiene practices after the armed conflict 2014. The indicator was measured based on the perception of interviewed women and men. Figure 3.47 shows that 9.2 per cent of interviewed women and 7.5 per cent of interviewed men changed their hygiene practices. The highest proportion of those who changes is in the Middle Area governorate where 15.1 per cent of interviewed women and 13.1 per cent of interviewed men stated that they have changed their hygiene practices. On the other hand, Figure 3.48 presents reasons for change, which vary between the governorates. The main reason is because sanitary facilities were targeted during the 2014 armed conflict. Other reasons include the economic situation, bad condition of sanitary facilities, unavailability of water and change in residence. Results related to this indicator are detailed in Table F.44 in ANNEX F.

Women Men

Changed Not changed Changed Not changed

100 100

80 80

60 60

40 40 Percentage (%) Percentage (%) 20 20

0 0 North Gaza Middle Khan Rafah Gaza North Gaza Middle Khan Rafah Gaza Area Younis Strip Area Younis Strip Governorate Governorate

Figure 3.47: Percentage of households that changed hygiene practices post-2014

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Economic situation Changing the place of residence Sanitary facilities have been targeted during the war Sanitary facilities need for rehabilitation Water is not available most of the time

70 60

50 40 30

Percentage (%) 20 10 0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.48: Reasons for change in hygiene practices

H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks This indicator shows the percentage of interviewed households with children under five years old infected by waterborne diseases (such as skin diseases, diarrhoea and giardiasis) during the two weeks before the survey. Figure 3.49 shows that 25 per cent of interviewed households with children under five years old in the Gaza Strip were infected by waterborne diseases. North and Gaza governorates had the highest percentage of infections at 31.7 per cent and 31.4 per cent respectively. On the other hand, Rafah governorate had the lowest percentage with a value of 12.5 per cent. The reason could be because Rafah governorate has the lowest percentage of households that use domestic water for drinking use (see indicator W11). In addition, the results are compatible with findings of the public health baseline study conducted by PWA in 2015. Results related to this indicator for all governorates/localities are detailed in Table F.45 in ANNEX F.

Presence of WASH related diseases Absence of WASH related diseases

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.49: Percentage of households with children < five years old infected by waterborne diseases

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

H9: Percentage of households with members above five years old who were infected by waterborne diseases in the past two weeks This indicator shows the percentage of interviewed households with members above five years old who were infected by waterborne diseases (such as skin diseases, diarrhoea and giardiasis) during the two weeks before the survey time. Figure 3.50 shows that 22.1 per cent of interviewed households with members above five years old were infected by waterborne diseases. The North governorate has a high percentage with an average value of 33.4 per cent, especially in Omm Al Nasser locality where the percentage is the highest with a value of 52.8 per cent. On the other hand, Rafah governorate has the lowest percentage of infections with 9.8 per cent, likely for the same reason mentioned above. In addition, the results are compatible with findings from the public health baseline study conducted by PWA in 201517. Results related to this indicator for all governorates/localities are detailed in Table F.46 in ANNEX F.

Presence of WASH related diseases Absence of WASH related diseases

100

Percentage (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.50: Percentage of households with members > five years old infected by waterborne diseases

H10: Percentage of households that noticed an appearance of new diseases post-2014 This indicator shows the percentage of interviewed households that noticed an appearance of new diseases after the 2014 armed conflict. The new diseases include cancer, skin diseases, stomach aches, fever, eyes diseases, heart diseases, pectoral diseases, meninges, asthma, epilepsy and psychosocial diseases. The interviewed people correlated the appearance of these diseases to the increase of insects and garbage, while other explanations included wastewater, water pollution and war after-effects. Figure 3.51 shows that 49.3 per cent of interviewed households in Gaza Strip noticed that appearance of new diseases after the 2014 conflict. The highest percentage is in the North governorate where around 70.6 per cent of interviewed households noticed an appearance of new diseases, especially in Omm Al Nasser where the percentage reached 98 per cent. On the other hand, Middle Area governorate has the lowest percentage of 30 per cent. Results of all governorates/localities are detailed in Table F.47 in ANNEX F.

17 Palestinian Water Authority, ‘Baseline Study on Water Quality & Public Health in the Gaza Strip’, 2015.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

% HHs 80

Percenatge (%) 20

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.51: Percentage of households that noticed an appearance of new diseases post-2014

H11: Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post-2014 This indicator shows the percentage of women of reproductive age who didn’t have appropriate sanitary materials for menstruation before and after the 2014 armed conflict. Figure 3.52 shows little change before and after 2014. The percentage of women of reproductive age in Gaza Strip who don’t have appropriate menstrual materials is 3.7 per cent after 2014. The North governorate has the highest percentage of five per cent, especially in Omm Al Nasser locality which has the highest percentage of 15.6 per cent. On the other hand, the Middle Area governorate has the lowest percentage of 1.4 per cent. Results related to this indicator for all governorates/localities are detailed in Table F.48 in ANNEX F.

Pre 2014 Post 2014

5.00

4.00

3.00

2.00

Percentage (%) 1.00

0.00 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.52: Percentage of women with no access to appropriate materials for menstruation pre- and post- 2014

H12: Percentage of households that received hygiene kits in the recent period (in 2015) This indicator shows the percentage of interviewed households that received hygiene kits in 2015 as assistance after the 2014 armed conflict. Figure 3.53 describes the results, where only 7.1 per cent of interviewed households in Gaza Strip received hygiene kits after 2014. However, after discussing these results with the WASH-MWG, it was found that the percentage of

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

interviewed households that received hygiene kits in 2015 is much less than the actual percentage and doesn’t reflect the actual situation. This may indicate that interviewees were hesitant to mention that they already received hygiene kits so they would not lose the chance to receive another one in any future interventions. Results related to this indicator for all governorates/localities are detailed in Table F.49 in ANNEX F.

% of HHs received hygiene kits 10

4 Percentage (%) 2

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.53: Percentage of households that received hygiene kits in 2015

H13: Percentage of households with a need for hygiene materials This indicator shows the percentage of interviewed households that need hygiene materials, because sanitary conditions inside the household are poor and their economic situation is bad. Figure 3.54 shows that 16.8 per cent of households in Gaza Strip are in need of hygiene materials, and this percentage is in the same range across governorates. However, the percentage is higher in some localities, mainly Omm Al Nasser (47.2 per cent), Al Qarara (39.5 per cent) and An Nuseirat Camp (30.8 per cent). Results related to this indicator for all governorates/localities are detailed in Table F.50 in ANNEX F.

% of HHs

10 Percentage(%) 5

0 North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate

Figure 3.54: Percentage of households with need for hygiene materials

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

H14: Changes in need priorities for hygiene pre- and post-2014 This indicator shows the perceptions of interviewed women and men regarding need priorities related to hygiene before and after the 2014 armed conflict. Figure 3.55 shows no considerable variation in need priorities between before and after the 2014 conflict, while the perception of women and men is similar. The highest priority of interviewed people is their desire to be provided with hygiene kits “HK” (57.5 per cent), while 25 per cent of the interviewed households prioritized the need for cheap cleaning materials. On the other hand, people are attentive to the need for public awareness related to hygiene (17.4 per cent). Results related to this indicator are detailed in Table F.51 in ANNEX F.

Post-2014

Women Men Women+Men

50 40 30 20 Percentage (%) 10 0 Cheap HK Public Other cleaning awarnness materials Priority

Figure 3.55: Variation of needs priorities of hygiene in Gaza Strip pre- and post-2014

H15: Different coping mechanisms used by women and men for hygiene This indicator presents the coping mechanisms used by the interviewed households to mitigate or solve problems related to hygiene. Table 3.3 shows the key results in Gaza Strip, which were ordered according to the perception of interviewed women and men together. The results show that around 5.8 per cent of interviewed people are doing nothing to mitigate the problems related to hygiene, and this may indicate that they don’t face any problems or they don’t care about the problems. Results related to this indicator are detailed in Table F.52 in ANNEX F.

Table 3.3 Coping mechanisms used by people related to hygiene problems in Gaza Strip

% of % of % of # Mechanism women women men and men 1 Cleaning the house regularly 48.65 41.12 43.94 2 Using sufficient cleaning materials and tools 28.38 41.07 36.32 Safe and regular management of solid waste by using tight garbage 3 10.9 7.67 8.88 bags and putting the garbage outside the house 4 Doing nothing 5.91 5.7 5.78 5 Learning good hygiene practices 2.45 2.17 2.27 6 Using enough water for personal and household cleaning 1.69 1.26 1.42 7 Others 2.02 1.01 1.39

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Focus group findings Table F.53 in ANNEX F summarizes the discussion during four focus groups sessions related to WASH conditions and needs. As shown in the table, the number of women who attended was more than men. This is because the number of women interviewees during implementation of the field survey was fewer than the number of men interviewees, and it was necessary to get additional input from women. The WASH needs addressed by attendees were similar in all sessions, mainly: improvement of domestic water quality, increasing hours of domestic water supply, adding additional domestic water storages, installation/rehabilitation of wastewater networks, and obtaining household garbage containers and hygiene materials.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

POTENTIAL INTERVENTIONS

General All findings arising from the present assessment describe the need for a variety of interventions in the Gaza Strip and a strong holistic approach. All sectors (water, sanitation and hygiene) are in need of serious urgent intervention and efforts must be made in all fields.

Generally, the main problems related to WASH are the same throughout the Gaza Strip but more critical in some localities. Hereafter, the main actions that need to be implemented will be defined, specifying the sensitive and priority areas of intervention. Seventeen interventions have been proposed based on the findings addressed in CHAPTER 3.

Water interventions All households in the Gaza Strip have access to domestic water with different levels of service depending on power availability, location, topography and number of beneficiaries. All households are connected either to a municipal water network or to a private well. The main problem related to domestic water is the poor quality of supplied water due to salinity. The presence of nitrates in the water is also considerable but it is perceived as less of a problem by the people because it is without odour or taste. In addition, there is need for enhancing water storage capacity since people need more water supply tanks for domestic use in all of the Gaza Strip as a main mitigation measure against irregular supply.

In regard to drinking water, improvements are necessary to increase the quality of drinking water by adding private desalination plants. In addition, there is need for enhancing drinking water storage capacity.

On the other hand, around 8.6 per cent of households in the Gaza Strip are doing nothing to cope or solve problems related to water in general. Public awareness campaigns should be conducted to promote awareness regarding water issues, mainly regarding drinking water quality and the importance of water storage cleaning and maintenance.

The main interventions related to the water problem in Gaza strip are listed below, and detailed in Table 4.1.

INT1: Enhancing drinking water storage capacity Intervention: Increasing the storage capacity of drinking water at vulnerable households by providing additional water tanks and jerry cans.

Indicators: W4: Variation of capacity of the drinking water storage pre- and post-2014

W6: Average of storage capacity of drinking water per household member pre- and post-2014

W17: Variation of needs priorities of drinking water pre- and post-2014

Key Many households in the Gaza Strip face declining drinking water storage capacity after 2014 as a direct result of the armed conflict and/or as a natural

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findings: increase in household members, with a financial inability to supply additional storage. The worst situation exists in Al Naser, Al Maghazi Camp, An Nuseirat Camp, Gaza City and Deir Al Balah where the percentage of households that need additional drinking water storage is 30.8 per cent, 21.4 per cent, 19.2 per cent, 15.4 per cent and 15.0 per cent respectively. Furthermore, the needs of other localities are addressed in Table 4.1, and Map 3 in ANNEX G. On the other hand, around 30 per cent of households in the Gaza Strip identify the supply of additional water storage as their greatest need related to drinking water, and this priority is distributed homogeneously across all governorates.

This intervention can also include drinking water distribution and should be accompanied by intervention INT5 (a public awareness campaign about the quality of safe drinking water) to raise the awareness of beneficiaries about the importance of cleaning drinking water storage and the quality of safe drinking water.

INT2: Enhancing domestic water storage capacity Intervention: Increasing the storage capacity of domestic water at the household level by providing additional water tanks.

Indicators: W5: Variation of capacity of domestic water storage pre- and post-2014

W7: Average of storage capacity of domestic water per household member pre- and post-2014

W18: Variation of needs priorities of domestic water pre- and post-2014

Key Many households in the Gaza Strip face decreasing domestic water storage findings: capacity after 2014 as a direct result of the armed conflict and/or a natural increase in household members, with a financial inability to supply additional storage. The worst situation is found in Khan Younis governorate, where the percentage of households in need of additional domestic water storage is significant in several localities, mainly in Khuzaa (67.2 per cent), Abasan al Kabira (45.7 per cent), Bani Suheila (32 per cent), Al Qarara (31.6 per cent) and Al Fukhari (25 per cent). The percentage is also high in other specific localities in the other governorates, mainly in Juhor ad Dik (33.3 per cent) and Gaza city (28.6 per cent) in Gaza governorate and Beit Lahia (25.5 per cent) in the North governorate. Furthermore, the needs of other localities are addressed in Table 4.1, and Map 4: INT2: Enhancing domestic water storage capacity in ANNEX G. On the other hand, around 28 per cent of households in the Gaza Strip identify the supply of additional water storage as their highest need priority related to domestic water.

This intervention should be accompanied with intervention INT6 (public awareness about the importance of cleaning domestic water storage) to raise awareness of beneficiaries about the importance of cleaning domestic water storage.

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INT3: Improving drinking water quality Intervention: Improving the quality of drinking water by licensing and monitoring private desalination plants (service providers), improving the capacity of desalination plants and training staff (plants owners and trucks owner).

Indicators: W1: Variation of source of drinking water pre- and post-2014

W8: Variation of perception about drinking water quality pre- and post-2014

Key More than 97 per cent of households in the Gaza Strip are using desalinated findings: water for drinking purposes from private desalination plants (water trucks) and other sources such as public filling points, RO home filters and bottled water. Based on the water chain assessment conducted by PWA-NRC18, 68 per cent of drinking water at the household level is biologically contaminated. However, most households in Gaza Strip are satisfied with the quality of drinking water they use, while only a few households are complaining about water salinity, odour, colour or taste, or a combination of two or more items. This is a critical negative indicator as it means that most of the people are not aware that their water is contaminated. This is a critical public health issue since unsafe drinking water can cause serious waterborne diseases. The perception of people about drinking water quality by governorate is addressed in Table 4.1, and Map 5 in ANNEX G.

This intervention should be accompanied with intervention INT5 (a public awareness campaign about the quality of safe drinking water) to raise awareness of beneficiaries about the importance of cleaning drinking water storage and the quality of safe drinking water.

INT4: Improving domestic water quality Intervention: Improving the quality of domestic water by rehabilitating water networks, monitoring municipal water wells, licensing unregistered wells in the areas unserved with municipal water supply services to ensure the water disinfection, removing illegal wells affecting the supply system, building/upgrading desalination plants, harvesting storm water, protecting groundwater from contamination by wastewater and agricultural fertilizers, and raising public awareness about water saving approaches.

Indicators: W3: Variation of source of domestic water pre- and post-2014

W9: Variation of perception about the domestic water quality pre- and post-2014

W18: Variation of needs priorities of the domestic water pre- and post-2014

Key Most of the households in the Gaza Strip are not satisfied with the quality of

18 Norwegian Refugee Council, “Desalinated Water Chain in the Gaza Strip ‘From Source to Mouth'”, 2015.

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findings: domestic water due to salinity (which is the major issue), odour, colour or taste or a combination of two or more items. The percentage of dissatisfaction is significant across all governorates. The worst situation is in Khan Younis and Middle Area governorate, where the percentage of households suffering from a bad quality of supplied domestic water is very high across all localities. The percentage is also high in Ash Shati’ Camp in Gaza governorate (79 per cent). Furthermore, the perception of people about supplied domestic water quality in all localities is addressed in Table 4.1, and Map 6 in ANNEX G. On the other hand, around two-thirds of households in Gaza Strip identify the improvement of domestic water quality as their highest need priority related to domestic water, since they prioritize the rehabilitation of water networks and building new desalination plants.

INT5: Public awareness campaign about the quality of safe drinking water Intervention: Raising public awareness about the quality of safe drinking water that can be used for drinking and cooking purposes. The objective includes raising awareness about the importance of cleaning drinking water storage vessels and the proper way to clean. The objectives would be achieved by conducting awareness campaigns targeting both women and men, especially those who are in charge of the management of drinking water supply.

Indicators: W1: Variation of source of drinking water pre- and post-2014

W2: Percentage of women and men who have/have no knowledge about the origin of the safe drinking water

W11: Percentage of women and men who use domestic water for drinking and cooking

W14: Cleaning conditions of drinking water storage

W17: Variation of needs priorities of the drinking water pre- and post-2014

Key Although more than 97 per cent of households in the Gaza Strip are using findings: desalinated water for drinking purposes, many households are using domestic water as an alternative resource for cooking (mainly) as well as for drinking. In addition, around seven per cent of households in Gaza Strip aren’t aware which water sources are safe for drinking and cooking. The situation is more significant in Khan Younis and North governorates, where around 25 per cent of households use domestic water for cooking and drinking. This is a critical indication as, based on the PWA report19, 96 per cent of groundwater is not drinkable, and therefore this misuse of domestic water can cause serious waterborne diseases. Moreover, many households in some localities don’t clean their drinking water storages properly, especially in Shokat as Sufi (19 per cent), Wadi as Salqa (18.5 per cent), Al Nasser (15.4 per cent) and Khan Younis city

19 Palestinian Water Authority, ‘Gaza Water Resources Status Report 2013/2014’, 2014.

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(13.6 per cent). Unclean storage can contaminate drinking water, increasing the prevalence of waterborne diseases (such as diarrhoea and giardiasis). Based on results of the water chain assessment conducted by PWA-NRC20, 11 per cent of supplied drinking water is contaminated during water handling at the household level. On the other hand, only 3.5 per cent of people prioritize public awareness related to drinking water aspects. This is an indication that people are downplaying the seriousness of the problems stated above, which makes this intervention a high priority. The situation in all governorates/localities is addressed in Table 4.1, and Map 7 and Map 8 in ANNEX G.

INT6: Public awareness about the importance of cleaning domestic water storage Intervention: Raising public awareness about the importance and proper method of cleaning domestic water storage, by conducting awareness campaigns targeting both women and men, especially men usually in charge of this task.

Indicators: W15: Cleaning conditions of domestic water storages

Key The percentage of households that don’t clean domestic water storage in a findings: proper way is very high in the whole Gaza Strip, reaching 100 per cent in some localities. Unclean storage can pollute water and cause serious skin diseases. The situation in all localities is addressed in Table 4.1, and Map 9 in ANNEX G.

Sanitation interventions The biggest sanitation problem that households face in the Gaza Strip is related to the unhealthy surrounding environment where most of the Gaza Strip population live. Most households in Gaza are suffering from a lack and/or insufficiency of wastewater infrastructure, storm water drainage, and safe solid waste disposal, which may cause serious diseases.

The main interventions related to sanitation problems in Gaza strip are listed below and detailed information is shown in Table 4.2.

INT7: Installation of toilets for vulnerable households Intervention: Enhancing sanitation conditions of vulnerable households that don’t have a toilet or don’t have sufficient toilets by supplying and installing new toilets.

Indicators: S1: Percentage of households without toilets or without sufficient toilets pre- and post-2014

S5: Variation of needs priorities of sanitation pre- and post-2014

Key There remain some households in Gaza Strip that don’t have a toilet inside the findings: house. The family members of these households have to defecate and urinate inside the house in a simple hole or outside the house in the open, which causes

20 Norwegian Refugee Council, “Desalinated Water Chain in the Gaza Strip ‘From Source to Mouth'”, 2015.

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a critical hygiene issue. These households are frequently located in slums in some localities, mainly in Beit Lahia, Beit Hanoun, Gaza city, Al Mughraqa, Juhor ad Dik, Wadi as Salqa, Khan Younis city, Bani Suhaila, Abasan al Kabira and Khuza’a. Moreover, many households in Gaza Strip don’t have a sufficient toilet to person ratio. More than eight persons per toilet is not enough to ensure adequate hygiene conditions (according to WASH-MWG recommendations). This can cause urinary problems and/or stool retention due to the long waiting time to use the toilet. The worst cases are in Deir al Balah Camp, Al Maghazi, Al Fukhari, Al Qarara, Shokat as Sufi and Al Mughraqa, where the percentage of households that don’t have sufficient toilets is 25 per cent, 23.1 per cent, 25 per cent, 15.8 per cent, 17.4 per cent and 15.6 per cent respectively. On the other hand, households in Gaza Strip identify that an increase of the quantity and quality of toilets is a top priority related to sanitation needs. However, intervention depends mainly on the ability to install infrastructure for the new toilet unit inside the house. The situation in all localities is addressed in Table 4.2, and Map 10 and Map 11 in ANNEX G.

INT8: Installation of household wastewater connections Intervention: Installation and/or extension of wastewater networks and getting rid of cesspits to protect groundwater and avoid environment pollution.

Indicators: S2: Variation of households without access to wastewater networks pre- and post-2014

S5: Variation of needs priorities of sanitation pre- and post-2014

Key Many localities in Gaza Strip are still only partially covered by wastewater findings: network services, especially in the Middle Area, Khan Younis and Rafah governorates. This problem is critical since households that don’t have access to wastewater networks have to use cesspits which are not well isolated in most cases and enable wastewater to infiltrate groundwater. In addition, in some areas mainly where WASH-affected households are, the cesspits are in bad condition and overflow continuously, polluting the surrounding environment and enhancing the appearance and spread of insects and rodents that can cause serious illnesses. On the other hand, households in Gaza Strip across all governorates identify the need for access to a reliable wastewater system as their highest priority related to sanitation needs, since they prioritize the installation and/or extension of new wastewater networks and the building and/or upgrading of a wastewater treatment plant. The situation in all localities is addressed in Table 4.2, and Map 12 in ANNEX G.

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INT9: Installation of storm water drainage systems Intervention: Protecting households from storm water accumulation by installing and upgrading storm water drainage systems at the household and municipal levels.

Indicators: S3: Percentage of households without proper surrounding storm water drainage

Key Many households across the Gaza Strip are suffering from undrained storm findings: water due to improper or insufficient drainage systems. The worst situation is found in un-urbanized and downstream areas where storm water accumulates, surrounding households due to the profile of roads and topography respectively. The problem becomes worse when storm water mixes with garbage and/or flooded wastewater, polluting the environment and causing hygiene problems from an increase in mosquitoes and other vectors. The situation in all localities is addressed in Table 4.2, and Map 13 in ANNEX G.

INT10: Enhancing solid waste management Intervention: Enhancing solid waste management at household and community levels, by supporting municipal services, providing solid waste containers, providing household garbage containers, combating insects and rodents and raising public awareness.

Indicators: S4: Percentage of households that need access to safe solid waste management

Key Most households in the Gaza Strip have no access to a safe means of disposal findings: for their solid wastes, and have to burn, bury or leave the garbage in open spaces on a daily basis, which leads to environmental pollution and enhances the spread of disease vectors such as insects and rodents. The situation is critical across all governorates and requires urgent intervention. The situation in all localities is addressed in Table 4.2, and Map 14 in ANNEX G.

Hygiene interventions The need for intervention related to hygiene issues in the Gaza Strip is essential in terms of facilities, materials and awareness. The percentage of people who experience waterborne disease is significant mainly due to poor hygiene conditions. Many households in the Gaza Strip are suffering from the unavailability or poor condition of hygiene facilities (hand washing sinks, showers and kitchen sinks). Financially, many households are not able to obtain sufficient hygiene materials for personal and/or cleaning use.

Regarding hygiene practices, habits and attitudes, the picture is clear in terms of the need for raising awareness. The main bottlenecks are hand washing and showering practices, which are not performed properly.

The main interventions related to hygiene problems in Gaza strip are listed below, while detailed information is shown in Table 4.3.

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INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households Intervention: Enhancing hygiene practices by installing hand washing facilities for vulnerable households that don’t have one, and by rehabilitating hand washing facilities for vulnerable households that have hand washing facilities in poor condition.

Indicators: H2: Percentage of households without or with poor hand washing facilities post- 2014

Key There remain households in Gaza Strip that don’t have a hand washing facility findings: inside the home. The worst situation is in Omm Al Nasser, Al Qarara, Bani Suheila, Juhoe ad Dik and Al Mughraqa where the percentage of households without a hand washing facility is 39.6 per cent, 36.8 per cent, 25.8 per cent, 20.0 per cent and 14.6 per cent respectively. Moreover, many households in Gaza Strip have hand washing facilities that are in poor condition. The situation is critical in several localities. The worst is in Khan Younis Camp, An Nuseirat Camp, Omm Al Nasser, Ash Shati' Camp and Khuza'a where the percentage of households that have poor hand washing facilities is 54.3 per cent, 46.2 per cent, 45.3 per cent, 44.6 per cent and 40.9 per cent respectively. The unavailability or poor condition of hand washing facilities can discourage people from washing their hands properly and sufficiently, which can cause serious disease. In addition, grey water may leak and accumulate on the ground without drainage, which can attract mosquitoes that may cause serious illness. This intervention is a high priority because of the importance of frequent use of hand washing facilities for ablution purposes. The situation in all localities is addressed in Table 4.3, and Map 15 and Map 16 in ANNEX G.

This intervention should be accompanied by intervention INT14 (public awareness about proper hygiene practices) to raise awareness of beneficiaries about proper hand washing practices.

INT12: Installation/Rehabilitation of shower facilities for vulnerable households Intervention: Enhancing hygiene practices by installing shower facilities for vulnerable households that don’t have a shower facility, and by rehabilitating shower facilities for vulnerable households that have shower facilities in poor condition.

Indicators: H3: Percentage of households without or with shower facilities in poor condition post-2014

Key There remain households in Gaza Strip that don’t have a shower facility inside findings: the house. The worst situation is in Omm Al Nasser, Khan Younis Camp, Wadi as Salqa, Al Qarara, An Nuseirat Camp and Bani Suheila where the percentage of households with no shower facilities is 88.7 per cent, 34.3 per cent, 32.6 per cent, 31.6 per cent, 30.8 per cent and 29.9 per cent respectively. Moreover, many households in Gaza Strip have shower facilities in poor condition. The worst can be found in Al Qarara, Ash Shati' Camp, Khuza'a and Khan Younis Camp where the percentage of households that have shower facilities in poor condition is 44.7 per cent, 44.6 per cent, 44.5 per cent and 40.7 per cent respectively. The unavailability or the poor condition of showers can discourage

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

people to shower properly and sufficiently, increasing the prevalence of skin diseases. The situation in all localities is addressed in Table 4.3, and Map 17 and Map 18 in ANNEX G.

This intervention should be accompanied with intervention INT14 (public awareness about proper hygiene practices) to raise awareness of beneficiaries about proper showering practices.

INT13: Installation/Rehabilitation of kitchen sinks (dish washing basins) for vulnerable households Intervention: Enhancing hygiene practices by installing kitchen sinks for vulnerable households that don’t include a sink, and by rehabilitating kitchen sinks for vulnerable households that have sinks in poor condition.

Indicators: H4: Percentage of households without or with kitchen sinks in poor condition post-2014

Key There remain some households in Gaza Strip that don’t have a kitchen sink findings: inside their homes. The worst situation is in Omm Al Nasser, Juhor ad Dik and Al Qarara where the percentage of households with no kitchen sink is 56.6 per cent, 28.9 per cent and 23.7 per cent. Many households in the Gaza Strip have kitchen sinks in poor condition. The situation is critical in several localities. The worst are in Khan Younis Camp, Ash Shati' Camp, Al Qarara, Khuza’a and An Nuseirat Camp where the percentage of households that have kitchen sinks in poor condition is 55.0 per cent, 54.4 per cent, 50.0 per cent, 46.7 per cent and 42.3 per cent respectively. The unavailability and poor condition of kitchen sinks can discourage washing dishes properly and sufficiently, which in turn may contaminate food. In addition, grey water may accumulate on the ground and stay without drainage and attract mosquitoes that might cause serious illness to people. The situation in all localities is addressed in Table 4.3, and Map 19 and Map 20 in ANNEX G.

