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Cited by 78Child Nutrition and Water AccessHealth and Conflict StudiesWater Resource Management and Quality

Social and geographic inequalities in water, sanitation and hygiene access in 21 refugee camps and settlements in Bangladesh, Kenya, Uganda, South Sudan, and Zimbabwe

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Calderón-Villarreal, Alhelí, Schweitzer, Ryan, Kayser, Georgia·2022·International Journal for Equity in Health
DOI 10.1186/s12939-022-01626-3PMC PMC8857872
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Abstract

Introduction: Many refugees face challenges accessing water, sanitation, and hygiene (WASH) services. However, there is limited literature on WASH access for refugee populations, including for menstrual health services. Unmet WASH access needs may therefore be hidden, amplifying morbidity and mortality risks for already vulnerable refugee populations. The aim of this study was therefore to quantitatively analyze WASH access among refugee camps, with a focus on households with women of reproductive age. Methods: This was a cross-sectional study that utilized the Standardized WASH Knowledge, Attitude and Practice (KAP) Survey. A total of 5632 household questionnaires were completed by the United Nations Refugee Agency in 2019 in 21 refugee camps and settlements in Bangladesh, Kenya, South Sudan, Uganda, and Zimbabwe. WASH access (14 items) and social and geographic stratifiers were analyzed at the household-level including the refugee camp, country of the settlement, having women of reproductive age, members with disability/elderly status, and household size. We calculated frequencies, odds ratios, and performed bivariate and multivariate analyses to measure inequalities. We developed a Female WASH Access Index to characterize WASH access for households with women of reproductive age. Results: Most refugee households had high levels of access to improved water (95%), low levels of access to waste disposal facility (64%) and sanitation privacy (63%), and very low access to basic sanitation (30%) and hand hygiene facility (24%). 76% of households with women of reproductive age had access to menstrual health materials. WASH access indicators and the Female WASH Access Index showed large inequalities across social and geographic stratifiers. Households with disabled or elderly members, and fewer members had poorer WASH access. Households with women of reproductive age had lower access to basic sanitation. Conclusions: Large inequalities in WASH access indicators were identified between refugee sites and across countries, in all metrics. We found high levels of access to improved water across most of the refugee camps and settlements studied. Access to basic hygiene and sanitation, sanitation privacy, waste disposal, and menstrual health materials, could be improved across refugee sites. Households with women of reproductive age, with 4+ members, and without members with disability/elderly status were associated with higher WASH access. The female WASH access index piloted here could be a useful tool to quickly summarize WASH access in households with women of reproductive age.

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  • There is insufficient research explicitly examining experiences of water insecurity-related SGBV among refugee adolescents and youth.

    “There is insuf fi cient research explicitly examining experiences of water insecurity-related SGBV among refugee adolescents and youth who may experience water scarcity (Calderón-Villarreal et al . 2022) and a high prevalence of SGBV before, during, and following con fl ict-related migration (Stark et al. 2017; Logie et al . 2019a).”

    From Water insecurity and sexual and gender-based violence among refugee youth: qualitative insights from a humanitarian setting in Uganda (2022) · cites this paper as Calderón-Villarreal et al. 2022

    The Abstract Introduction says literature on WASH access among refugees is limited, and the Discussion (Sanitation) describes GBV risks associated with inadequate sanitation for women and girls. Neither passage establishes a research gap specifically about water insecurity-related SGBV experiences among refugee adolescents and youth. The paper's Limitations also state that its data could not be analyzed by household members' ages. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Calderón-Villarreal, A., Schweitzer, R., & Kayser, G.
Affiliations
  • San Diego State University (US)
  • Office of the United Nations High Commissioner for Refugees (CH)
  • University of California San Diego (US)
Corresponding author
Calderón-Villarreal, Alhelí
ORCID
Venue
International Journal for Equity in Health
Publisher
Springer Science and Business Media LLC
Published
2022-02-19
Volume
21
Issue
1
Pages
27-27
ISSN
1475-9276 (ISSN-L)
DOI
10.1186/s12939-022-01626-3
PMC
PMC8857872
OpenAlex
W4213243834
Cited by
78
References
7
Citations by year
2026: 21 · 2025: 19 · 2024: 17 · 2023: 13 · 2022: 8
FWCI
8.36
Type
journal article
Language
en
Update notices
correction (2022-05-10)
Open access
Licence
Locations
  • International Journal for Equity in Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
National Institute of Environmental Health Sciences (K01ES031697)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
  • Health Sciences › Health Professions › General Health Professions › Health and Conflict Studies
  • Physical Sciences › Environmental Science › Water Science and Technology › Water Resource Management and Quality
Keywords
water, sanitation and hygiene, refugee camps, refugee settlement, women of reproductive age, menstrual health, waste disposal, hand hygiene, household size, improved water access
MeSH terms
South Sudan, Refugee Camps, Aged, Bangladesh, Cross-Sectional Studies, Female, Humans, Hygiene, Kenya, Sanitation, Uganda, Water, Water Supply, Zimbabwe

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