WASH ASSESSMENT AT THE HOUSEHOLD LEVEL IN THE GAZA STRIP. June 2017

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2 WASH ASSESSMENT AT THE HOUSEHOLD LEVEL IN THE GAZA STRIP June 2017

3 The Gaza Strip is facing immense challenges related to water, sanitation and hygiene (WASH), which pose significant health risks to its nearly two million residents and constrain the socioeconomic development of the Palestinian people. Despite the best efforts of the Palestinian Water Authority (PWA) and our many partners, the deteriorating WASH situation has been compounded by the damage caused by 10 years of blockade and three wars. The consequences of the last armed conflict in 2014 are still felt by the WASH sector in direct and indirect ways, limiting the capacity to develop and deliver basic services to children and families in the Gaza Strip, including the key human right of access to safe water and sanitation. Since the last Israeli military operation in 2014, no household assessmentswere carried out that focused on WASH conditions until this greatly appreciated report. PWA is grateful to the financial and technical support providedby UNICEF, which made this vitally important work possible. The main objective of the assessment was to produce grassroots research of WASH conditions at the household level in the Gaza Strip while generating a comparative analysis that informed the identification of critical responses and actions. The field work was exhaustive with 2,382 households reached under a study with 47 indicators. Seventeen interventions have been proposed based on WASH needs identifiedby the assessment. The main water-related interventions will enhance storage capacity, improve quality of both drinking and domestic water, and promote public awareness of the importance of cleaning water storage. PWA thanks the Gaza WASH Cluster, Gruppo di Volontaria to Civile (GVC), the Palestinian Hydrology Group (PHG), UNICEF and other UN partners,the Ministry of Housing and Public Works, and the Ministry of Public Affairs for contributing to this timely and needed assessment. R. El Sheikh Deputy Head, Palestinian Water Authority 1

4 Safe drinking water and good hygiene practices are essential for the survival and healthy development of children. Without them, the lives of children are at risk because for children under five, water- and sanitation-related diseases are one of the leading causes of death globally. Throughout the West Bank and Gaza, UNICEF works with the Palestinian Water Authority (PWA) to strengthen accountability parameters and capacity to plan, budget, coordinate and promote scaling up of WASH services. Part of our strategy is to support upstream work, and this is why we are pleased to be part of this assessment the first comprehensive household-level WASH survey in Gaza since the 2014 conflict. Palestinian children continue to experience difficulties in realizing their right to safe drinking water. In 2016, UNICEF and our partners provided support to improving the water, sanitation and hygiene conditions of an estimated 536,000 Palestinian children and their families.our work under the leadership of the PWA and the Coastal Municipalities Water Utilities (CMWU) contributed to the progress Palestine made towards achieving national and global goals for WASH, but serious underlying challenges with infrastructure and wastewater management remain. These obstacles and bottlenecks jeopardize the ability of the affected population to access safe drinking water and sustain a clean, healthy living environment, especially for children. The situation is acute in Gaza, where less than five percent of the water drawn from the coastal aquifer is estimated to be fit for human consumption, and a 2012 UN report projected that if current trends continue, damage to the aquifer will be irreversible by We are confident national and local authorities will act onthe assessment s findings and recommendations. UNICEF will do all we can to help the State of Palestine implement the jointly agreedinterventions. In addition to the partners recognized in the forward, namely PWA and CMWU, I would like to express my thanks and gratitude to the Government of Japan for funding this study, to GVC and PHG for conducting the data collection and analysis and to the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) and the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) for their important contributions to this study. June Kunugi Special Representative, UNICEF State of Palestine 2