INT14: Public awareness about proper hygiene practices Intervention: Raising the awareness of women, men, girls and boys about the importance of hand washing, especially by using soap, and improving showering practices.

Indicators: H5: Percentage of people who don’t wash hands frequently enough H6: Percentage of people who shower frequently enough

H14: Variation of needs priorities of hygiene pre- and post-2014

Key A high percentage of people in the Gaza Strip don’t wash their hands properly findings: with soap after using the toilet, after changing diapers, before eating, and touching or preparing food. The situation is critical in all localities, considering the adverse impact of lack of hand washing on the prevalence of diarrhoeal and respiratory diseases which are among the leading causes of child mortality and morbidity. Moreover, a considerable percentage of people in Gaza Strip don’t

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practice proper body hygiene, including proper showering. The worst situation is in Rafah governorate where the percentage of people who don’t shower properly is significant in all localities, while the most critical is Al Naser with a percentage of 53.9 per cent. In Omm Al Nasser the percentage is high with a value of 28.3 per cent. The percentage is considerable in Al Qarara and Abassan al Jadida in Khan Younis governorate with a value of 23.7 per cent and 21.4 per cent respectively. The opportunity to shower infrequently can encourage inactivity and cause serious skin disease. On the other hand, most people don’t identify awareness promotion about proper hygiene practices as a high need priority, which leads intervention to be a key public health issue and a top priority in the whole Gaza Strip. The situation in all localities is addressed in Table 4.3, and Map 21 and Map 22 in ANNEX G.

INT15: Identification of hot spots of waterborne diseases Intervention: Identifying the hot spots of waterborne diseases, such as skin diseases, diarrhoea and giardiasis; recognizing water quality (from source to mouth), environmental conditions, and people’s attitudes and practices. The objective includes conducting public awareness promotion campaigns regarding the reasons, symptoms and treatment of waterborne diseases.

Indicators: H8: Percentage of households with children under five years old with diseases

H9: Percentage of households with members above five years old with diseases

Key Many households in the Gaza Strip, especially those that have children under findings: five years old, have been infected by waterborne diseases, such as diarrhoea, giardia and skin diseases. The situation is significant in several localities, where the worst is found in Omm Al Nasser and Juhor ad Dik. In addition, these results are compatible with findings from the public health baseline study conducted by PWA in 201521. The situation in all localities is addressed in Table 4.3, and Map 23 and Map 24 in ANNEX G.

INT16: Improving the menstrual hygiene management of vulnerable women Intervention: Improving the menstrual hygiene management of vulnerable women by providing them with appropriate menstrual materials and promoting awareness about proper menstruation practices.

Indicators: H11: Percentage of women with no access to appropriate sanitary materials menstruation pre- and post-2014

Key Not all women of reproductive age in Gaza Strip have appropriate materials for findings: menstruation. Although the percentage of those without is not high, it is considered a critical hygiene issue. Omm Al Nasser is the worst case where 15.6 per cent of women have improper menstruation management. The

21 Palestinian Water Authority, ‘Baseline Study on Water Quality & Public Health in the Gaza Strip’, 2015.

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percentage is also significant in Khan Younis Camp, Deir al Balah and Beit Hanoun with 8.9 per cent, 7.7 per cent and 7.4 per cent respectively. The situation in all localities is addressed in Table 4.3, and Map 25 in ANNEX G.

INT17: Distribution of hygiene kits Intervention: Enhancing hygiene conditions of households, through the distribution of hygiene kits (including the basic materials, such as soap, shampoo, tooth paste, detergents, etc.) and prompting public awareness about sufficient household cleaning.

Indicators: H13: Percentage of households in need of hygiene materials

Key Many households in Gaza Strip are in need of hygiene items since they are findings: suffering from poor hygiene conditions inside their houses and financially are not able to obtain sufficient hygiene materials. The need is high in many localities, while the worst situation is found in Omm Al Nasser where 47.2 per cent of households need hygiene materials. The situation is also very dire in Al Qarara, An Nuseirat Camp, Ash Shati' Camp and Khan Younis Camp, where the percentage is 39.5 per cent, 30.8 per cent, 29.4 per cent and 29.3 per cent respectively. The need in all localities is addressed in Table 4.3, and Map 26 in ANNEX G.

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Table 4.1: Water interventions

INT5 INT1 INT2 INT3 INT4 INT6 Locality (A) (B) % of HHs % of HHs % of HHs % of HHs % of HHs % of HHs % of HHs (1) (2) (3) (4) (5) (6) (7) North Beit Lahia 10.1 25.5 29.1 8.8 53.3 Beit Hanoun 6.6 13.2 36.2 6.7 61.7 Jabalia 5.4 12.3 7.7 38.5 24.4 6.2 67.7 Jabalia Camp 4.3 13.6 14.2 6.2 70.4 Omm Al Nasser 0.0 1.9 13.2 1.9 13.2 Gaza Gaza 15.4 28.6 52.5 6.1 83.6 Ash Shati' Camp 4.4 4.4 79.4 6.5 90.2 Madinat Ezahra (*) 0.0 * 0.0 * 3.2 0.0 * 11.3 0.0 * 80.0 * Al Mughraqa 5.2 14.6 41.7 5.2 81.3 Juhor ad Dik 12.2 33.3 36.7 4.4 52.2 Middle Area An Nuseirat 12.8 12.8 87.2 0.0 89.7 An Nuseirat Camp 19.2 19.2 80.8 0.0 96.4 Az Zawayda 2.7 10.8 75.7 8.1 100.0 Al Bureij 4.6 10.6 77.3 1.5 100.0 Al Bureij Camp 11.1 14.8 51.9 7.4 100.0 Al Maghazi 3.9 7.7 4.6 69.2 19.4 7.7 100.0 Al Maghazi Camp 21.4 21.4 85.7 3.6 80.8 Deir al Balah 15.0 15.0 80.0 10.0 92.5 Deir al Balah Camp 0.0 25.0 87.5 0.0 100.0 Al Musaddar (*) 0.0 * 0.0 * 50.0 * 0.0 * 100.0 * Wadi as Salqa 5.9 17.0 36.3 18.5 96.3 Khan Younis Al Qarara 5.3 31.6 76.3 5.3 79.0 Khan Younis 5.4 18.9 87.8 13.6 69.6 Khan Younis Camp 4.3 6.4 72.9 7.9 81.4 Bani Suheila 0.0 32.0 88.7 0.0 56.7 8.9 25.5 Abasan al Jadida 7.1 21.4 71.4 0.0 42.9 Abasan al Kabira 2.9 45.7 77.1 0.0 48.6 Khuza'a 2.2 67.2 87.6 3.7 84.7 Al Fukhari 12.5 25.0 87.5 0.0 25.0 Rafah Rafah 2.1 7.4 68.8 10.5 86.2 Rafah Camp 6.4 2.1 56.0 8.5 80.9 5.1 10.7 Shokat as Sufi 3.7 18.4 65.8 19.0 99.0 Al Naser 30.8 15.4 76.9 15.4 100.0

Remarks: (*) Representative sample size is small (1) % of households that faced a decrease in drinking water storage capacity after 2014. (2) % of households that faced a decrease in domestic water storage capacity after 2014. (3) % of households supplied by unacceptable drinking water quality (based on people perception not on lab analysis). (4) % of households supplied by unacceptable domestic water quality (based on people perception not on lab analysis). (5) % of households using domestic water as alternative source for drinking and cooking. (6) % of households that don’t clean drinking water storage properly. (7) % of households that don’t clean domestic water storage properly.

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Table 4.2: Sanitation interventions

INT7 INT8 INT9 INT10 (A) (B) Locality % of HHs % of HHs % of HHs % of HHs % of HHs (1) (2) (3) (4) (5) North Beit Lahia 2.2 8.8 21.4 52.2 80.8 Beit Hanoun 1.3 14.8 8.7 47.7 79.2 Jabalia 0.0 6.9 1.5 24.6 37.7 Jabalia Camp 0.0 10.5 0.0 51.2 86.4 Omm Al Nasser 0.0 11.3 58.5 92.5 96.2 Gaza Gaza 1.0 9.3 5.9 25.0 57.8 Ash Shati' Camp 0.0 14.1 1.1 79.4 88.0 Madinat Ezahra (*) 0.0 * 0.0 * 0.0 * 0.0 * 60.0 * Al Mughraqa 1.0 15.6 55.2 57.3 83.3 Juhor ad Dik 4.4 7.8 87.8 71.1 86.7 Middle Area An Nuseirat 0.0 5.1 10.3 20.5 56.4 An Nuseirat Camp 0.0 11.5 19.2 53.9 76.9 Az Zawayda 0.0 5.4 35.1 56.8 78.4 Al Bureij 0.0 9.1 78.8 66.7 66.7 Al Bureij Camp 0.0 11.1 7.4 7.4 51.9 Al Maghazi 0.0 23.1 46.2 53.9 65.4 Al Maghazi Camp 0.0 7.1 21.4 57.1 78.6 Deir al Balah 0.0 7.5 5.0 37.5 50.0 Deir al Balah Camp 0.0 25.0 0.0 25.0 62.5 Al Musaddar (*) 0.0 * 0.0 * 50.0 * 100.0 * 0.0 * Wadi as Salqa 1.5 11.9 74.1 88.2 87.4 Khan Younis Al Qarara 0.0 15.8 55.3 81.6 86.8 Khan Younis 2.7 14.2 33.8 40.5 60.8 Khan Younis Camp 0.7 12.1 40.7 78.6 86.4 Bani Suheila 4.1 10.3 83.5 27.8 57.7 Abasan al Jadida 0.0 0.0 64.3 57.1 14.3 Abasan al Kabira 2.9 14.3 85.7 48.6 42.9 Khuza'a 1.5 4.4 54.7 46.0 62.8 Al Fukhari 0.0 25.0 87.5 62.5 62.5 Rafah Rafah 0.5 13.8 28.6 56.1 72.5 Rafah Camp 0.7 9.9 0.0 59.6 83.7 Shokat as Sufi 0.5 17.4 51.6 84.7 92.6 Al Naser 0.0 7.7 69.2 61.5 46.2

Remarks: (*) Representative sample size is small (1) % of households that don’t have toilets. (2) % of households that don’t have sufficient number of toilets. (3) % of households that need access to a wastewater network. (4) % of households suffering from storm water accumulation/floods surrounding their houses. (5) % of households that don’t have safe means of solid waste disposal.

2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table 4.3: Hygiene interventions

INT11 INT12 INT13 INT14 INT15 INT16 INT17 (A) (B) (A) (B) (A) (B) (A) (B) (A) (B) % of Locality % of % of % of % of % of % of % of % of % of % of % of Wome HHs HHs HHs HHs HHs HHs HHs HHs HHs HHs HHs (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) n (12) (11)

North Beit Lahia 7.7 35.2 22.5 19.8 14.8 28.6 62.1 13.2 24.8 31.3 4.8 26.9 Beit Hanoun 8.1 33.6 10.1 32.9 10.7 32.9 48.3 13.4 37.4 36.2 7.4 26.9 Jabalia 2.3 17.7 4.6 13.9 3.1 13.9 83.1 7.7 24.6 20.0 5.2 3.1 Jabalia Camp 4.3 31.5 14.8 25.9 13.0 30.9 73.5 8.6 29.2 37.7 0.4 6.2 Omm Al Nasser 39.6 45.3 88.7 1.9 56.6 34.0 47.2 28.3 51.2 52.8 15.6 47.2 Gaza Gaza 4.8 17.7 13.2 15.4 8.5 16.7 68.5 9.5 31.4 28.6 4.8 8.8 Ash Shati' Camp 12.0 44.6 21.7 44.6 6.5 54.4 82.6 9.8 26.1 10.9 4.2 29.4 Madinat Ezahra (*) 0.0 * 0.0 * 0.0 * 0.0 * 20 * 0.0 * 40 * 0.0 * 0.0 * 0.0 * 0.0 * 0.0 * Al Mughraqa 14.6 21.9 19.8 26.0 10.4 27.1 68.8 14.6 29.6 20.8 4.7 20.8 Juhor ad Dik 20.0 10.0 24.4 10.0 28.9 8.9 74.4 11.1 40.4 30.0 1.4 22.2 Middle Area An Nuseirat 2.6 2.6 2.6 2.6 0.0 2.6 82.1 2.6 16.7 7.7 0.0 0.0 An Nuseirat Camp 3.9 46.2 30.8 23.1 3.9 42.3 69.2 19.2 0.0 26.9 2.1 30.8 Az Zawayda 8.1 13.5 10.8 18.9 2.7 24.3 78.4 8.1 13.6 21.6 0.0 13.5 Al Bureij 1.5 13.6 1.5 13.6 1.5 13.6 93.9 3.0 27.0 18.2 0.0 3.0 Al Bureij Camp 3.7 14.8 3.7 14.8 3.7 11.1 92.6 3.7 23.1 11.1 0.0 3.7 Al Maghazi 0.0 23.1 7.7 23.1 0.0 23.1 80.8 3.9 26.7 7.7 0.0 15.4 Al Maghazi Camp 10.7 28.6 17.9 25.0 7.1 32.1 85.7 0.0 12.5 10.7 0.0 25.0 Deir al Balah 0.0 5.0 2.5 5.0 0.0 5.0 70.0 10.0 0.0 10.0 7.7 2.5 Deir al Balah Camp 0.0 0.0 12.5 0.0 0.0 25.0 100.0 12.5 100 * 12.5 0.0 0.0 Al Musaddar (*) 0.0 * 0.0 * 0.0 * 0.0 * 0.0 * 0.0 * 100 * 0.0 * 0.0 * 100 * 0.0 * 0.0 * Wadi as Salqa 10.4 29.6 32.6 14.8 11.1 30.4 91.9 12.6 7.1 7.4 2.4 26.7 Khan Younis Al Qarara 36.8 36.8 31.6 44.7 23.7 50.0 86.8 23.7 20.0 15.8 2.6 39.5 Khan Younis 11.5 21.0 14.9 19.6 10.1 21.0 68.2 8.1 31.9 23.0 1.9 17.6 Khan Younis Camp 12.9 54.3 34.3 40.7 7.1 55.0 73.6 16.4 25.4 20.7 8.9 29.3 Bani Suheila 25.8 28.9 29.9 21.7 18.6 28.9 66.0 6.2 25.0 15.5 3.7 3.1 Abasan al Jadida 0.0 0.0 0.0 0.0 0.0 0.0 50.0 21.4 14.3 28.6 0.0 0.0 Abasan al Kabira 14.3 20.0 22.9 14.3 17.1 22.9 54.3 0.0 30.0 25.7 5.5 0.0 Khuza'a 8.8 40.9 11.0 44.5 8.0 46.7 73.0 5.1 20.6 24.1 2.5 13.1 Al Fukhari 0.0 0.0 0.0 0.0 0.0 12.5 25.0 0.0 25.0 0.0 0.0 0.0 Rafah Rafah 7.9 34.9 7.9 34.4 11.1 30.2 87.3 28.6 7.8 5.3 3.5 18.0 Rafah Camp 4.3 34.0 8.5 34.0 7.1 29.8 80.9 27.0 14.7 18.4 0.4 22.0 Shokat as Sufi 6.8 38.4 9.5 35.3 10.5 36.3 88.4 39.0 16.4 7.4 3.1 24.2 Al Naser 7.7 23.1 7.7 15.4 15.4 7.7 92.3 53.9 0.0 * 15.4 3.9 23.1

Remarks: (*) Representative sample size is small (1) % of households that don’t have hand washing facilities. (2) % of households that have hand washing facilities in poor condition. (3) % of households that don’t have shower facilities. (4) % of households that have shower facilities in poor condition. (5) % of households that don’t have kitchen sinks. (6) % of households that have kitchen sinks in poor condition. (7) % of households that don’t wash hands frequently. (8) % of households that don’t shower frequently. (9) % of households with children under 5 years old infected by waterborne diseases. (10) % of households with members above 5 years old infected by waterborne diseases. (11) % of women of reproductive age that don’t have appropriate materials for menstruation. (12) % of households that need hygiene kits.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

CONCLUSION AND RECOMMENDATIONS

Conclusion

General The deteriorated WASH situation in Gaza Strip has been compounded by nine years of blockades during three consecutive destructive wars, posing significant health risks to 1.8 million residents and constraining socioeconomic development. The consequences of the armed conflict in 2014 are still affecting the WASH sector. Fifty days of continuous attacks caused a huge scale of destruction, devastation and displacement. Extensive damage to water and wastewater facilities has been preliminary reported by CMWU/PWA, estimated at around US$ 34 million. The reconstruction process is going very slowly, restricting any humanitarian response or development plan. Problems arising from the slow implementation of the Gaza Reconstruction Mechanism (GRM), prohibition on entry of dual-use materials, inadequate power supplies and lack of government regulation have seriously worsened the WASH situation in Gaza Strip.

Supporting the WASH cluster in defining the most appropriate strategic approach to respond to WASH needs in the Gaza strip, GVC, PHG and UNICEF offered to take the lead and propose an assessment for the current WASH situation at the household level in all Gaza Strip. The objective of this assessment was to generate a comparative analysis that informs identification of critical responses and actions that contribute positively and efficiently to assure minimum WASH standards of all Gaza Strip population and thereby reducing health risks.

The assessment was monitored regularly by the WASH-monitoring group, Technical Working Group, which is a part of the WASH Cluster, in order to advise the assessment process and to guide work progress and data analysis in all stages to ensure the highest quality of output data.

Methodology The framework adopted for this assessment consisted of four main consequent stages implemented in seven months; 1) preparation 2) data collection, 3) data analysis and 4) report writing. The preparation stage included pre-meetings with the WASH-MWG to agree on the final objectives, structure and required outputs, and also included selection of the work team. The data collection stage included a field survey conducted through a prepared questionnaire and supported by other data collection tools; focus groups, observatory reports and secondary data from previous implemented assessments. The data analysis included the elaboration of indicators. The last stage included the writing of this report.

The required minimum sample size that represents households in all Gaza Strip was calculated by using a statistical equation. The result was 2,382 households which represent the total of 303,330 households in Gaza Strip. The minimum sample size was then adjusted to be 3,125 households, considering that 20 per cent of total questionnaires to be implemented would be excluded in the cleaning process due to bias errors and improper household responses. The sample was stratified based on governorates and localities and targeted four groups: internally displaced persons, non-affected, war-affected and wash-affected. Data collection was performed in three phases in which 3,977 questionnaires were implemented, after carrying out a testing phase including 624 questionnaires. Three thousand one hundred and sixty six questionnaires

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

were validated during the data cleaning process while the remaining questionnaires were excluded from the data analysis process.

Forty-seven indicators have been elaborated to explain the findings of the socio-economic and WASH conditions at household level over the whole Gaza Strip, before and after the 2014 armed conflict. The elaborated indicators include seven indicators related to socio-economic, 19 indicators related to water, six indicators related to sanitation, and 15 indicators related to hygiene.

Key findings Three thousand one hundred and sixty-six valid questionnaires out of the total number of filled out questionnaires (3,977) were analysed according to governorates and localities. Sixty-three per cent of interviewees were men and 37 per cent were women, while the age of interviewees ranged from 17-90 years. The survey also considered the variation of land types and life levels (type of shelter, income, education, etc).

Forty-seven indicators were elaborated to indicate the key WASH conditions at household level before and after the 2014 armed conflict; seven indicators related to socio-economic, 19 indicators related to water, six indicators related to sanitation, and 15 indicators related to hygiene.

In general, variation of the investigated situation before and after 2014 was not significant in most indicators. The reason may be traced back to the period that intervened between the 2014 conflict and the survey time, in which people set up mitigation measures of their own in fast response to the crisis. In addition, there was no significant difference between the perception of women and men regarding the WASH needs.

Socio-economic indicators The households participating in the Gaza Strip reflected the following age groups: children aged 0-5 years is 16.2 per cent and aged 6-18, 19-35, 36-60 and > 60 years is 34.0 per cent, 29.3 per cent, 17.3 per cent and 3.2 per cent respectively, while the sex ratio is 105.8. In terms of housing density in the Gaza Strip, the results show that the average household area is 126.12 m2, the average number of rooms per household is 2.87, number of persons per room is 2.20 and the average area per person is 20 m2. The results show that 8.7 per cent of interviewed households in the Gaza Strip are headed by women.

The percentage of interviewed internally displaced persons and war-affected families that had a negative income variation in the Gaza Strip due to the 2014 armed conflict is 45 per cent, while 99 per cent of interviewed internally displaced families in the Gaza Strip are planning to go back to their original houses.

With regard to the monthly WASH expenses, the results show that the interviewed households are spending 33.8 NIS/C/M (8.9 USD/C/M) on WASH items. The highest portion is spent on cleaning materials with a rate of 10.6 NIS/C/M (2.8 USD/C/M) and the lowest portion is spent on solid waste disposal with rate of 1.6 NIS/C/M (0.4 USD/C/M), while the other WASH expenses are in between; 4.9, 4.2, 7.3 and 5.2 NIS/C/M (1.3, 1.1, 1.9 and 1.4 USD/C/M) for drinking water, domestic water, hygiene materials and feminine hygiene items respectively.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Water indicators The main source of drinking water for interviewed households is desalinated water supplied mainly from water trucks (85 per cent) and public filling points (11 per cent). 84 per cent of interviewed households are supplied by domestic water from municipal networks and 16 per cent from private wells. Regarding water quality, results show that 94 per cent of interviewed households in the Gaza Strip are satisfied about drinking water quality. In regard to domestic water quality, the situation is bad across all governorates/localities. Only 43 per cent of interviewed households are satisfied about domestic water quality. The households complained mainly of salinity of supplied domestic water and they didn’t recognize the presence of nitrate which has no odour or taste.

The results show that around seven per cent of interviewed households don’t know of a safe water source for drinking purposes. Around 18 per cent of interviewed households are using domestic water as an alternative source for drinking and cooking purposes, while around six per cent of interviewed households are using drinking water for domestic purposes mainly because of the salinity of supplied domestic water.

In terms of water storage, results show that around eight per cent of interviewed households in the Gaza Strip reported a decrease in drinking water storage capacity after 2014, while 20 per cent of interviewed households had a decrease in domestic water storage facilities. Each family member’s proportion of water storage capacity corellates with land type. For drinking water, the results show that the average storage capacity of interviewed households in the Gaza Strip after 2014 is 57, 50 and 38 litre/capita in urban, rural and camp areas respectively. The results for domestic water are 283, 254 and 237 litre/capita respectively.

On the other hand, most interviewed women and men were aware of the importance of cleaning drinking water storage vessels (94 per cent of interviewed women and 92 per cent of interviewed men). People’s perceptions about the importance of cleaning domestic water storage are alarming, as 76 per cent of interviewed women and 79 per cent of interviewed men don’t recognize the importance.

In regards to the handling of drinking water, most interviewed households prefer not to involve children and women in the process; only 11 per cent of interviewed households in Gaza Strip engage children and 2 per cent engage women in the collection of drinking water.

The results show that 57 per cent of interviewed households in the Gaza Strip don’t pay for domestic water, of which 87 per cent don’t pay because of their economic situation or lack of social responsibility while the remaining households don’t pay because they are not connected to a municipal network or well (they get water from private/illegal wells or public filling points).

Of the water needs priorities of interviewed people, the highest priority is to have additional storage for both drinking water and domestic water, and secondly to have better water quality through the rehabilitation of water pipes and building of more water desalination plants.

In regard to coping mechanisms used to mitigate the water problem in the Gaza Strip, interviewed households mainly applied the approach of water saving through reducing water consumption inside the household and also increasing available storage capacity.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Sanitation indicators Regarding the availability of toilets inside households, the results show that only one per cent of interviewed households don’t have toilets, while 11 per cent of interviewed households don’t have a sufficient number of toilets.

In term of wastewater networks coverage, the results show that 30 per cent of interviewed households in the Gaza Strip are not connected to wastewater networks and they are using insulated cesspits and small holes that pollute the groundwater and the environment. On the other hand, the results show that 51 per cent of interviewed households have no access to a proper drainage system and are suffering from the accumulation of polluted storm water surrounding their houses during intense rainfalls.

The worst finding on sanitation is related to solid waste management, where around 72 per cent of interviewed households don’t have access to a safe means of solid waste disposal.

Regarding sanitation needs priorities of interviewed people, the highest priority for interviewed people is to extend/install wastewater networks (48 per cent), while 24 per cent of interviewed households prioritized the need to increase toilet units.

Hygiene indicators The main source of water heating that interviewed households use in the Gaza Strip is electricity (62 per cent), while other households are using mainly a gas heating system or a solar panel heating system.

Regarding the availability of sanitary facilities, the results show that around nine per cent of interviewed households in the Gaza Strip don’t have any hand washing sink, and 17 per cent don’t have a shower, while 11 per cent don’t have a kitchen sink. Regarding the condition of available sanitary facilities, the results show that around 28 per cent of interviewed households in Gaza Strip have a hand washing sink in poor condition, and 24 per cent have a shower in poor condition, while 27 per cent have a kitchen sink in poor condition.

In regard to hygiene practices, the situation is bad in the Gaza Strip (considering the perception of interviewees) in terms of hand washing. 72 per cent of interviewed women and 75 per cent of interviewed men don’t wash their hands properly. In terms of showering practices, the results show that 12 per cent of interviewed women and 15 per cent of interviewed men in the Gaza Strip don’t shower sufficiently. Moreover, 3.7 per cent of women of reproductive age don’t have appropriate materials for menstruation.

Regarding sanitation related diseases, the percentage of interviewed households infected by waterborne diseases is significant, 25 per cent of households with children under five years and 22 per cent of households with members above five years have been infected by waterborne diseases. Also 49.3 per cent of interviewed households in the Gaza Strip noticed the appearance of other new diseases after the 2014 conflict.

Finally, the highest need priority of interviewed people regarding hygiene is to provide free hygiene kits (58 per cent) and to obtain cheap cleaning materials (25 per cent).

Potential interventions All findings arising from the present assessment show the need for different kinds of interventions in the whole Gaza Strip for all sectors; water, sanitation and hygiene. In general,

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

the main problems related to WASH are similar in the whole Gaza Strip, but more critical in some localities.

Seventeen interventions have been proposed based on WASH needs found by the assessment. The main interventions related to water are to enhance storage capacity and improve quality of both drinking and domestic water and to promote public awareness about the importance of cleaning water storage.

For sanitation problems, proposed interventions are urgent in order to protect the surrounding environment and promote hygiene conditions. The proposed sanitation interventions include installation of new toilets for vulnerable households, installation of wastewater household connections, installation/upgrade of storm water drainage systems and improvement of solid waste disposal means.

Regarding hygiene interventions, all proposed interventions are very important as they mitigate or solve key public health issues. The proposed hygiene interventions include installation and maintenance of sanitation facilities, hand washing sinks, showers and kitchen sinks. The interventions also include awareness promotion campaigns on proper hand washing and showering practices, enhancement of menstruation management for vulnerable women and distribution of hygiene kits. The interventions entail the identification of hot spots of waterborne disease.

Recommendations

Top priorities of interventions 1. All the proposed interventions are considered crucial in order to recover the WASH situation in the Gaza Strip. However, priorities should be elaborated based on findings of the assessment that relate to the main needs of the population. The following interventions are considered priorities, as the need percentage is high in the whole Gaza Strip and/or greatly affecting public health:

- INT4: Improving domestic water quality (especially in Gaza, Middle Area, Khan Younis and Rafah). - INT5: Public awareness campaign about the quality of safe drinking water - INT6: Public awareness about the importance of cleaning domestic water storage. - INT7 (A): Installation of toilets for vulnerable households that don’t have a toilet. - INT8: Installation of household wastewater connections (especially in Khan Younis and Rafah governorates). - INT9: Installation of storm water drainage systems. - INT10: Enhancing solid waste disposal management. - INT14 (A): Public awareness about proper hand washing practices. - INT15: Identification of hot spot areas of waterborne disease.

