water and habitat: public health engineering during armed conflict, 1983-2013
TRANSCRIPT
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WATER AND HABITATPUBLIC HEALTH ENGINEERING DURING ARMED CONFLICT:1983-2013
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International Committee of the Red Cross19, avenue de la Paix1202 Geneva, Switzerland
T +41 22 734 60 01 F +41 22 733 20 57E-mail: [email protected] www.icrc.org ICRC, September 2013
Front cover: Jamil Ahmed/ICRC
WATER AND HABITAT
THE WATER AND HABITAT UNIT AT THE ICRC WAS SET UP IN 1983.IT ASSISTS COMMUNITIES IN NEED AND VULNERABLE GROUPSSUCH AS DISPLACED PEOPLE AND DETAINEES.
WATER, SANITATION, SHELTER, CONSTRUCTION, ESSENTIAL SERVICES
PUBLIC HEALTH ENGINEERING DURING ARMED CONFLICT:1983-2013
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1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
The ICRC was born on the battleeld o Solerino
150 years ago. The nature o warare and the needs o
people aected by it have changed dramatically since
then. And so has the nature o humanitarian work. The
ICRC seeks to be in close contact with the people it tries
to help, and to maintain a dialogue with them. To that
end, it constantly adapts the activities it undertakes
during armed conict and other orms o violence.
Water-and-habitat projects became part o the ICRCs
humanitarian response about 30 years ago. During
a complex large-scale operation along the Thai-
Cambodian border 1979, ICRC delegates, having iden-
tied the diverse needs o more than a million dis-placed people, developed a public-health approach
that included provision o clean water and sanitation
and creation o a health inrastructure.
In the beginning, the ICRCs water-and-habitat activi-
ties mainly took the orm o emergency work in rural
areas rom building small water distribution systems
and latrines in remote Salvadoran villages to major
assis-tance operations during the Ethiopian amine
1985-1987. By the 1990s the ICRC was responding
to situations in Iraq and the ormer Yugoslavia, or
instance where the destruction o inrastructure in
densely populated environments had aected mil-
lions o people. In Baghdad in 1991, many large health-
care acilities and complex water supply systems had
ceased to unction owing to the destruction o elec-
trical power stations. The ICRC made a substantial
commitment to keeping the citys power grid, water
supply and water treatment plants running. And in
Syria in 2012, the ICRC provided water treatment prod-
ucts to ensure that people throughout the country
had access to sae drinking water; the organization also
donated generators to water pumping stations.
The prevalence o protracted conicts has led to the
ICRC taking a longer view and emphasizing sustain-
ability in its approach. Its ocus, within communities,
is on preventing disease through hygiene-awareness
programmes and sanitation management. At the struc-
tural level it concerns itsel with system maintenance
and sewage treatment or evacuation. Both kinds o
work require interaction with a broad range o com-
munity-based groups, partners and authorities.
Over the last 30 years, the ICRCs Water and Habitat
Unit, or WatHab, has also been incorporated in ICRC
activities to benet particularly vulnerable people.
The unit has developed a specic expertise in deten-
tion-related issues: in prisons, overcrowding and poor
sanitation can pose serious health risks. WatHab engi-
neers work at all levels o a prison system to respond to
individual needs and to general structural problems.
The unit has also contributed to the ICRCs physical
rehabilitation programme by constructing or renovat-
ing orthopaedic centres. The longest running o these
centres is in Kabul and over the years it, together with
six other centres in Aghanistan, has enabled 150,000
Aghans to be tted with articial l imbs.
Anticipating needs and managing existing water sup-
plies to ensure their sustain-ability: these are two o
the most crucial challenges conronting WatHab today.
The unit now uses geographic inormation systems to
track population movements and the spread o dis-
ease and to manage water systems. In northern Ethio-
pia, a region particularly vulnerable to environmental
changes, the authorities need rapid and reliable inor-
mation. Technology and training provided by the ICRC
make it possible now or local water boards to monitor
thousands o water points throughout the region.
There are over 500 WatHab engineers at present, with
widely varying proessional backgrounds. In some
50 countries, the unit can draw on the local knowl-
edge and expertise o a large number o locally hired
employees. Together with their expatriate colleagues,
they are one o the ICRCs major assets.
Pierre Krhenbhl
Director o Operations
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1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
www.icrc.org/saewater-30years
ICRC WATER AND HABITAT PROJECTS:1983-2013
Countries in whichWater and Habitat projectswere realized for
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F.DeBros/ICRC
Uqd, Yemen. Arrival o the clinoboxoperating theatre.
WAR IN THE DESERTIn 1962, war broke out in Yemen. Doctors rom the
International Committee o the Red Cross (ICRC) vis-
ited remote areas o the country in 1962 and 1963;
they sent back reports that were starkly reminiscent
o Henry Dunants account o the suering endured by
wounded soldiers on the battleeld at Solerino in 1859
the events that inspired the creation o the ICRC.
This excerpt rom one o those reports describes the
situation conronting those injured in the remote north,
near the border o Saudi Arabia, where health care or
soldiers and civilians was virtually non-existent:
Transport or the wounded is very long; it happens on
a mans back, or on the back o a donkey, or a camel and
can take eight days beore [the injured person] reaches
a doctor. It is not astonishing thereore that many o the
injured died en route.
These reports led the ICRC in 1963 to send numerous
medical teams and to set up a ully equipped 50-bed
eld hospital in the Uqd desert, near the Saudi bor-
der. It was not an easy task. Hospital equipment had
to be transported by air and then carried by lorry over
unpaved, rutted roadways ull o sand and rocks.
The ty beds were immediately occupied and hos-
pital capacity had to be immediately increased to one
hundred beds, wrote one nurse who was there at the
time and whose reports were published several years
later in the International Review of the Red Cross . The
temperature was high in the tents at midday, partic-
ularly in the summer, when 50 degrees Celsius is normal.
The ICRC teams were sae only at night. They worked
ceaselessly under the cover o darkness, treating and
operating on the wounded, who were lying in heaps
on the ground.
The initial team o thirty people included doctors, sur-
geons, anaesthetists, nurses, mechanics, drivers, radio
technicians, storekeepers and a cook. The scarcity o
water, which made sanitation and maintaining basic
standards o hygiene extremely difcult, was an inescap-
able act o lie. Despite this, there were no water or sani-
tation engineers on the initial team. The need or water,
being paramount, required in the same nurses words
a constant coming and going between the hospital
and the well some twenty kilometres away, across tracks
which were a severe trial or the tank lorries.
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YvesDebraine/ICRC
ICRC
Protective red crossemblem showinglocation oUqd eld hospital.(Right)
Uqd, Yemen.ICRC eld hospital. THE WAR FOR WATER
Until the mid-1970s, scarcity o water was the main
issue in tribal conicts in northern Yemen. The civil war
that lasted rom 1962 to 1970 had made water even
scarcer or those who had been displaced and or those
involved in the ghting. In this harsh environment, the
ICRCs hospital was something o an oasis.
I was very surprised, Pascal Gellety, a French doctor
who worked there in 1964, told interviewers. I expected
a little hospital in a tent, but what I ound was a ully
equipped hospital that was unctioning admirably
well in particularly difcult conditions in the middle o
the desert.
