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Treat, contain, repeat: key links between water supply, sanitation and urban health

PascaleHofmann14 January 2019

This blog is the third of the health in urban development blog series. View also:

Health in secondary urban centres: Insights from Karonga, Malawi
By Don Brown

Gaza: Cage Politics, Violence and Health
By Haim Yacobi

If you are interested in DPU’s new MSc in Health in Urban Development, more information can be found on our website.

 

In Dar es Salaam, Tanzania’s main economic and administrative centre, high population densities, the accumulation of informal lower-income residents, lack of access to clean water and poor sanitary conditions have been associated with a range of water and sanitation-related diseases. Cholera outbreaks are a frequent occurrence during the rainy season and some settlements in the city are among the worst affected in the country. In this context, I argue that urban water poverty needs to be tackled using a proactive rather than reactive approach at the local level to yield long-lasting health benefits.

Main access road in an informal settlement in Dar es Salaam after an episode of heavy rainfall (Photo © P. Hofmann, 2015)

 

Tackling urban water poverty and community health promotion

Internationally, the link between urban water poverty – i.e. inadequate access to water supply and sanitation facilities, and public health – is widely recognised whereby improvements in accessing water and sanitation are deemed crucial in tackling a diverse range of diseases and improving the lives of the poor.

Such thinking calls for integrated and consistent approaches, which, as emphasised by a UNICEF WASH specialist in Tanzania are evidently lacking in most policy-driven practices on the ground.

“Hygiene and sanitation awareness, behaviour change, communication and empowerment are maybe done in urban areas but erratically, not systematically. When the rains are coming and there is threat of cholera etc. then you will find people will announce:  ‘food vendors cover properly your food and make sure it is hot and whatever, please clean your surroundings, no solid waste should be seen and liquid waste, please drain it out completely’ etc. […] or there is a cholera outbreak in a certain locality in Dar es Salaam and it is feared that it might spread, so that happens but on a regular basis there is not a lot done” (quote from UNICEF WASH specialist).

During the recent cholera outbreak in 2015 government spending increased significantly to treat the affected population. While curative measures are vital, efforts to improve water supply and sanitation constitute essential steps towards future outbreaks. Similarly, some municipalities in Dar es Salaam have put continuous support into household fumigation programmes to impede the spread of malaria but fall short of investing in preventative measures to keep people healthy – i.e. reduce mosquito breeding sites through the provision of safe drinking water, improved sanitation and hygiene. Currently, the onus is predominantly on residents themselves to be pre-emptive in their everyday practices with regards to potential health implications but not everybody is equally aware or shares the same ability to act. In the absence of sufficient government action, those who can have invested in better access to water, improved sanitation facilities and even flood defences.

Drainage channel built by two neighbouring households to divert water from the Msimbazi river, which carries wastewater from nearby wastewater stabilisation ponds (Photo © P. Hofmann, 2015)

 

“In 2011 there was flooding and we lost our livestock and we had to start afresh. What actually happened is there has been increased silt in the Msimbazi river. At the same time, there is wastewater that comes from the ponds and where these meet, that impact pushes the water towards our land. […] we constructed this drainage channel jointly with my neighbour after the flooding to try and divert the water from coming in” (quote from a resident in an informal settlement in Dar es Salaam).

The need for a proactive, decentralised approach

Ward health officers are officially tasked with preventing water-related diseases and promoting environmental health in their jurisdiction through regular water quality tests at local water supply schemes and inspections of businesses and households with no equivalent paid staff at sub-ward level. However, with limited resources at ward level much of the action regarding water supply, sanitation and environmental health depends on voluntary efforts in the communities by residents themselves and facilitated through sub-ward committees, water committees and community representatives. Many health officers at the ward level understand the importance of sanitation, drainage and safely-managed water supply but struggle to influence the agenda at higher levels of government. The Decentralisation by Devolution Policy introduced in the 1990s transferred responsibilities to local government for service improvements but without fiscal decentralisation or devolution of decision-making power. Decentralisation should pave the way for bottom-up participatory planning processes but municipalities in Dar es Salaam focus on central government priorities while continuing to disregard lower levels of government and their efforts to address local challenges. Decentralised decision-making structures are therefore not a guarantee for more democratic processes.