2. Based on findings of the assessment concerning the main needs of the population, the following localities are considered a priority because they are the most affected localities in term of WASH conditions at household level: - North governorate: Omm Al Nasser.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

- Gaza governorate: Ash Shati’ Camp and Juhor ad Dik. - Middle Area governorate: An Nuseirat Camp and Wadi as Salqa. - Khan Younis governorate: Al Qarara, Khan Younis Camp and Khuza’a. - Rafah governorate: Shokat as Sufi and Al Naser.

Further assessments 1. The localities of Madinat Ezahra and Al Musaddar were represented by a small sample size because the number of households there is small compared to other localities in Gaza Strip. Therefore, for some interventions, further assessments may be needed, especially for hygiene interventions which should be deeper developed after a comprehensive investigation of people’s practices and attitudes. 2. Further data cross-checking accompanied by on-the-spot assessments are needed considering that some interventions could have been carried out since completion of the current assessment. 3. Further assessments should be carried out to establish possible correlations and linkages between household WASH conditions and the education level of household members. 4. The regular supply of domestic water in the Gaza Strip is challenging as it is highly affected by availability of electrical power. Further assessments should be conducted to gain a better understanding of water delivery conditions considering relevant scenarios, hours of power availability, applied zoning systems, production rate and number of connected households.

Suggested approach for interventions 1. Future interventions should be incorporated into the planning strategy of PWA, CWMU and the WASH Cluster. 2. Coordination within the WASH Cluster and key WASH stakeholders should be ensured before any intervention is undertaken in order to avoid duplication. 3. The proposed interventions should be integrated with other related interventions planned and/or undertaken by other agencies. 4. Interventions should be coordinated with CMWU and/or municipalities to ensure feasibility to carry out proposed activities. For example, installation of wastewater networks could be necessary in some localities but capacity of the treatment plant might be insufficient to receive additional quantities of wastewater. 5. Solid waste interventions including the provision of bins, trash containers and machineries need to be cross-checked with Solid Waste Management Councils. 6. Wastewater interventions must be accompanied by more compressive interventions, such as wetland treatment, condominium septic tanks, improvement of main wastewater treatment plant, re-use of water and recharge of the aquifer. Some repairs are temporary solutions and can create a misuse of the system if not considered part of a more compressive plan of intervention. 7. One of the main obstacles to improving water and sanitation services in the Gaza Strip is the deteriorated electricity situation. This should be considered during the design and planning phase of interventions in order to implement mitigation measures with an aim of furnishing affordable and reliable services. 8. Public awareness and hygiene promotion campaigns are a top priority and should always accompany any related hard (physical) intervention. 9. Information activities such as media campaigns targeting rural communities should accompany any proposed intervention.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Advocacy The proposed interventions will be more effective if they are accompanied with advocacy activities at both local and international levels. The advocacy interventions should be employed at household level to enable the people and local NGOs to demand the official line parties of the WASH sector in Gaza Strip to provide sufficient and reliable services. This can be achieved by improving the technical and managerial capacities of the WASH sector in Gaza Strip, paralleled with a real and worthy intervention from the concerned international community, donors and INGOs. For this purpose, there is a need to push the donors and third member states to invest more and to give their pledged donations to the local community to rehabilitate and develop the WASH sector in Gaza Strip. The major stakeholders should work toward the recovery of the Gaza Strip as well, ensuring the cost-effectiveness of their financial support and upholding their obligations by urging Israel to lift the blockade, facilitate the entry of construction materials and also to take WASH materials off the dual use list. It is extremely important to advocate to the donor communities a financial plan that is assured to overcome any interruptions due to external interference and to provide timing and continuity in the development process of a regular supply in Gaza Strip. Any intervention is hampered by the deteriorated environmental situation of water sources in Gaza should become a fundamental advocacy message.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

REFERENCES

Berenson, M., Levine, D., and Szabat, K., Basic Business Statistics: Concepts and Applications, 13th Ed., Pearson, UK, 2015.

Norwegian Refugee Council, ‘‘Desalinated Water Chain in the Gaza Strip ‘From Source to Mouth'”, 2015.

Office for the Coordination of Humanitarian Affairs, ‘Gaza Crises Appeal’, 2014.

Office for the Coordination of Humanitaritan Affairs, ‘THE GAZA STRIP: The Humanitarian Impact of the Blockade’, 2015.

Palestinian Central Bureau of Statistics, ‘Demographic Indicators’ (http://www.pcbs.gov.ps/Portals/_Rainbow/Documents/e.htm), 2015.

Palestinian Central Bureau of Statistics, (http://www.pcbs.gov.ps/site/512/default.aspx?tabID=512&lang=en&ItemID=1441&mid=3171&w version=Staging), 2015.

Palestinian Central Bureau of Statistics, ‘Population Projections’, (http://www.pcbs.gov.ps/site/lang__en/803/default.aspx), 2015.

Palestinian Central Bureau of Statistics, (http://www.pcbs.gov.ps/site/512/default.aspx?tabID=512&lang=en&ItemID=1165&mid=3172&w version=Staging), 2014.

Palestinian Hydrology Group and United Nations Children's Emergency Fund, ‘Water, Sanitation and Hygiene Household Survey, Gaza’, 2010.

Palestinian Water Authority, ‘Baseline Study on Water Quality & Public Health in the Gaza Strip’, 2015.

Palestinian Water Authority, ‘Gaza Strip: Water Crisis Deepens: Without Sustainable Solutions, Future at Stake’, 2015.

Palestinian Water Authority, ‘Gaza Water Resources Status Report 2013/2014’, 2014.

United Nations Special Coordinator Office, ‘UNSCO Socio-Economic Report: Overview of the Palestinian Economy in Q3/2015’, 2015.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

ANNEX A : WASH-MWG ToR

Introduction In the Gaza Strip, the longstanding blockade has created an unsustainable water and sanitation situation for the 1,819,980 people (896,542 females and 923,438 males) who are living there. As a result of the last Israeli military operation in July and August 2014, water and wastewater services were further hampered, having direct consequences on serious deteriorating living and hygiene conditions in these households.

Moreover, the electricity system was severely damaged when the only power plant in Gaza was hit during the war. Electrical generators supplying water and wastewater facilities are heavily used and overloaded by long hours of operations. The supplied water is rarely sufficient and most collected raw sewage is discharged into the environment because of the difficulty to booster it.

In light of this critical situation, the WASH cluster essentially desired a clear picture of the whole situation. Therefore, GVC and PHG proposed to carry out an assessment in order to identify the WASH conditions at the household level, mapping and prioritizing areas of the intervention as well as linking the consequences of infrastructure damage (and later rehabilitation and reconstruction) and household conditions.

The WASH-MWG has been established in order to harmonize and coordinate the survey proposed by GVC and PHG and supported by UNICEF using competences and experiences of PWA, CMWU and all WASH agencies focal points that work in the Gaza Strip. The WASH-MWG is chaired by PWA/CMWU, under the overall collaboration of UNICEF, Wash Cluster, GVC and PHG and along with the Water Quality Working Group (WQWG) and other working groups.

Objectives - To work towards a coordinated and integrated approach in the all WASH assessments and monitoring processes at household level. - To work alongside the appropriate Palestinian Authorities in order to plan and coordinate all activities. - To ensure links and communication between the water sector and other relevant sectors in particular shelter/NFI and health cluster. - To work towards and ensure prioritization, evidence based actions, and gap filling. - To ensure gender mainstreaming in all WASH assessment process. - To set up a common approach in monitoring WASH household conditions to be used by all the actors involved in the WASH and Public Health sectors.

Structure - WASH-MWG is a Technical Working Group and part of the WASH Cluster, chaired by PWA/CMWU. - WASH Cluster Coordinator will act as facilitator of the WASH-MWG for WASH agencies working in the Gaza Strip and with the support of GVC and PHG. - Members of the WASH-MWG: ISC, Oxfam GB, GVC, ACF and IRPAL (as they are the WASH Focal Points of the different Governorates in Gaza Strip), UNICEF, UNRWA, NRC along with PWA and CMWU and with the support of ICRC.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

- WASH-MWG has no time limit, and its confirmation and ToRs will be revised among the members of the WASH cluster.

Tasks and responsibilities - Create an open and accessible database of information gathered by different surveys, based on format and methodologies set up during the assessment carried out by GVC and PHG and supported by UNICEF. - Advise the process of the WASH assessment at household level, by ensuring that relevant standards, procedures and approaches are formulated and agreed upon by all members of the WASH-MWG. - Collect and address information on hazards and risks at each location, identifying the gaps and priorities of interventions. - Provide a link between the infrastructure damage assessment done by CMWU/PWA and the WASH situation at household level. - Promote adopted and verified standards to be used in future similar intervention as part of indication by the Cluster Coordinator. - Set up tools to implement future studies/assessments on WASH conditions household level, through an accessible database of competences and skills from various agencies. - Ensure effective and coherent WASH assessment and analysis, accessible to all relevant partners in order to prevent any overlapping with other WASH actors’ activities/assessments. - Promote information sharing activities both as seminars or documents about results of the assessments and to collect feedback and comments.

Principles of Partnership - Equality: Equality requires mutual respect between members of the partnership irrespective of size and power. The WASH-MWG members respect each other’s mandates, obligations and independence and recognize each other’s constraints and commitments. Mutual respect however will not preclude organizations from engaging in constructive dissent. - Transparency: Transparency is achieved through dialogue between all members on an equal footing, with an emphasis on early consultations and early sharing of information. Communication and transparency, including financial transparency, increase the level of trust among organizations. - Result-oriented approach: Effective humanitarian action must be reality-based and action- oriented. This requires result-oriented coordination based on effective capabilities and concrete operational capacities. - Responsibility: WASH-MWG members have an ethical obligation to each other to accomplish their tasks responsibly, with integrity and in a relevant and appropriate way. They will commit to activities only when they have the means, competencies, skills and capacity to deliver on their commitments. - Complementarity: The diversity of the WASH-MWG members is an asset if they build on their comparative advantages and complement each other’s contributions.

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

ANNEX B : LIST OF MEETINGS AND WORKSHOPS

Table B.1: List of conducted meetings and workshops

# Date Partner Main agenda WASH- - To present and discuss the WASH assessment proposal and the ToR of 1 23/03/2015 MWG the WASH-MWG - To present and discuss the final draft of the WASH assessment proposal WASH- 2 05/08/2015 - To review and finalize the methodology of the assessment, focusing on MWG the sample size - To update the partners about the assessment progress WASH- st 3 09/09/2015 - To present the findings of the 1 phase MWG - To discuss the next steps - To introduce the assessment objectives 4 14/09/2015 MoHPW - To ask to get access to the database of the war-affected households and internally displaced persons - To introduce the assessment objectives 5 20/09/2015 OCHA - To ask to get access to the database of the internally displaced families - To introduce the assessment objectives 6 28/09/2015 MoSA - To ask to get access to the database of the war-affected households and internally displaced persons - To update NRC about the assessment progress 7 29/09/2015 NRC - To identify the internally displaced persons and war affected areas - To ask the support of OCHA to reach the required number of internally 8 30/09/2015 OCHA displaced persons in all governorates of Gaza Strip - To update CMWU about the assessment progress - To identify the war-affected areas in term of WASH 9 30/09/2015 CMWU - To get update and recommendations about the CMWU assessment of customers satisfaction 10 04/10/2015 MoHPW - To get the data of the war-affected households - To update PWA about the assessment progress 11 04/10/2015 PWA - To consult PWA about the recommended sampling approach - To update CMWU about the assessment progress - To ask CMWU to support and facilitate the field work in cooperation with 12 13/10/2015 CMWU the local municipalities - To identify the WASH-affected areas - To update UNRWA about the assessment progress 13 19/10/2015 UNRWA - To ask UNRWA about the recommendations needed during the implementation of the survey in the Camps - To update CMWU about the assessment progress 14 20/10/2015 CMWU - To discuss about the WASH-affected areas - To update NRC about the assessment progress 15 20/10/2015 NRC - To ask NRC about the findings of the water chain assessment - To update ACF about the assessment progress 16 27/10/2015 ACF - To identify the WASH and war affected areas in Khan Younis governorate - To update IRPAL about the assessment progress 17 28/10/2015 IRPAL - To identify the WASH and war affected areas in Rafah governorate - To update Oxfam about the assessment progress 18 28/10/2015 Oxfam - To identify the WASH and war affected areas in Gaza governorate - To update ISC about the assessment progress 19 28/10/2015 ISC - To identify the WASH and war affected areas in the North governorate - To present the main problems found in the Camps based on the 20 04/11/2015 UNRWA assessment findings - To inquiry about UNRWA and other agencies interventions WASH- - To discuss the progress of the assessment and get feedback and 21 30/11/2015 MWG recommendations WASH- - To discuss the findings of the assessment and get feedback and 22 02/03/2016 MWG recommendations

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ANNEX C : QUESTIONNAIRE TEMPLATE

GENERAL INFORMATION Date of survey (dd/mm/y) Supervisor name Time of starting interview HH address Time of finishing interview Tel. or mobile Questionnaire no. Governorate GPS coordinates Locality Area per municipality Interviewer Name Type Rural Camp Urban

SECTION (1) households AND SOCIO-ECONOMIC INFORMATION Name of interviewee Sex of the interviewee Female Male Age

Do you have any kind of physical disability (OBSERVATORY QUESTION BY THE yes No SURVEYOR)? Are you the head of the HH? yes No

Marital status of the HH head Single Married Divorced Widow

Occupation of the HH head of family Information about the Interviewee after 2014 My home was affected by 2014 Attack but I still leave in my

place Please indicate which one of the following you are: IDP from the last 2014 Attack My home was not affected by 2014 Attack If your home was affected or you are an IDP, was your home repaired/reconstructed? If yes please indicate when and Yes No how: If the answer is yes, please indicate when 1 month later 2-6 months 6-10 months Currently INGO, Local Palestinian My house was repaired/reconstructed by: UN Agency Private money NGO Authority If you are an IDP away from original place, when do you Unknown Less than 1yr 1-2yrs 3yrs+ expect to go back? Never If you are an IDP and moved to another place, please indicate your original housing governorate If you are an IDP and moved to another place, please indicate your original housing locality If you are an IDP and moved to another place, please indicate your original housing area per municipality If you are not affected, do you host other family/ies? yes No

If yes, how many families are you hosting without money? Sex 0-5 6-18 19-35 36-60 60+

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Female

Male

Information about HH Members/Shelter Total No. of HH members: Age and Sex of HH Family Members Sex / Age 0-5 6-18 19-35 36-60 60+ Female Male Income Average Age of Male family members and income average Income average 15-18 19-35 36-60 60+ less than 1000 Male 1000-2000 2000-4000 4000+ Age of female family members and income average less than 1000 1000-2000 Female 2000-4000 4000+ Estimate total income per HH How much money (NIS) do you allocate from your income for the following materials per month before 2014 attack? None 0-50 50-100 100-200 201-300 301-500 >500 Drinking Water Non drinking water Solid waste disposal Hygiene materials Female Hygiene items Cleaning materials Food Electricity Telecommunications Transportation How much money (NIS) do you allocate from your income for the following materials per month after 2014 attack? None 0-50 50-100 100-200 201-300 301-500 >500 Drinking Water Non drinking water

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Solid waste disposal Hygiene materials Female Hygiene items Cleaning materials Food Electricity Telecommunications Transportation Source of Income Governmental Private Social affairs INGOs Donations UNRWA If you are an IDP or affected, was your income changed negatively? Yes No Slightly (I earn almost the same) Medium (I earn a bit more than the half I was earning) If answer is yes, Please Specify Severely (I earn less than the half I was earning before) Completely (I am not earring anything right now) How regular is your income? Not regular Daily Weekly Monthly

households with Special Needs If yes please specify # of members with physical

disability Are there any of the family members with special needs (disabilities) If yes please specify # of members with mental

disability Number of family members 0-5 6-18 19-35 36-60 60+ with disabilities Female

Male Type of Ownership Condition of Shelter Owned Rented Hosted

Apartment in a Tower Separate House Type of Shelter Asbestos/ Zinco Caravan Tent Wood No. of rooms without kitchen and toilets/bathrooms Total area (m2) Level of Education Type of Education Sex Kindergarten School University Post Education No. and level of education for males No. and level of education for females Are there any of the family male members over 5 years and did not had any education Yes No If the answer is yes, please specify the no.

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Are there any of the family female members over 5 years and did not had any education Yes No If the answer is yes, please specify the no.

If there is a decline in attendance of the school before and after the 2014 attack? Yes No Too many children There are not toilets for girls and boys If the answer is yes, please specify the reasons? Classrooms are not clean No drinking water available Others: There are not clean toilets (open)

SECTION (2) households AND WATER households and Water System Infrastructure Please indicate your water network system condition before 2014 Please indicate your water network system condition after 2014 Not existing Not functioning Not existing Not functioning Poorly function Functioning Poorly function Functioning Water coming from the Water coming from the pipes truck What is in your opinion source of "drinking water"? Desalinated water Bottled water Wells Water Sources Sources of drinking Water pre & post-2014 conflict Pre Post Sources of domestic Water pre &post-2014 conflict Pre Post Municipal network (Mekarot) Municipal network (Mekarot) Municipal network (Wells) Municipal network (Wells) Municipal network (Mekorot blended) Municipal network (Mekorot blended) Private well Private well Tanker delivery (vendors) Tanker delivery (vendors) Desalination Unit (home filters) Desalination Unit (home filters) Public filling points Public filling points Bottling Bottling Rain Water Collecting and Uses Do you harvest Raining water? Yes No

Drinking use Domestic use If yes, for what use/s? Farming Animal use Water Uses The different uses of drinking water, please select from The different uses of domestic water, please select Priority Selection Priority Selection the following from the following Drinking Drinking Bathing Bathing Cleaning Cleaning Cooking Cooking

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Washing the dishes Washing the dishes Showering the children Showering the children Ablution Ablution Others (Specify) Others (Specify) Water Accessibility Drinking Water Accessibility Accessibility level Before 2014 After 2014 Is there a change in level of accessibility Yes No If there is a change in the accessibility, what are the Easily Accessible It is more expensive reasons? Medium Accessible It is cheaper It is closer Hardly Accessible It is further Others (Specify) Are there children engaged in a process of collecting water? Yes No less than5 5-10 10-15 15+ If yes, how far does it take to reach the water source? ( please specify in minutes)

Are there women engaged in a process of collecting water? Yes No less than5 5-10 10-15 15+ If yes, how far does it take to reach the water source? ( please specify in minutes)

Domestic Water Accessibility Accessibility level Before 2014 After 2014 Is there a change in level of accessibility Yes No If there is a change in the accessibility, what are the Easily Accessible It is more expensive reasons? Medium Accessible It is cheaper It is closer Hardly Accessible It is further Others (Specify) Are there children engaged in a process of collecting water? Yes No less than5 5-10 10-15 15+ If yes, how far does it take to reach the water source? ( please specify in minutes)

Are there women engaged in a process of collecting water? Yes No less than5 5-10 10-15 15+ If yes, how far does it take to reach the water source? ( please specify in minutes)

Water Frequency Does your water come through the municipality? Yes No

If the answer is yes, How frequently does your household Drinking water Domestic water receive water from the municipality? Before 2014 After 2014 Before 2014 After 2014 Not Connected daily: Less than 4 hrs/ day 5 to 12 hrs/day more than 12 hrs/day Once a week I do not know 100

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Drinking Water Do you pay for your drinking water before Yes Do you pay for your drinking water after Yes 2014? No 2014? No Daily Daily Weekly Weekly If yes, how frequent before 2014? If yes, how frequent after 2014? Every two weeks Every two weeks Every one month Every one month Less than 100 NIS Less than 100 NIS How much do you pay for drinking water 100-200 How much do you pay for drinking water 100-200 per month before 2014? 200-300 per month after 2014? 200-300 300+ 200-300 Domestic water Do you pay for your non drinking water Yes Do you pay for your non drinking water Yes before 2014? No after 2014? No Daily Daily Weekly Weekly If yes, how frequent before 2014? If yes, how frequent after 2014? Every two weeks Every two weeks Every one month Every one month Less than 100 NIS Less than 100 NIS How much do you pay for domestic water 100-200 How much do you pay for domestic 100-200 per month before 2014? 200-300 water per month after 2014? 200-300 300+ 200-300 Water Storage Methods and Capacities Drinking Water Storage and Capacities Do you store your drinking water before Yes Do you store your drinking water after Yes 2014? No 2014? No Jerry Cans Jerry Cans Plastic Tanks Plastic Tanks If yes, please specify the methodology If yes, please specify the methodology Metal Tanks Metal Tanks before 2014 after 2014 Concrete cistern Concrete cistern Bottles Bottles Is the drinking water shared with other Yes Is the drinking water shared with other Yes households before 2014? No households after 2014? No Capacity of the Water Storage (drinking water) liters 1 – 25 26-50 51-100 101-200 201 - 400 401-500 501-1000 1000+ before 2014 Capacity of the Water Storage (drinking water) liters after 1 – 25 26-50 51-100 101-200 201 - 400 401-500 501-1000 1000+ 2014 Domestic Water Storage and Capacities

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Do you store your domestic water before yes Do you store your domestic water after yes 2014? No 2014? No Jerry Cans Jerry Cans If yes, please specify the methodology Plastic Tanks If yes, please specify the methodology Plastic Tanks before 2014 Metal Tanks after 2014 Metal Tanks Concrete cistern Concrete cistern Is the drinking water shared with other yes Is the drinking water shared with other yes households before 2014? No households after 2014? No 1 – 200 201 - 400 401-600 601-800 801-1000 1001-1500 1501-2000 Capacity of the Water Storage (drinking water) liters before 2014

1 – 200 201 - 400 401-600 601-800 801-1000 1001-1500 1501-2000 Capacity of the Water Storage (drinking water) liters after 2014

Water Storage Condition Drinking Water Storage Condition Do you clean /wash your drinking water Yes 1 If yes, how often monthly? tank/s? No 2 Is there a tight cover for your drinking Yes 3 water tanks No 4 Domestic Water Storage Condition Do you clean /wash your drinking water Yes 0 If yes, how often monthly? tank/s? No 1 Is there a tight cover for your drinking Yes 2 water tanks No 3 Water Quality Drinking Water Quality What do you think of the quality of the Acceptable If not acceptable please indicate the Salinity Odor drinking water before 2014? Not acceptable reason before 2014 Color Taste

Municipal network (Mekarot) Municipal network (Wells) Where do you think the safest drinking water comes from Municipal network (Mekorot blended) Private well before 2014 Tanker delivery (vendors) Desalination Unit (home filters) Public filling points Bottling What do you think of the quality of the Acceptable If not acceptable please indicate the Salinity Odor drinking water after 2014? Not acceptable reason after 2014 Color Taste

Municipal network (Mekarot) Municipal network (Wells) Where do you think the safest drinking water comes from Municipal network (Mekorot blended) Private well after 2014 Tanker delivery (vendors) Desalination Unit (home filters) Public filling points Bottling How do you prioritize the following needs of drinking water Rehabilitation of water pipelines Extra water tanks

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at your level from 1 to 6, 1 is the most important before Cleaning of water source Low cost water 2014 Distribute Home desalination filters Public Awareness on Water Are there any other important needs not mentioned above, please

specify: Rehabilitation of water pipelines Extra water tanks Cleaning of water source Low cost water How do you prioritize the following needs of drinking water at your level from 1 to 6, 1 is the most important after 2014 Distribute Home desalination filters Public Awareness on Water Are there any other important needs not mentioned above, please

specify: Domestic Water Quality What do you think of the quality of the Acceptable If not acceptable please indicate the Salinity Odor domestic water before 2014? Not acceptable reason before 2014 Color Taste

Municipal network (Mekarot) Municipal network (Wells) Where do you think the safest domestic water comes from Municipal network (Mekorot blended) Private well before 2014 Tanker delivery (vendors) Desalination Unit (home filters) Public filling points What do you think of the quality of the Acceptable If not acceptable please indicate the Salinity Odor domestic water after 2014? Not acceptable reason after 2014 Color Taste

Municipal network (Mekarot) Municipal network (Wells) Where do you think the safest domestic water comes from Municipal network (Mekorot blended) Private well after 2014 Tanker delivery (vendors) Desalination Unit (home filters) Public filling points Rehabilitation of water pipelines Extra water tanks How do you prioritize the following needs of domestic Cleaning of water source Low cost water water at your level from 1 to 6, 1 is the most important Distribute Home desalination filters Public Awareness on Water before 2014 Are there any other important needs not mentioned above, please

specify: Rehabilitation of water pipelines Extra water tanks How do you prioritize the following needs of domestic Cleaning of water source Low cost water water at your level from 1 to 6, 1 is the most important Distribute Home desalination filters Public Awareness on Water after 2014 Are there any other important needs not mentioned above, please

specify: What are coping mechanisms and mitigation measures to alleviate the problems related to water in your House? What do you think you can do on personal level and community level to contribute to the problems related to Water?

SECTION (3) households AND SANITATION households and Sanitation Infrastructure Please indicate your sanitation network system condition before 2014 Please indicate your sanitation network system condition after 2014 Not existing Not functioning Not existing Not functioning

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Poorly function Functioning Poorly function Functioning Toilets and Sanitation System Yes If yes, How many toilets 1 2 3 4 Do you have toilets before 2014? do you have before No 2014? What Type of toilet do you Sit down toilet with water flush Squat toilet with water flush Pit latrines others have before 2014? Is the toilet pre-2014 shared with other families before Yes If the answer is yes, please specify the sex and age before 2014 2014? No Sex / Age 0-5 6-18 19-35 36-60 60+ Female Male If it is shared with other families, are there toilets for males Yes If it is shared with other families, are the toilets divided yes and for females before 2014? No per each family before 2014? No yes If yes, How many toilets 1 2 3 4 Do you have toilets after 2014? No do you have after 2014? What Type of toilet do you Sit down toilet with water flush Squat toilet with water flush Pit latrines Others have after 2014? Is the toilet pre-2014 shared with other families after Yes If the answer is yes, please specify the sex and age after 2014 2014? No Sex / Age 0-5 6-18 19-35 36-60 60+ Female Male If it is shared with other families, are there toilets for males Yes If it is shared with other families, are the toilets divided yes and for females after 2014? No per each family after 2014? No Condition of the walls, floor cleanliness? OSERVATION BY THE SURVEYOR REQUREID Poor Medium Clean Is the toilet connected to a wastewater system? if yes specify Pipelines Cesspits I get rid of the sewage water from my private money for a private

If cesspits or septic tank, please select one of the following? company I call the local municipality to vacuum the sewage water Before 2014 After 2014

Weekly If you call the municipality to vacuum the sewage water, please specify the time before & Every two weeks after 2014? Every one month Every two months more than two months Yes Are there proper drainages surrounding the HH? How do you manage your household garbage before 2014? No I burn it I bury it

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more I leave it in an empty field close to my house, if this one: what is the distance less than 10 10 - 30 m 30-50 m 50-75m 75-100m >100m than200 from your house to the field?

I leave it in a container for the municipality to collect it before 2014, if this two weeks 3 times a week once a week once every two weeks others one: how often do they collect it? Others, please specify I burn it How do you manage your household garbage after 2014? I bury it more I leave it in an empty field close to my house, if this one: what is the distance less than 10 10 - 30 m 30-50 m 50-75m 75-100m >100m than200 from your house to the field?

I leave it in a container for the municipality to collect it before2014, if this two weeks 3 times a week once a week once every two weeks others one: how often do they collect it? Others, please specify With some garbage Full of SURVEYOR OBSERVATION: how clean are the home surroundings? Clean around garbage Has there been a flood of sewage network in your area Yes If yes, when did it Summer Winter near your home for the last 12 months, No happen? Winter and Summer

What are the priority needs in terms of sanitation? From 1 (the most important) till 6 the less What are the priority needs in terms of sanitation? From 1 (the most important) till before 2014 6 the less after 2014

Increase the quantity of toilets Increase the quantity of toilets Increase the quality of toilets Increase the quality of toilets Improve sewage system Improve sewage system Awareness raising of the risk of bad sewage disposal Awareness raising of the risk of bad Sewage disposal Building wastewater treatment plants Building wastewater treatment plants Activate the rule of the local municipalities in check-up and taking Activate the rule of the local municipalities in check-up and taking actions actions Are there any other important needs not mentioned above, please Are there any other important needs not mentioned above, please specify: specify: What are coping mechanisms and mitigation measures to alleviate the problems related to Sanitation in your House? What do you think you can do on personal level and community level to contribute to the problems related to Sanitation?

