Regular handwashing during an emergency helps prevent the spread of diseases like diarrhoea, cholera and others. Handwashing Facilities need to be provided next to all toilet facilities. If handwashing is not a common practice, it needs to be promoted by tackling the drivers of handwashing behaviour. Handwashing Facilities require a constant supply of water and soap.User interface used for urination and defecation.

Handwashing with soap and water after being in contact with faecal matter, for example when going to the toilet, can lead to a substantial reduction of diarrhoeal diseases. Different studies suggest a 35–45 % reduction of the mortality rate due to diarrhoea and other water-related diseases. The practice of handwashing needs to be strongly promoted in any emergency situation and users should always have the means to wash their hands with soap. Handwashing promotion is especially important if the affected community is not used to regular handwashingor is traumatised. Two critical times for handwashing with soap should always be promoted: After using the toilet or after cleaning the bottom of a child who has been defecating, and before preparing food and eating. Handwashing stations need to be present within a short radius (max 5 m) of each toilet, regardless if private, shared or public and in all places where food is prepared or eaten, such as markets, kitchens and eateries.

Design Considerations

A handwashing station has to include a constant source of water and soap. If water is not available, an alcohol-based hand sanitiser (or ash) may be used as an alternative. Handwashing facilities include taps of different sorts connected to a pipe or a container or simple low-cost solutions like Tippy Taps, which consist of a suspended jerrycan that can be tipped with a foot lever allowing water to flow out. Drainage of effluent is required in order to keep the area around the handwashing station clean and hygienic and not muddy and flooded. Effluent can be captured in a bucket catching the grey-water, or can be discharged into open drainage channels or into a closed sewer. Where soil conditions permit, greywater can be disposed of on-site, e.g. in Soak Pits D.10 . Alternatively, treatment and reuse options can be considered. Handwashing stations have to be inclusive  X.10 and children and people with reduced mobility have to be able to reach the handwashing facilities to use them. A very important design consideration is the durability of the tap. The tap needs to be very robust in order to prevent theft or breakage.

Materials

Piped water or buckets with fitted taps are required for handwashing water distribution. The standard for handwashing water quantity at public toilets is 1–2 L per user per day. The amount needed increases if the water from these stations is used for other purposes, such as general cleaning of a toilet (2–8 L per cubicle per day), visiting of mosques (5 L per visitor per day) and/or laundry (4–6 L per person per day). The minimum standard for soap for personal hygiene including handwashing is 250 g per person per month. In public facilities, a constant supply of soap has to be ensured and can be good point of distributing soap to the community. If soap is limited it can be protected by drilling a hole through the bar of soap and tying it to the handwashing station (soap on a rope).

Applicability

Handwashing needs to be enforced through constant promotion X.12 in any type of humanitarian emergency and at any stage by using multiple communication channels. Handwashing and handwashing promotion is particularly important in the acute stage of an emergency to prevent a worsening of the public health situation. People who are traumatised may be more prone to neglect their personal hygiene.

Operation and Maintenance

Water containers need to be refilled and soap needs to be restocked constantly in public facilities and distributed where handwashing is in private shelters. With piped water, there needs to be a plumber available for minor maintenance work and repairs. Drainage channels C.5 and Soak Pits D.10 for effluent disposal need to be checked for clogging on a regular basis. The Handwashing Facilities need to be kept clean. In the acute response phase of an emergency and during active hygiene promotion campaigns one staff member per toilet block, next to handwashing facilities, can remind people to wash their hands and provide guidance on operating the handwashing stations and toilets.

Costs

Soap bars and plastic buckets for handwashing stations are usually cheap and locally available. They should be bought in great quantities at the beginning of an emergency. Other costs involve personnel for hygiene promotion and the construction of drainage or Soak Pits.

Social Considerations

Promotion of handwashing X.12 is crucial during an emergency. However the provision of Handwashing Facilities needs to be ensured first, or the promotion efforts will be less effective. Promotion of handwashing does not necessarily require a health-based message. Handwashing promotion messages can include social pressure, emotional or aesthetic appeals. Drivers or barriers for certain behaviours need to be assessed in order to have an effective message for the promotion of handwashing. The involvement of local champions and hygiene promoters is key for a successful campaign. In some cases, behaviour change interventions will be needed. Promotion of handwashing has to address different drivers of the behaviour like health risk perceptions, cost-benefit beliefs, emotions, experienced social pressure, abilities, and action and barrier-reduction planning.