But there were problems. Rationing, o water and pro-
visions, was a lingering issue; as was the challenge
or European doctors and nurses rom Zurich, Paris or
Madrid o working in the desert. Nonetheless, between
1963 and 1965, doctors and nurses living in this small
colony o tents saw some 160 patients every day and
carried out more than 2,000 surgical operations.
The Uqd hospital has become emblematic o neutral
humanitarian action and is a symbol o the ICRCs com-
mitment to go wherever help is needed. Yemen might
have been an exceptionally challenging assignment,
but it was ar rom being the only difcult one that ICRC
delegations have had: rom Indo-China to West Arica,
delegates and surgical teams have had to cope with
settings in which lack o water and sanitation, and poor
public health conditions, took as many lives as bombs
and bullets did. As a result o mission reports about the
secondary health eects o conict malaria, diarrhoea
and malnutrition, or instance the ICRC developed the
holistic approach to public health during emergencies
that it employs today.
The ICRC began working in Yemen a little over 50 years
ago. Today, it carries out a wide range o activities in
the country: or instance, providing medical supplies
or hospitals, health-care acilities and physical rehabili-
tation centres in various parts o the country, making
physical improvements to these acilities, and training
local medical personnel. The ICRC has also been able
to ensure that the population aected (some 430,000
people in 2012) has sae drinking water. Ambitious
water and sanitation projects are under way: these
could reduce territorial tensions over water and greatly
improve living conditions or those caught up in the
current crisis.
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GrardLeblanc/ICRC
THE TURNING POINTIn 1979, more than a million people in ight rom
the ghting and violence in Cambodia settled in and
around several massive reugee camps in Thailand, a
short distance rom the Cambodian border.
Needs were great and conditions tough; the humani-
tarian response was many-sided and substantial. The
ICRC had agreed to coordinate the distribution o ood
and medicines, as well as other activities conducted by
the numerous humanitarian organizations working in
the camps. It also helped to build up many essential
elements o the camps inrastructure: rom latrines to
health posts, and then a ull-sized eld hospital.
This swit and unexpected settlement o a large num-
ber o people equivalent to the population o a small
city in a semi-tropical orest posed a serious threat
to public health. At the Mak Moun reugee camp
(above), the ICRC trucked in large quantities o water.
Meanwhile, water engineers rom the ICRC and other
humanitarian organizations worked to nd local
sources that could provide a steady supply o water or
the camps massive population.
As the operation unolded, it quickly became clear
that a greater level o expertise in managing water and
sanitation was needed to keep the camps population
healthy. Rmy Russbach, then the head o the ICRCs
medical division, was impressed by the work o water
and sanitation experts particularly rom the Australian
Red Cross and the New Zealand Red Cross who were
creating systems or pumping clean, sae water and
distributing it to a population already eeling the eects
o water-borne diseases.
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GrardLeblanc/ICRC
GrardLeblanc/ICRC
V.
Olivier/ICRC
Construction o the hospital (below) is not yet complete, but it has alreadybegun to provide essential services.
Arrival o rst batch o reugees at the ICRC's Khao I Dang camp inThailand. Locally available bamboo was used to build the camp hospital.
At the same time, a French doctor named Pierre Perrin
working in the camps (rst or Mdecins Sans Frontires
and later or the ICRC) was becoming very worried
about the state o his patients health. Increasingly,
medical teams were dealing with diseases or which the
surgeons bench was not the remedy: the solution lay in
improving standards o hygiene within the entire com-
munity. Perrin developed a model he called the health
pyramid. This would change the ICRCs approach, as
well as that o many humanitarian organizations, to
assisting people aected.
At the top o the pyramid is curative care, such as
emergency surgery, which is usually provided only at a
hospital or eld hospital. In the middle is public health
vaccinations, basic medicines: this is a daily concern
and such care is dispensed normally at a health post. At
the bottom are nutrition and sanitation the two key
blocks, Perrin argued.
But the ICRC had no expertise o its own or dealing
with the water and sanitation needs o large popula-
tions. Doctors rom the ICRCs medical division were
asked to direct and oversee the development o water
and sanitation systems while they were setting up and
running eld hospitals such as the one at the Khao
I Dang camp, which was made out o locally available
bamboo. No one would even think o asking a water
engineer to operate on a patient, but doctors are being
asked all the time to do things outside their area o
expertise,Perrin noted.
Rmy Russbach, an early supporter, agreed. A ew
years later, in 1983, he would hire the people needed
to sta the newly created Water and Sanitation Unit.
The work o Perrin, Russbach and others would help
change the delivery o assistance in the decades that
ollowed; it would also make public health a consider-
ation in mounting emergency operations. But all this
did not happen overnight.
During great displacements opopulations, the absence o potablewater and the accumulation ogarbage have a signifcant impacton morbidity and mortality rates,comparable in their destructivenessto the use o weapons.Rmy RussbachHead of the ICRCs medical division (1977-1994)
It makes no sense, he reasoned, to manage the health
o vulnerable people rom the top down with cura-
tive care i their immediate environment and,
crucially, their water supply, is unhealthy. I you put
all your attention at the top o the pyramid, then you
have no oundation the pyramid is inverted and will
topple over,he said.
Perrin was a passionate advocate with a air or draw-
ing cartoons to illustrate his mission reports. He laid
out his case boldly and clearly. It is hopeless to take
care only o the sick people i nothing else is done or
the sanitation in a camp at the same time,he wrote.
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GrardLeblanc/ICRC
EdouardWiniger/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998
1983
19
Pipes being laid to supply villageswith clean water (let).
Northern El Salvador (below).Equipment, or setting up an ICRC radio aerial,being transported.
THE BIRTH OF WATHABEL SALVADOR 1983Russbach was persuaded by the ICRCs experiences in
the reugee camps on the Thai-Cambodian border that
the organization needed greater technical expertise in
water and sanitation. At the time, he recalls, there was
a prevailing myth that medicine was a kind o saviour
that would cure all ills an idea that was completely
anchored in the habits o donors and victims.
It took considerable energy to change the mind-set,
Russbach says. The rst big step was taken in 1980,
when the ICRCs Assembly reassessed the organiza-
tions medical activities. In principle, the Assembly
agreed to hire a nutritionist and a sanitation engineer
(Alain Mourey and Bob Smyth, respectively). This led
to the establishment, in June 1983, o the ICRCs Water
and Sanitation Unit.
Next came a period o intense activity and numerous
eld missions: newly hired engineers built water and
sanitation systems in various conict zones rom small
water catchment and water distribution systems in
remote villages o war-torn El Salvador to major opera-
tions during the Ethiopian amine o 1985.
The El Salvador operation was humanitarian assistance
in its most concrete orm. Basic materials or construc-
tion, such as wooden beams, planks, sheet metal, nails,
basic tools, sand and cement, were put directly into the
hands o people aected by conict. A new opening
in terms o assistance was created in that era, says
Franois Rue, recalling his rst mission in El Salvador
as a eld delegate.
