21.1 Why sanitation kills more than the disaster
In humanitarian emergencies, diseases transmitted from feces to the mouth (diarrhea, cholera, hepatitis A, typhoid) can cause more than 40% of deaths in the acute phase, according to the review by Connolly and colleagues (2004) cited in the water, sanitation, and hygiene literature. The WHO warns that the main health risks after a disaster come from poor disposal of feces, and that toilets must be set up immediately. In the U.S. the risk is lower, but the mechanism is the same: if the water is cut off, people stop washing their hands, the toilet fills up, flies carry germs from feces to food, and diarrhea spreads through the whole house.
Diarrhea in a healthy person is a nuisance. In extreme heat, with no air conditioning and little water, it is severe dehydration within hours. To recognize and treat it (oral rehydration salts), see chapter 7.
How germs travel
Specialists sum it up as five routes that lead from feces to the mouth: fingers, flies, fluids (water), fields (soil), and food. Each measure in this chapter blocks one of them:
| Route | How it is blocked |
|---|---|
| Fingers | Handwashing at the right moments; a washing station next to the bathroom and next to the kitchen. |
| Flies | Cover feces with absorbent material; sealed bags; trash in containers with lids. |
| Fluids | Drinking water kept separate and covered; purify any doubtful water (chapter 3). |
| Soil | Don't dump feces on the grass or in planters; pick up dog feces. |
| Food | Wash and disinfect dishes; don't leave food uncovered; clean hands when cooking. |