SECTION (4) households AND HYGIENE What is the main source for heating water for bathing before 2014? What is the main source for heating water for bathing after 2014? Solar Heating Solar Heating Electrical heating Electrical heating Gas heating Gas heating Wood Wood

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Other Other Hygiene Facilities Facility (Before 2014) non existing poor medium good Facility (After 2014) non existing poor medium good Hand sinks Hand sinks shower shower Washing machines Washing machines Washing dishes sink Washing dishes sink If any of them does not exist nowadays, what do you do? I do it outside the house I go to my family members house I pay someone to do it I do not do it as often as before Others: (open question) Cleaning Materials and Practices ( OBSERVATIONAL BY THE SURVEYOR) Before 2014 Yes No After 2014 Yes No Are toilets cleaning items available? Are there communal solid waste bins? Are there communal solid waste bins? Does household have access to shower? Does household have access to shower? Is shower shared with other households? Is shower shared with other households? Is shower shared with other households? Do the women and girls in your household have Do the women and girls in your household have

appropriate materials for menstruation? appropriate materials for menstruation? Are the women and girls in your household able to keep Are the women and girls in your household able to

clean during menstruation? keep clean during menstruation? Is condition of shower sanitary good? Is condition of shower sanitary good? Yes Expensive Do you have soap at home? (Observation!!) If not, what is the reason? No Others Please answer the following behavior questions: How many times family members have a shower in Summer? How many times family members have a shower in winter? Every day Every day 4 times or more per week 4 times or more per week At Least 1 time per week At Least 1 time per week Less often Less often When do you use to wash your hands in Summer? When do you use to wash your hands in Winter? before eating before eating after eating after eating before cooking before cooking after cooking after cooking before going to the toilet before going to the toilet after going to the toilet after going to the toilet before changing the diapers before changing the diapers after changing the diapers after changing the diapers

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others others

Are there any change in the previous behaviors pre and If yes, please specify the reason: post the attack

Diseases Has anyone in your household <5 year of age had Yes Has anyone in your household <5 year of age had Yes unusual disease symptoms such as Skin, diarrhea and unusual disease symptoms such as Skin, diarrhea and Giardiasis in the past two weeks? No Giardiasis in the past four weeks? No Has anyone in your household >5 year of age had Yes Has anyone in your household >5 year of age had Yes unusual disease symptoms such as Skin, diarrhea and unusual disease symptoms such as Skin, diarrhea and No No Giardiasis in the past two weeks? Giardiasis in the past four weeks? Did you receive any assistance as hygiene kits? if yes Yes If yes when was the last time when was the last time No During the last one month During the last two months 2-5 months ago since 6 months from 6-12 months before 2014 attack

Yes Was the assistance you find it useful? If yes, why? No If yes, please Increased amount of garbage in the surrounding area Did you notice the appearance of new diseases after the Yes specify the Appearance of insects that were not existing 2014 attack? No reason Others, please specify What are the priority needs in terms of Hygiene before 2014? (from 1 to 3) What are the priority needs in terms of Hygiene after 2014? (from 1 to 3) Lower prices of hygiene kits Lower prices of hygiene kits Public awareness Public awareness Hygiene kits Hygiene kits Are there any other important needs not mentioned above, please Are there any other important needs not mentioned above, please specify: specify: What are coping mechanisms and mitigation measures to alleviate the problems related to Hygiene in your House? What do you think you can do on personal level and community level to contribute to the problems related to Hygiene?

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ANNEX D : HOUSEHOLDS SAMPLING

Table D.1: Planned minimum number of questionnaires

Minimum number of questionnaires % of interna # of # of # of % of % of Total lly interna Total # of war- non- war- non- # of Governorate/Locality populatio (2) (3) displac % of # of lly # of (1) HHs IDPs affecte affecte affecte affecte war- n (4) (5) ed Total total displac non- d d d d affecte person HHs HHs ed affected d s person s North Beit Lahia 86,526 14,421 1,122 297 13,002 8 % 2 % 90 % 23.9 % 149 12 3 134 Beit Hanoun 51,073 8,512 662 175 7,675 8 % 2 % 90 % 14.1 % 88 7 2 79 Jabalia 165,110 27,518 2,141 567 24,811 8 % 2 % 90 % 45.5 % 284 22 6 256 Jabalia Camp 56,290 9,382 730 193 8,459 8 % 2 % 90 % 15.5 % 97 8 2 87 Omm Al Nasser 3,773 629 49 13 567 8 % 2 % 90 % 1.0 % 6 1 0 6 Total 362,772 60,462 4,704 1,245 54,513 8 % 2 % 90 % 19.9 % 623 48 13 562 Gaza Gaza 566,331 94,389 5,017 1973 87,399 5 % 2 % 93 % 90.5 % 972 52 20 900 Ash Shati' Camp 43,681 7,280 387 152 6,741 5 % 2 % 93 % 7.0 % 75 4 2 69 Madinat Ezahra 3,889 648 34 14 600 5 % 2 % 93 % 0.6 % 7 0 0 6 Al Mughraqa 8,241 1,374 73 29 1,272 5 % 2 % 93 % 1.3 % 14 1 0 13 Juhor ad Dik 3,681 614 33 13 568 5 % 2 % 93 % 0.6 % 6 0 0 6 Total 625,823 104,304 5,544 2,180 96,580 5 % 2 % 93 % 34.4 % 1,075 57 22 995 Middle Area An Nuseirat 47,177 7,863 480 134 7,249 6 % 2 % 92 % 17.8 % 81 5 1 75 An Nuseirat Camp 36,146 6,024 367 103 5,554 6 % 2 % 92 % 13.7 % 62 4 1 57 Az Zawayda 21,795 3,633 222 62 3,349 6 % 2 % 92 % 8.2 % 37 2 1 35 Al Bureij 12,671 2,112 129 36 1,947 6 % 2 % 92 % 4.8 % 22 1 0 20 Al Bureij Camp 30,889 5,148 314 88 4,746 6 % 2 % 92 % 11.7 % 53 3 1 49 Al Maghazi 8,412 1,402 86 24 1,293 6 % 2 % 92 % 3.2 % 14 1 0 13 Al Maghazi Camp 20,682 3,447 210 59 3,178 6 % 2 % 92 % 7.8 % 36 2 1 33 Deir al Balah 70,045 11,674 712 199 10,763 6 % 2 % 92 % 26.5 % 120 7 2 111 Deir al Balah Camp 8,284 1,381 84 24 1,273 6 % 2 % 92 % 3.1 % 14 1 0 13 Al Musaddar 2,410 402 24 7 370 6 % 2 % 92 % 0.9 % 4 0 0 4 Wadi as Salqa 5,944 991 60 17 913 6 % 2 % 92 % 2.2 % 10 1 0 9 Total 264,455 44,076 2,688 751 40,637 6 % 2 % 92 % 14.5 % 454 28 8 419

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Khan Younis Al Qarara 24,906 4,151 225 122 3,804 5 % 3 % 92 % 7.3 % 43 2 1 39 Khan Younis 179,701 29,950 1,621 883 27,446 5 % 3 % 92 % 52.6 % 309 17 9 283 Khan Younis Camp 47,503 7,917 428 233 7,255 5 % 3 % 92 % 13.9 % 82 4 2 75 Bani Suheila 39,941 6,657 360 196 6,100 5 % 3 % 92 % 11.7 % 69 4 2 63 Abasan al Jadida 7,642 1,274 69 38 1,167 5 % 3 % 92 % 2.2 % 13 1 0 12 Abasan al Kabira 23,198 3,866 209 114 3,543 5 % 3 % 92 % 6.8 % 40 2 1 37 Khuza'a 11,524 1,921 104 57 1,760 5 % 3 % 92 % 3.4 % 20 1 1 18 Al Fukhari 6,978 1,163 63 34 1,066 5 % 3 % 92 % 2.0 % 12 1 0 11 Total 341,393 56,899 3,079 1,678 52,142 5 % 3 % 92 % 18.8 % 586 32 17 537 Rafah Rafah 158,414 26,402 1,304 247 24,851 5 % 1 % 94 % 70.2 % 272 13 3 256 Rafah Camp 44,956 7,493 370 70 7,053 5 % 1 % 94 % 19.9 % 77 4 1 73 Shokat as Sufi 13,961 2,327 115 22 2,190 5 % 1 % 94 % 6.2 % 24 1 0 23 Al Naser 8,206 1,368 68 13 1,287 5 % 1 % 94 % 3.6 % 14 1 0 13 Total 225,537 37,590 1,857 351 35,382 5 % 1 % 94 % 12.4 % 387 19 4 365 Gaza Strip 279,25 Total 1,819,980 303,330 17,872 6,205 6 % 2 % 92 % 1 % 3,125 184 64 2,877 3

Remarks: (1) Total population was obtained from Palestinian Central Bureau of Statistics (Ref: Palestinian Central Bureau of Statistics, ‘Population Projections’, http://www.pcbs.gov.ps/site/lang__en/803/default.aspx), 2015. (2) Household size = 6 members (Ref: Palestinian Central Bureau of Statistics, ‘Demographic Indicators’), 2015. (3) Total number of internally displaced persons was obtained from Office for the Coordination of Humanitarian Affairs per each governorate (then stratified per each locality) (4) Total number of war-affected households was obtained from MoHPW per each governorate (then stratified per each locality) (5) The original plan in the proposal included only non-affected households without targeting specific WASH-affected households.

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ANNEX E : INDICATORS FORMULATION

Table E.1: Indicators formulation

# Indicator Involved questions/data Formulation 1 Socio-economic indicators SE1 Percentage distribution of 1. Sex and age of households 1. Data filtering based on governorate population based on sex and members age 2. Governorate SE2 Average housing density 1. Number of households 1. Data filtering based on governorate members 2. Total area of shelter 3. Number of rooms 4. Governorate SE3 Percentage of households 1. Sex of interviewee (female) 1. Data filtering based on governorate headed by women 2. Head of the HH? (yes) 3. Governorate SE4 Percentage of Internally 1. Target group (internally 1. Data filtering based on governorate displaced families planning displaced persons) to go back to their home 2. Time going back home? (all answers except ‘never’) 3. Governorate SE5 Percentage of Internally 1. Target group (Internally 1. Data filtering based on governorate displaced families and war- displaced persons and war- affected families having affected) negative variation of income 2. Income changed negatively? post-2014 (yes) 3. Governorate SE6 Percentage of variation of 1. Monthly WASH materials 1. [Monthly WASH materials expenses monthly WASH items expenses pre-2014 post-2014]- [Monthly WASH expenses per household 2. Monthly WASH materials materials expenses pre-2014]= pre- and post-2014 expenses post-2014 <0: expenses decreased 3. Governorate >0: expenses increased =0: no variation 2. Data filtering based on governorate SE7 Average monthly WASH 1. Monthly WASH materials 1. [Monthly WASH materials expenses items expenses post-2014 expenses post-2014 post-2014]/[Number of households 2. Number of households members] (NIS/Capita/Month) members 2. Data filtering based on governorate 3. Governorate 2 Water indicators W1 Variation of source of 1. Source of drinking water pre- 1. Data filtering based on governorate drinking water pre- and post- 2014 2014 2. Source of drinking water post-2014 3. Governorate W2 Percentage of women and 1. Opinion about "drinking 1. Know: options (coming from the men who have/have no water" truck, desalinated water, bottled knowledge about the origin 2. Sex of interviewee water) of the safe drinking water 3. Governorate Don’t know: options(coming from the pipes, wells) 2. Data filtering based on governorate and sex of interviewee W3 Variation of source of 1. Source of domestic water 1. Data filtering based on governorate domestic water pre- and pre-2014

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post-2014 2. Source of domestic water post-2014 3. Governorate W4 Variation of capacity of the 1. Capacity of the drinking 1. [Capacity of the drinking water drinking water storage pre- water storage pre-2014 storage post-2014]-[ Capacity of the and post-2014 2. Capacity of the drinking drinking water storage pre-2014]= water storage post-2014 <0: capacity decreased 3. Governorate >0: capacity increased 4. Locality =0: no variation 2. Data filtering based on governorate and locality W5 Variation of capacity of the 1. Capacity of the domestic 1. [Capacity of the domestic water domestic water storage pre- water storage pre-2014 storage post-2014]-[ Capacity of the and post-2014 2. Capacity of the domestic domestic water storage pre-2014]= water storage post-2014 <0: capacity decreased 3. Governorate >0: capacity increased 4. Locality =0: no variation 2. Data filtering based on governorate and locality W6 Average of storage capacity 1. Capacity of the drinking 1. [Capacity of the drinking water of drinking water per HH water storage pre-2014 storage pre-2014]/[Number of members pre- and post- 2. Capacity of the drinking households members] (Litre/Capita) 2014 water storage post-2014 2. [Capacity of the drinking water 3. Number of households storage post-2014]/[Number of members households members] (Litre/Capita) 4. Governorate 3. Data filtering based on governorate 5. Land type and land type W7 Average of storage capacity 1. Capacity of the domestic 1. [Capacity of the domestic water of domestic water per HH water storage pre-2014 storage pre-2014]/[Number of members pre- and post- 2. Capacity of the domestic households members] (Litre/Capita) 2014 water storage post-2014 2. [Capacity of the domestic water 3. Number of households storage post-2014]/[Number of members households members] (Litre/Capita) 4. Governorate 3. Data filtering based on governorate 5. Land type and land type W8 Variation of perception about 1. Quality of the drinking water 1. Data filtering based on governorate the drinking water quality (not acceptable) pre-2014 pre- and post-2014 2. Reasons (salinity, odour, taste, turbidity) pre-2014 3. Quality of the drinking water (not acceptable) post-2014 4. Reasons (salinity, odour, taste, turbidity) post-2014 5. Governorate W9 Variation of perception about 1. Quality of the domestic water 1. Data filtering based on governorate the domestic water quality (not acceptable) pre-2014 and locality pre- and post-2014 2. Reasons (salinity, odour, taste, turbidity) pre-2014 3. Quality of the domestic water (not acceptable) post-2014 4. Reasons (salinity, odour, taste, turbidity) post-2014 5. Governorate 6. Locality W10 Percentage of women and 1. The different uses of drinking 1. Data filtering based on governorate men who use drinking water water: options (bathing, for domestic use cleaning, dishes washing, children showing, ablution)

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2. Sex of interviewee 3. Governorate W11 Percentage of women and 1. The different uses of 1. Data filtering based on governorate men who use domestic domestic water: options water for drinking use (drinking, cooking) 2. Sex of interviewee 3. Governorate W12 Percentage of households 1. Are there children engaged 1. Data filtering based on governorate engaging children in drinking in a process of collecting water collection drinking water (yes) 2. Governorate W13 Percentage of households 1. Are there women engaged in 1. Data filtering based on governorate engaging women in drinking a process of collecting water collection drinking water (yes) 2. Governorate W14 Cleaning conditions of the 1. Do you clean /wash your 1. Points: drinking water storages drinking water tank/s? Clean (yes): 3 point 2. How often monthly? Clean (no): 0 point 3. Is there a tight cove for 1 per month: 1 point drinking water tank 2 per month: 2 point 4. Sex of interviewee 3 per month: 3 point 5. Governorate 4 per month: 4 point 6. Locality >4 per month: 4 point Cover (yes): 3 point Cover (no): 0 point Weight (sum): = or < 3 points: bad = or > 4 points: good 2. Data filtering based on governorate and locality W15 Cleaning conditions of the 1. Do you clean /wash your 1. Points: domestic water storages domestic water tank/s? Clean (yes): 3 point 2. How often during the last 12 Clean (no): 0 point months? 1 per last 12 months: 1 point 3. Is there a tight cove for 2 per last 12 months: 2 point domestic water tank 3 per last 12 months: 3 point 4. Sex of interviewee 4 per last 12 months: 4 point 5. Governorate 5 per last 12 months: 4 point 6. Locality Cover (yes): 3 point Cover (no): 0 point Weight (sum): = or < 3 points: bad = or > 4 points: good 2. Data filtering based on governorate and locality W16 Percentage of households 1. Pay for your domestic water? 1. Don’t pay because of economic that don’t pay for domestic (No) situation or lack of social water 2. Sources of domestic water responsibility: sources (municipal 3. Governorate network) 4. Locality Don’t pay because of having free source: sources (private well, public filling point) 2. Data filtering based on governorate and locality W17 Variation of needs priorities 1. Needs of drinking water 1. Data filtering based on governorate of the drinking water pre- before 2014 and post-2014 2. Needs of drinking water after 2014

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3. Sex of interviewee 4. Governorate W18 Variation of needs priorities 1. Needs of domestic water 1. Data filtering based on governorate of the domestic water pre- before 2014 and post-2014 2. Needs of domestic water after 2014 3. Sex of interviewee 4. Governorate W19 Different coping 1. Coping mechanisms and 1. Data filtering based on governorate mechanisms carried out by mitigation measures to women and men related to alleviate the problems related water problems to water 2. Sex of interviewee 3. Governorate 3 Sanitation indicators S1 Percentage of households 1. Do you have toilets before 1. Don’t have: Do you have toilets (No) without toilets or without 2014? Not sufficient: [number of households sufficient toilets pre- and 2. How many toilets before members / number of toilet] > 8 post-2014 2014? 2. Data filtering based on governorate 3. Do you have toilets after and locality 2014? 4. How many toilets after 2014? 5. Number of households members 6. Governorate 7. Locality S2 households without access 1. Sanitation system condition 1. Data filtering based on governorate to wastewater networks pre- before 2014 (does not exist) and locality and post-2014 2. Sanitation system condition after 2014 (does not exist) 3. Governorate 4. Locality S3 Percentage of households 1. Are there proper drainages 1. Data filtering based on governorate without proper surrounding surrounding the HH? (No) and locality storm water drainages 2. Governorate 3. Locality S4 Percentage of households 1. How do you manage your 1. Need access to safe solid waste that need access to safe household garbage? disposal: options (bury it, burn it, solid waste disposal 2. How clean are the home [leave it in open space & surrounding surroundings? with some garbage around or full of 3. Governorate garbage ]) 4. Locality 2. Data filtering based on governorate and locality S5 Variation of needs priorities 1. Needs of sanitation before 1. Data filtering based on governorate of the sanitation pre- and 2014 post-2014 2. Needs of sanitation after 2014 3. Sex of interviewee 4. Governorate S6 Different coping 1. Coping mechanisms and 1. Data filtering based on governorate mechanisms carried out by mitigation measures to women and men related to alleviate the problems related sanitation problems to sanitation 2. Sex of interviewee 3. Governorate 4 Hygiene H1 Variation of source of water 1. Main source for heating 5. Data filtering based on governorate

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heating pre- and post-2014 water for bathing before and locality 2014? 2. Main source for heating water for bathing after 2014? 3. Governorate 4. Locality H2 Percentage of households 1. Hand sink after 2014 1. Not available: options (not existing) without or with poor hand 2. Governorate Available with good conditions: washing facility post-2014 3. Locality options (medium, good) Available with poor conditions: options (poor) 2. Data filtering based on governorate and locality H3 Percentage of households 1. Shower after 2014 1. Not available: options (not existing) without or with poor shower 2. Governorate Available with good conditions: facility post-2014 3. Locality options (medium, good) Available with poor conditions: options (poor) 2. Data filtering based on governorate and locality H4 Percentage of households 1. Dishes sink after 2014 1. Not available: options (not existing) without or with poor kitchen 2. Governorate Available with good conditions: sink post-2014 3. Locality options (medium, good) Available with poor conditions: options (poor) 2. Data filtering based on governorate and locality H5 Percentage of people who 1. When do you use to wash 1. Wash your hands in summer OR do untimely proper hand your hands in summer? wash your hands in winter: Blank washing practice 2. When do you use to wash options (After going toilet OR After your hands in winter? changing diapers OR Before cooking 3. Sex of interviewee OR Before eating) 4. Governorate 2. Data filtering based on governorate 5. Locality and locality H6 Percentage of people who 1. How many times family 1. Shower in summer? OR shower in do and don’t do sufficient members have a shower in winter?: showering practice summer? Points: 2. How many times family every day: 5 point members have a shower in 4 times: 3 point winter? 1 time: 1 point 3. Sex of interviewee < 1 time: 0 point 4. Governorate Weight (sum): 5. Locality < or = 4: bad >4: good 2. Data filtering based on governorate and locality H7 Change of hygiene practices 1. Are there any change in the 1. Data filtering based on governorate post-2014 previous behaviours pre and post the conflict 2. Reason? 3. Sex of interviewee 4. Governorate H8 Percentage of households 1. Has anyone <5 year of age 1. Data filtering based on governorate with children under 5 years had unusual disease old infected by waterborne symptoms such as skin, diseases in the last 2 weeks diarrhoea and giardiasis in the past two weeks? 2. Age of household members

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(<5) 3. Governorate 4. Locality H9 Percentage of households 1. Has anyone >5 year of age 1. Data filtering based on governorate with members above 5 years had unusual disease and locality old infected by waterborne symptoms such as skin, diseases in the last 2 weeks diarrhoea and giardiasis in the past two weeks? 2. Governorate 3. Locality H10 Percentage of households 1. Did you notice the 1. Data filtering based on governorate that noticed appearance of appearance of new diseases and locality new diseases after the 2014 conflict? 2. Governorate 3. Locality H11 Percentage of women with 1. Age and sex of household 1. Women of reproductive age: no access to appropriate members (women >5 and 50 per cent of (age 5-18) sanitary materials for <60) 100 per cent of (age 19-36) menstruation pre- and post- 2. Governorate 50 per cent of (age 36-60) 2014 3. Locality 2. Data filtering based on governorate and locality H12 Percentage of households 1. Did you receive any 1. Data filtering based on governorate that received hygiene kits in assistance as hygiene kits and locality the last period (2015) (yes) 2. When was the last time (all answers except ‘before 2014’) 3. Governorate 4. Locality H13 Percentage of households 1. Priority needs in terms of 1. Priority needs in terms of Hygiene with need for hygiene Hygiene after 2014 (hygiene after 2014 (hygiene kits = 1) AND materials kits) Condition of the walls and floor 2. Condition of the walls and cleanliness? (poor) floor cleanliness? (poor) 2. Data filtering based on governorate 3. Governorate and locality 4. Locality H14 Variation of needs priorities 1. Needs of hygiene before 1. Data filtering based on governorate of hygiene pre- and post- 2014 2014 2. Needs of hygiene after 2014 3. Sex of interviewee 4. Governorate H15 Different coping 1. Coping mechanisms and 1. Data filtering based on governorate mechanisms carried out by mitigation measures to women and men related to alleviate the problems related hygiene problems to hygiene 2. Sex of interviewee 3. Governorate

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ANNEX F : TABLES OF FINDINGS

Table F.1: Total number of implemented and valid questionnaires based on the target group per governorate/locality

Total # of implemented (1) Total # of valid questionnaires questionnaires Governorate/Locality NORMA NORMA IDP WAR WASH IDP WAR WASH L L North Beit Lahia 12 55 76 124 12 54 70 46 Beit Hanoun 52 60 19 78 52 54 18 25 Jabalia 29 19 0 207 29 18 0 83 Jabalia Camp 7 44 85 59 7 44 85 26 Omm Al Nasser 3 22 30 6 3 20 28 2 Total 103 200 210 474 103 190 201 182 Gaza Gaza 286 97 34 556 278 91 31 223 Ash Shati' Camp 0 0 93 40 0 0 83 9 Madinat Ezahra 0 0 0 6 0 0 0 5 Al Mughraqa 5 24 65 18 5 23 62 6 Juhor ad Dik 29 64 0 3 25 63 0 2 Total 320 185 192 623 308 177 176 245 Middle Area An Nuseirat 13 8 0 73 13 8 0 18 An Nuseirat Camp 12 2 7 32 12 2 7 5 Az Zawayda 5 6 14 33 5 6 14 12 Al Bureij 7 36 14 9 7 36 14 9 Al Bureij Camp 7 2 0 38 7 2 0 18 Al Maghazi 6 11 5 6 6 10 5 5 Al Maghazi Camp 5 18 0 38 5 18 0 5 Deir al Balah 15 1 0 83 13 1 0 26 Deir al Balah Camp 4 1 0 9 4 1 0 3 Al Musaddar 0 0 0 7 0 0 0 2 Wadi as Salqa 9 112 16 11 8 105 15 7 Total 83 197 56 339 80 189 55 110 Khan Younis Al Qarara 9 20 8 38 4 19 8 7 Khan Younis 28 19 36 168 28 18 34 68 Khan Younis Camp 9 0 131 55 8 0 122 10 Bani Suheila 8 66 11 67 7 61 11 18 Abasan al Jadida 4 0 0 13 4 0 0 10 Abasan al Kabira 4 19 0 37 4 18 0 13 Khuza'a 5 136 0 18 4 132 0 1 Al Fukhari 4 0 0 11 4 0 0 4 Total 71 260 186 407 63 248 175 131 Rafah Rafah 29 18 82 174 28 18 69 74 Rafah Camp 10 9 99 33 10 9 97 25 Shokat as Sufi 9 130 55 27 9 120 54 7 Al Naser 4 3 0 13 4 3 0 6 Total 52 160 236 247 51 150 220 112 Gaza Strip Total 629 1,002 880 2,090 605 954 827 780

Remarks: (1) Total number includes the questionnaires implemented during the training phase (see CHAPTER 2).