The importance of engaging urban poor communities

To lower the burden of water and sanitation-related diseases, engagement of communities with the authorities (utility and municipal government) is crucial but often limited and slow. Until recently, one of Dar es Salaam’s municipalities prohibited low-income communities living near wastewater stabilisation ponds to use them for safe sewage disposal. A lengthy period of continuous interaction between the local community, the municipality and the utility, facilitated by a local NGO, eventually led to a pilot initiative that connects household toilets to the nearby ponds using simplified technology. This has reduced the number of pits being informally emptied during the rainy season and led to a safer and healthier environment for residents.

Inspection chambers of the simplified sewerage pilot in an informal settlement of Dar es Salaam (Photo © P. Hofmann, 2015)

The utility seems keen to replicate the scheme elsewhere in the city, which shows potential that policy-driven practices can be transformed, scaled up and institutionalised in ways that are more integrated and sensitive towards the needs of the urban poor if sufficient consideration is given to the scope for scaling up and sharing the benefits more equally within a settlement.

 

Pascale is a Lecturer at the Development Planning Unit, UCL, where she leads the MSc in Environment and Sustainable Development Programme. Her current research is particularly concerned with the dialectics of urban water poverty, examining different policy-driven and everyday practices and their impact on everyday trajectories of the urban water poor. She is interested in generating knowledge towards developing feasible pathways out of urban water poverty.

The knot at the end of the rope: Violence, hope, and transformation in El Salvador and Mexico

ArianaMarkowitz11 December 2018

I spent an afternoon in August with a group of young men in a skate park on the outskirts of San Salvador, El Salvador. The park was part of a larger recreational complex and more people drifted in as the hours passed. The day was stifling and even if shade in the park was limited, at least sometimes there was a breeze in the air, unlike inside the low-income housing blocks that ringed the park and the shacks that climbed up the surrounding streets, splintering into a labyrinth of dead-end alleys.

The young men in the skate park told me story after story about police and gang brutality. At one point I asked them to draw a picture of a place or a situation in which they felt unsafe, uncomfortable, or anxious and another place or situation where they felt the opposite. One person stared at a blank piece of paper for 10 minutes, unable to think of any time or place where he had ever felt safe. Another drew an imaginary safe place where there were no abuses of power, people interacted as equals, homes were dignified, and greenery was abundant. After leaving the park later that day, a taxi driver told me about almost joining a gang some 15 years earlier, but changing his mind at the last minute based on the somber regrets of someone who had decided to go through with it. Later that night on my way home, I saw a body on the street. No one stopped and when I slowed down to get a closer look, my car was almost hit from behind.

A drawing produced by one of the young men in the skate park. In his words, “What makes me feel unsafe, uncomfortable, or anxious is the police, corruption, murders, and interpersonal violence.”

This situation is part of what is driving Central Americans, especially from the so-called ‘Northern Triangle’ countries of El Salvador, Honduras, and Guatemala, to flee, seeking a better life or, in some cases, a life at all in the United States. More and more the migrants and displaced people are traveling in mass because most of their journey is through Mexico and the Mexican state has repeatedly demonstrated its unwillingness or inability to protect asylum seekers’ human rights, leaving them vulnerable to opportunistic people and cartel violence while they travel, often with babies and children in tow. The poor treatment of migrants and displaced people is an extension of the Mexican state’s similar unwillingness or inability to protect Mexican citizens’ human rights. Nearly 250,000 Mexicans have been killed in the last 10 years and there are more disappearances now in Mexico than there were under the dictatorships in South America, including the still unresolved case of 43 students disappearing in 2014, apparently at the hands of state security agents with assistance from organized criminal groups under the protection of military forces. Just like I saw in El Salvador, poverty in Mexico is both a driver and a result of violence, and decades of repeated abuses have corroded Mexicans’ confidence in each other and in their government. Several years ago when I was documenting police reform in Mexico, I was struck by how government insiders and partners recalled processes that were difficult but ultimately successful while outsiders saw failures and suspected conspiracies.