5 ACKNOWLEDGEMENT GVC is thankful to the numerous individuals who shared their ideas and experiences and to all partners that contributed to developing and informing this report. It could not have been completed without their commitment and active support. Many thanks to UNICEF, which financially and thechnically supported this initiative, the Gaza WASH Cluster, which facilitated the information sharing, the Palestinian Water Authority and Coastal Municipalities Water Utilities that chaired the assessment process, and WASH-MWG members (ACF, Oxfam, IRPAL, ISC, and Norwegian Refugee Council), all of which substantially contributed to the assessment s progress in all stages. GVC is also grateful to the Ministry of Housing and Public Works, Ministry of Social Affairs, United Nations Office for the Coordination of Humanitarian Affairs, United Nations Relief and Works Agency and local municipalities and community-based organizations for providing data for the target groups. Particular thanks go to Giorgio Cancelliere, professor at Bicocca University Milan, for his extremely valuable inputs, comments and suggestions. Last but not least, many special thanks to all GVC-PHG staff for all the great efforts they provided to carry out this assessment, which would not be possible without their hard work. Yours sincerely, Luca De Filicaia GVC Country Director opt 3

6 EXECUTIVE SUMMARY The Gaza Strip is facing immense challenges related to water, sanitation and hygiene (WASH), which pose significant health risks to its 1.8 million residents and constrain socioeconomic development. Groundwater from the coastal aquifer is the only water resource available in the Gaza Strip. However, abstraction from the aquifer stands at four times the aquifer s recharge rate at 200 MCM/year, and is expected to rise to 260 MCM/year by In addition, more than 96 per cent of abstracted water is polluted and not fit for human consumption due to high salinity levels from sea water intrusion and high nitrate levels from excessive use of agrochemicals and wastewater infiltration. The water supply in the Gaza Strip is estimated at 90 l/c/d, below acceptable water quantity standards of 100 l/c/d recommended by the World Health Organization (WHO). Furthermore, the absence of sufficient wastewater treatment facilities results in approximately 35 MCM/year of untreated/partially treated wastewater discharged into the sea along the Gaza coast. The deteriorated WASH situation has been compounded by nine years of blockade and three consecutive destructive wars. The consequences of the last armed conflict in 2014 are still affecting the WASH sector in direct and indirect ways by limiting the capacity to develop and deliver basic needs and services to people living in the Gaza Strip. Fifty days of continuous attacks caused massive destruction, devastation and displacement. Extensive damage to water and wastewater facilities reported by the Coastal Municipalities Water Utilities (MWU) and the Palestinian Water Authority (PWA) has received a preliminary estimate of around US$ 34 million. The reconstruction process is going slowly. Since the last Israeli military operation ( Protective Edge, 2014), there has been no household assessment carried out that focused on the operation s impact on WASH conditions. In light of this, the WASH Cluster needs to conduct a contextual assessment. As such, GVC and the Palestinian Hydrology Group (PHG) proposed to undertake a thorough assessment with the financial and technical support of UNICEF. They evaluated the WASH conditions in the Gaza Strip at the household level, highlighting the diverse consequences suffered by women, men, girls and boys. The main objective was to assess WASH conditions at the household level in the Gaza Strip while generating a comparative analysis that informed the identification of critical responses and actions. These, in turn, will contribute positively and efficiently to assuring minimum WASH standards for all Gaza Strip residents and thereby reduce health risks. Assessment methodology This assessment was conducted from September 2015 to March 2016 under the framework of the WASH monitoring working group (the technical working group that is part of the WASH Cluster), which was established to coordinate the assessment proposed by GVC, PHG and UNICEF. The framework adopted for this assessment consisted of four main consequent stages: 1) preparation, 2) data collection, 3) data analysis, and 4) report writing. The preparation stage included pre-meetings with the WASH monitoring working group to agree on final objectives, structure and required outputs, and also included the selection of a work team. The data collection stage included a field survey conducted through a prepared questionnaire and supported by complementary data; focus group workshops, observatory reports; and secondary 4