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Table F.2: Number of questionnaires based on sex and age of interviewee

Total <19 years 19-35 years # of # of % of # of % of Governorate # of # of % of # of % of wome wome wome wome wome men men men men men n n n n n North 248 428 0 0.00 0 0.00 99 39.92 165 38.55 Gaza 404 502 2 0.50 1 0.20 163 40.35 181 36.06 Middle Area 106 328 0 0.00 0 0.00 37 34.91 126 38.41 Khan Younis 309 308 1 0.32 0 0.00 115 37.22 89 28.90 Rafah 117 416 0 0.00 3 0.72 27 23.08 177 42.55 Gaza Strip 1,184 1,982 3 0.25 4 0.20 441 37.25 738 37.24

Total 36-60 years >60 years # of # of % of # of % of Governorate # of # of % of # of % of wome wome wome wome wome men men men men men n n n n n North 248 428 131 52.82 230 53.74 18 7.26 33 7.71 Gaza 404 502 208 51.49 261 51.99 31 7.67 59 11.75 Middle Area 106 328 61 57.55 172 52.44 8 7.55 30 9.15 Khan Younis 309 308 178 57.61 172 55.84 15 4.85 47 15.26 Rafah 117 416 74 63.25 202 48.56 16 13.68 34 8.17 Gaza Strip 1,184 1,982 652 55.07 1,037 52.32 88 7.43 203 10.24

Table F.3: Number of questionnaires based on land type

Total Urban Rural Camp Governorate # of % of # of % of # of % of # of % of HHs HHs HHs HHs HHs HHs HHs HHs North 676 21.35 461 68 53 8 162 24 Gaza 906 28.62 628 69 186 21 92 10 Middle Area 434 13.71 343 79 2 0 89 21 Khan Younis 617 19.49 326 53 151 24 140 23 Rafah 533 16.84 379 71 13 2 141 26 Gaza Strip 3,166 100 2,137 67.50 405 12.79 624 19.71

Locality Type Locality Type Locality Type North An Nuseirat Urban Khan Younis Urban Beit Lahia Urban An Nuseirat Camp Camp Khan Younis Camp Camp Beit Hanoun Urban Az Zawayda Urban Bani Suheila Urban Jabalia Urban Al Bureij Urban Abasan al Jadida Rural Jabalia Camp Camp Al Bureij Camp Camp Abasan al Kabira Urban Omm Al Nasser Rural Al Maghazi Urban Khuza'a Rural Gaza Al Maghazi Camp Camp Al Fukhari Urban Gaza Urban Deir al Balah Urban Rafah Ash Shati' Camp Camp Deir al Balah Camp Camp Rafah Urban Madinat Ezahra Urban Al Musaddar Rural Rafah Camp Camp Al Mughraqa Rural Wadi as Salqa Urban Shokat as Sufi Urban Juhor ad Dik Rural Khan Younis Al Naser Rural Middle Area Al Qarara Urban Al Qarara Urban

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Table F.4: Number of questionnaires based on shelter type

Apartment Asbestos/Zinco Separate house Others Total # Governorate # of % of # of % of # of % of # of % of of HHs HHs HHs HHs HHs HHs HHs HHs HHs North 676 91 13.46 224 33.14 353 52.22 8 1.18 Gaza 906 322 35.54 160 17.66 406 44.81 18 1.99 Middle Area 434 103 23.73 111 25.58 214 49.31 6 1.38 Khan Younis 617 57 9.24 187 30.31 361 58.51 12 1.94 Rafah 533 28 5.25 274 51.41 228 42.78 3 0.56 Gaza Strip 3,166 601 18.98 956 30.20 1,562 49.34 47 1.48

Table F.5: Number of questionnaires based on average HH monthly income

<1000 NIS 1000-1800 NIS 1801-2300 NIS 2301-4000 NIS >4000 NIS (<263 USD) (263-474 USD) (474-605 USD) (605-1053 USD) (1053 USD) Governorate # of % of # of % of # of % of # of % of # of % of HHs HHs HHs HHs HHs HHs HHs HHs HHs HHs North 365 53.99 225.00 33.28 23.00 3.40 55.00 8.14 8.00 1.18 Gaza 422 46.58 351.00 38.74 54.00 5.96 69.00 7.62 10.00 1.10 Middle Area 207 47.70 149.00 34.33 26.00 5.99 47.00 10.83 5.00 1.15 Khan Younis 383 62.07 165.00 26.74 37.00 6.00 29.00 4.70 3.00 0.49 Rafah 343 64.35 134.00 25.14 21.00 3.94 32.00 6.00 3.00 0.56 Gaza Strip 1,720 54.33 1,024 32.34 161 5.09 232 7.33 29 0.92

Table F.6: SE1: Percentage distribution of population based on sex and age

0-5 years 6-18 years 19-35 years Governorate Wome Wome Girls Boys Total Men Total Men Total n n North 17.84 16.78 17.29 37.86 37.79 37.82 26.33 27.26 26.81 Gaza 15.30 16.97 16.16 33.42 33.67 33.55 29.51 29.43 29.47 Middle Area 14.44 15.90 15.16 31.69 32.84 32.26 31.47 30.75 31.11 Khan Younis 15.61 15.07 15.33 32.58 34.11 33.37 28.59 28.79 28.69 Rafah 16.36 17.39 16.90 31.06 32.75 31.95 31.51 31.30 31.40 Gaza Strip 15.96 16.49 16.23 33.59 34.39 34.00 29.24 29.32 29.28

36-60 years >60 years Total Governorate Wome Wome Wome Men Total Men Total Men Total n n n North 15.89 16.19 16.05 2.09 1.98 2.03 48.67 51.33 100.00 Gaza 18.05 16.03 17.00 3.73 3.91 3.82 48.21 51.79 100.00 Middle Area 19.90 17.31 18.61 2.51 3.21 2.86 50.32 49.68 100.00 Khan Younis 19.44 18.40 18.91 3.78 3.63 3.70 48.62 51.38 100.00 Rafah 18.01 15.47 16.69 3.06 3.08 3.07 47.75 52.25 100.00 Gaza Strip 18.11 16.60 17.33 3.10 3.21 3.16 48.60 51.40 100.00

Table F.7: SE2: Average housing density

Average # of Average Total HH Total # Total # Average Total # # of persons area per Governorate area of of HH area of HHs 2 2 rooms per person (m ) rooms persons (m ) 2 per HH room (m ) North 676 85,746 1,917 4,331 126.84 2.84 2.26 19.80 Gaza 906 119,946 2,679 5,735 132.39 2.96 2.14 20.91 Middle Area 434 53,613 1,263 2,697 123.53 2.91 2.14 19.88

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Khan Younis 617 77,042 1,791 3,914 124.87 2.90 2.19 19.68 Rafah 533 62,958 1,432 3,290 118.12 2.69 2.30 19.14 Gaza Strip 3,166 399,305 9,082 19,967 126.12 2.87 2.20 20.00

Table F.8: SE3: Percentage of households headed by women

# of interviewed # of HHs headed % of HHs headed Governorate Total # of HHs women by women by women North 676 248 59 8.73 Gaza 906 404 79 8.72 Middle Area 434 106 25 5.76 Khan Younis 617 309 66 10.7 Rafah 533 117 47 8.82 Gaza Strip 3,166 1,184 276 8.72

Table F.9: SE4: Percentage of internally diplaced families planning to go back to their home

% of Total # of HHs Total # of Internally # of internally displaced families Governorate (families) displaced families families going back home going back home North 676 103 102 99.03 Gaza 906 308 306 99.35 Middle Area 434 80 79 98.75 Khan Younis 617 63 62 98.41 Rafah 533 51 50 98.04 Gaza Strip 3,166 605 599 99.01

Table F.10: SE5: Percentage of internally displaced families and war-affected families having negative variation of income post-2014

internally displaced families and war- # of internally affected HHs having negative income displaced families variation Governorate Total # of HHs and war-affected HHs # of HHs % of HHs

North 676 293 127 43.34 Gaza 906 485 258 53.20 Middle Area 434 269 164 60.97 Khan Younis 617 311 100 32.15 Rafah 533 201 58 28.86 Gaza Strip 3,166 1,559 707 45.35

Table F.11: SE6: Percentage of variation of monthly WASH items expenses per household pre- and post-2014

% of HHs Total # of % of HHs % of HHs with no WASH item HHs paying more paying less paying variation North Drinking water 2.37 5.03 92.6 Domestic water 3.11 6.36 90.53 676 Hygiene materials 5.47 6.8 87.72 Female hygiene items 3.55 3.4 93.05

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Cleaning materials 6.07 5.62 88.31 Solid waste disposal 1.78 4.14 94.08 Gaza Drinking water 2.43 6.4 91.17 Domestic water 9.82 9.27 80.91 Hygiene materials 3.09 6.4 90.51 906 Female hygiene items 2.32 2.43 95.25 Cleaning materials 4.42 6.84 88.74 Solid waste disposal 5.3 7.73 86.98 Middle Area Drinking water 1.15 2.3 96.54 Domestic water 4.84 4.84 90.32 Hygiene materials 3.46 3 93.55 434 Female hygiene items 2.07 2.07 95.85 Cleaning materials 4.61 3.23 92.17 Solid waste disposal 3.46 3 93.55 Khan Younis Drinking water 6.97 6.32 86.71 Domestic water 4.21 6.48 89.3 Hygiene materials 5.83 4.38 89.79 617 Female hygiene items 1.94 2.43 95.62 Cleaning materials 8.1 5.67 86.22 Solid waste disposal 2.11 6.65 91.25 Rafah Drinking water 1.31 9.19 89.49 Domestic water 3.38 3.75 92.87 Hygiene materials 533 2.63 5.25 92.12 Female hygiene items 1.5 1.31 97.19 Cleaning materials 1.88 3 95.12 Solid waste disposal 2.81 2.63 94.56 Gaza Strip Drinking water 2.94 6 91.06 Domestic water 5.53 6.57 87.9 Hygiene materials 4.11 5.43 90.46 3,166 Female hygiene items 2.34 2.4 95.26 Cleaning materials 5.09 5.21 89.7 Solid waste disposal 3.25 5.24 91.5

Table F.12: SE7: Average monthly WASH items expenses post-2014 in NIS/capita/month (USD/capita/month)

Female Total Drinking Domestic Solid Hygiene Cleaning Governorate hygiene WASH water water waste materials materials materials materials 4.56 2.89 1.35 8.06 5.78 10.76 33.40 North (1.20) (0.76) (0.36) (2.12) (1.52) (2.83) (8.79) 5.33 5.20 1.91 8.13 4.80 11.01 36.38 Gaza (1.40) (1.37) (0.50) (2.14) (1.26) (2.90) (9.57) 5.53 3.97 1.30 5.62 5.68 11.31 33.41 Middle Area (1.46) (1.04) (0.34) (1.48) (1.49) (2.98) (8.79) 4.86 4.16 1.52 7.50 4.79 10.72 33.55 Khan Younis (1.28) (1.09) (0.40) (1.97) (1.26) (2.82) (8.83) 4.34 4.14 1.53 5.99 5.31 09.05 30.38 Rafah (1.14) (1.09) (0.40) (1.58) (1.40) (2.38) (7.99) 4.93 4.16 1.57 7.29 5.21 10.61 33.77 Gaza Strip (1.30) (1.09) (0.41) (1.92) (1.37) (2.79) (8.89)

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Table F.13: W1: Changes in source of drinking water pre- and post-2014

Pre-2014 Post-2014 Water source Total # of HHs # of HHs % of HHs # of HHs % of HHs North Bottling 7 1.04 7 1.04 RO home unit 35 5.18 28 4.14 Municipal network 46 6.8 47 6.95 676 Private well 14 2.07 9 1.33 Public filling points 57 8.43 66 9.76 Water trucks 535 79.14 537 79.44 Gaza Bottling 7 0.77 12 1.32 RO home unit 15 1.66 13 1.43 Municipal network 5 0.55 13 1.43 906 Private well 7 0.77 4 0.44 Public filling points 36 3.97 57 6.29 Water trucks 844 93.16 819 90.4 Middle Area Bottling 0 0 0 0 RO home unit 9 2.07 6 1.38 Municipal network 4 0.92 3 0.69 434 Private well 1 0.23 0 0 Public filling points 13 3 15 3.46 Water trucks 412 94.93 415 95.62 Khan Younis Bottling 0 0 0 0 RO home unit 43 6.97 20 3.24 Municipal network 35 5.67 12 1.94 617 Private well 2 0.32 4 0.65 Public filling points 70 11.35 111 17.99 Water trucks 479 77.63 486 78.77 Rafah Bottling 3 0.56 7 1.31 RO home unit 11 2.06 14 2.63 Municipal network 6 1.13 10 1.88 533 Private well 5 0.94 7 1.31 Public filling points 82 15.38 93 17.45 Water trucks 438 82.18 420 78.8 Gaza Strip Bottling 17 0.54 26 0.82 RO home unit 113 3.57 81 2.56 Municipal network 96 3.03 85 2.68 3,166 Private well 29 0.92 24 0.76 Public filling points 258 8.15 342 10.8 Water trucks 2,708 85.53 2,677 84.55

Table F.14: W2: Percentage of women and men who can/cannot identify safe drinking water resources

Have knowledge Have no knowledge Sex of Total # of Governorate % of % of interviewee HHs # of people # of people people people Women 248 215 86.69 33 13.31 North Men 428 353 82.48 75 17.52 Women & Men 676 568 84.02 108 15.98

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Women 404 376 93.07 28 6.93 Gaza Men 502 477 95.02 25 4.98 Women & Men 906 853 94.15 53 5.85 Women 106 101 95.28 5 4.72 Middle Area Men 328 326 99.39 2 0.61 Women & Men 434 427 98.39 7 1.61 Women 309 292 94.5 17 5.5 Khan Younis Men 308 292 94.81 16 5.19 Women & Men 617 584 94.65 33 5.35 Women 117 109 93.16 8 6.84 Rafah Men 416 408 98.08 8 1.92 Women & Men 533 517 97 16 3 Women 1,184 1,093 92.31 91 7.69 Men 1,982 1,856 93.64 126 6.36 Gaza Strip Women & 3,166 2,949 93.15 217 6.85 Men

Table F.15: W3: Variation of source of domestic water pre- and post-2014

Pre-2014 Post-2014 Water source Total # of HHs # of HHs % of HHs # of HHs % of HHs North Municipal network 607 89.79 610 90.24 Private well 54 7.99 56 8.28 676 Public filling points 3 0.44 3 0.44 Water trucks 23 3.4 16 2.37 Gaza Municipal network 795 87.75 799 88.19 Private well 102 11.26 106 11.7 906 Public filling points 2 0.22 2 0.22 Water trucks 14 1.55 11 1.21 Middle Area Municipal network 270 62.21 276 63.59 Private well 167 38.48 161 37.1 434 Public filling points 0 0 0 0 Water trucks 5 1.15 2 0.46 Khan Younis Municipal network 565 91.57 576 93.35 Private well 53 8.59 43 6.97 617 Public filling points 0 0 0 0 Water trucks 8 1.3 9 1.46 Rafah Municipal network 399 74.86 398 74.67 Private well 133 24.95 139 26.08 533 Public filling points 0 0 0 0 Water trucks 11 2.06 9 1.69 Gaza Strip Municipal network 2,636 83.26 2,659 83.99 Private well 509 16.08 505 15.95 3,166 Public filling points 5 0.16 5 0.16 Water trucks 61 1.93 47 1.48

122

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.16: W4: Change in capacity of the drinking water storage pre- and post-2014

No capacity change Capacity decreased Capacity increased Governorate/ Total # % of % of % of Locality of HHs # of HHs # of HHs # of HHs HHs HHs HHs North Beit Lahia 182 143 78.57 12 6.59 27 14.84 Beit Hanoun 149 128 85.91 15 10.07 6 4.03 Jabalia 130 119 91.54 7 5.38 4 3.08 Jabalia Camp 162 150 92.59 7 4.32 5 3.09 Omm Al Nasser 53 50 94.34 0 0 3 5.66 Total 676 590 87.28 41 6.07 45 6.66 Gaza Gaza 623 473 75.92 96 15.41 54 8.67 Ash Shati' Camp 92 87 94.57 4 4.35 1 1.09 Madinat Ezahra 5 5 100 0 0 0 0 Al Mughraqa 96 84 87.5 5 5.21 7 7.29 Juhor ad Dik 90 59 65.56 11 12.22 20 22.22 Total 906 708 78.15 116 12.8 82 9.05 Middle Area An Nuseirat 39 32 82.05 5 12.82 2 5.13 An Nuseirat Camp 26 21 80.77 5 19.23 0 0 Az Zawayda 37 36 97.3 1 2.7 0 0 Al Bureij 66 63 95.45 3 4.55 0 0 Al Bureij Camp 27 22 81.48 3 11.11 2 7.41 Al Maghazi 26 25 96.15 1 3.85 0 0 Al Maghazi Camp 28 20 71.43 6 21.43 2 7.14 Deir al Balah 40 34 85 6 15 0 0 Deir al Balah Camp 8 8 100 0 0 0 0 Al Musaddar 2 2 100 0 0 0 0 Wadi as Salqa 135 121 89.63 8 5.93 6 4.44 Total 434 384 88.48 38 8.76 12 2.76 Khan Younis Al Qarara 38 35 92.11 2 5.26 1 2.63 Khan Younis 148 132 89.19 8 5.41 8 5.41 Khan Younis Camp 140 130 92.86 6 4.29 4 2.86 Bani Suheila 97 73 75.26 0 0 24 24.74 Abasan al Jadida 14 13 92.86 1 7.14 0 0 Abasan al Kabira 35 29 82.86 1 2.86 5 14.29 Khuza'a 137 110 80.29 3 2.19 24 17.52 Al Fukhari 8 6 75 1 12.5 1 12.5 Total 617 528 85.58 22 3.57 67 10.86 Rafah Rafah 189 178 94.18 4 2.12 7 3.7 Rafah Camp 141 127 90.07 9 6.38 5 3.55 Shokat as Sufi 190 152 80 7 3.68 31 16.32 Al Naser 13 9 69.23 4 30.77 0 0 Total 533 466 87.43 24 4.5 43 8.07 Gaza Strip Total 3,166 2,676 84.52 241 7.61 249 7.86

123

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.17: W5: Changes in capacity of the domestic water storage pre- and post-2014

No capacity change Capacity decreased Capacity increased Governorate/ Total # % of % of % of Locality of HHs # of HHs # of HHs # of HHs HHs HHs HHs North Beit Lahia 182 154 84.62 24 13.19 4 2.2 Beit Hanoun 149 103 69.13 38 25.5 8 5.37 Jabalia 130 112 86.15 16 12.31 2 1.54 Jabalia Camp 162 131 80.86 22 13.58 9 5.56 Omm Al Nasser 53 50 94.34 1 1.89 2 3.77 Total 676 550 81.36 101 14.94 25 3.7 Gaza Gaza 623 386 61.96 178 28.57 59 9.47 Ash Shati' Camp 92 87 94.57 4 4.35 1 1.09 Madinat Ezahra 5 5 100 0 0 0 0 Al Mughraqa 96 75 78.13 14 14.58 7 7.29 Juhor ad Dik 90 56 62.22 30 33.33 4 4.44 Total 906 609 67.22 226 24.94 71 7.84 Middle Area An Nuseirat 39 32 82.05 5 12.82 2 5.13 An Nuseirat Camp 26 20 76.92 5 19.23 1 3.85 Az Zawayda 37 31 83.78 4 10.81 2 5.41 Al Bureij 66 58 87.88 7 10.61 1 1.52 Al Bureij Camp 27 21 77.78 4 14.81 2 7.41 Al Maghazi 26 22 84.62 2 7.69 2 7.69 Al Maghazi Camp 28 18 64.29 6 21.43 4 14.29 Deir al Balah 40 32 80 6 15 2 5 Deir al Balah Camp 8 6 75 2 25 0 0 Al Musaddar 2 2 100 0 0 0 0 Wadi as Salqa 135 104 77.04 23 17.04 8 5.93 Total 434 346 79.72 64 14.75 24 5.53 Khan Younis Al Qarara 38 26 68.42 12 31.58 0 0 Khan Younis 148 112 75.68 28 18.92 8 5.41 Khan Younis Camp 140 130 92.86 9 6.43 1 0.71 Bani Suheila 97 58 59.79 31 31.96 8 8.25 Abasan al Jadida 14 8 57.14 3 21.43 3 21.43 Abasan al Kabira 35 18 51.43 16 45.71 1 2.86 Khuza'a 137 40 29.2 92 67.15 5 3.65 Al Fukhari 8 6 75 2 25 0 0 Total 617 398 64.51 193 31.28 26 4.21 Rafah Rafah 189 166 87.83 14 7.41 9 4.76 Rafah Camp 141 134 95.04 3 2.13 4 2.84 Shokat as Sufi 190 144 75.79 35 18.42 11 5.79 Al Naser 13 9 69.23 2 15.38 2 15.38 Total 533 453 84.99 54 10.13 26 4.88 Gaza Strip Total 3,166 2,356 74.42 638 20.15 172 5.43

Table F.18: W6: Average storage capacity of drinking water per household member pre- and post-2014 (litre/capita)

Total # Pre-2014 Post-2014 Governorate of HHs Urban Rural Camp Urban Rural Camp North 676 50.18 79.68 36.71 48.93 80.61 36.37 Gaza 906 64.43 69.8 44.37 59.82 71.98 43.41 Middle Area 434 67.45 157.5 59.48 65.57 157.5 50.94 Khan Younis 617 38.17 11.8 50.72 41.49 11.95 49.12 Rafah 533 59.25 52.08 18.87 64.99 34.1 16.39

124

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Gaza Strip 3,166 56.92 49.34 40.2 56.51 49.93 37.83

Table F.19: W7: Average of storage capacity of domestic water per household member pre- and post-2014 (litre/capita)

Total # Pre-2014 Post-2014 Governorate of HHs Urban Rural Camp Urban Rural Camp North 676 309.18 232.49 285.3 270.22 238.55 271.03 Gaza 906 372.02 321.79 222.92 330.03 283.31 219.28 Middle Area 434 269.1 315 255.8 255.52 315 230.39 Khan Younis 617 286.64 371.11 174.02 234.16 228.47 167.87 Rafah 533 296.25 185.96 278.09 286.53 180.65 284 Gaza Strip 3,166 315.48 324.1 245.3 282.83 253.87 237.39

Table F.20: W8: Changes in perceptions about drinking water quality pre- and post-2014

Water quality Pre-2014 Post-2014 Total # Governorate Acceptable Not Acceptable Acceptable Not Acceptable of HHs # of % of # of % of # of % of # of % of HHs HHs HHs HHs HHs HHs HHs HHs North 676 630 93.2 46 6.8 624 92.31 52 7.69 Gaza 906 880 97.13 26 2.87 877 96.8 29 3.2 Middle Area 434 416 95.85 18 4.15 414 95.39 20 4.61 Khan Younis 617 570 92.38 47 7.62 562 91.09 55 8.91 Rafah 533 506 94.93 27 5.07 506 94.93 27 5.07 Gaza Strip 3,166 3,002 94.82 164 5.18 2,983 94.22 183 5.78

Issues of unacceptable drinking water quality (%) Pre-2014 Post-2014 Governorate Salinity Odour Turbidit Taste Salinity Odour Turbidit Taste y y North 39.13 6.52 15.22 80.43 43.48 6.52 17.39 95.65 Gaza 42.31 3.85 11.54 84.62 42.31 3.85 11.54 92.31 Middle Area 22.22 0 0 88.89 33.33 0 0 100 Khan Younis 51.06 6.38 8.51 78.72 59.57 4.26 6.38 82.98 Rafah 88.89 18.52 25.93 70.37 81.48 18.52 29.63 85.19 Gaza Strip 49.39 7.32 12.8 79.88 47.54 6.01 12.02 80.87

Table F.21: W9: Variation of perception about the domestic water quality pre- and post-2014

Water quality Pre-2014 Post-2014 Governorate/ Total # Acceptable Not Acceptable Acceptable Not Acceptable Locality of HHs # of % of # of % of # of % of # of % of HHs HHs HHs HHs HHs HHs HHs HHs North Beit Lahia 182 133 73.08 49 26.92 129 70.88 53 29.12 Beit Hanoun 149 97 65.1 52 34.9 95 63.76 54 36.24 Jabalia 130 70 53.85 60 46.15 80 61.54 50 38.46 Jabalia Camp 162 140 86.42 22 13.58 139 85.8 23 14.2 Omm Al Nasser 53 47 88.68 6 11.32 46 86.79 7 13.21 Total 676 487 72.04 189 27.96 489 72.34 187 27.66 Gaza

125

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Gaza 623 314 50.4 309 49.6 296 47.51 327 52.49 Ash Shati' Camp 92 5 5.43 87 94.57 19 20.65 73 79.35 Madinat Ezahra 5 5 100 0 0 5 100 0 0 Al Mughraqa 96 53 55.21 43 44.79 56 58.33 40 41.67 Juhor ad Dik 90 60 66.67 30 33.33 57 63.33 33 36.67 Total 906 437 48.23 469 51.77 433 47.79 473 52.21 Middle Area An Nuseirat 39 6 15.38 33 84.62 5 12.82 34 87.18 An Nuseirat 26 5 19.23 21 80.77 5 19.23 21 80.77 Camp Az Zawayda 37 12 32.43 25 67.57 9 24.32 28 75.68 Al Bureij 66 15 22.73 51 77.27 15 22.73 51 77.27 Al Bureij Camp 27 15 55.56 12 44.44 13 48.15 14 51.85 Al Maghazi 26 8 30.77 18 69.23 8 30.77 18 69.23 Al Maghazi 28 5 17.86 23 82.14 4 14.29 24 85.71 Camp Deir al Balah 40 7 17.5 33 82.5 8 20 32 80 Deir al Balah 8 1 12.5 7 87.5 1 12.5 7 87.5 Camp Al Musaddar 2 0 0 2 100 1 50 1 50 Wadi as Salqa 135 85 62.96 50 37.04 86 63.7 49 36.3 Total 434 159 36.64 275 63.36 155 35.71 279 64.29 Khan Younis Al Qarara 38 7 18.42 31 81.58 9 23.68 29 76.32 Khan Younis 148 33 22.3 115 77.7 18 12.16 130 87.84 Khan Younis 140 43 30.71 97 69.29 38 27.14 102 72.86 Camp Bani Suheila 97 21 21.65 76 78.35 11 11.34 86 88.66 Abasan al 14 9 64.29 5 35.71 4 28.57 10 71.43 Jadida Abasan al 35 18 51.43 17 48.57 8 22.86 27 77.14 Kabira Khuza'a 137 109 79.56 28 20.44 17 12.41 120 87.59 Al Fukhari 8 1 12.5 7 87.5 1 12.5 7 87.5 Total 617 241 39.06 376 60.94 106 17.18 511 82.82 Rafah Rafah 189 42 22.22 147 77.78 59 31.22 130 68.78 Rafah Camp 141 64 45.39 77 54.61 62 43.97 79 56.03 Shokat as Sufi 190 64 33.68 126 66.32 65 34.21 125 65.79 Al Naser 13 5 38.46 8 61.54 3 23.08 10 76.92 Total 533 175 32.83 358 67.17 189 35.46 344 64.54 Gaza Strip Total 3,166 1,499 47.35 1,667 52.65 1,372 43.34 1,794 56.66

Issues of unacceptable domestic water quality ( %) Pre-2014 Post-2014 Governorate/Locality Salinity Odour Turbidit Taste Salinity Odour Turbidit Taste y y North Beit Lahia 95.92 12.24 14.29 28.57 92.45 13.21 16.98 33.96 Beit Hanoun 98.08 5.77 9.62 25 98.15 3.7 9.26 24.07 Jabalia 91.67 15 8.33 50 90 16 10 60 Jabalia Camp 86.36 18.18 22.73 77.27 91.3 21.74 26.09 65.22 Omm Al Nasser 33.33 0 50 66.67 28.57 0 28.57 71.43 Total 92.06 11.64 13.23 41.27 90.91 11.76 14.44 43.32 Gaza

126

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Gaza 99.03 16.83 20.39 38.83 99.08 19.27 20.8 40.98 Ash Shati' Camp 100 18.39 28.74 65.52 100 20.55 30.14 69.86 Madinat Ezahra 0 0 0 0 0 0 0 0 Al Mughraqa 100 9.3 13.95 39.53 97.5 7.5 15 35 Juhor ad Dik 100 0 0 33.33 100 6.06 3.03 27.27 Total 99.36 15.35 20.04 43.5 99.15 17.55 20.51 43.97 Middle Area An Nuseirat 100 0 3.03 36.36 100 0 2.94 26.47 An Nuseirat Camp 100 9.52 9.52 61.9 100 14.29 14.29 52.38 Az Zawayda 100 24 28 64 100 10.71 14.29 46.43 Al Bureij 96.08 0 0 17.65 94.12 1.96 0 21.57 Al Bureij Camp 100 8.33 8.33 33.33 100 14.29 7.14 21.43 Al Maghazi 100 16.67 16.67 38.89 100 11.11 11.11 33.33 Al Maghazi Camp 100 8.7 17.39 56.52 100 4.17 16.67 33.33 Deir al Balah 93.94 6.06 9.09 36.36 93.75 12.5 6.25 21.88 Deir al Balah Camp 100 14.29 28.57 71.43 100 14.29 14.29 42.86 Al Musaddar 100 0 0 0 100 0 0 0 Wadi as Salqa 86 4 6 28 85.71 4.08 6.12 26.53 Total 96 6.91 9.45 38.18 95.7 6.81 7.53 30.11 Khan Younis Al Qarara 93.55 3.23 3.23 12.9 93.1 3.45 3.45 10.34 Khan Younis 98.26 6.96 9.57 19.13 99.23 11.54 10 17.69 Khan Younis Camp 100 3.09 13.4 46.39 100 2.94 14.71 43.14 Bani Suheila 100 3.95 5.26 32.89 100 1.16 5.81 30.23 Abasan al Jadida 80 20 40 40 90 50 30 30 Abasan al Kabira 94.12 0 0 11.76 100 7.41 3.7 11.11 Khuza'a 100 3.57 0 25 100 0 0 6.67 Al Fukhari 100 0 14.29 0 100 0 0 0 Total 98.4 4.52 8.51 28.46 99.22 5.28 7.44 21.53 Rafah Rafah 99.32 5.44 16.33 25.17 100 8.46 19.23 36.15 Rafah Camp 98.7 1.3 9.09 36.36 98.73 2.53 12.66 39.24 Shokat as Sufi 99.21 2.38 5.56 12.7 100 1.6 3.2 7.2 Al Naser 87.5 0 12.5 25 100 0 0 20 Total 98.88 3.35 10.89 23.18 99.71 4.36 11.34 25.87 Gaza Strip Total 97.66 8.52 12.96 34.61 97.88 9.25 12.37 31.88