The country was riven by internal conict and grow-
ing numbers o civilians were being displaced by the
conict. The newly created Water and Sanitation Unit
(then part o the Medical Division) provided resh
access to water, in signicant quantities, or 135,000
people displaced by the ghting or trapped in villages
surrounded by it. ICRC activities in El Salvador included
the ollowing: searching or missing persons, visiting
detainees, undertaking eld medical missions, pro-
viding ood assistance and water and sanitation.
It was a period o growth and experimentation, with
engineers learning to adapt to radically dierent envi-
ronments and evolving conicts. It was decided early
on that the ICRCs activities in this connection would
be guided by high levels o technical expertise and
scientic proessionalism. In 1983, Dr Giorgio Nembrini,
a chemist who specialized in water treatment and
environmental analysis, was appointed head o the
Water and Sanitation Unit.
The units activities gradually broadened. For instance,
it began to work in detention acilities (prisons in
Uganda and Zaire were among the rst); this presented
new challenges as well as opportunities or support-
ing the ICRCs protection work. Activities that are
now regarded as comparatively routine aspects o
the ICRCs eorts to improve living conditions or
detainees were pioneered in that era.
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1918
DanyGignoux/ICRC
DanyGignoux/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983
1985
1986 1987
Displaced persons, at the Quiha camp in Ethiopia,waiting or water to be distributed.
Tigray, Mekele.Installation o a sandlter next toa water reservoir.
ETHIOPIA 1985-1987
Civil war, extreme poverty and drought led to a am-
ine that aected millions o people, mainly in Tigray
and Eritrea. The joint response o the Ethiopian Red
Cross Society and the ICRC was o an unprecedented
scale. About a million people were given assistance
in the orm o ood, seed and medical care. Wells and
spring catchments were rehabilitated, ensuring access
to water or villages aected, camps housing internally
displaced persons, and therapeutic eeding centres.
The photograph on the let shows a sand-ltrationsystem being set up.
It was during the Ethiopian am-ine that the engineering approachbegan to receive consideration Suddenly, the head o operations at that time, Jean Pierre Hock was saying, You have to do more.
And small was no longer beautiul.And we did it. In act, we grew withthe needs and we were alwaysready to take up the challenges.Dr Giorgio Nembrini
The team also continued to experiment with new
technology and worked with its colleagues in the ICRCs
assistance division on improving ood security by umi-
gating crops to protect them rom insects such as
locusts. Most o the operations were in rural or remote
areas and the water systems were relatively small-scale.
But there were some notable exceptions: the massive
Ethiopia assistance operation, the restoration o the
power grid and water systems in Monrovia during the
Liberian civil war, and the provision o water to the
besieged population o Beirut.
Gradually, the idea that engineers could also be
humanitarians, like doctors and other conventional
delegates in the eld, gained acceptance. At the same
time, the humanitarian sector as a whole was becom-
ing more proessionalized: many o the ICRCs Water
and Sanitation engineers came rom other areas,
bringing with them technical and proessional skills
o other kinds. Yves Etienne, who had worked or the
World Bank beore joining the ICRC in 1986, was such
an engineer. At the time, Etienne recalls, a rigid distinc-
tion was observed between emergency operations
and development.There was a certain distrust within
the ICRC o diversiying assistance activities, he says.
We noticed, even in the medical sta, a reluctance to
recognize water and sanitation as health activities in
the proper sense.
Formal recognition within the ICRC took shape in
1998, when the Water and Sanitation Unit and the
Construction Unit, then under the assistance division,
were merged and Riccardo Conti a hydrogeologist
and mining engineer who had worked abroad in the
mining sector or ten years beore undertaking mis-
sions in Arica, Asia, Europe and the Middle East or
the ICRC became the rst head o the newly created
Water and Habitat Unit, or WatHab.
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ThierryGassmann/ICRC
FredGrimm/ICRC
1984 1985 1986 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 201303
1986
198919881987
SUDAN 1986-1989
As the civil war in South Sudan worsened, a major
assistance operation was launched, targeting inter-
nally displaced people who had gathered around
government-controlled towns, as well as civilians in
areas held by the Sudan Peoples Liberation Army.
Water projects or internally displaced people, and
or eeding centres and health inrastructure proj-
ects, were an essential aspect o the ICRCs response.
The photograph above shows a woman at an ICRC
water project in Yirol, now in central South Sudan. In
Narus, the ICRC set up a water pump at a spring (above,
right) or people in desperate need o resh, clean
drinking water.
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LuzLuzemo/ICRC
LucChessex/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1990 1991 1992 1993 1994 1995 1996 1997 19981983
1988
1989
MOZAMBIQUE 1989
ANGOLA 1988
In 1988, the ICRC negotiated access to both security
detainees and civilians aected by the conict. Forthe people o Inhaminga (below), as or many others
in Mozambique, access to a reliable supply o water
was oten limited. The ICRC transported spare parts or
water pumps where needed; and a sanitary engineer
worked with the Programa Nacional de Agua Rural, a
government organization, to sink several wells and
repair a number o those already in existence.
Drought and conict had a direct impact on the
harvest and on nutrition. Access to war-aected victims
was not always easy. Ater lengthy negotiations with
all the parties, the ICRC obtained security guarantees
to resume work in the provinces o Huambo, Bi and
Benguela. Here, despite the erce ghting in progress,
ICRC sanitary engineers completed projects in 25 towns
or thousands o internally displaced people and resi-
dents. The ICRCs response also included improving
conditions or patients in health centres and hospitals;
in addition, the ICRC set up nutrition centres, as well as
more health centres.
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SergeCorrieras/ICRC
ThomasPizer/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1991 1992 1993 1994 1995 1996 1997 19981983 1984 1985 1986 1987 1988 1989 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
1990
CAMBODIA 1990
As the ICRCs medical operations grew in the 1990s, its
engineers helped to repair or build acilities or provid-
ing adequate water, heating, cooling and sanitation, as
well as energy efciency and the proper handling o
medical waste oten in very difcult circumstances.
Underground wells were developed to supply the
ICRCs sub-delegation and the surgery hospital in
Mongkolborei in north-western Cambodia. ICRC engi-
neers also built a prosthetic workshop in Battambang
in 1991 to provide low-cost prostheses or amputees;
the workshop is now helping ageing amputees adjust
to their prostheses.
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CarloHeathcote/ICRC
FranoisRuef/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1992 1993 1994 1995 1996 1997 19981983
1991
Kabul, ICRC orthopaedic centre.
KABUL, AFGHANISTAN 1991
In the 1990s, the ICRC expanded its activities in the
area o physical rehabilitation, and WatHab provided
support or that. One example is the construction o
the orthopaedic centre in Kabul. Conceived during the
civil war that broke out ater the Soviet withdrawal, the
centre continues to serve those who have lost limbs
throughout this long and difcult period in Aghani-
stans history. Other centres would ollow in Mazar-
i-Shari, Herat, Jalalabad, Gulbahar, Lashkar Gah and
Faizabad and the WatHab team would play a crucial
role in their construction. Over the years, some 150,000
Aghans have received prostheses at these centres.