7 data from previous implemented assessments. The data analysis included the elaboration of indicators. Sample size for the field survey was calculated on a statistical equation for representativeness. According to the defined criteria, 2,382 households is representative of the total of 303,330 households in the Gaza Strip. Considering that 20 per cent of the implemented questionnaires are excluded in the cleaning process, the total minimum sample size was adjusted and rounded to 3,125 households. The sample was stratified based on governorates and localities and classified into four target groups; internally displaced persons, non-affected, war-affected and WASH-affected, of which the last was proposed by WASH-MWG during implementation of the assessment. Data collection was performed in three phases; 3,977 surveys were implemented after carrying out a testing phase including 624 surveys and 3,166 questionnaires were validated during the data cleaning process. The remaining questionnaires were excluded from the data analysis process. Forty-seven indicators were developed to explain the findings of WASH conditions at the household level over the whole Gaza Strip with a link to the socio-economic situation before and after the 2014 armed conflict. Seven indicators were related to socio-economic conditions, 19 indicators were related to water, six indicators related to sanitation, and 15 indicators related to hygiene. Main findings Based on key findings of the assessment, results show that interviewed households are spending 33.8 New Israeli Sheqel (NIS)/capita (8.9 United States Dollar (USD)/capita) monthly on the WASH items; 10.6 NIS/capita (2.8 USD/capita) for cleaning supplies, 7.3 NIS/capita (1.9 USD/capita) for hygiene supplies, 5.2 NIS/capita (1.4 USD/capita) for feminine hygiene items, 4.9 NIS/capita (1.3 USD/capita) for drinking water, 4.2 NIS/capita (1.1 USD/capita) for domestic water, and 1.6 NIS/capita (0.4 USD/capita) for solid waste disposal. Additionally, 57 per cent of interviewed households in the Gaza Strip don t pay for domestic water, Of these, 87 per cent don t pay because of their economic situation or lack of social responsibility while the remaining households don t pay because they are not connected to a municipal network or well (they get water from private/illegal wells or public filling points). Regarding the water situation, results show that the main source of drinking water for interviewed households is desalinated water supplied mainly from water trucks (85 per cent) and public filling points (11 per cent). On the other hand, 84 per cent of interviewed households are supplied by domestic water from municipal networks and 16 per cent from private wells. Around 18 per cent of interviewed households use domestic water sometimes as an alternative source for drinking and cooking. The results show also that 94 per cent of interviewed households in the Gaza Strip are satisfied with the drinking water quality, while only 43 per cent of interviewed households are not satisfied with domestic water quality, mainly because of a salinity issue. In terms of water storage, eight per cent of interviewed households in the Gaza Strip experienced a decrease in drinking water storage capacity, while 20 per cent of interviewed households described a decrease in domestic water storage facilities after Ninety-four per cent of interviewed women and 92 per cent of interviewed men were aware of the importance of cleaning drinking water storage, while 76 per cent of interviewed women and 79 per cent of interviewed men don t recognize the importance of cleaning domestic water storage vessels. 5

8 One per cent of interviewed households don t have toilets; 11 per cent of interviewed households don t have a sufficient number of toilets. Indictors show that 30 per cent of interviewed households in the Gaza Strip are not connected to wastewater networks and they are using insulated cesspits and small holes that pollute groundwater and the environment. Moreover, 51 per cent of interviewed households have no access to proper drainage systems and are suffering from an accumulation of polluted storm water surrounding their houses during intense rainfalls. The most disturbing sanitation issue relates to solid waste management: around 72 per cent of interviewed households don t have a safe means of solid waste disposal. Results of the assessment show that around nine per cent of interviewed households in the Gaza Strip don t have a hand washing sink, 17 per cent don t have a shower and 11 per cent don t have a kitchen sink. The results illustrate poor hygiene practices: 72 per cent of interviewed women and 75 per cent of interviewed men in the Gaza Strip don t wash their hands properly, while 12 per cent of interviewed women and 15 per cent of interviewed men don t shower sufficiently. Moreover, 3.7 per cent of reproductive aged women don t have appropriate materials for menstruation. The percentage of waterborne disease (such as skin disease, diarrhoea and giardiasis) infection is significant. Twenty-five per cent of households with children under five years and 22 per cent of households with members above five years have been infected by waterborne diseases. Recommended interventions Seventeen interventions have been proposed based on WASH needs illustrated by the assessment. The main water-related interventions will enhance storage capacity, improve quality of both drinking and domestic water, and promote public awareness of the importance of cleaning water storage. In regards to sanitation, urgent interventions are proposed to protect the surrounding environment and promote good hygiene. Proposed sanitation interventions include installation of new toilets for vulnerable households, installation of wastewater household connections, installation or upgrade of storm water drainage systems and the improvement of solid waste disposal. In terms of interventions related to hygiene, all of the proposals are very important because they mitigate or solve key public health issues. The proposed interventions include installation and maintenance of sanitation facilities; hand washing sinks, showers and kitchen sinks. Interventions include promotional awareness campaigns about proper hand washing and showering practices, enhancement of menstruation management for vulnerable women, distribution of hygiene kits and identification of hot spots of waterborne disease. 6