Table F.22: W10: Percentage of women and men who use drinking water for domestic use

Total # of HHs People using drinking water for domestic (interviewees) Women Men Women & Men Governorate Wome Wome # of % of # of % of # of % of Men n & n HHs HHs HHs HHs HHs HHs Men North 248 428 676 1 0.4 36 8.41 37 5.47 Gaza 404 502 906 20 4.95 15 2.99 35 3.86 Middle Area 106 328 434 3 2.83 1 0.3 4 0.92 Khan Younis 309 308 617 23 7.44 27 8.77 50 8.1 Rafah 117 416 533 12 10.26 43 10.34 55 10.32 Gaza Strip 1,184 1,982 3,166 59 4.98 122 6.16 181 5.72

Total # of HHs For bathing ( %) For cleaning ( %) Governorate (interviewees) Wome Men Wome Wome Men Wome Wome Men Wome

127

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

n n & n n & n n & Men Men Men North 248 428 676 0.4 7.24 4.73 0.4 7.01 4.59 Gaza 404 502 906 3.96 1.59 2.65 0.99 0.6 0.77 Middle Area 106 328 434 2.83 0.3 0.92 1.89 0.3 0.69 Khan Younis 309 308 617 2.91 3.57 3.24 1.62 2.6 2.11 Rafah 117 416 533 4.27 5.05 4.88 1.71 1.92 1.88 Gaza Strip 1,184 1,982 3,166 2.87 3.63 3.35 1.18 2.52 2.02

For washing dishes ( %) For ablution ( %) For children showering ( %) Wome Wome Wome Governorate Wome Wome Wome Men n & Men n & Men n & n n n Men Men Men North 0.4 7.48 4.88 0.4 7.48 4.88 0 5.84 3.7 Gaza 0.99 1 0.99 1.49 0.8 1.1 1.49 1.59 1.55 Middle Area 1.89 0.3 0.69 0.94 0.3 0.46 0.94 0.3 0.46 Khan Younis 2.59 2.6 2.59 5.18 3.57 4.38 3.56 5.19 4.38 Rafah 4.27 3.61 3.75 6.84 5.05 5.44 4.27 5.29 5.07 Gaza Strip 1.69 3.08 2.56 2.7 3.48 3.19 1.94 3.63 3

Table F.23: W11: Percentage of women and men who use domestic water as an alternative source of drinking water

Total # of HHs People using domestic water for drinking use (interviewees) Women Men Women & Men Governor Wome ate Wome # of # of # of % of Men n & % of HHs % of HHs n HHs HHs HHs HHs Men North 248 428 676 59 23.79 106 24.77 165 24.41 Gaza 404 502 906 48 11.88 54 10.76 102 11.26 Middle 28 26.42 56 17.07 84 19.35 106 328 434 Area Khan 77 24.92 80 25.97 157 25.45 309 308 617 Younis Rafah 117 416 533 23 19.66 34 8.17 57 10.69 1,98 235 19.85 330 16.65 565 17.85 Gaza Strip 1,184 3,166 2

Total # of HHs (interviewees) For drinking ( %) For cooking ( %) Governorate Women & Women & Women Women Men Women Men Women Men Men Men & Men North 248 428 676 5.65 14.72 11.39 23.79 24.77 24.41 Gaza 404 502 906 0.74 2.79 1.88 11.88 10.56 11.15 Middle Area 106 328 434 0.94 0.61 0.69 26.42 17.07 19.35 Khan Younis 309 308 617 1.94 2.27 2.11 24.92 25.97 25.45 Rafah 117 416 533 4.27 2.16 2.63 19.66 7.93 10.51 Gaza Strip 1,184 1,982 3,166 2.45 4.79 3.92 19.85 16.55 17.78

Table F.24: W12: Percentage of households engaging children in drinking water collection

# of HHs engaging % of HHs engaging Governorate Total # of HHs children children North 676 72 10.65 Gaza 906 128 14.13 Middle Area 434 13 3

128

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Khan Younis 617 82 13.29 Rafah 533 49 9.19 Gaza Strip 3,166 344 10.87

Table F.25: W13: Percentage of households engaging women in drinking water collection

# of HHs engaging % of HHs engaging Governorate Total # of HHs women women North 676 20 2.96 Gaza 906 16 1.77 Middle Area 434 6 1.38 Khan Younis 617 20 3.24 Rafah 533 10 1.88 Gaza Strip 3,166 72 2.27

Table F.26: W14: Cleaning conditions for drinking water storage vessels

Total # of People perception about the cleaning conditions of the drinking water HHs storages (interviewee Bad cleaning conditions Good cleaning conditions Governorate/ s) Women Men Women Men Locality # of # of # of % of # of % of # of % of # of % of Wom Me HHs HHs HHs HHs HHs HHs HHs HHs en n North Beit Lahia 34 148 6 17.65 10 6.76 28 82.35 138 93.24 Beit Hanoun 49 100 2 4.08 8 8.00 47 95.92 92 92.00 Jabalia 41 89 3 7.32 5 5.62 38 92.68 84 94.38 Jabalia Camp 120 42 8 6.67 2 4.76 112 93.33 40 95.24 Omm Al Nasser 4 49 0 0.00 1 2.04 4 100.00 48 97.96 Total 248 428 19 7.66 26 6.07 229 92.34 402 93.93 Gaza Gaza 262 361 15 5.73 23 6.37 247 94.27 338 93.63 Ash Shati' Camp 41 51 4 9.76 2 3.92 37 90.24 49 96.08 Madinat Ezahra 3 2 0 0.00 0 0.00 3 100.00 2 100.00 Al Mughraqa 53 43 4 7.55 1 2.33 49 92.45 42 97.67 Juhor ad Dik 45 45 2 4.44 2 4.44 43 95.56 43 95.56 Total 404 502 25 6.19 28 5.58 379 93.81 474 94.42 Middle Area An Nuseirat 13 26 0 0.00 0 0.00 13 100.00 26 100.00 An Nuseirat 9 17 0 0.00 0 0.00 9 100.00 17 100.00 Camp Az Zawayda 4 33 0 0.00 3 9.09 4 100.00 30 90.91 Al Bureij 18 48 0 0.00 1 2.08 18 100.00 47 97.92 Al Bureij Camp 3 24 0 0.00 2 8.33 3 100.00 22 91.67 Al Maghazi 5 21 0 0.00 2 9.52 5 100.00 19 90.48 Al Maghazi 12 16 1 8.33 0 0.00 11 91.67 16 100.00 Camp Deir al Balah 2 6 0 0.00 0 0.00 2 100.00 6 100.00 Camp Deir al Balah 15 25 1 6.67 3 12.00 14 93.33 22 88.00 Al Musaddar 2 0 0 0.00 0 0.00 2 100.00 0 0.00 Wadi as Salqa 23 112 2 8.70 23 20.54 21 91.30 89 79.46

129

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Total 106 328 4 3.77 34 10.37 102 96.23 294 89.63 Khan Younis Al Qarara 7 31 0 0.00 2 6.45 7 100.00 29 93.55 Khan Yunis 66 82 3 4.55 6 7.32 63 95.45 76 92.68 Khan Younis 76 64 6 7.89 5 7.81 70 92.11 59 92.19 Camp Bani Suheila 78 19 0 0.00 0 0.00 78 100.00 19 100.00 Abasan al 10 4 0 0.00 0 0.00 10 100.00 4 100.00 Jadida Abasan al 14 21 0 0.00 0 0.00 14 100.00 21 100.00 Kabira Khuza'a 55 82 0 0.00 5 6.10 55 100.00 77 93.90 Al Fukhari 3 5 0 0.00 0 0.00 3 100.00 5 100.00 Total 309 308 9 2.91 18 5.84 300 97.09 290 94.16 Rafah Rafah 27 162 4 14.81 13 8.02 23 85.19 149 91.98 Rafah Camp 60 81 2 3.33 10 12.35 58 96.67 71 87.65 Shokat as Sufi 27 163 7 25.93 29 17.79 20 74.07 134 82.21 Al Naser 3 10 0 0.00 2 20.00 3 100.00 8 80.00 Total 117 416 13 11.11 54 12.98 104 88.89 362 87.02 Gaza Strip 1,9 Total 1,184 70 5.91 160 8.07 1,114 94.09 1,822 91.93 82

Table F.27: W15: Cleaning conditions for domestic water storage vessels

People perception about the cleaning conditions of the domestic Total # of HHs water storages Governorate/ (interviewees) Bad cleaning conditions Good cleaning conditions Locality Women Men Women Men # of # of # of % of # of % of # of % of # of % of Women Men HHs HHs HHs HHs HHs HHs HHs HHs North Beit Lahia 34 148 29 85.29 68 45.95 5 14.71 80 54.05 Beit Hanoun 49 100 31 63.27 61 61.00 18 36.73 39 39.00 Jabalia 41 89 26 63.41 62 69.66 15 36.59 27 30.34 Jabalia Camp 120 42 82 68.33 32 76.19 38 31.67 10 23.81 Omm Al Nasser 4 49 2 50.00 5 10.20 2 50.00 44 89.80 Total 248 428 170 68.55 228 53.27 78 31.45 200 46.73 Gaza Gaza 262 361 213 81.30 308 85.32 49 18.70 53 14.68 Ash Shati' Camp 41 51 37 90.24 46 90.20 4 9.76 5 9.80 100.0 Madinat Ezahra 3 2 3 1 50.00 0 0.00 1 50.00 0 Al Mughraqa 53 43 40 75.47 38 88.37 13 24.53 5 11.63 Juhor ad Dik 45 45 27 60.00 20 44.44 18 40.00 25 55.56 Total 404 502 320 79.21 413 82.27 84 20.79 89 17.73 Middle Area An Nuseirat 13 26 11 84.62 24 92.31 2 15.38 2 7.69 An Nuseirat Camp 9 17 7 77.78 14 82.35 2 22.22 3 17.65 100.0 100.0 Az Zawayda 4 33 4 33 0 0.00 0 0.00 0 0 100.0 100.0 Al Bureij 18 48 18 48 0 0.00 0 0.00 0 0 Al Bureij Camp 3 24 3 100.0 24 100.0 0 0.00 0 0.00

130

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

0 0 100.0 100.0 Al Maghazi 5 21 5 21 0 0.00 0 0.00 0 0 100.0 Al Maghazi Camp 12 16 12 15 93.75 0 0.00 1 6.25 0 Deir al Balah 15 25 13 86.67 24 96.00 2 13.33 1 4.00 100.0 100.0 Deir al Balah Camp 2 6 2 6 0 0.00 0 0.00 0 0 100.0 Al Musaddar 2 0 2 0 0.00 0 0.00 0 0.00 0 Wadi as Salqa 23 112 20 86.96 110 98.21 3 13.04 2 1.79 Total 106 328 97 91.51 319 97.26 9 8.49 9 2.74 Khan Younis Al Qarara 7 31 5 71.43 25 80.65 2 28.57 6 19.35 Khan Younis 66 82 39 59.09 64 78.05 27 40.91 18 21.95 Khan Younis Camp 76 64 64 84.21 50 78.13 12 15.79 14 21.88 Bani Suheila 78 19 47 60.26 8 42.11 31 39.74 11 57.89 100.0 Abasan al Jadida 10 4 6 60.00 0 0.00 4 40.00 4 0 Abasan al Kabira 14 21 7 50.00 10 47.62 7 50.00 11 52.38 Khuza'a 55 82 47 85.45 69 84.15 8 14.55 13 15.85 Al Fukhari 3 5 1 33.33 1 20.00 2 66.67 4 80.00 Total 309 308 216 69.90 227 73.70 93 30.10 81 26.30 Rafah Rafah 27 162 21 77.78 142 87.65 6 22.22 20 12.35 Rafah Camp 60 81 47 78.33 67 82.72 13 21.67 14 17.28 Shokat as Sufi 27 163 26 96.30 162 99.39 1 3.70 1 0.61 100.0 100.0 Al Naser 3 10 3 10 0 0.00 0 0.00 0 0 Total 117 416 97 82.91 381 91.59 20 17.09 35 8.41 Gaza Strip Total 1,184 1,982 900 76.01 1568 79.11 284 23.99 414 20.89

Table F.28: W16: Percentage of households that don’t pay for domestic water

HHs that don’t pay HHs that don’t pay because they are not because of economic Governorate/ Total # of HHs that don’t pay connected to situation or lack of Locality HHs municipal social responsibility network/well # of HHs % of HHs # of HHs % of HHs # of HHs % of HHs North Beit Lahia 182 144 79.12 126 87.5 18 12.5 Beit Hanoun 149 74 49.66 74 100 0 0 Jabalia 130 63 48.46 56 88.89 7 11.11 Jabalia Camp 162 111 68.52 97 87.39 14 12.61 Omm Al Nasser 53 41 77.36 39 95.12 2 4.88 Total 676 433 64.05 392 90.53 41 9.47 Gaza Gaza 623 310 49.76 279 90 31 10 Ash Shati' Camp 92 65 70.65 65 100 0 0 Madinat Ezahra 5 0 0.00 0 0 0 0 Al Mughraqa 96 55 57.29 41 74.55 14 25.45 Juhor ad Dik 90 64 71.11 36 56.25 28 43.75 Total 906 494 54.53 421 85.22 73 14.78 Middle Area

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An Nuseirat 39 16 41.03 16 100 0 0 An Nuseirat Camp 26 14 53.85 6 42.86 8 57.14 Az Zawayda 37 26 70.27 22 84.62 4 15.38 Al Bureij 66 31 46.97 10 32.26 21 67.74 Al Bureij Camp 27 17 62.96 17 100 0 0 Al Maghazi 26 10 38.46 9 90 1 10 Al Maghazi Camp 28 16 57.14 16 100 0 0 Deir al Balah 40 12 30.00 11 91.67 1 8.33 Deir al Balah Camp 8 3 37.50 3 100 0 0 Al Musaddar 2 0 0.00 0 0 0 0 Wadi as Salqa 135 71 52.59 16 22.54 55 77.46 Total 434 216 49.77 126 58.33 90 41.67 Khan Younis Al Qarara 38 24 63.16 20 83.33 4 16.67 Khan Younis 148 74 50.00 72 97.3 2 Khan Younis Camp 140 88 62.86 77 87.5 11 Bani Suheila 97 67 69.07 67 100 0 0 Abasan al Jadida 14 3 21.43 3 100 0 0 Abasan al Kabira 35 24 68.57 24 100 0 0 Khuza'a 137 124 90.51 124 100 0 0 Al Fukhari 8 3 37.50 3 100 0 0 Total 617 407 65.96 390 95.82 17 4.18 Rafah Rafah 189 77 40.74 74 96.1 3 3.9 Rafah Camp 141 90 63.83 89 98.89 1 1.11 Shokat as Sufi 190 72 37.89 59 81.94 13 18.06 Al Naser 13 8 61.54 6 75 2 25 Total 533 247 46.34 228 92.31 19 7.69 Gaza Strip Total 3,166 56.76 1,797 86.64 1,557 13.36 240

Table F.29: W17: Changes in need priorities for drinking water pre- and post-2014

Total # of HHs Perception of people (interviewees) Pre-2014 Post-2014 % of % of Priority % of % of Wome %of Wome %of Wome Men Wome Wome n Men n & Men n & n n Men Men North Distributing home desalination 14.11 19.63 17.6 14.11 17.06 15.98 filters Extra water tanks 38.31 25.7 30.33 42.74 22.66 30.03 Low cost water 7.66 1.64 3.85 8.87 1.4 4.14 Public awareness on drinking 2.82 4.91 4.14 2.02 4.91 3.85 water 248 428 Rehabilitation of water 14.52 19.39 17.6 14.52 26.17 21.89 pipelines Building more desalination 20.56 27.8 25.15 16.53 27.34 23.37 plants No priority 2.02 0.93 1.33 1.21 0.7 0.89 Gaza Distributing home desalination 21.53 20.72 21.08 21.04 17.53 19.09 filters 404 502 Extra water tanks 31.68 24.9 27.92 32.43 23.11 27.26

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Low cost water 10.4 2.39 5.96 7.67 1.39 4.19 Public awareness on drinking 2.97 6.77 5.08 2.23 6.37 4.53 water Rehabilitation of water 12.38 17.93 15.45 17.57 23.31 20.75 pipelines Building more desalination 20.3 26.29 23.62 18.56 27.29 23.4 plants No priority 0.74 1.2 0.99 0.5 1.2 0.88 Middle Area Distributing home desalination 8.49 7.62 7.83 7.55 6.4 6.68 filters Extra water tanks 33.96 33.23 33.41 33.02 31.71 32.03 Low cost water 1.89 1.22 1.38 4.72 1.22 2.07 Public awareness on drinking 2.83 3.66 3.46 2.83 3.66 3.46 water 106 328 Rehabilitation of water 15.09 20.73 19.35 11.32 26.22 22.58 pipelines Building more desalination 37.74 33.54 34.56 40.57 30.79 33.18 plants No priority 0 0 0 0 0 0 Khan Younis Distributing home desalination 23.62 19.81 21.72 19.74 18.51 19.12 filters Extra water tanks 29.45 36.69 33.06 30.42 33.44 31.93 Low cost water 1.94 0.65 1.3 1.62 0.32 0.97 Public awareness on drinking 2.91 6.49 4.7 1.62 5.52 3.57 water 309 308 Rehabilitation of water 20.39 21.1 20.75 34.3 27.92 31.12 pipelines Building more desalination 21.04 14.94 17.99 11.65 13.96 12.8 plants No priority 0.65 0.32 0.49 0.65 0.32 0.49 Rafah Distributing home desalination 6.84 8.41 8.07 4.27 8.17 7.32 filters Extra water tanks 45.3 27.4 31.33 46.15 22.6 27.77 Low cost water 1.71 1.92 1.88 2.56 2.4 2.44 Public awareness on drinking 2.56 1.92 2.06 1.71 1.44 1.5 water 117 416 Rehabilitation of water 22.22 29.57 27.95 22.22 37.02 33.77 pipelines Building more desalination 20.51 30.77 28.52 23.08 28.37 27.2 plants No priority 0.86 0 0.19 0 0 0 Gaza Strip Distributing home desalination 17.91 15.59 16.46 16.39 13.77 14.75 filters Extra water tanks 34.04 28.81 30.76 35.47 25.93 29.5 Low cost water 6 1.66 3.28 5.57 1.41 2.97 Public awareness on drinking 2.87 4.79 4.07 2.03 4.44 3.54 water 1,184 1,982 Rehabilitation of water 16.13 21.64 19.58 21.2 28 25.46 pipelines Building more desalination 22.13 26.99 25.17 18.75 26.03 23.31 plants No priority 0.93 0.55 0.69 0.59 0.5 0.54

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Table F.30: W18: Changes in need priorities of domestic water pre- and post-2014

Total # of HHs Perception of people (interviewees) Pre-2014 Post-2014 % of % of Priority % of % of Wome % of Wome % of Wome Men Wome Wome n Men n & Men n & n n Men Men North Distributing home desalination 0 0 0 1.61 1.64 1.63 filters Extra water tanks 43.15 22.43 30.03 39.11 19.63 26.78 Low cost water 0 0 0 2.02 0 0.74 Public awareness on domestic 0 0 0 2.02 4.91 3.85 water 248 428 Rehabilitation of water 29.03 52.1 43.64 34.68 54.67 47.34 pipelines Building more desalination 20.97 17.52 18.79 19.35 18.69 18.93 plants No priority 0 0 0 1.21 0.93 1.04 Gaza Distributing home desalination 0 0 0 0.99 4.38 2.87 filters Extra water tanks 34.41 17.93 25.28 37.87 19.92 27.92 Low cost water 0 0 0 2.48 0 1.1 Public awareness on domestic 0 0 0 0.99 3.98 2.65 water 404 502 Rehabilitation of water 33.66 53.78 44.81 39.6 53.78 47.46 pipelines Building more desalination 20.79 17.93 19.21 17.57 17.73 17.66 plants No priority 0 0 0 0.74 0.2 0.44 Middle Area Distributing home desalination 0 0 0 2.83 2.74 2.76 filters Extra water tanks 26.42 17.07 19.35 33.02 17.68 21.43 Low cost water 0 0 0 3.77 1.52 2.07 Public awareness on domestic 0 0 0 2.83 2.13 2.3 water 106 328 Rehabilitation of water 31.13 59.76 52.76 24.53 60.67 51.84 pipelines Building more desalination 33.02 17.68 21.43 33.02 15.24 19.59 plants No priority 0 0 0 0 0 0 Khan Younis Distributing home desalination 0 0 0 0.97 2.27 1.62 filters Extra water tanks 42.72 23.38 33.06 43.04 23.05 33.06 Low cost water 0 0 0 1.62 0 0.81 Public awareness on domestic 0 0 0 0.65 2.92 1.78 water 309 308 Rehabilitation of water 33.33 61.69 47.49 39.16 67.21 53.16 pipelines Building more desalination 16.83 7.47 12.16 13.92 4.22 9.08 plants No priority 0 0 0 1.29 0.32 0.81 Rafah

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Distributing home desalination 0 0 0 0.85 0.24 0.38 filters Extra water tanks 49.57 23.56 29.27 52.14 21.39 28.14 Low cost water 0 0 0 1.71 0.24 0.56 Public awareness on domestic 0 0 0 1.71 0.96 1.13 water 117 416 Rehabilitation of water 34.19 70.67 62.66 35.9 73.32 65.1 pipelines Building more desalination 11.11 3.85 5.44 6.84 3.85 4.5 plants No priority 0 0 0 1.71 0 0.38 Gaza Strip Distributing home desalination 0 0 0 1.27 2.32 1.93 filters Extra water tanks 39.19 20.79 27.67 40.46 20.28 27.83 Low cost water 0 0 0 2.2 0.3 1.01 Public awareness on domestic 0 0 0 1.35 3.08 2.43 water 1,184 1,982 Rehabilitation of water 32.43 59.18 49.18 36.74 61.3 52.12 pipelines Building more desalination 19.93 13.22 15.73 17.31 12.51 14.31 plants No priority 0 0 0 1.01 0.3 0.57

Table F.31: W19: Different coping mechanisms carried out by women and men related to water problems

Total # of Coping mechanisms carried out by people HHs Women & Women Men (interviewees) Men Mechanism # of Wom # of % of # of % of % of Men HH en HHs HHs HHs HHs HHs s Saving water through reducing the water 136 422 35.64 942 47.53 43.08 consumption 4 Increasing the storage capacity of domestic 203 17.15 405 20.43 608 19.2 water though using enough tanks Using small tanks and jerry cans to store 211 17.82 189 9.54 400 12.63 water for emergencies Purchasing drinking water for domestic use 157 13.26 141 7.11 298 9.41 when the domestic water is not available Doing no action 106 8.95 166 8.38 272 8.59 Maintaining the household internal water 8 0.68 50 2.52 58 1.83 pipes Getting the domestic water from the 1,184 1,982 30 2.53 20 1.01 50 1.58 neighbors when it is not available Getting the water from own private well 7 0.59 36 1.82 43 1.36 Reuse of the grey water for agriculture 18 1.52 8 0.4 26 0.82 purposes Reusing the water for ground cleaning 16 1.35 4 0.2 20 0.63 Using stand-by power generator when the electricity is not available to pump the water 4 0.34 7 0.35 11 0.35 to the roof tanks Using the detergents during the cleaning to 0 0 11 0.55 11 0.35 reduce the required water quantity Storm water harvesting 1 0.08 1 0.05 2 0.06 Using RO filters to desalinate the water 1 0.08 1 0.05 2 0.06

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Covering the storage tanks tightly to avoid 0 0 1 0.05 1 0.03 water pollution

Table F.32: S1: Percentage of households without toilets or without sufficient toilets pre- and post-2014

HHs without a toilet HHs without sufficient toilets Total Pre-2014 Post-2014 Pre-2014 Post-2014 Governorate/Locality # of # of % of # of % of # of % of # of % of HHs HHs HHs HHs HHs HHs HHs HHs HHs North Beit Lahia 182 2 1.1 4 2.2 14 7.69 16 8.79 Beit Hanoun 149 0 0 2 1.34 14 9.4 22 14.77 Jabalia 130 0 0 0 0 4 3.08 9 6.92 Jabalia Camp 162 0 0 0 0 14 8.64 17 10.49 Omm Al Nasser 53 1 1.89 0 0 6 11.32 6 11.32 Total 676 3 0.44 6 1 52 8 70 10 Gaza Gaza 623 0 0 6 0.96 35 5.62 58 9.31 Ash Shati' Camp 92 0 0 0 0 13 14.13 13 14.13 Madinat Ezahra 5 0 0 0 0 0 0 0 0 Al Mughraqa 96 0 0 1 1.04 13 13.54 15 15.63 Juhor ad Dik 90 0 0 4 4.44 4 4.44 7 7.78 Total 906 0 0 11 1 65 7 93 10 Middle Area An Nuseirat 39 0 0 0 0 2 5.13 2 5.13 An Nuseirat Camp 26 0 0 0 0 3 11.54 3 11.54 Az Zawayda 37 0 0 0 0 2 5.41 2 5.41 Al Bureij 66 0 0 0 0 6 9.09 6 9.09 Al Bureij Camp 27 0 0 0 0 3 11.11 3 11.11 Al Maghazi 26 0 0 0 0 7 26.92 6 23.08 Al Maghazi Camp 28 0 0 0 0 2 7.14 2 7.14 Deir al Balah 40 0 0 0 0 2 5 3 7.5 Deir al Balah Camp 8 0 0 0 0 1 12.5 2 25 Al Musaddar 2 0 0 0 0 0 0 0 0 Wadi as Salqa 135 0 0 2 1.48 16 11.85 16 11.85 Total 434 0 0 2 0.46 44 10 45 10 Khan Younis Al Qarara 38 0 0 0 0 5 13.16 6 15.79 Khan Younis Camp 140 1 0.71 1 0.71 16 11.43 17 12.14 Khan Younis 148 2 1.35 4 2.7 21 14.19 21 14.19 Bani Suheila 97 0 0 4 4.12 7 7.22 10 10.31 Abasan al Jadida 14 0 0 0 0 0 0 0 0 Abasan al Kabira 35 0 0 1 2.86 3 8.57 5 14.29 Khuza'a 137 0 0 2 1.46 3 2.19 6 4.38 Al Fukhari 8 0 0 0 0 1 12.5 2 25 Total 617 3 0.49 12 2 56 9 67 11 Rafah Rafah 189 0 0 1 0.53 26 13.76 26 13.76 Rafah Camp 141 0 0 1 0.71 14 9.93 14 9.93 Shokat as Sufi 190 1 0.53 1 0.53 29 15.26 33 17.37 Al Naser 13 0 0 0 0 1 7.69 1 7.69 Total 533 1 0.19 3 1 70 13 74 14 Gaza Strip Total 3,166 7 0.22 34 1 287 9 349 11

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Table F.33: S2: Households without access to wastewater networks pre- and post-2014