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PhilippeDutoit/ICRC
MarcBouvier/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1992 1993 1994 1995 1996 1997 19981983 1984 19851983 1987 19881986 1989
1991
Al Musayab, near the city o Karbala (let).Water treatment plant constructedin the 1950s and not used or several years.The ICRC eventually rehabilitated it.
Baghdad, Saddam City Hospital (above).Provision o sae drinking water.
THE NEW URBANBATTLEGROUND
IRAQ 1991
When the coalition o orces led by the United States
launched its attack on Iraq in 1991, it used heavy
aerial bombardment o military and industrial sites as a
means to weaken Iraqs ability to wage war.
Electrical power stations that supplied not only the
countrys military apparatus, but also acilities vital to
the health o the civilian population, were aected.
The outage o power in much o Baghdad aected
hospitals, ood markets and the systems that supplied
the citys seven million people with clean water.
The Geneva Conventions say you cant bomb thewater treatment plants, but there is nothing in the
Conventions that explicitly says you cant bomb the
power plants,says Riccardo Conti, Head o the Water
and Habitat Unit at the time. The problem or the civil-
ian population is that i you bomb the power plants,
you also aect the water treatment plants.
As a consequence, the population in addition to
dealing with the direct eects o bombing, some o
which caused considerable numbers o civilian deaths
and injuries also had to cope with the spread o a
variety o inectious diseases. Outbreaks o cholera,
or example, were linked to the disruption o essen-
tial services over a long period during which hospital
services were overwhelmed and access curtailed.
Civilians were already suering under the sanctions
imposed by the United Nations Security Council
ollowing Iraqs annexation o Kuwait in August 1990.
The military action by coalition orces in January 1991
severely damaged the countrys inrastructure even
urther. The economic sanctions continued, and they
added to the problems o Iraqis. The ICRC maintained
its response throughout this period, by providing
support or hospitals and livelihoods and by repairing
and maintaining electrical power stations damaged
by bombing.
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MarcBouvier/ICRC
OmarSaad/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
2001
Wasit, near the city o Kut.Water treatment plant completelyrenovated by the ICRC.The plant supplies water to all2,000 inhabitants o the city.
Baghdad.Team o technicians working inAl Wethba pumping station.
IRAQ: TWENTY YEARS LATER,THE WORK GOES ON
For the ICRC engineers who went to Baghdad, the
operation was a turning point. This was the rst time
that they had had to repair a highly developed water
system o this scale. Beore, conicts tended to aect
rural areas,says Conti.
Given the scale and complexity o Iraqs water systems,
the ICRC appointed or the rst time a water and
sanitation coordinator to work with local authorities
and international organizations in what would become
a substantial, long-term commitment to keeping the
citys power grid, water supply and water treatment
plants up and running.
The teams experiences in Beirut and Monrovia in 1989
had prepared them somewhat. There, ICRC engineers
realized the importance o orming partnerships with
local agencies and engineers, many o whom had con-
siderable experience and expertise.
[Beirut in 1989] is where our intervention in urban
centres began, says Nembrini. Under sometimes
heavy shelling we were able to restore the supply o
water in the southern suburbs and on part o the east
side o the town by installing a large generator at a
pumping station.
It was big or us at that time. We were suddenly deal-
ing with thousands o cubic metres or cities with
the related engineering complexity, he recalls. The
people were not in camps but they were living within
the theatre o the operations. They were dened as
the urban trapped,preerring to live where they were
used to, rather than crowding into reugee camps or
some other place that nobody knows.
The team had come a long way since El Salvador in
1983, when some o the relatively small, rural systems
it set up in remote villages were considered the limit o
the ICRCs capacity.
In order to mitigate some o the consequences o the
conict, the ICRC has helped local water boards to
improve the quality and increase the quantity o the
water they supply, as well as to ensure better evacu-
ation o wastewater. These eorts have continued
uninterruptedly since 1995 and have helped to prevent
the spread o water-borne diseases, thus protecting
millions o people. Ater the US invasion and thesubsequent collapse o the government o President
Saddam Hussein in 2003, the ICRC provided substantial
aid in the orm o medical supplies, water and other
essentials to more than 65 urban hospitals, and carried
out emergency repair work on water, sanitation and
power systems in hospitals and maternity and paediatric
centres throughout Iraq. Mobile water-distribution units
were also set up in urban areas suering rom acute
shortages, and regular deliveries made by ICRC water
tankers to regions with no other source o water. The
ICRCs eorts to improve the countrys basic inrastruc-
ture, which has not yet recovered ully, remain in place.
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3332
CdricPiralla/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 201319 84 19 851983 1987 19881986 1989
1992
SOMALIA 1992
When civil war broke out in Somalia in 1991, nearly all
State services collapsed and gaining access to water
became increasingly difcult. Water was also o stra-
tegic importance and water installations, vital to local
populations, were oten destroyed or military purposes.
Hundreds o boreholes along the transhumance route
or nomadic herding communities that relied on animal
production were no longer maintained. For the ICRC, the
rehabilitation o water points like the one shown above
is crucial or the integrated assistance it provides in a
country oten hit by drought, ooding and disease.
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34 35
JolleCome/ICRC
LaurentSazy/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
1993
Split. Water-supply point in ronto a ruined building.
BOSNIA-HERZEGOVINA 1993
The struggle to nd clean water is one o the lesser-
known stories o this protracted conict. In some places,
distribution and treatment plants were destroyed dur-
ing the ghting or ell into disrepair or lack o parts and
chemicals. Elsewhere, they could not be used because
there was no electricity and access to water sources
was restricted, leaving isolated areas with no drinking
water. In addition to negotiating access or civilians
to water supplies, the ICRC worked to ensure that the
water available was sae to drink. The ICRCs water and
sanitation teams worked in some 70 dierent munici-
palities in the coastal city o Split, or instance, where
water was pumped rom in ront o a ruined building.
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3736
GuillaumeBinet/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1995 1996 1997 19981983
1994
A STRONG COMMITMENT
RWANDA 1994
Since 1915, the ICRC has been devising and conducting
activities to protect prisoners, detainees and internees
held in connection with international and non-inter-
national armed conicts.
The ICRCs mandate in this connection was rea-
rmed by the Third Geneva Convention o 1949, which
replaced and signicantly broadened the scope o the
1929 Convention on the Treatment o Prisoners o War.
More than 80 years ater the adoption o the Third
Geneva Convention, which entitles the ICRC to visit
prisoners o war without any restrictions, ICRC dele-
gates continue to monitor conditions o detention.
For the ICRC, the term conditions o detentionincludes
such things as the degree o respect or the detaineesphysical and mental integrity shown by the personnel
in charge o their lives; the material conditions o deten-
tion (ood, accommodation and hygiene); access to
health care and to a certain minimum amount o exer-
cise and leisure; and possibilities or maintaining amily
and social relationships, or working and or receiving
vocational training.
The all-detainees approach
Ater the Rwandan genocide in 1994, the ICRCs
approach to detention took a major shit. Detention
activities used to be strictly oriented towards prisoners
o war, security detainees or civilian internees; but the
massive increase in the jail population linked to the
Rwandan conict had unprecedented consequences
that led the ICRC to develop sanitation systems and
other health-related programmes aimed at helping
all detainees.