9 TABLE OF CONTENTS ACKNOWLEDGEMENT... 3 EXECUTIVE SUMMARY... 4 Assessment methodology...4 Main findings...5 Recommended interventions...6 TABLE OF CONTENTS... 7 LIST OF FIGURES...11 LIST OF TABLES...13 LIST OF MAPS...15 LIST OF ABBREVIATIONS...16 INTRODUCTION...17 Background General socio-economic situation in the Gaza Strip Justifications Goal and objectives Goal...20 Objectives...20 WASH monitoring working group METHODOLOGY...22 Assessment framework Data Collection Questionnaire design...22 Sampling approach Field survey implementation...25 Households selection...27 Complementary data Focus groups...28 Observatory reports...28 Secondary data...29 Data analysis Indicators elaboration...29 Analysis limits...30 FINDINGS AND DISCUSSION...31 General Socio-economic indicators SE1: Percentage distribution of population based on sex and age...34 SE2: Average housing density

10 SE3: Percentage of households headed by women...35 SE4: Percentage of internally displaced families planning to go back to their homes...36 SE5: Percentage of internally displaced persons and war-affected families with negative variation of income (less purchase power) post SE6: Percentage of variation of monthly WASH items expenses per household pre- and post SE7: Average monthly WASH items expenses post Water indicators W1: Variation of source of drinking water pre- and post W2: Percentage of women and men who know the origins of safe drinking water...40 W3: Variation of sources of domestic water pre- and post W4: Variation in capacity of drinking water storage pre- and post W5: Variation in capacity of the domestic water storage pre- and post W6: Average storage capacity for drinking water per household member pre- and post W7: Average of storage capacity of domestic water per household member pre- and post W8: Changes in perception about drinking water quality pre- and post W9: Changes in perception of domestic water quality pre- and post W10: Percentage of women and men who use drinking water for domestic use...46 W11: Percentage of women and men who use domestic water for drinking and cooking...47 W12: Percentage of households engaging children in drinking water collection...48 W13: Percentage of households engaging women in drinking water collection...48 W14: Cleaning of drinking water storage vessels...49 W15: Cleaning conditions of domestic water storage vessels...50 W16: Percentage of households that don t pay for domestic water...50 W17: Changes in need priorities related to drinking water pre- and post W18: Changes in need priorities related to domestic water pre- and post W19: Different coping mechanisms used by women and men related to water problems...53 Sanitation indicators S1: Percentage of households without toilets or without sufficient toilets pre- and post S3: Percentage of households without proper surrounding storm water drainage...55 S4: Percentage of households that need access to safe solid waste disposal...56 S5: Changes in need priorities related to sanitation pre- and post S6: Different coping mechanisms used by women and men to resolve sanitation problems...57 Hygiene indicators H1: Variation of source of water heating pre- and post H2: Percentage of households entirely without or with poor hand washing facilities post H3: Percentage of households entirely without or with poor shower facilities post H4: Percentage of households entirely without or with a poor kitchen sink post H5: Percentage of people who don t wash their hands in a timely or proper manner...61 H6: Percentage of people who shower sufficiently...62 H7: Change in hygiene practices post H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks...64 H9: Percentage of households with members above five years old who were infected by waterborne diseases in the past two weeks