Governorate/ Pre-2014 Post-2014 Total # of HHs Locality # of HHs % of HHs # of HHs % of HHs North Beit Lahia 182 39 21.43 39 21.43 Beit Hanoun 149 14 9.4 13 8.72 Jabalia 130 4 3.08 2 1.54 Jabalia Camp 162 1 0.62 0 0 Omm Al Nasser 53 31 58.49 31 58.49 Total 676 89 13.17 85 12.57 Gaza Gaza 623 35 5.62 37 5.94 Ash Shati' Camp 92 0 0 1 1.09 Madinat Ezahra 5 0 0 0 0 Al Mughraqa 96 54 56.25 53 55.21 Juhor ad Dik 90 77 85.56 79 87.78 Total 906 166 18.32 170 18.76 Middle Area An Nuseirat 39 6 15.38 4 10.26 An Nuseirat Camp 26 5 19.23 5 19.23 Az Zawayda 37 13 35.14 13 35.14 Al Bureij 66 51 77.27 52 78.79 Al Bureij Camp 27 2 7.41 2 7.41 Al Maghazi 26 13 50 12 46.15 Al Maghazi Camp 28 6 21.43 6 21.43 Deir al Balah 40 2 5 2 5 Deir al Balah Camp 8 0 0 0 0 Al Musaddar 2 1 50 1 50 Wadi as Salqa 135 100 74.07 100 74.07 Total 434 199 45.85 197 45.39 Khan Younis Al Qarara 38 20 52.63 21 55.26 Khan Younis 148 49 33.11 50 33.78 Khan Younis Camp 140 58 41.43 57 40.71 Bani Suheila 97 80 82.47 81 83.51 Abasan al Jadida 14 9 64.29 9 64.29 Abasan al Kabira 35 27 77.14 30 85.71 Khuza'a 137 71 51.82 75 54.74 Al Fukhari 8 7 87.5 7 87.5 Total 617 321 52.03 330 53.48 Rafah Rafah 189 56 29.63 54 28.57 Rafah Camp 141 2 1.42 0 0 Shokat as Sufi 190 99 52.11 98 51.58 Al Naser 13 9 69.23 9 69.23 Total 533 166 31.14 161 30.21 Gaza Strip Total 3,166 941 29.72 943 29.79

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Table F.34: S3: Percentage of households without proper surrounding storm water drainage

HHs without proper surrounding drainages Governorate/Locality Total # of HHs # of HHs % of HHs North Beit Lahia 182 95 52.2 Beit Hanoun 149 71 47.65 Jabalia 130 32 24.62 Jabalia Camp 162 83 51.23 Omm Al Nasser 53 49 92.45 Total 676 330 48.82 Gaza Gaza 623 156 25.04 Ash Shati' Camp 92 73 79.35 Madinat Ezahra 5 0 0 Al Mughraqa 96 55 57.29 Juhor ad Dik 90 64 71.11 Total 906 348 38.41 Middle Area An Nuseirat 39 8 20.51 An Nuseirat Camp 26 14 53.85 Az Zawayda 37 21 56.76 Al Bureij 66 44 66.67 Al Bureij Camp 27 2 7.41 Al Maghazi 26 14 53.85 Al Maghazi Camp 28 16 57.14 Deir al Balah 40 15 37.5 Deir al Balah Camp 8 2 25 Al Musaddar 2 2 100 Wadi as Salqa 135 119 88.15 Total 434 257 59.22 Khan Younis Al Qarara 38 31 81.58 Khan Younis 148 60 40.54 Khan Younis Camp 140 110 78.57 Bani Suheila 97 27 27.84 Abasan al Jadida 14 8 57.14 Abasan al Kabira 35 17 48.57 Khuza'a 137 63 45.99 Al Fukhari 8 5 62.5 Total 617 321 52.03 Rafah Rafah 189 106 56.08 Rafah Camp 141 84 59.57 Shokat as Sufi 190 161 84.74 Al Naser 13 8 61.54 Total 533 359 67.35 Gaza Strip Total 3,166 1,615 51.01

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2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.35: S4: Percentage of households that need access to safe solid waste disposal

HHs without safe solid waste disposal Governorate/Locality Total # of HHs means # of HHs % of HHs North Beit Lahia 182 147 80.77 Beit Hanoun 149 118 79.19 Jabalia 130 49 37.69 Jabalia Camp 162 140 86.42 Omm Al Nasser 53 51 96.23 Total 676 505 74.7 Gaza Gaza 623 360 57.78 Ash Shati' Camp 92 81 88.04 Madinat Ezahra 5 3 60 Al Mughraqa 96 80 83.33 Juhor ad Dik 90 78 86.67 Total 906 602 66.45 Middle Area An Nuseirat 39 22 56.41 An Nuseirat Camp 26 20 76.92 Az Zawayda 37 29 78.38 Al Bureij 66 44 66.67 Al Bureij Camp 27 14 51.85 Al Maghazi 26 17 65.38 Al Maghazi Camp 28 22 78.57 Deir al Balah 40 20 50 Deir al Balah Camp 8 5 62.5 Al Musaddar 2 0 0 Wadi as Salqa 135 118 87.41 Total 434 311 71.99 Khan Younis Al Qarara 38 33 86.84 Khan Younis 148 90 60.81 Khan Younis Camp 140 121 86.43 Bani Suheila 97 56 57.73 Abasan al Jadida 14 2 14.29 Abasan al Kabira 35 15 42.86 Khuza'a 137 86 62.77 Al Fukhari 8 5 62.5 Total 617 408 66.13 Rafah Rafah 189 137 72.49 Rafah Camp 141 118 83.69 Shokat as Sufi 190 176 92.63 Al Naser 13 6 46.15 Total 533 437 81.99 Gaza Strip Total 3,166 2,263 71.52

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Table F.36: S5: Change in need priorities in sanitation pre- and post-2014

Total # of HHs Perception of people (interviewees) Pre-2014 Post-2014 % of % of Priority % of % of Wome %of Wome %of Wome Men Wome Wome n Men n & Men n & n n Men Men North Activate the rule of the local 1.21 6.54 4.59 1.21 7.01 4.88 municipalities Awareness raising about 4.84 4.21 4.44 4.03 6.54 5.62 sanitation Building wastewater treatment 3.23 7.24 5.77 4.03 8.41 6.8 plants 248 428 Increase the quality of toilets 6.45 5.37 5.77 6.85 6.31 6.51 Increase the quantity of toilets 18.15 9.58 12.72 18.95 9.35 12.87 Installation/extension of 63.71 65.89 65.09 63.31 61.45 62.13 wastewater network Others 0.81 0 0.3 0.81 0 0.3 No priority 1.61 1.17 1.33 0.81 0.93 0.89 Gaza Activate the rule of the local 2.97 5.98 4.64 3.22 5.58 4.53 municipalities Awareness raising about 5.94 8.76 7.51 5.69 8.96 7.51 sanitation Building wastewater treatment 6.19 5.58 5.85 6.44 5.98 6.18 plants 404 502 Increase the quality of toilets 8.66 4.98 6.62 9.16 6.57 7.73 Increase the quantity of toilets 25 14.74 19.32 26.49 18.33 21.96 Installation/extension of 50.25 59.56 55.41 48.02 53.59 51.1 wastewater network Others 0.25 0 0.11 0.5 0.2 0.33 No priority 0.99 0.4 0.66 0.5 0.8 0.66 Middle Area Activate the rule of the local 2.83 0.91 1.38 2.83 0.91 1.38 municipalities Awareness raising about 3.77 6.1 5.53 3.77 5.79 5.3 sanitation Building wastewater treatment 3.77 2.74 3 3.77 3.35 3.46 plants 106 328 Increase the quality of toilets 15.09 11.89 12.67 14.15 13.41 13.59 Increase the quantity of toilets 23.58 36.28 33.18 24.53 34.45 32.03 Installation/extension of 50.94 41.77 44.01 50.94 41.77 44.01 wastewater network Others 0 0.3 0.23 0 0.3 0.23 No priority Khan Younis Activate the rule of the local 1.62 3.25 2.43 1.62 3.25 2.43 municipalities Awareness raising about 1.94 6.49 4.21 1.94 6.49 4.21 sanitation Building wastewater treatment 309 308 14.24 18.51 16.37 14.89 19.16 17.02 plants Increase the quality of toilets 7.44 8.12 7.78 7.77 9.09 8.43 Increase the quantity of toilets 20.06 16.56 18.31 23.95 19.16 21.56 Installation/extension of 53.4 46.43 49.92 48.54 42.21 45.38

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2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

wastewater network Others 0.32 0 0.16 0.32 0 0.16 No priority 0.97 0.65 0.81 0.97 0.65 0.81 Rafah Activate the rule of the local 0 2.64 2.06 0 2.64 2.06 municipalities Awareness raising about 1.71 4.57 3.94 3.42 3.85 3.75 sanitation Building wastewater treatment 7.69 16.59 14.63 5.13 15.87 13.51 plants 117 416 Increase the quality of toilets 9.4 8.17 8.44 11.11 8.41 9.01 Increase the quantity of toilets 36.75 33.89 34.52 36.75 36.3 36.4 Installation/extension of 41.03 33.65 35.27 36.75 32.21 33.21 wastewater network Others 0.85 0 0.19 0.85 0 0.19 No priority 2.56 0.48 0.94 5.98 0.72 1.88 Gaza Strip Activate the rule of the local 1.94 4.14 3.32 2.03 4.14 3.35 municipalities Awareness raising about 4.05 6.1 5.34 3.97 6.46 5.53 sanitation Building wastewater treatment 7.6 9.79 8.97 7.77 10.19 9.29 plants 1,184 1,982 Increase the quality of toilets 8.53 7.37 7.8 8.95 8.43 8.62 Increase the quantity of toilets 23.31 21.49 22.17 25.08 22.96 23.75 Installation/extension of 53.04 50.5 51.45 50.51 47.07 48.36 wastewater network Others 0.42 0.05 0.19 0.51 0.1 0.25 No priority 1.18 0.55 0.79 1.18 0.66 0.85

Table F.37: S6: Different coping mechanisms used by women and men to improve sanitation

Coping mechanisms carried out by people Total # of HHs Women & (interviewees) Women Men Mechanism Men # of % of # of % of # of % of Women Men HHs HHs HHs HHs HHs HHs Cleaning and maintaining the household 417 35.22 769 38.8 1186 37.46 internal wastewater pipes and strainers Avoid throwing solid wastes, cooking oil and sands inside the wastewater 267 22.55 398 20.08 665 21 strainers Doing no action 187 15.79 209 10.54 396 12.51 Covering the household wastewater 140 11.82 143 7.21 283 8.94 strainers very well Vacuuming the cesspits regularly 44 3.72 220 11.1 264 8.34 Connecting only the toilets to the 1,184 1,982 cesspits to avoid cesspit overflow (the 65 5.49 121 6.1 186 5.87 grey water is used for irrigation or discharged into the street) Drilling new cesspits when the existing 21 1.77 44 2.22 65 2.05 one is full Reducing water consumption to decease wastewater quantity to avoid 13 1.1 37 1.87 50 1.58 cesspits overflow NA (no knowledge about the required 18 1.52 22 1.11 40 1.26

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coping mechanisms) Using insecticide to combat the insects 12 1.01 19 0.96 31 0.98 available due to the wastewater

Table F.38: H1: Changes in source of water heating pre- and post-2014

Pre-2014 Post-2014 Electri Electri Solar Gas Solar Gas Governorate/ Total # c. Wood c. Wood heating heating heating heating Locality of HHs heating heating % of % of % of % of % of % of % of % of HHs HHs HHs HHs HHs HHs HHs HHs North

Beit Lahia 182 46.7 43.41 28.57 27.47 32.97 46.7 31.87 29.67 Beit Hanoun 149 59.73 59.06 16.11 16.11 29.53 59.06 31.54 19.46 Jabalia 130 68.46 67.69 23.85 4.62 51.54 67.69 26.15 8.46 Jabalia Camp 162 63.58 69.14 23.46 4.32 43.83 69.75 32.1 6.17 Omm Al Nasser 53 3.77 13.21 11.32 83.02 3.77 11.32 13.21 83.02 Total 676 54.44 55.33 22.34 19.38 36.09 56.21 29.29 21.89 Gaza Gaza 623 56.02 69.98 19.1 8.51 30.34 65.81 30.82 9.79 Ash Shati' Camp 92 25 58.7 55.43 8.7 21.74 58.7 55.43 8.7 Madinat Ezahra 5 20 80 0 0 20 80 0 0 Al Mughraqa 96 44.79 54.17 40.63 18.75 31.25 54.17 44.79 22.92 Juhor ad Dik 90 45.56 55.56 22.22 17.78 13.33 50 37.78 30 Total 906 50.44 65.78 25.28 10.49 27.81 62.36 35.32 13.02 Middle Area An Nuseirat 39 53.85 89.74 5.13 2.56 43.59 92.31 7.69 0 An Nuseirat 26 46.15 76.92 7.69 3.85 26.92 76.92 19.23 3.85 Camp Az Zawayda 37 54.05 67.57 8.11 5.41 43.24 67.57 16.22 8.11 Al Bureij 66 54.55 69.7 4.55 4.55 28.79 75.76 12.12 9.09 Al Bureij Camp 27 59.26 59.26 3.7 7.41 44.44 59.26 11.11 3.7 Al Maghazi 26 46.15 61.54 7.69 19.23 23.08 61.54 19.23 23.08 Al Maghazi 28 75 60.71 3.57 0 28.57 46.43 28.57 3.57 Camp Deir al Balah 40 80 90 2.5 0 47.5 92.5 2.5 0 Deir al Balah 8 75 87.5 37.5 0 37.5 87.5 37.5 0 Camp Al Musaddar 2 100 0 0 0 50 50 0 0 Wadi as Salqa 135 54.07 37.04 18.52 4.44 31.11 33.33 37.78 9.63 Total 434 57.83 61.75 9.91 4.61 34.56 61.29 21.43 7.14 Khan Younis Al Qarara 38 50 57.89 21.05 26.32 7.89 44.74 42.11 44.74 Khan Younis 148 46.62 63.51 25.68 13.51 33.11 66.22 30.41 11.49 Khan Younis 140 28.57 45.71 49.29 14.29 24.29 45 53.57 14.29 Camp Bani Suheila 97 68.04 64.95 18.56 10.31 38.14 62.89 32.99 10.31 Abasan al Jadida 14 85.71 85.71 7.14 0 64.29 85.71 7.14 0 Abasan al Kabira 35 80 82.86 14.29 2.86 31.43 68.57 42.86 17.14 Khuza'a 137 79.56 86.13 18.98 2.92 18.98 78.83 45.99 24.09 Al Fukhari 8 50 62.5 12.5 37.5 37.5 62.5 12.5 25 Total 617 56.24 65.96 26.9 11.02 27.88 62.88 40.19 17.02 Rafah Rafah 189 52.38 56.08 20.11 8.99 38.62 56.08 26.46 11.64

142

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Rafah Camp 141 29.79 70.92 35.46 1.42 19.86 73.76 39.01 1.42 Shokat as Sufi 190 40 62.11 38.95 16.84 11.05 68.42 48.95 26.32 Al Naser 13 69.23 53.85 0 46.15 38.46 61.54 30.77 38.46 Total 533 42.4 62.1 30.39 10.69 23.83 65.29 37.9 14.82 Gaza Strip Total 3,166 52.08 62.41 23.72 11.72 29.85 61.5 33.51 15.19

Table F.39: H2: Percentage of households without or with poor hand washing facilities post-2014

Hand washing sink is Hand washing sink is available Governorate/Localit Total # of not available With good conditions With poor conditions y HHs % of % of % of # of HHs # of HHs # of HHs HHs HHs HHs North Beit Lahia 182 14 7.69 104 57.14 64 35.16 Beit Hanoun 149 12 8.05 87 58.39 50 33.56 Jabalia 130 3 2.31 104 80 23 17.69 Jabalia Camp 162 7 4.32 104 64.2 51 31.48 Omm Al Nasser 53 21 39.62 8 15.09 24 45.28 Total 676 57 8.43 407 60.21 212 31.36 Gaza Gaza 623 30 4.82 483 77.53 110 17.66 Ash Shati' Camp 92 11 11.96 40 43.48 41 44.57 Madinat Ezahra 5 0 0 5 100 0 0 Al Mughraqa 96 14 14.58 61 63.54 21 21.88 Juhor ad Dik 90 18 20 63 70 9 10 Total 906 73 8.06 652 71.96 181 19.98 Middle Area An Nuseirat 39 1 2.56 37 94.87 1 2.56 An Nuseirat Camp 26 1 3.85 13 50 12 46.15 Az Zawayda 37 3 8.11 29 78.38 5 13.51 Al Bureij 66 1 1.52 56 84.85 9 13.64 Al Bureij Camp 27 1 3.7 22 81.48 4 14.81 Al Maghazi 26 0 0 20 76.92 6 23.08 Al Maghazi Camp 28 3 10.71 17 60.71 8 28.57 Deir al Balah 40 0 0 38 95 2 5 Deir al Balah Camp 8 0 0 8 100 0 0 Al Musaddar 2 0 0 2 100 0 0 Wadi as Salqa 135 14 10.37 81 60 40 29.63 Total 434 24 5.53 323 74.42 87 20.05 Khan Younis Al Qarara 38 14 36.84 10 26.32 14 36.84 Khan Younis 148 17 11.49 100 67.57 31 20.95 Khan Younis Camp 140 18 12.86 46 32.86 76 54.29 Bani Suheila 97 25 25.77 44 45.36 28 28.87 Abasan al Jadida 14 0 0 14 100 0 0 Abasan al Kabira 35 5 14.29 23 65.71 7 20 Khuza'a 137 12 8.76 69 50.36 56 40.88 Al Fukhari 8 0 0 8 100 0 0 Total 617 91 14.75 314 50.89 212 34.36 Rafah Rafah 189 15 7.94 108 57.14 66 34.92 Rafah Camp 141 6 4.26 87 61.7 48 34.04 Shokat as Sufi 190 13 6.84 104 54.74 73 38.42 Al Naser 13 1 7.69 9 69.23 3 23.08

143

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Total 533 35 6.57 308 57.79 190 35.65 Gaza Strip Total 3,166 280 8.84 2,004 63.3 882 27.86

Table F.40: H3: Percentage of households without or with poor shower facility post-2014

Shower facility is not Shower facility is available Governorate/Localit Total # of available With good conditions With poor conditions y HHs % of % of % of # of HHs # of HHs # of HHs HHs HHs HHs North Beit Lahia 182 41 22.53 105 57.69 36 19.78 Beit Hanoun 149 15 10.07 85 57.05 49 32.89 Jabalia 130 6 4.62 106 81.54 18 13.85 Jabalia Camp 162 24 14.81 96 59.26 42 25.93 Omm Al Nasser 53 47 88.68 5 9.43 1 1.89 Total 676 133 19.67 397 58.73 146 21.6 Gaza Gaza 623 82 13.16 445 71.43 96 15.41 Ash Shati' Camp 92 20 21.74 31 33.7 41 44.57 Madinat Ezahra 5 0 0 5 100 0 0 Al Mughraqa 96 19 19.79 52 54.17 25 26.04 Juhor ad Dik 90 22 24.44 59 65.56 9 10 Total 906 143 15.78 592 65.34 171 18.87 Middle Area An Nuseirat 39 1 2.56 37 94.87 1 2.56 An Nuseirat Camp 26 8 30.77 12 46.15 6 23.08 Az Zawayda 37 4 10.81 26 70.27 7 18.92 Al Bureij 66 1 1.52 56 84.85 9 13.64 Al Bureij Camp 27 1 3.7 22 81.48 4 14.81 Al Maghazi 26 2 7.69 18 69.23 6 23.08 Al Maghazi Camp 28 5 17.86 16 57.14 7 25 Deir al Balah 40 1 2.5 37 92.5 2 5 Deir al Balah Camp 8 1 12.5 7 87.5 0 0 Al Musaddar 2 0 0 2 100 0 0 Wadi as Salqa 135 44 32.59 71 52.59 20 14.81 Total 434 68 15.67 304 70.05 62 14.29 Khan Younis Al Qarara 38 12 31.58 9 23.68 17 44.74 Khan Younis 148 22 14.86 97 65.54 29 19.59 Khan Younis Camp 140 48 34.29 35 25 57 40.71 Bani Suheila 97 29 29.9 47 48.45 21 21.65 Abasan al Jadida 14 0 0 14 100 0 0 Abasan al Kabira 35 8 22.86 22 62.86 5 14.29 Khuza'a 137 15 10.95 61 44.53 61 44.53 Al Fukhari 8 0 0 8 100 0 0 Total 617 134 21.72 293 47.49 190 30.79 Rafah Rafah 189 15 7.94 109 57.67 65 34.39 Rafah Camp 141 12 8.51 81 57.45 48 34.04 Shokat as Sufi 190 18 9.47 105 55.26 67 35.26 Al Naser 13 1 7.69 10 76.92 2 15.38 Total 533 46 8.63 305 57.22 182 34.15 Gaza Strip Total 3,166 524 16.55 1,891 59.73 751 23.72

144

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.41: H4: Percentage of households without or with poor kitchen sink post-2014

Kitchen sink is not Kitchen sink is available Governorate/Localit Total # of available With good conditions With poor conditions y HHs % of % of % of # of HHs # of HHs # of HHs HHs HHs HHs North Beit Lahia 182 27 14.84 103 56.59 52 28.57 Beit Hanoun 149 16 10.74 84 56.38 49 32.89 Jabalia 130 4 3.08 108 83.08 18 13.85 Jabalia Camp 162 21 12.96 91 56.17 50 30.86 Omm Al Nasser 53 30 56.6 5 9.43 18 33.96 Total 676 98 14.5 391 57.84 187 27.66 Gaza Gaza 623 53 8.51 466 74.8 104 16.69 Ash Shati' Camp 92 6 6.52 36 39.13 50 54.35 Madinat Ezahra 5 1 20 4 80 0 0 Al Mughraqa 96 10 10.42 60 62.5 26 27.08 Juhor ad Dik 90 26 28.89 56 62.22 8 8.89 Total 906 96 10.6 622 68.65 188 20.75 Middle Area An Nuseirat 39 0 0 38 97.44 1 2.56 An Nuseirat Camp 26 1 3.85 14 53.85 11 42.31 Az Zawayda 37 1 2.7 27 72.97 9 24.32 Al Bureij 66 1 1.52 56 84.85 9 13.64 Al Bureij Camp 27 1 3.7 23 85.19 3 11.11 Al Maghazi 26 0 0 20 76.92 6 23.08 Al Maghazi Camp 28 2 7.14 17 60.71 9 32.14 Deir al Balah 40 0 0 38 95 2 5 Deir al Balah Camp 8 0 0 6 75 2 25 Al Musaddar 2 0 0 2 100 0 0 Wadi as Salqa 135 15 11.11 79 58.52 41 30.37 Total 434 21 4.84 320 73.73 93 21.43 Khan Younis Al Qarara 38 9 23.68 10 26.32 19 50 Khan Younis 148 15 10.14 102 68.92 31 20.95 Khan Younis Camp 140 10 7.14 53 37.86 77 55 Bani Suheila 97 18 18.56 51 52.58 28 28.87 Abasan al Jadida 14 0 0 14 100 0 0 Abasan al Kabira 35 6 17.14 21 60 8 22.86 Khuza'a 137 11 8.03 62 45.26 64 46.72 Al Fukhari 8 0 0 7 87.5 1 12.5 Total 617 69 11.18 320 51.86 228 36.95 Rafah Rafah 189 21 11.11 111 58.73 57 30.16 Rafah Camp 141 10 7.09 89 63.12 42 29.79 Shokat as Sufi 190 20 10.53 101 53.16 69 36.32 Al Naser 13 2 15.38 10 76.92 1 7.69 Total 533 53 9.94 311 58.35 169 31.71 Gaza Strip Total 3,166 337 10.64 1,964 62.03 865 27.32

145

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.42: H5: Percentage of people who are untimely in their hand washing practice

Total # of HHs People don’t wash their hands in a timely manner (interviewees) Women Men Governorate/Locality # of # of Men # of HHs % of HHs # of HHs % of HHs Women North Beit Lahia 34 148 24 70.59 89 60.14 Beit Hanoun 49 100 25 51.02 47 47 Jabalia 41 89 32 78.05 76 85.39 Jabalia Camp 120 42 88 73.33 31 73.81 Omm Al Nasser 4 49 1 25 24 48.98 Total 248 428 170 68.55 267 62.38 Gaza Gaza 262 361 176 67.18 251 69.53 Ash Shati' Camp 41 51 34 82.93 42 82.35 Madinat Ezahra 3 2 1 33.33 1 50 Al Mughraqa 53 43 37 69.81 29 67.44 Juhor ad Dik 45 45 40 88.89 27 60 Total 404 502 288 71.29 350 69.72 Middle Area An Nuseirat 13 26 11 84.62 21 80.77 An Nuseirat Camp 9 17 6 66.67 12 70.59 Az Zawayda 4 33 2 50 27 81.82 Al Bureij 18 48 17 94.44 45 93.75 Al Bureij Camp 3 24 3 100 22 91.67 Al Maghazi 5 21 2 40 19 90.48 Al Maghazi Camp 12 16 10 83.33 14 87.5 Deir al Balah 15 25 10 66.67 18 72 Deir al Balah Camp 2 6 2 100 6 100 Al Musaddar 2 0 2 100 0 0 Wadi as Salqa 23 112 21 91.3 103 91.96 Total 106 328 86 81.13 287 87.5 Khan Younis Al Qarara 7 31 6 85.71 27 87.1 Khan Younis 66 82 44 66.67 57 69.51 Khan Younis Camp 76 64 58 76.32 45 70.31 Bani Suheila 78 19 54 69.23 10 52.63 Abasan al Jadida 10 4 5 50 2 50 Abasan al Kabira 14 21 5 35.71 14 66.67 Khuza'a 55 82 38 69.09 62 75.61 Al Fukhari 3 5 0 0 2 40 Total 309 308 210 67.96 219 71.1 Rafah Rafah 27 162 25 92.59 140 86.42 Rafah Camp 60 81 49 81.67 65 80.25 Shokat as Sufi 27 163 25 92.59 143 87.73 Al Naser 3 10 2 66.67 10 100 Total 117 416 101 86.32 358 86.06 Gaza Strip Total 1,184 1,982 855 72.21 1,481 74.72

People who don’t do proper hand washing in timely manner Total # of HHs After Governorate/Locality After using Before (interviewees) changing Before eating toilet cooking diapers

146

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

# of % of % of % of % of # of % of % of % of % of Wom Wom Wom Wom Wom Men Men Men Men Men en en en en en North Beit Lahia 34 148 0 0 64.71 57.43 32.35 33.78 20.59 10.81 Beit Hanoun 49 100 2.04 1 46.94 35 6.12 25 4.08 5 Jabalia 41 89 0 0 68.29 84.27 34.15 44.94 21.95 5.62 Jabalia Camp 120 42 3.33 0 72.5 73.81 5.83 30.95 8.33 2.38 Omm Al Nasser 4 49 0 0 25 42.86 25 10.2 25 4.08 Total 248 428 2.02 0.23 64.92 57.71 14.52 31.07 11.69 6.78 Gaza Gaza 262 361 0.38 2.49 64.5 64.27 8.4 31.86 6.11 6.93 Ash Shati' Camp 41 51 2.44 0 78.05 82.35 29.27 60.78 34.15 27.45 Madinat Ezahra 3 2 0 0 33.33 50 0 50 0 0 Al Mughraqa 53 43 5.66 6.98 60.38 65.12 9.43 41.86 24.53 6.98 Juhor ad Dik 45 45 0 2.22 84.44 53.33 20 28.89 20 6.67 Total 404 502 1.24 2.59 67.33 65.14 11.88 35.46 12.87 8.96 Middle Area An Nuseirat 13 26 0 0 84.62 69.23 0 57.69 0 34.62 An Nuseirat Camp 9 17 0 0 66.67 58.82 11.11 23.53 0 5.88 Az Zawayda 4 33 0 3.03 50 75.76 0 48.48 0 24.24 Al Bureij 18 48 0 0 88.89 81.25 38.89 75 38.89 35.42 Al Bureij Camp 3 24 0 4.17 100 87.5 0 66.67 0 4.17 Al Maghazi 5 21 0 0 40 66.67 20 52.38 0 14.29 Al Maghazi Camp 12 16 0 0 83.33 75 8.33 62.5 0 37.5 Deir al Balah 15 25 0 0 66.67 68 13.33 32 13.33 8 Deir al Balah Camp 2 6 0 0 100 100 0 50 0 0 Al Musaddar 2 0 0 0 100 0 0 0 0 0 Wadi as Salqa 23 112 0 0 91.3 86.61 8.7 56.25 8.7 4.46 Total 106 328 0 0.61 80.19 78.96 13.21 55.49 10.38 15.85 Khan Younis Al Qarara 7 31 0 3.23 71.43 83.87 14.29 48.39 28.57 12.9 Khan Younis 66 82 0 3.66 62.12 65.85 4.55 30.49 7.58 14.63 Khan Younis Camp 76 64 2.63 1.56 71.05 68.75 18.42 18.75 10.53 6.25 Bani Suheila 78 19 0 0 69.23 52.63 8.97 21.05 2.56 15.79 Abasan al Jadida 10 4 0 0 50 50 0 0 0 0 Abasan al Kabira 14 21 0 4.76 28.57 47.62 7.14 33.33 0 23.81 Khuza'a 55 82 0 1.22 67.27 71.95 10.91 29.27 1.82 1.22 Al Fukhari 3 5 0 20 0 20 0 20 0 20 Total 309 308 0.65 2.6 64.72 66.88 10.81 28.57 5.83 9.74 Rafah Rafah 27 162 0 0.62 81.48 82.72 40.74 43.83 3.7 0 Rafah Camp 60 81 1.67 1.23 75 67.9 13.33 55.56 0 0 Shokat as Sufi 27 163 3.7 1.84 92.59 77.91 25.93 59.51 11.11 8.59 Al Naser 3 10 0 0 66.67 90 66.67 50 0 0 Total 117 416 1.71 1.2 80.34 78.13 23.93 52.4 3.42 3.37 Gaza Strip Total 1184 1982 1.18 1.46 68.58 68.82 13.34 40.31 9.63 8.58