The pri mary objective is saeguarding the health o
detainees: saving lives and reducing rates o mor-
bidity and mortality. Over the past 30 years, WatHab
engineers have acquired specic expertise in the area
o environmental engineering as it relates to places
o detention, in order to improve public health and
ensure dignied living conditions.
ICRC engineers are now members o multidisciplinary
teams composed o protection delegates, health dele-
gates and nutritionists. Their activities are broad in
scope, ranging rom assessing the needs and health
risks associated with individual detainees to addressing
the root causes o deciencies in a given penitentiary
system. Today, the ICRC carries out detention activities
in 101 contexts; there are WatHab programmes in 37 and
they benet over 160,000 detainees each year.
Ater the horriying waves o massacres in which
armed militias wiped out hundreds o thousands o
civilians around two million Rwandan reugees ed
to camps across the borders with Zaire, Tanzania and
Burundi. A urther 500,000 people were displaced
within the country. From the outset, the aims o the
ICRCs water and sanitation programme in Rwanda were
twoold: to curb the outbreak o disease in the camps
and to rehabilitate the countrys main water supply
networks. A total o 10 camps or around 250,000 dis-
placed people were equipped with emergency water-
distribution systems, and materials or the construction
o latrines were provided. The ICRC also launched a
special programme in October 1994 to improve access
to potable water, ood and health care or thousands o
detainees living in squalid, overcrowded prisons.
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3938
EricBouvet/ICRC
PaulGrabhorn/ICRC
PaulGrabhorn/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1997 19981983
1995
1996
Grozny.Water distribution point installedby the ICRC.
Gihanga.Water distribution point beinginstalled by the ICRC.
BURUNDI 1995
CHECHNYA 1996
Political strie that weakened the government, peri-
odic attacks over a long period by rebel groups who
took reuge in urban areas, and large-scale operations
by militias and sections o the army: all these contrib-
uted to the deterioration o social and economic con-
ditions. Some 100,000 residents and displaced people
on the Imbo plain to the north-west o Bujumbura
Renewed ghting between ederal troops and Chechen
separatists impelled successive waves o civilians to
leave or neighbouring republics. Those who did not
ee remained trapped in their homes while their towns
and villages were shelled. Ater a large-scale oensive
by ederal orces in July, about 200,000 civilians ed the
capital city o Grozny. In response, the ICRC rehabili-
tated water and power networks and distributed water
by trucks in uncovered areas in the northern Caucasus.
The ICRC also got Groznys sewage system, including
13 pumping stations, working again.
were deprived o water as a result o violence in the
surrounding hills. As diarrhoea and cholera began to
spread, an emergency plan o action was switly put
into place. By the end o September 1995, in many vil-
lages and camps or displaced people around the coun-
try, the water supply had been secured.
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4140
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1997 19981983 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
1996
1999
EAST TIMOR 1996
The expressions o joy on the aces o these childrenis eloquent proo o the undamental human need or
water. This water tap was installed by the Indonesian
Red Crescent and the ICRC in the village o Riattu dur-
ing a violent chapter in Indonesias history. As ghting
ared up between Indonesian orces and the armed
opposition, the Indonesian Red Crescent and ICRC
water engineers collaborated on a broad range o proj-
ects, including hydrogeological surveys, the sinking o
new wells, and the building o extensive water distri-
bution networks to supply widely dispersed hamlets.
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4342
Je
anNordmann/ICRC
TillMayer/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 19981983
1997
Monrovia.An ICRC team chlorinates arehabilitated well.
ICRC staf helping the LiberianRed Cross clean upthe market-place in Monrovia.
LIBERIA 1997
During times o extreme crisis, maintaining public ser-
vices such as delivering water or removing solid waste
can help prevent the spread o diseases and provide
some order amidst the chaos. Liberia in the late 1990s
was subject to many actors that threatened its stabil-
ity. In 1997, the ICRC supervised maintenance work on
some 500 wells and pumps supplying drinking water
to Monrovia, the capital city. It also built or repaired
sanitation and water-supply acilities in places where
thousands o displaced people had gathered, as well
as in medical acilities in Monrovia and the provinces.
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44 45
PaulGrabhorn/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 19981983
1997
MALI 1997
In northern Mali, as part o a programme called Water,
Spring o Lie, the I CRC rehabilitated water points such
as this one in Haoussa. These water points are critical
to the survival o livestock belonging to pastoralist
Tuareg communities. The situation in northern Mali
was already delicate and the persistent drought ag-
gravated matters: it gave rise to steadily growing
discontent in some sections o the population and
hence to conditions that were more raught with
danger. In 1996, the ICRC carried out environmental
sanitation work and rehabilitated traditional wells as
part o its medical programme in northern Mali.
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4746
MarizildaCruppe/AgenceO
Globo/ICRC
PhilMoore/ICRC
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 19971983
1998
Burungo village, near Goma (above).The ICRC building installations or water distribution.
Volcanodistrict, Goma, North Kivu province (right).A young boy walks between reshly laid water pipes.In 2002, an eruption o the Nyiragongo volcanocompletely destroyed the district.
DEMOCRATIC REPUBLIC OFTHE CONGO 1998
The eastern part o Congo has endured a series o dra-
matic events over the last 20 years, rom the inux o
a million reugees in 1994 to the volcanic eruption in
the town o Goma. In 1998, the people o the Demo-
cratic Republic o the Congo were caught in a proxy
war between a number o neighbouring States. The
ICRC maintained its activities, reurbishing vital water
distribution systems in cities in the ve provinces most
aected by the conict. Improving water systems and
modernizing medical acilities were the ICRCs top
priorities. Over the last two decades, the ICRC has
continued to work with dedicated local operators to
provide water and sanitation acilities or displaced
people and civilians in rural and urban areas.
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48 49
ICRC
BorisHeger/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
1999
ERITREA 1999
KOSOVO 1999
Following the war with Ethiopia in 1998, tens o thou-
sands o Eritreans living on the Ethiopian border
remained displaced or years. In order to help many o
those in displacement camps to return home, the ICRC
provided support or some 50 rural water projects,
donated building materials or the reconstruction
o homes, and helped rehabilitate local health inra-
structure. Given the availability o expertise in it, solar
technology was avoured or water pumping systems.
A series o air strikes on targets by NATO member
countries shattered much o the regions inrastructure
and let it on the verge o economic collapse. Some
800,000 ethnic Albanians ed, mainly to neighbouring
Albania, the ormer Yugoslav Republic o Macedonia,
and Montenegro. ICRC engineers were active through-
out the crisis, providing support or public-health acil-
ities and launching a programme that helped reurbish
wells throughout the country.
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50 51
MarcBleich/ICRC
LucChessex/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
1999
LOKICHOKIO, KENYA 1999
The scale o casualties in the Sudanese civil war, which
broke out in 1986, was such that it necessitated the
establishment o an ICRC eld hospital in Lokichokio,
a village in northern Kenya on the Sudanese border.
The hospital grew considerably over the years: its
maximum capacity rose to 500 beds, and at one time
was thought to be the biggest eld hospital in the
world. When it closed in 2006, over 60,000 surgical
procedures had been carried out on 37,905 patients.
