Safer Management and Reliable Treatment (SMaRT) of faecal sludge in emergencies.

Project SMaRT is developing practical adaptations and interventions to better respond to the handling and disposal of faecal sludge. WHAT HUMANITARIAN NEED IS BEING ADDRESSED? Humanitarian crises following natural disasters or armed conflicts can lead to the sudden and rapid displacement of human populations. Safely managing human excreta during these times is vital if waterborne disease outbreaks such as cholera or typhoid are to be avoided or contained. But, despite progress, the UN estimates that one billion people across 43 countries are at risk of cholera. And the World Health Organization has warned that increasing resistance to antibiotics to treat typhoid is helping the pathogen spread to communities that lack access to adequate WASH facilities. So, it's vital that human excreta from domestic and healthcare sources is safely contained and treated promptly during the onset of humanitarian emergencies, especially in densely populated contexts (such as those found in refugee camps). However, conventional biological treatments typically take many weeks to establish and so they need to be backed up by quicker, more scalable chemical-based processes (such as those involving lime). WHAT IS THE INNOVATIVE SOLUTION BEING ADOPTED AND HOW WILL IT IMPROVE EXISTING HUMANITARIAN PRACTICE? Project SMaRT is addressing the inconsistencies and shortcomings associated with lime treatment (a chemical-based approach). The team is targeting issues around the quality and purity of lime supplies, and issues around optimal lime dosing, pathogen removal and the suitability of lime for application in healthcare settings (including for the safe containment and treatment of infectious waste). The innovation will offer humanitarian actors an off-the-shelf backstop to deploy during the onset of a crisis, particularly useful while longer-term biological sewage treatment is established. WHAT PROGRESS HAS BEEN MADE? At the heart of the project are two faecal sludge treatment plants (FSTP's) and laboratories run by MSF and BRAC, receiving waste from across the world's largest refugee camp at Cox's Bazar. Staff are helping to develop simple, novel field-based kits to test the quality of lime, and to produce diagrammatic dosing protocols based on the amount of lime content needed to achieve satisfactory reductions in microbe concentrations. They're also using lab-based approaches to assess pathogen removal. The outcomes are helping MSF, BRAC and non-governmental organisations more effectively control, optimise and tailor lime-based treatment to specific sites and applications, to strengthen health outcomes. INNOVATION POTENTIAL The team's approach is ideal for densely populated emergency settings and could be scaled up to provide standardised kits containing everything needed to treat a given volume of excreta. Applications also extend to augmenting biological treatment during waterborne disease outbreaks and to handling waste from healthcare settings. Controlled lime treatment trials are currently underway at the MSF-run FSTP using faecal sludge of known age, composition and origin from communal septic tanks, piped wastewaters and from healthcare facilities within the camp. The findings will help identify optimal treatment conditions and support the production of simplified user manuals and the wider deployment of the method to aid international emergency response. MSF pit emptying team ensuring safe disposal of clinical waste at a healthcare facility. User manuals to support the lime treatment of faecal sludge A set of illustrative user manuals including visual instructions have been created by the project. These manuals have been principally designed for humanitarian practitioners operating in low-resource settings, and to support them in assessing the quality and effectiveness of lime treatment on faecal sludge whilst in the field. User manual: Field-based assessment of lime quality This illustrative manual focusses on a simple, portable field-based approach for establishing the quality of lime supplies. Having a better understanding of the quality of lime supplies is important as it can improve decision-making on how much lime is needed to safely treat faecal sludge. Characterising the quality of already available lime supplies can also help reduce the reliance on costly imported lime supplies during humanitarian emergencies. User manual: Detecting and enumerating somatic coliphages in faecal sludge This illustrative manual focusses on an approach for the detection and enumeration of bacteriophages (somatic coliphages) in faecal sludge. Bacteriophages are viruses capable of infecting bacteria and they tend to be more resistant than traditional faecal indicator bacteria (such as s Escherichia coli ). Somatic coliphages can give a better indication of the behaviour and removal of viral pathogens. User manual: Lime dosing and treatment performance monitoring This illustrative manual focusses on an approach for monitoring and determining effective batch treatment of human excreta during periods of rapid accumulation such as the onset of humanitarian crises, or during waterborne disease outbreaks. The manual provides guidance on how to establish and monitor treatment efficacy (even during periods of fluctuation in faecal sludge composition or lime quality), to ensure that a suitable level of pathogen reduction (treatment) has been achieved in the treated product. ‍ [.slimline-cta-box] Links to more information [.slimline-cta_paragraph] From Clinics to Sludge: The many facets of MSF Bluephage interview James Ebdon Radio 4 Interview with Melvyn Bragg ('In Our Time') [.slimline-cta_paragraph][.slimline-cta-box]