147

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Table F.43: H6: Percentage of people who do and don’t do sufficient showering

People who do sufficient People who don’t do sufficient Total # of HHs showering practice showering practice (interviewees) Governorate/ Women Men Women Men Locality # of # of # of % of # of % of # of % of # of % of Wome Men HHs HHs HHs HHs HHs HHs HHs HHs n North Beit Lahia 34 148 34 100 124 83.78 0 0 24 16.22 Beit Hanoun 49 100 45 91.84 84 84 4 8.16 16 16 Jabalia 41 89 37 90.24 83 93.26 4 9.76 6 6.74 Jabalia Camp 120 42 107 89.17 41 97.62 13 10.83 1 2.38 Omm Al Nasser 4 49 4 100 34 69.39 0 0 15 30.61 Total 248 428 227 91.53 366 85.51 21 8.47 62 14.49 Gaza Gaza 262 361 235 89.69 329 91.14 27 10.31 32 8.86 Ash Shati' Camp 41 51 35 85.37 48 94.12 6 14.63 3 5.88 Madinat Ezahra 3 2 3 100 2 100 0 0 0 0 Al Mughraqa 53 43 39 73.58 43 100 14 26.42 0 0 Juhor ad Dik 45 45 40 88.89 40 88.89 5 11.11 5 11.11 Total 404 502 352 87.13 462 92.03 52 12.87 40 7.97 Middle Area An Nuseirat 13 26 13 100 25 96.15 0 0 1 3.85 An Nuseirat 9 17 8 88.89 13 76.47 1 11.11 4 23.53 Camp Az Zawayda 4 33 4 100 30 90.91 0 0 3 9.09 Al Bureij 18 48 16 88.89 48 100 2 11.11 0 0 Al Bureij Camp 3 24 3 100 23 95.83 0 0 1 4.17 Al Maghazi 5 21 4 80 21 100 1 20 0 0 Al Maghazi 12 16 12 100 16 100 0 0 0 0 Camp Deir al Balah 15 25 13 86.67 23 92 2 13.33 2 8 Deir al Balah 2 6 2 100 5 83.33 0 0 1 16.67 Camp Al Musaddar 2 0 2 100 0 0 0 0 0 0 Wadi as Salqa 23 112 19 82.61 99 88.39 4 17.39 13 11.61 Total 106 328 96 90.57 303 92.38 10 9.43 25 7.62 Khan Younis Al Qarara 7 31 5 71.43 24 77.42 2 28.57 7 22.58 Khan Younis 66 82 58 87.88 78 95.12 8 12.12 4 4.88 Khan Younis 76 64 63 82.89 54 84.38 13 17.11 10 15.63 Camp Bani Suheila 78 19 73 93.59 18 94.74 5 6.41 1 5.26 Abasan al Jadida 10 4 7 70 4 100 3 30 0 0 Abasan al Kabira 14 21 14 100 21 100 0 0 0 0 Khuza'a 55 82 52 94.55 78 95.12 3 5.45 4 4.88 Al Fukhari 3 5 3 100 5 100 0 0 0 0 Total 309 308 275 89 282 91.56 34 11 26 8.44 Rafah Rafah 27 162 24 88.89 111 68.52 3 11.11 51 31.48 Rafah Camp 60 81 47 78.33 56 69.14 13 21.67 25 30.86 Shokat as Sufi 27 163 16 59.26 100 61.35 11 40.74 63 38.65 Al Naser 3 10 2 66.67 4 40 1 33.33 6 60 Total 117 416 89 76.07 271 65.14 28 23.93 145 34.86 Gaza Strip

148

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Total 1,184 1,982 1,039 87.75 1684 84.96 145 12.25 298 15.04

Table F.44: H7: Change of hygiene practices post-2014

People who did not People who perceived Total # of HHs (interviewees) perceive change in the change in the practices Governorate practices % of # of women # of men % of women % of men % of women men North 248 428 6.85 4.91 93.15 95.09 Gaza 404 502 11.14 5.98 88.86 94.02 Middle Area 106 328 15.09 13.11 84.91 86.89 Khan Younis 309 308 8.09 10.06 91.91 89.94 Rafah 117 416 5.13 5.53 94.87 94.47 Gaza Strip 1184 1982 9.21 7.47 90.79 92.53

Reasons of change ( %) Sanitary # of HH having Water is facilities Sanitary hygiene Changing the not Governorate Economic have been facilities need practices place of available situation targeted for change residence most of during the rehabilitation the time war North 38 15.79 5.26 26.32 28.95 23.68 Gaza 75 18.67 17.33 21.33 34.67 8 Middle Area 59 8.47 8.47 20.34 20.34 42.37 Khan Younis 56 8.93 7.14 62.5 5.36 16.07 Rafah 29 34.48 6.9 24.14 20.69 13.79 Gaza Strip 257 15.56 10.12 31.13 22.57 20.62

Table F.45: H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks

# of HHs Presence of waterborne Absence of waterborne Governorate/ Total # of with diseases diseases Locality HHs children # of HHs % of HHs # of HHs % of HHs <5 North Beit Lahia 182 105 26 24.76 79 75.24 Beit Hanoun 149 99 37 37.37 62 62.63 Jabalia 130 61 15 24.59 46 75.41 Jabalia Camp 162 89 26 29.21 63 70.79 Omm Al Nasser 53 41 21 51.22 20 48.78 Total 676 395 125 31.65 270 68.35 Gaza Gaza 623 341 107 31.38 233 68.33 Ash Shati' Camp 92 46 12 26.09 34 73.91 Madinat Ezahra 5 3 0 0 3 100 Al Mughraqa 96 54 16 29.63 38 70.37 Juhor ad Dik 90 47 19 40.43 28 59.57 Total 906 491 154 31.36 336 68.43 Middle Area An Nuseirat 39 18 3 16.67 15 83.33 An Nuseirat Camp 26 10 0 0 10 100 Az Zawayda 37 22 3 13.64 19 86.36

149

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Al Bureij 66 37 10 27.03 27 72.97 Al Bureij Camp 27 13 3 23.08 10 76.92 Al Maghazi 26 15 4 26.67 11 73.33 Al Maghazi Camp 28 16 2 12.5 14 87.5 Deir al Balah 40 16 0 0 16 100 Deir al Balah Camp 8 2 2 100 0 0 Al Musaddar 2 0 0 0 0 0 Wadi as Salqa 135 70 5 7.14 65 92.86 Total 434 219 32 14.61 187 85.39 Khan Younis Al Qarara 38 15 3 20 12 80 Khan Younis 148 72 23 31.94 49 68.06 Khan Younis Camp 140 71 18 25.35 52 73.24 Bani Suheila 97 52 13 25 39 75 Abasan al Jadida 14 7 1 14.29 6 85.71 Abasan al Kabira 35 20 6 30 14 70 Khuza'a 137 63 13 20.63 50 79.37 Al Fukhari 8 8 2 25 6 75 Total 617 308 79 25.65 228 74.03 Rafah Rafah 189 103 8 7.77 94 91.26 Rafah Camp 141 75 11 14.67 64 85.33 Shokat as Sufi 190 104 17 16.35 87 83.65 Al Naser 13 6 0 0 6 100 Total 533 288 36 12.5 251 87.15 Gaza Strip Total 3,166 1,701 426 25.04 1,272 74.78

Table F.46: H9: Percentage of households with members above five years of age infected by waterborne diseases in the past two weeks

# of Presence of waterborne Absence of waterborne Total # of households diseases diseases Governorate/Locality HHs with # of HHs % of HHs # of HHs % of HHs members>5 North Beit Lahia 182 182 57 31.32 125 68.68 Beit Hanoun 149 149 54 36.24 95 63.76 Jabalia 130 130 26 20 104 80 Jabalia Camp 162 162 61 37.65 101 62.35 Omm Al Nasser 53 53 28 52.83 25 47.17 Total 676 676 226 33.43 450 66.57 Gaza Gaza 623 623 178 28.57 445 71.43 Ash Shati' Camp 92 92 10 10.87 82 89.13 Madinat Ezahra 5 5 0 0 5 100 Al Mughraqa 96 96 20 20.83 76 79.17 Juhor ad Dik 90 90 27 30 63 70 Total 906 906 235 25.94 671 74.06 Middle Area An Nuseirat 37 37 3 7.69 36 92.31 An Nuseirat Camp 8 8 7 26.92 19 73.08 Az Zawayda 135 135 8 21.62 29 78.38 Al Bureij 66 66 12 18.18 54 81.82 Al Bureij Camp 27 27 3 11.11 24 88.89

150

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Al Maghazi 26 26 2 7.69 24 92.31 Al Maghazi Camp 28 28 3 10.71 25 89.29 Deir al Balah 2 2 4 10 36 90 Deir al Balah Camp 40 40 1 12.5 7 87.5 Al Musaddar 39 39 2 100 0 0 Wadi as Salqa 26 26 10 7.41 125 92.59 Total 434 434 55 12.67 379 87.33 Khan Younis Al Qarara 38 38 6 15.79 32 84.21 Khan Younis 148 148 34 22.97 114 77.03 Khan Younis Camp 140 140 29 20.71 111 79.29 Bani Suheila 97 97 15 15.46 82 84.54 Abasan al Jadida 14 14 4 28.57 10 71.43 Abasan al Kabira 35 35 9 25.71 26 74.29 Khuza'a 137 137 33 24.09 104 75.91 Al Fukhari 8 8 0 0 8 100 Total 617 617 130 21.07 487 78.93 Rafah Rafah 141 141 10 5.29 179 94.71 Rafah Camp 190 190 26 18.44 115 81.56 Shokat as Sufi 13 13 14 7.37 176 92.63 Al Naser 189 189 2 15.38 11 84.62 Total 533 533 52 9.76 481 90.24 Gaza Strip Total 3,166 3,166 698 22.05 2468 77.95

Table F.47: H10: Percentage of households that noticed appearance of new diseases post-2014

HHs that noticed new diseases Governorate/Locality Total # of HHs # of HHs % of HHs North Beit Lahia 182 121 66.48 Beit Hanoun 149 110 73.83 Jabalia 130 84 64.62 Jabalia Camp 162 110 67.90 Omm Al Nasser 53 52 98.11 Total 676 477 70.56 Gaza Gaza 623 327 52.49 Ash Shati' Camp 92 67 72.83 Madinat Ezahra 5 0 0.00 Al Mughraqa 96 40 41.67 Juhor ad Dik 90 71 78.89 Total 906 505 55.74 Middle Area An Nuseirat 39 15 38.46 An Nuseirat Camp 26 10 38.46 Az Zawayda 37 12 32.43 Al Bureij 66 32 48.48 Al Bureij Camp 27 8 29.63 Al Maghazi 26 12 46.15 Al Maghazi Camp 28 4 14.29 Deir al Balah 40 16 40.00 Deir al Balah Camp 8 4 50.00 Al Musaddar 2 0 0.00 Wadi as Salqa 135 17 12.59 Total 434 130 29.95 Khan Younis Al Qarara 38 12 31.58

151

2016 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP

Khan Younis 148 44 29.73 Khan Younis Camp 140 40 28.57 Bani Suheila 97 50 51.55 Abasan al Kabira 35 14 40.00 Abasan al Jadida 14 12 85.71 Khuza'a 137 66 48.18 Al Fukhari 8 2 25.00 Total 617 240 38.90 Rafah Rafah 189 56 29.63 Rafah Camp 141 64 45.39 Shokat as Sufi 190 79 41.58 Al Naser 13 9 69.23 Total 533 208 39.02 Gaza Strip Total 3,166 1,560 49.27

Table F.48: H11: Percentage of women with no access to appropriate materials for menstruation pre- and post-2014

Women of reproductive age with no access to appropriate Total # of women of materials for menstruation Governorate/Locality reproductive age Pre-2014 Post-2014 # of women % of women # of women % of women North Beit Lahia 294 6 2.04 14 4.76 Beit Hanoun 271 15 5.54 20 7.38 Jabalia 211 3 1.42 11 5.21 Jabalia Camp 283 2 0.71 1 0.35 Omm Al Nasser 64 8 12.5 10 15.63 Total 1,123 34 3.03 56 4.99 Gaza Gaza 1,043 50 4.79 50 4.79 Ash Shati' Camp 167 10 5.99 7 4.19 Madinat Ezahra 4 0 0 0 0.00 Al Mughraqa 171 5 2.92 8 4.68 Juhor ad Dik 143 1 0.70 2 1.40 Total 1528 66 4.32 67 4.38 Middle Area An Nuseirat 60 0 0 0 0.00 An Nuseirat Camp 47 0 0 1 2.13 Az Zawayda 68 0 0 0 0.00 Al Bureij 114 0 0 0 0.00 Al Bureij Camp 66 0 0 0 0.00 Al Maghazi 53 4 7.55 0 0.00 Al Maghazi Camp 49 0 0 0 0.00 Deir al Balah 52 4 7.69 4 7.69 Deir al Balah Camp 16 0 0 0 0.00 Al Musaddar 3 0 0 0 0.00 Wadi as Salqa 252 1 0.40 6 2.38 Total 780 9 1.15 11 1.41 Khan Younis Al Qarara 78 3 3.85 2 2.56 Khan Younis 259 5 1.93 5 1.93 Khan Younis Camp 247 24 9.72 22 8.91 Bani Suheila 164 3 1.83 6 3.66 Abasan al Kabira 55 3 5.45 3 5.45

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Abasan al Jadida 21 0 0 0 0.00 Khuza'a 204 4 1.96 5 2.45 Al Fukhari 12 0 0 0 0.00 Total 1,040 42 4.04 43 4.13 Rafah Rafah 313 12 3.83 11 3.51 Rafah Camp 253 1 0.40 1 0.40 Shokat as Sufi 290 8 2.76 9 3.10 Al Naser 26 1 3.85 1 3.85 Total 882 22 2.49 22 2.49 Gaza Strip Total 5353 173 3.23 199 3.72

Table F.49: H12: Percentage of households that received hygiene kits in the last period (2015)

HHs received hygiene kits Governorate/Locality Total # of HHs # of HHs % of HHs North Beit Lahia 182 3 1.65 Beit Hanoun 149 11 7.38 Jabalia 130 6 4.62 Jabalia Camp 162 3 1.85 Omm Al Nasser 53 0 0 Total 676 23 3.4 Gaza Gaza 623 41 6.58 Ash Shati' Camp 92 0 0 Madinat Ezahra 5 0 0 Al Mughraqa 96 1 1.04 Juhor ad Dik 90 21 23.33 Total 906 63 6.95 Middle Area An Nuseirat 39 1 2.56 An Nuseirat Camp 26 1 3.85 Az Zawayda 37 0 0 Al Bureij 66 6 9.09 Al Bureij Camp 27 1 3.7 Al Maghazi 26 3 11.54 Al Maghazi Camp 28 6 21.43 Deir al Balah 40 1 2.5 Deir al Balah Camp 8 1 12.5 Al Musaddar 2 0 0 Wadi as Salqa 135 22 16.3 Total 434 42 9.68 Khan Younis Al Qarara 38 1 2.63 Khan Younis 148 9 6.08 Khan Younis Camp 140 1 0.71 Bani Suheila 97 24 24.74 Abasan al Jadida 14 0 0 Abasan al Kabira 35 2 5.71 Khuza'a 137 21 15.33 Al Fukhari 8 2 25 Total 617 60 9.72 Rafah

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Rafah 189 4 2.12 Rafah Camp 141 2 1.42 Shokat as Sufi 190 27 14.21 Al Naser 13 4 30.77 Total 533 37 6.94 Gaza Strip Total 3,166 225 7.11

Table F.50: H13: Percentage of households with need for hygiene materials

HHs that need for hygiene kits Governorate/Locality Total # of HHs # of HHs % of HHs North Beit Lahia 182 49 26.92 Beit Hanoun 149 40 26.85 Jabalia Camp 162 10 6.17 Jabalia 130 4 3.08 Omm Al Nasser 53 25 47.17 Total 676 128 18.93 Gaza Gaza 623 55 8.83 Ash Shati' Camp 92 27 29.35 Madinat Ezahra 5 0 0 Al Mughraqa 96 20 20.83 Juhor ad Dik 90 20 22.22 Total 906 122 13.47 Middle Area An Nuseirat 39 0 0 An Nuseirat Camp 26 8 30.77 Az Zawayda 37 5 13.51 Al Bureij 66 2 3.03 Al Bureij Camp 27 1 3.7 Al Maghazi 26 4 15.38 Al Maghazi Camp 28 7 25 Deir al Balah 40 1 2.5 Deir al Balah Camp 8 0 0 Al Musaddar 2 0 0 Wadi as Salqa 135 36 26.67 Total 434 64 14.75 Khan Younis Al Qarara 38 15 39.47 Khan Younis 148 26 17.57 Khan Younis Camp 140 41 29.29 Bani Suheila 97 3 3.09 Abasan al Jadida 14 0 0 Abasan al Kabira 35 0 0 Khuza'a 137 18 13.14 Al Fukhari 8 0 0 Total 617 103 16.69 Rafah Rafah 189 34 17.99 Rafah Camp 141 31 21.99 Shokat as Sufi 190 46 24.21 Al Naser 13 3 23.08 Total 533 114 21.39

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Gaza Strip Total 3,166 531 16.77

Table F.51: H14: Variation of needs priorities of hygiene pre- and post-2014

Total # of HHs Perception of people (interviewees) Pre-2014 Post-2014 % of % of Priority % of % of Wome %of Wome %of Wome Men Wome Wome n Men n & Men n & n n Men Men North Cheap cleaning materials 33.87 18.93 24.41 27.82 15.42 19.97 Hygiene kits “HK” 41.13 54.44 49.56 48.39 57.71 54.29 248 428 Public awareness 25 26.64 26.04 23.79 26.87 25.74 Other 0 0 0 0 0 0 Gaza Cheap cleaning materials 31.68 30.48 31.02 23.27 24.1 23.73 Hygiene kits “HK” 43.56 47.61 45.81 55.2 54.58 54.86 404 502 Public awareness 24.5 21.31 22.74 21.04 20.92 20.97 Other 0.25 0.6 0.44 0.5 0.4 0.44 Middle Area Cheap cleaning materials 12.26 32.32 27.42 10.38 30.18 25.35 Hygiene kits “HK” 65.09 50 53.69 72.64 54.88 59.22 106 328 Public awareness 22.64 17.68 18.89 16.98 14.94 15.44 Other 0 0 0 0 0 0 Khan Younis Cheap cleaning materials 19.42 34.09 26.74 16.18 33.77 24.96 Hygiene kits “HK” 67.96 50 59 74.43 52.27 63.37 309 308 Public awareness 12.62 15.91 14.26 9.39 13.96 11.67 Other 0 0 0 0 0 0 Rafah Cheap cleaning materials 47.01 35.58 38.09 35.9 32.45 33.21 Hygiene kits “HK” 47.86 54.09 52.72 59.83 57.21 57.79 309 308 Public awareness 5.13 10.34 9.19 4.27 10.34 9.01 Other 0 0 0 0 0 0 Gaza Strip Cheap cleaning materials 28.72 29.92 29.47 22.47 26.49 24.98 Hygiene kits “HK” 51.77 51.21 51.42 60.81 55.5 57.49 1,184 1,982 Public awareness 19.43 18.72 18.98 16.55 17.91 17.4 Other 0.08 0.15 0.13 0.17 0.1 0.13

Table F.52: H15: Different coping mechanisms carried out by women and men related to hygiene problems

Coping mechanisms carried out by people Total # of HHs Women & (interviewees) Women Men Mechanism Men # of % of # of % of # of % of Women Men HHs HHs HHs HHs HHs HHs Cleaning the house regularly 576 48.65 815 41.12 1391 43.94 Using sufficient cleaning materials and 336 28.38 814 41.07 1150 36.32 tools Safe and regular management of solid 1,184 1,982 waste by using tight garbage bags and 129 10.9 152 7.67 281 8.88 putting the garbage outside the house Doing no action 70 5.91 113 5.7 183 5.78

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Learning the good hygiene practices 29 2.45 43 2.17 72 2.27 Using enough water for personal and 20 1.69 25 1.26 45 1.42 household cleaning Allowing sun rays and fresh air to enter 18 1.52 13 0.66 31 0.98 the house by opening the windows NA (no knowledge about the required 5 0.42 4 0.2 9 0.28 coping mechanisms) Burning wastes outside the house 1 0.08 3 0.15 4 0.13

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Table F.53: Focus groups findings and discussion (based on attendee perception)

# Focus group WASH conditions WASH needs

1 Location: Ash - Domestic water quality is very bad due to high salinity and the mixing of - Pumping water from eastern Shati' Camp - Gaza water with sewage, which cause skin diseases, damage the clothes and wells with good water quality. governorate rust the metal cooking tools. The salinity of the water has been increasing - Increasing the hours of water for 15 years. The water sometimes has also a bad smell, especially in the supply. summer. This makes the water even not usable for the plants and animals. - Distributing additional domestic - Domestic water accessibility is hard. The water is supplied 3 times a week, water tanks. Attendees: 8 women and 11 while most of the time the electricity is off. This forces many people - Providing stand-by power generators to pump the water to men sometimes to buy water from trucks or to use sea water for the cleaning purposes. the tanks when the electricity is - The water network is extremely bad. Small stones that block the water flow not available. inside the pipes. - Distributing drinking water on - The municipality is performing poorly to fix such problems related to water. weakly basis. - Households are buying drinking water from the water trucks and grocery - Rehabilitating the wastewater shops. network. - The wastewater network is extremely bad. The leakage of wastewater from - Collecting garbage in regular the network is common. The houses are on a lower level than the streets, way and covering all the camp. which allows the leaked wastewater to flow back to the houses over the - Distributing garbage bins. roads. - Distributing hygiene materials. - In the winter seasons, the situation gets worse. This is because the rain water flows into the wastewater network and lets the wastewater flood the roads and then houses. - The cleaning service of the camp is not sufficient, where only the main streets are cleaned without considering smaller roads. - The solid waste containers are not distributed properly in the camp, and the wastes are collected after a long time, which causes bad smells especially in the summer. - Insects and rodents are widespread inside the camp.

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2 Location: Beit - Domestic water quality is bad due to high salinity. The salinity of the water - Increasing water pressure in the Hanoun - North has been increasing for 5 years. network. governorate - Domestic water supply is irregular. Some households are not connected to - Distributing additional domestic the municipal water network, and the municipality forces those households water tanks. to install connection to the network on their expenses. - Upgrading wastewater network. - Water pressure is low which hinders the households from filling fully their - Distributing garbage bins with Attendees: 9 men tanks. plastic bags. - Households are buying drinking water from the water trucks and grocery shops. - The wastewater network is not covering all the area, and some households are depending on the cesspits which are vacuumed on their expenses. The cesspits there are enhancing the appearance and spread of insects in the area. - The municipality is modestly providing its cleaning services to the community, and still it is unsatisfactory. - There are many containers located close to the households which cause bad smells and insect appearance. - The municipality is evacuating the garbage from the main streets only and not from the secondary streets. 3 Location: An - Domestic water quality is bad due to the high salinity. Many households are - Distributing additional domestic Nuseirat - Middle using domestic water for cooking. water tanks. Area governorate - Domestic water supply is irregular, especially in the summer. The - Providing stand-by power households located in the higher level are the most affected by this generators to pump the water to problem. the tanks when the electricity is - Households are buying drinking water from the water trucks and grocery not available. Attendees: 21 women shops. - Distributing garbage bins for - Some households are disposing the grey water into the streets or the trees. with plastic bags. - Wastewater network is blocked frequently especially in winter. - Rehabilitating household - Lack of municipal evacuation of the solid waste containers. wastewater connections. - Insects and rodents are widespread. - Combating insects and rodents. - Cleaning the streets.

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- Awareness raising related to WASH aspects.

4 Location: Khuza’a - Domestic water quality is bad due to the high salinity that causes diseases - Providing stand-by power - Khan Younis related to hair and skin. generators to pump the water to governorate - Domestic water supply is irregular, especially in the summer, while most of the tanks when the electricity is the time the electricity is off. The tanks are insufficient to the households. not available. - There is sand in the water network. - Distributing drinking water - The water pressure is low, and households are finding great difficulty to fill tanks. Attendees: 26 their water tanks, and sometimes are doing this manually. women - Installing solar water heating - Households are buying drinking water from the water trucks and grocery systems shops. - Installing wastewater - There is no wastewater network, and households are depending on connections. cesspits. - Distributing cleaning materials. - Some households are disposing the grey water into the trees. - Insects and rodents are widespread. - Spread of bad smell in the area especially during the night. - Increase of skin diseases.

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ANNEX G : MAPS Map 1: War-affected areas

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Map 2: WASH-affected areas

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Map 3: INT1: Enhancing drinking water storage capacity

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Map 4: INT2: Enhancing domestic water storage capacity

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Map 5: INT3: Improving drinking water quality

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Map 6: INT4: Improving domestic water quality

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Map 7: INT5: Public awareness campaign about the quality of safe drinking water (A)

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Map 8: INT5: Public awareness campaign about the quality of safe drinking water (B)

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Map 9: INT6: Public awareness about the importance of the cleaning of domestic water storage

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Map 10: INT7: Installation of toilets for vulnerable households (A)

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Map 11: INT7: Installation of toilets for vulnerable households (B)

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Map 12: INT8: Installation of HH wastewater connections

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Map 13: INT9: Installation of storm water drainage systems

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Map 14: INT10: Enhancing solid waste management

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Map 15: INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households (A)

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Map 16: INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households (B)

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Map 17: INT12: Installation/Rehabilitation of shower facilities for vulnerable households (A)

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Map 18: INT12: Installation/Rehabilitation of shower facilities for vulnerable households (B)

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Map 19: INT13: Installation/Rehabilitation of kitchen sinks for vulnerable households (A)

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Map 20: INT13: Installation/Rehabilitation of kitchen sinks for vulnerable households (B)

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Map 21: INT14: Public awareness about proper hygiene practices (A)

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Map 22: INT14: Public awareness about proper hygiene practices (B)

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Map 23: INT15: Identification of the hot spot areas of waterborne diseases (A)

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Map 24: INT15: Identification of the hot spot areas of waterborne diseases (B)

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Map 25: INT16: Enhancing the menstrual hygiene management of vulnerable women

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Map 26: INT17: Distribution of hygiene kits

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