Such rapid expansion, accompanied by the exigencies
o adjusting to shiting needs, required a lot o work
behind the scenes.
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52 53
FredClarke/ICRC
FredClarke/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
2000
GEORGIA 2000
It is oten the case during conicts that peoples lives
are dependent on the bravery o certain persons who
dare to go to work. Few people are aware o their
eorts, but water operators such as this control-room
guard at a water pumping station in Sukhumi, in north-
western Georgia, are quietly keeping others alive. War
also orces water engineers rom their posts or destroys
the machinery needed to keep the water owing, as
in this abandoned water pumping station. When that
happens, the ICRC can provide lielines. For example, in
2000, ater an assessment o the water and sanitation
needs o 6,500 Chechen reugees and 8,000 residents
in the Pankisi valley, communal latrines and baths were
built and a water piping system installed.
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54 55
JessicaBarry/ICRC
CarloH
eathcote/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
2002
AFGHANISTAN 2002
Ater the collapse o the Taliban government in late
2001, the people o Aghanistan strove to create a basis
or stability and reconstruction. Hostilities remained
largely dormant, but tensions did are up rom time to
time. By the end o 2001, the ICRC had restored the ull
range o its activities throughout the country. These
were maintained throughout 2002 and the Aghan
operation became the largest mounted by the organi-
zation anywhere. In 2002, the ICRC improved water
supply and sanitation or some 2.7 million people.
In the north, during the winter o 2003-2004, poor
snowall gave rise to worries about drought. The ICRC
worked with the inhabitants o Shaidan village to con-
struct a dam to store water or irrigating the villages
agricultural land.
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56 57
BorisHeger/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2006 2007 2008 2009 2010 2011 2012 2013
2005
DARFUR 2005
As a result o the civil war that broke out in 2003,
over two million civilians were internally displaced or
became reugees in neighbouring Chad, where, oten,
they were housed or sought reuge in urban areas.
The ICRC oered assistance not only in camps such as
the one in Gereida, but also in remote villages cut o
rom most assistance, where water was vital or armers
dependent on livestock. In many o these areas, such
as Al Hosh (let), water points had been destroyed and
needed to be rehabilitated with ICRC help.
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58 59
OlivierMoeckli/ICRC
SarahBaumgartner/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
2005
1999 2000 2001 2002 2003 2004 2006 2007 2008 2009 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983
Muzafarabad.Aerial viewo ICRC eld hospital.
MUZAFFARABAD, PAKISTAN 2005
When an earthquake measuring 7.6 on the Richter scalestruck Pakistan-administered Kashmir on 8 October,
tens o thousands o people were killed and some
3.5 million let homeless. Entire villages were at-
tened, and water and electricity networks, roads,
schools and health acilities suered massive damage.
Many people rom severely aected rural areas
sought assistance in Muzaarabad, the largest city in
the region, even though it had also been badly dam-
aged. Owing to extensive damage in Muzaarabad, a
eld hospital with 100 beds (established jointly with
the Norwegian and Finnish Red Cross Societies) was
set up on the outeld in the citys cricket stadium.
The outeld also served as a h elipad or relie ights,
because the quake had made the roads impassable.
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60 61
BenotSchaefer/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 20131983
2006
1999 2000 2001 2002 2003 2004 2005 2007 2008 2009 2010 2011 2012 20131998
LEBANON 2006
The most intense hostilities since the civil war o
19751991 resulted in more than 1,000 people, mostly
civilians, being killed, thousands wounded and hun-
dreds o thousands displaced. The damage to civilian
inrastructure, including roads, bridges, power plants
and water supply acilities was widespread. Water sup-
ply acilities in the south suered more damage than
those in other parts o the country. The ICRC provided
leadership and coordination or the International Red
Cross and Red Crescent Movements response, which
included relie in the orm o ood, water, basic shelter
equipment and household essentials, as well as sup-
plies or health acilities treating the wounded and the
sick. Along with the Lebanese Water Board, ICRC engi-
neers ocused their eorts on restoring the supply o
electricity, essential or running urban water schemes.
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62 63
ICRC
ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2008 2009 2010 2011 2012 2013
20072007
YEMEN 2007
The conict in Yemen had damaged many key water
sites, such as this one (right) in Al-Har. ICRC water
and habitat engineers worked on the restoration
and reconstruction o water supply systems (like the
one below) in many parts o the country, including
Saada, Dahyan and the Marran, to benet bothinternally displaced persons and the resident popu-
lation. The country has had a chronic water shortage
or decades: every year, the quantities o water that
Yemenis pump rom aquiers is greater than that
deposited by the rains; and underground reserves
are shrinking.
Yemen has one o the lowestratios o water to inhabitantsin the world, and the situa-tion is worsening by the day.Countrywide, the water tableis dropping by between oneand seven metres per year.Andres Casal, 2009Then the ICRCs water engineer in Saada
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64 65
Domin
icSansoni/ICRC
ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
2007
2008 2009 2010 2011 2012 20132005 2006
SRI LANKA 2007MYANMAR, CYCLONE NARGIS 2008
In the early months o 2007, thousands o people were
displaced by the ghting in the north o the country.
The ICRC rst distributed tents at the Kiran camp or
displaced persons in Batticaloa. Then it launched a pro-
gramme to construct more durable and permanent
shelters. Because o the number o people aected, and
the speed with which they had been displaced, it was
difcult to obtain building materials in sufcient quan-
Following Cyclone Nargis, which devastated many vil-
lages in Myanmar in May 2008, a team o Myanmar Red
Cross and ICRC engineers took mobile water-treatment
units to two islands in the region o Dedaye. Meanwhile,
assistance in places o detention continued: some 14,000
detainees and sta in 27 dierent prisons received assis-
tance in the orm o water and sanitation.
tities immediately. The number o internally displaced
was estimated to be as high as 300,000. Needs were dire,
among the displaced as well as among the communi-
ties hosting them. The ICRC, sometimes in cooperation
with local branches o the Sri Lanka Red Cross Society,
provided assistance to some 300,000 conict-aected
people in the orm o ood, essential household items,
shelter materials and improved water acilities.
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66 67
MarkoKokic/ICRC
TeriPengilley/ICRC
MarkoKokic/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2009 2010 2011 2012 2013
2008
CENTRAL AFRICAN REPUBLIC 2008
Following a decrease in ghting in the north, armed
groups and the government signed a peace agree-
ment in June. In August, conict ared up again,
mainly in the north-west; this time it also involved a
group that had rearmed ater being dormant or some
months. The renewed ghting, combined with wide-
spread lawlessness, displaced more people, hampered
the delivery o aid and prevented the tens o thou-
sands already displaced rom returning home. In 2008,
the ICRC, together with the Central Arican Red Cross
Society, improved hygiene and water acilities or
180,000 people.