Amidst so much darkness, DPU’s Étienne von Bertrab has opted to look for light. A few years ago he began developing what is now Albora, an initiative that traces Mexico’s “geographies of hope” through identifying, studying, documenting, and showcasing transformative projects throughout the country. Spotlighting this work demonstrates the that there are other ways to develop, progress, and grow, ones in which no one mistakes violence for a solution, where access to water and other natural resources is universal, where citizens are informed and engaged, and where everyone strives for the greater good.

Luis Domínguez, an engineer working for Agua para Siempre, has dedicated decades of his life to assisting communities fight soil erosion and restore river basins in the impoverished Mixteca region.

One such project is Agua para Siempre (‘water forever’), established 30 years ago by a then young couple, who decided that they would defend and support their poorest compatriots. They landed in the Sierra Mixteca in the Mexican state of Puebla, an arid and fast-eroding area that had been and continued to be hollowed out because of migration to large Mexican cities and the United States. With time, the couple understood that access to water was fundamental to addressing poverty and migration, so they began to study pre-Hispanic methods for soil retention and cultivation and advocate for their re-adoption in surrounding communities. Today, their organization, Alternativas y Procesos de Participación Social, AC (‘alternatives and social participation processes’), has 300 people and thousands of local partners who are seeing the fruits of their sustained efforts. Communities are beginning to have access to water all year for small-scale cultivation, animal husbandry, and human consumption, and hundreds of small cooperatives have begun to produce amaranth, a pre-Columbian pseudo-grain that, like quinoa, is high in protein, vitamins, and minerals. Reversing previous trends, migration is falling, as is child malnutrition, thanks to the inclusion of amaranth in local diets.

The search for transformative initiatives also brought the Albora team, which includes five DPU alumni, to Mexico City where a Mexican historian and novelist, his family, and a dozen others have formed the Brigada para Leer en Libertad (‘brigade to read in freedom’). The brigade has cultivated new readers through facilitating horizontal and informal access to authors, expanding the availability of books, and creating free places to read. So far, they have gifted or sold more than a million books at an affordable price to girls, boys, women, and men in a country where the high price of books makes bookstores elitist and inaccessible and public libraries are few. To that end, the brigade also establishes libraries, with a recent campaign resulting in the donation of nearly 70,000 books. These books have become the basis for carefully curated collections in formerly empty libraries in the southern Mexican state of Chiapas. The brigade promotes reading for pleasure but also as a political act—an essential step towards the full exercise of conscious citizenship.

Free public gatherings are central to the Brigada’s book fairs in which women, men and children engage in dialogues with authors about their work and about the Mexican political conjuncture and ways out of the crises.

These projects and others are harnessing the power of hope to fuel alternative visions of their society. They demonstrate the fundamental importance of restoring and cultivating hope, necessary for active citizenship, and united, powerful communities, not just in Mexico or El Salvador but everywhere where injustice and inequality construct blocks for us to stumble over. The projects challenge us to look beyond our cynicism and apathy.

Before I left the skate park in August, one young man told me that he was glad I had come. “Most people don’t come looking for us, and the people who do don’t listen to what we have to say,” he said. “I hope you’ve been able to hear us and that the stories of our lives help you do your work.”

To learn more about Albora and contribute to its crowdfunding campaign, active until Tuesday, 18 December and only funded if it reaches 100% of its goal, go here.

Ariana Markowitz is a PhD student at DPU researching how fear and trauma manifest and become defining characteristics of urban landscapes. Taking cues from this damage, especially in marginalized communities, she looks for alternative ways of repairing frayed social fabric and healing.

Elections and the homeless: who is heard?