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68 69
AlBaba/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20131983
2009
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 20131983
GAZA 2009
Developing water delivery systems in the densely
populated Gaza Strip is a ormidable task. Access to
surace water is almost non-existent and ground-
water resources are limited. Restrictions on the import
o building materials and lack o unding and space
are other obstacles. Wastewater treatment is a vital
public health issue. In 2009, construction o the Raah
wastewater treatment plant three years in the plan-
ning got under way. The builders relied as much as
possible on materials that could be ound or manuac-
tured locally, including piping and even cement blocks
recovered rom the remnants o the old Raah wall. The
plant, which was inaugurated in 2011, treats 20,000
cubic metres o wastewater a day or 175,000 inhabi-
tants. During the three-week Israeli military operation
in the Gaza Strip in 2009, the ICRC with the consento both sides continued to carry out its activities: it
was able to assist authorities in maintaining essential
inrastructure or health care and access to water.
Its a great challengeto carry out construction
projects in the Strip, asbuilding materials cannot beimported. Humanitarianorganizations such as theICRC are orced eitherto come up with alternativeand creative ways o pro-ceeding, or to put essentialprojects on hold.Marek Komarzynski
An ICRC engineer in Gaza
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70 71
GettyImages/ICRC
SamuelBonnet/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 20131984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983
2009
JUBA, SOUTH SUDAN 2009
The ICRC eld hospital in Lokichokio, a village in north-
ern Kenya on the Sudanese border, had been set up
to deal with the mounting casualties o the Sudanese
civil war. In 2006, when ICRC operations at the hospital,
where amputees had been treated, were shut down, the
organization saw the need or an equivalent in South
Sudan to ensure adequate ollow-up or patients. For the
estimated 35,000 amputees in South Sudan, the physical
rehabilitation centre built by the ICRC in Juba over a two-
year period was an immensely signicant development.
The centre, including a workshop or manuacturing and
repairing prostheses, was handed over to the health
authorities in 2009. Staed by 26 technicians, the centre
has a yearly capacity o 1,200 patients and can house up
to 100 patients at a time. It reects the ICRCs long-term
engagement in South Sudan with those who have lost
limbs during the conict.
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72 73
NormandBlouin/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2010 2011 2012 20131987 1988 1989 1990 1991 1992
2009
SENEGAL 2009
In the Casamance region o Senegal, the long-standing
conrontation between government orces and armed
opposition remained unresolved. Uncertain security
conditions, coupled with the presence o mines, pre-
vented displaced people including those who had
sought reuge across the border in Guinea-Bissau
rom returning home. In Casamance and in Guinea-
Bissau, the ICRC worked with National Societies to
improve community health through hygiene promo-
tion and the installation o public water points and
latrines. As women played a crucial role in managing
the daily lives and preserving the economic security
o amilies, the ICRC worked to improve their access to
clean water and provided support or market garden-
ing projects.
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74 75
MarkoKokic/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2011 2012 2013
2010
2010 AND BEYONDIn 2012, WatHab conducted activities in 50 countries,
with the direct involvement o over 500 people. It is
now an essential part o the ICRCs operations, as
inseparable rom the humanitarian response as health-
related activities curative and preventive the provi-
sion o access to ood, and the ensuring o protection,
in accordance with the Geneva Conventions, or civil-
ians and people engaged in conict.
Today, WatHab has become a natural part o the ICRC
and is present in all situations where its needed,notes
Pierre Perrin, one o the doctors who laid the ounda-
tions or the units creation 30 years ago.
No one knows what challenges or opportunities the
next 30 years will bring, but everything suggests thatthe issues will become more complex, that public
health risks are growing, and that the solutions that
are developed will have to be continuously adapted to
new realities. One major trend is population growth in
cities, which are increasingly becoming battlegrounds
and where civilians are trapped without coping
mechanisms like those available to people in rural
areas. Another is the growing complexity and inter-
dependence o the technological aspects o essential
urban inrastructure: electricity, water, and medical
acilities. Access and proximity are essential or build-
ing up our understanding, not only o the people
aected, but also o the technical issues involved. This
is by no means a given in conict areas today: there are
many more actors on the scene and conicts are oten
unstructured. These constraints notwithstanding, the
authorities and the people aected remain an integral
part o any response. The scope o engineering skills
must be expanded to develop suitable solutions that
make use o new technology and approaches, and o
ideas and innovations rom the people who manage
and benet rom these systems over the long term.
I remain condent that challenges will produce solu-
tions as long as we can count on our imagination and
sense o humanity. Over the last 30 years, we have
constantly, within the organization and beyond, been
exible and open to change, and we will persevere
with that approach, says Philippe Dross, the current
head o WatHab.
In some conict zones, when humanitarian personnel
become targets, the ICRC is able, or a while, to develop
and manage projects remotely: it works with what is
available locally to deliver water or expand hospital ser-
vices. This has been a trend in several countries over the
last decade; it should not become a xed practice over
time, but it does provide positive results when access
is wholly unavailable. Weapon bearers throughoutthe world should be persuaded to respect the ICRCs
humanitarian mandate and the rights o civilians.
The good news is that in most conict zones, the ICRC
and other humanitarian organizations, particularly
the local networks provided by National Societies,
are able to obtain access to the people aected. As a
consequence, over the past three decades, millions o
people at risk have been able to evade the bullets and
the bombs; they have also been able to evade disease
and malnutrition, through access to clean water, basic
sanitation and adequate health-care acilities.
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76 77
ICRC
ICRC
SamuelBonnet/ICRC
AlexanderHumbert/ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2012 20132002 2003 2004 2005 2006 2007 2008
2010
2011
HAITI 2010
KYRGYZSTAN 2010
CTE DIVOIRE 2011
The devastating earthquake that struck Haiti on
12 January killed more than 230,000 people and let
over a million others homeless. It also inicted heavy
damage on the countrys inrastructure, including water
systems, roads, hospitals, and schools and other build-
ings. The ICRC responded by acilitating amily contacts
and by providing rst aid, hospital care, access to clean
water, and management o dead bodies. The Special
Fund or the Disabled, which had been providing sup-
port beore the earthquake or Healing Hands or Haiti,
a local oundation, mobilized the American, Australian,
Canadian and Norwegian Red Cross Societies to jointly
und a new building (above) on a privately donated plot
o land. Construction, supervised by the ICRC, began in
March 2011 and the building was ormally handed over
to Healing Hands or Haiti in March 2012.
Serious political tensions, ollowed by clashes between
young people o Kyrgyz and Uzbek origin, led to
the deaths o almost 400 people. Many others were
wounded and houses and public buildings burnt
down. Tens o thousands o people were internally
displaced and some 100,000 others ed to Uzbekistan;
a ew hundred crossed over into Tajikistan. The ICRC,
working with the National Societies concerned, pro-
vided ood, essential household items and clean water
to almost 400,000 people. By means o a cash-or-work
programme, the ICRC reconstructed 317 homes in
Kyrgyzstan, enabling people to have shelter beore
the onset o winter.
The wave o violence that swept Cte dIvoire severely
restricted local production o drinking water, as the
authorities were unable to import chemicals essential
or treating potable water. The ICRCs representations
to diplomatic authorities enabled an ICRC-chartered
ship to deliver 4,000 tonnes o lime (calcium oxide) to
the country. As a result, the ve million inhabitants o
Abidjan, the capital city, had water to drink.
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395E
3910E
1425N
1420N
ZibanGuyla
Kotakhilo
KhilMilo
DzhilChe
Mizbar
ImbaburTerara
IlaShet
IlaShet
MayAwehi
Shet
AdiChiana
UokhabitMarYam
BetGebet
DebreAnbesa
Guzar
AddiKelKel2
May Suhi
AdiKOO
Shet
UorgaAgazin
IntichO
DiberaAmba
UtzaGuza
KisadKhitsa
MayChAA(2)
MayChAA(1)
Mezbir
InineMaryam Bete
Kristiyan
Irar
HarmetDakEyano
Dubere
Cheguoro
AdiAbiy
Inine
Inine
Mezbir
E T H I O P I AE T H I O P I A
Tigray Water Resource authorities have
set themselves a goal: no village in Tigray willbe farther than 1.5 kilometres away from a
source of water.
The map above was created by the Tigray
Water Resource Bureau after an inventory of all
the water points in Woreda Ahferom in 2011.
It shows which villages have access to water
within 1.5 kilometres and which do not,
thereby indicating where water points have
to be repaired or constructed.
Hand pumps
Working
Broken
Served by functioning water points
within 1.5 km
Served by partially functioning water points
within 1.5 km Repairs are needed
Served by broken water point within 1.5 km
Repairs are urgently needed
Not served by a water point within 1.5 km
Additional water points are needed
Areas and villages
78 79
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2012 2013
2011
PUTTINGTHE ICRC ON THE MAPLITERALLYThe whereo humanitarian aid has always been a matter o much
importance to water and sanitation engineers: Where are the
people in need o water? Where can a reliable water source be
ound? Where should we lay the pipeline to bring water to the
people in need?
It is no surprise, thereore, that making maps and managing
geographic inormation systems (GIS) are key skills or water
and sanitation engineers. Consider, or example, one early GIS
project in the Somali capital o Mogadishu, where much o the
water supply is pumped rom hand-dug wells and distributed by
private vendors who carry the water by donkey cart or other smallvehicles. In 1997, the ICRC used GIS to study whether, as a result
o many o the wells being overused, the water in Mogadishu and
the surrounding areas had become too salty. Tests showed that
underground water containing sea salt was indeed moving inland
rom the coast had moved close to two kilometres since the last
measurements in the 1980s.
This type o analysis is important because understanding local
water tables and markets can be critical in deciding when, where,
how and with whom to drill a new borehole. These decisions could
alter not only water ows and aquier replenishment, but also
the local market system in which competition could easily lead to
conict or exacerbate tensions.
Now widely used in responding to conicts and natural disasters,
GIS allow humanitarian workers to track everything rom popula-
tion movements and water use to the spread o disease. According
to Robert Mardini, a ormer head o WatHab, early versions o such
systems have been in use within the unit since the 1990s. Today, a
more user-riendly, web-based programme, the ICRC Geoportal, is
used to map ICRC operations, activities and inrastructure such as
warehouses and other acilities.
A current ICRC project in Ethiopia oers another example o the
way GIS can be used to help local water boards to maintain water
systems. In this case, water technicians returning rom a water-
point maintenance tour can upload data to a new cloud-based
database that charts the unctional status o over 10,000 rural water
points. Thus the central water boards ofces are kept inormed o
where repairs are needed, saving time and resources. Such systems
have also been used to share vital inormation (about water points
or medical care) during rapid emergency response: the conict
in Libya, the oods in Pakistan and the 2010 earthquake in Haiti,
among many other examples.
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80 81
ICRC
ICRC
ICRC
1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 19981983 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2011
2012 2013
SOUTH SUDAN 2012
KEYSANEY HOSPITAL,MOGADISHU 2011
SYRIA 2013
As a consequence o border clashes and civil war in
South Kordoan and Blue Nile states, over 170,000 reu-
gees entered South Sudan. The ICRC provided support
or United Nations agencies in two camps or displaced
persons by upgrading water systems and providing
essential household items or 37,000 reugees.
Despite harsh security conditions and limited access,
the ICRC succeeded in constructing a new 400-square-metre operating theatre in Keysaney Hospital, a ormer
prison building where, in the last 20 years, more than
216,000 patients, including 30,000 war-wounded, have
received treatment.
Since the onset o the violence in Syria in March 2011,
the ICRC has been doing its utmost to respond to the
needs o those aected by the ghting. Together with
the Syrian Arab Red Crescent, the ICRC has been provid-
ing water, ood, medical supplies and other items to the
people aected, namely displaced persons.
In 2013, Peter Maurer, the president o the ICRC, said
that the ICRC was convinced that humanitarian orga-
nizations should provide support or governments
who were the rst responders in any crisis and not
act in their stead. He said that in 2012, the ICRC, act-
ing on this principle, was able to provide more than
1.5 million people with ood and household items;
and, in terms o water and sanitation, aided more than
12 million people in all.
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82
OUR HEARTFELT THANKS
MISSION
The International Committee o the Red Cross (ICRC)
is an impartial, neutral and independent organization
whose exclusively humanitarian mission is to protect
the lives and dignity o victims o armed conict and
other situations o violence and to provide them with
assistance. The ICRC also endeavours to prevent suering
by promoting and strengthening humanitarian law and
universal humanitarian principles. Established in 1863,
the ICRC is at the origin o the Geneva Conventions and
the International Red Cross and Red Crescent Movement.
It directs and coordinates the international activities
conducted by the Movement in armed conicts and other
situations o violence.
It has been close to hal a century since ICRC delegates
and surgeons set up a eld hospital in a remote part
o the Yemeni desert. On the Thai-Cambodian border,
20 years later, one o the rst complex, large-scale
ICRC operations took place. It marked the birth o the
public-health approach, which takes into account the
needs o communities living in complex environments
and ensures sae living conditions or individuals. It
also made possible the shit rom individual medical
care towards all-inclusive community support in
rural and urban settings and or the short as well as the
long term.
Civilians are the primary, and by ar the most numer-ous, victims o conict not always as a direct conse-
quence o the ghting, but because entire communities
are woundedwhen their habitual living environment
is disrupted. Their basic rights are oten disregarded
and their access to water, health, ood production and
essential services jeopardized. This can be seen at its
most dramatic in Syria today: hundreds o thousands
o people in the cities are enduring the grim conse-
quences o the ghting and are without access to
essential services and resources.
Each person is unique; as is each situation, requiring its
own proper solution. We learn rom our experiences,
rom all the persons we meet, rom technicians, host
communities and authorities. They help us towards di-
erent sorts o understanding: social, political or tech-
nical; without them, we would not be able to develop
solutions or the problems that we conront. Without
this human actor we would not be able to move or-
ward. Technical obstacles are seldom insuperable.
At present, the ICRC employs approximately 450 water,
sanitation and habitat specialists. They have one objec-
tive: to serve each individual and his or her community
as eectively as possible, mindul o their particularneeds and with respect or their dignity.
To all those who have supported our eorts to restore
or maintain peoples dignity over the last 30 years, we
oer our heartelt thanks.
And to all those who ought or and won institutional
support and created the Water and Sanitation Unit in
1983, we oer our most sincere gratitude.
Jean-Philippe Dross
Head, Water and Habitat Unit
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