LaurenAsfour30 April 2015

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Image: Courtesy of the Electoral Commission/Flickr via Homeless Link

With the UK elections creeping up on us, on the 7th May, I’d like to grapple with the volatile question of elections for who? Given the general apathy towards voting and politics, and the Guardian asking us, “are you engaged and energised by the election campaign – or can’t wait for it to end?”, I find myself considering: who is being represented in the political sphere, and are those marginalised by society being heard? On the MSc Social Development Practice, we have been exploring the importance of hearing from those who are regarded to be on the margins of society, and how their voice can be articulated to generate new knowledge and approaches to urban development.

IMG_0668The government encounters complex challenges in identifying those experiencing homelessness, particularly with the presence of the ‘Hidden Homeless’, who typically reside in bed and breakfast hotels or sleep on friends’ sofas. As such, there is no distinct voting classification for the homeless as a ‘sector’, but rather these individuals are grouped with those living in social housing.

My personal concern is that government fails to recognise the diversity between those experiencing homelessness and those in social housing – and thus an ignorance of the difference between those who benefit from the state, and those who appear to fall outside the system. Although those experiencing homelessness have a right to vote and exercise their voice in society, figures indicate that while 74% of homeowners turned out to vote at the last UK election, only 55% of those living in social housing (and those experiencing homelessness) voted. Such statistics would indicate that many of these individuals are not articulating their voice.

Democracy for who?

While the government maintains that it is working to ensure homeless people have and can access their rights, organisations such as Homeless Link ask: “are residents of social housing and homelessness services really part of democracy?” The government might argue that rough-sleepers’ right to vote indicates that they can access the ballot along with the rest of society – but are they doing so? Those experiencing homelessness need a declaration form from local authorities to vouch for them – but will such bureaucratic hurdles actually encourage individuals to engage in the system?

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Encouraging homeless voters

The ‘Your Vote Counts’ scheme is an initiative funded by government, aiming to engage rough-sleepers and those in social housing to participate more actively in democratic practices through voting. This is a great encouragement, and I look forward to seeing how such initiatives will materialise in the upcoming election.

With growing inequality in the UK, the voices of the marginalised are vital if we are to develop our society into one which safeguards all members of our community. Organisations such as Homeless Link are working diligently to encourage such engagement, with a recent article endeavouring to break down the barriers for those experiencing homelessness and provide clarity on themes such as:

  1. Have a say on important issues
  2. Make sure decision makers don’t ignore your views
  3. Improve your credit rating
  4. No fixed address? No problem
  5. Keep your information private
  6. Register online in minutes
  7. You don’t have to go to a polling station
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Photo taken at Webber Street Day Centre (or All Souls Clubhouse) courtesy of ASLAN, the ministry for homeless and vulnerably housed people of All Souls, Langham Place. Volunteer for ASLAN: http://volunteer.aslan.org.uk

Individualism or Dependence?

My question to all (and to myself), is how can we engage those experiencing homelessness – and others who have become marginalised by social structures – to contribute in the political sphere? How can we encourage such individuals into invited spaces for participation, to learn from their experiences and create substantive change for our society? [1]

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http://volunteer.aslan.org.uk

No matter who comes into government, whether you believe in the power of the welfare state or not – it is important that we don’t forget our individual duty to care, outside of the model propelled by the state. At the third annual conference on Homelessness, Social Exclusion and Health Inequalities, Dr Lynne Friedli, author of Mental Health, Resilience and Inequalities, highlighted that dependency is not failure, but rather a feature of being human.

As a sense of community is eroding, particularly amidst a growing individualism in London, how are we recognising our natural dependency on one another? And thus, if the vulnerable aren’t being heard, what is our role in advocating for their needs? Whilst inequality continues and homelessness remains prevalent in our society, how do we avoid silencing the most vulnerable – the very people who will depend most on the social system that all of our votes shape?

[1] See Gaventa, J. (2006), Finding the Spaces for Change: A Power Analysis. IDS bulletin. 37 (6).


Lauren Asfour is currently studying the MSc Social Development Practice at the DPU. She has been part of research in London on Regeneration Aspirations for Euston: Local Perspectives on the High Speed Two Rail Link and is a volunteer at ASLAN.

Mexico: Where does hope reside? (Part I)

Étiennevon Bertrab2 February 2015

They want a different future, Yucatán. Image: Étienne von Bertrab

They want a different future, Yucatán. Image: Étienne von Bertrab

Mexico is going through turbulent times and its future looks, if not pitch black, then highly uncertain and complex. This is a personal attempt to make sense of recent developments and to share some reflections on causes, implications, and sources of hope.

The recent wave of high-level corruption scandals and particularly the forced disappearance of the 43 rural students from Ayotzinapa, Guerrero, have been, for a majority of Mexicans, the straw that broke the camel’s back. Studies over the last few years had already shown a steady decline in levels of trust in State institutions; however, trust has reached an all time low and there are calls to ignore and boycott the mid-term elections this summer. Although most attention is placed on the machinery of corruption and impunity of PRI (the infamous political party that ruled Mexico for 70 years and came back to power in 2012), people are losing trust in all political parties.

Mexico has the worst political class in decades” concluded a recent panel on democracy and elections held at IBERO University. Internationally, only a year ago mainstream media made reference to ‘the time of Mexico’ and Time magazine portrayed president Peña Nieto as saviour. The Economist, which had praised his constitutional reforms – particularly the juicy energy reform that allows the privatisation of oil – has now referred to him as “a president who doesn’t get that he doesn’t get it”. For The New Yorker, the President himself is the clearest example of corruption in the country.

Protest street art, Guadalajara. Image: Étienne von Bertrab

Protest street art, Guadalajara. Image: Étienne von Bertrab

But corruption and impunity have been there for a while and the distance between the political class and ordinary people has been widely perceived and commented upon. Why are so many Mexicans in the streets over and over again, shouting ‘enough is enough’ and getting engaged in the public sphere in ways never seen before? Behind the Ayotzinapa case are around 100,000 deaths and more than 23,000 disappearances since 2006 (according to official figures), plus 150,000 displaced people according to Freedom House. Unsurprisingly, those affected the most are the poor and the marginalised amongst Mexican society.

More than two decades of neoliberal restructuring and particularly the culture of capitalist cronyism built by those in power, have benefitted only a few while too many women and men continue to live in poverty. Not to mention indigenous groups who for centuries have been victims of oppression and dispossession (for most, little has changed since colonial times). Across the country over 7 million young people can’t find opportunities to study or work and thus are unable to imagine a future in their own country. Apart from the negative effects on human development the country is losing its ‘demographic bonus’.

‘Where those above destroy, below we flourish’. Image: Creative Commons

‘Where those above destroy, below we flourish’

There is simply too much suffering in so many families and communities, and too few provisions to deal with the repercussions of eight years of crude violence on top of the generalised sense of injustice. The situation of human rights in Mexico, according to Amnesty International, is now the worst in the American continent.

In the latest developments, while the federal government declared the official investigation on the 43 disappeared students ‘closed’ last week, a new journalistic investigation revealed that most of the government’s ‘evidence’ was obtained through torture. The federal government will surely defend its version (referred to as the ‘historical truth’ by the attorney general) with full force, and repression to protestors is likely to escalate. These practices should also not come as a surprise: according to Human Rights Watch, there have been over 9,000 complaints of abuse by the army since 2006.

For an audio account of the investigation that proved that the authorities at the national level were involved in the disappearances, you can listen to Steve Fisher, one of the authors of the original article in Proceso magazine, here. Channel 4 News has also produced an informative video entitled ‘Are Mexico’s disappeared students victims of drug war?’ – available on its website.

 

Part II, on hope, solidarity and opportunities for research that can make a difference will be published on the DPU blog next week.

Étienne von Bertrab is a Teaching Fellow at the DPU and a guest lecturer in universities in Mexico. He also works as a consultant in the UK and in Mexico, where he has been a social activist for ten years. Twitter: @etiennista