11 H11: Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post H12: Percentage of households that received hygiene kits in the recent period (in 2015)...66 H13: Percentage of households with a need for hygiene materials...66 H14: Changes in need priorities for hygiene pre- and post H15: Different coping mechanisms used by women and men for hygiene...68 Focus group findings POTENTIAL INTERVENTIONS General Water interventions INT1: Enhancing drinking water storage capacity...69 INT2: Enhancing domestic water storage capacity...69 INT3: Improving drinking water quality...70 INT4: Improving domestic water quality...70 INT5: Public awareness campaign about the quality of safe drinking water...71 INT6: Public awareness about the importance of cleaning domestic water storage Sanitation interventions INT7: Installation of toilets for vulnerable households...72 INT8: Installation of household wastewater connections...73 INT9: Installation of storm water drainage systems...73 INT10: Enhancing solid waste management Hygiene interventions INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households...74 INT12: Installation/Rehabilitation of shower facilities for vulnerable households...75 INT13: Installation/Rehabilitation of kitchen sinks (dish washing basins) for vulnerable households...75 INT14: Public awareness about proper hygiene practices...75 INT15: Identification of hot spots of waterborne diseases...76 INT17: Distribution of hygiene kits...77 CONCLUSION AND RECOMMENDATIONS Conclusion General Methodology Key findings Potential interventions Recommendations Top priorities of interventions Further assessments Suggested approach for interventions Advocacy...87 REFERENCES...88 ANNEX A: WASH-MWG ToR...89 ANNEX B: LIST OF MEETINGS AND WORKSHOPS...91 ANNEX C: QUESTIONNAIRE TEMPLATE

12 ANNEX D: HOUSEHOLDS SAMPLING ANNEX E : INDICATORS FORMULATION ANNEX F : TABLES OF FINDINGS

13 LIST OF FIGURES Figure 3.1: Number of the valid questionnaires per governorate based on target group and sex of interviewee Figure 3.2: Number of the valid questionnaires per governorate based on sex and age of the interviewees Figure 3.3: Number of the valid questionnaires per governorate based on average HH monthly income Figure 3.4: Percentage distribution of household members based on age Figure 3.5: Average housing density Figure 3.6: Percentage of households headed by women Figure 3.7: Percentage of internally displaced families going back to their home Figure 3.8: Percentage of internally displaced persons and war-affected families that had negative variation of income Figure 3.11: Total WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month) 39 Figure 3.13: Percentage of people who know the source of the safe drinking water in Gaza Strip Figure 3.14: Variation of source of domestic water in Gaza Strip pre- and post Figure 3.15: Variation of capacity of the drinking water storage pre- and post Figure 3.16: Variation of capacity of the domestic water storage pre- and post Figure 3.17: Average of storage capacity of drinking water per household member pre- and post (litre/capita) Figure 3.18: Average of storage capacity of domestic water per household member pre- and post-2014 (litre/capita) Figure 3.19: Variation of perception about the drinking water quality pre- and post Figure 3.20: Aspects of drinking water quality pre- and post Figure 3.21: Variation of perception about the domestic water quality pre- and post Figure 3.22: Aspects of domestic water quality pre- and post Figure 3.23: Percentage of women and men who use drinking water for domestic use Figure 3.24: Domestic uses of drinking water Figure 3.25: Percentage of women and men who use domestic water for drinking and cooking 47 Figure 3.26: Misuses of domestic water Figure 3.27: Percentage of households engaging children in drinking water management Figure 3.28: Percentage of households engaging women in drinking water management Figure 3.29: Cleaning conditions of drinking water storage Figure 3.30: Cleaning conditions of domestic water storage vessels Figure 3.31: Percentage of households that don t pay fees for domestic water Figure 3.32: Reasons why households don t pay fees for domestic water Figure 3.33: Variation of needs priorities of the drinking water in Gaza Strip pre- and post Figure 3.34: Variation of needs priorities of domestic water in Gaza Strip pre- and post Figure 3.35: Percentage of households without toilets or with no sufficient toilets pre- and post Figure 3.36: Percentage of households without access to wastewater networks pre- and post Figure 3.37: Percentage of households without proper surrounding drainage

14 Figure 3.38: Percentage of households that need access to safe solid waste disposal Figure 3.40: Variation of source of water heating pre- and post Figure 3.41: Percentage of households without or with poor hand washing facility post Figure 3.42: Percentage of households without or with poor shower facility post Figure 3.43: Percentage of households without or with poor kitchen sink post Figure 3.44: Percentage of people who don t wash their hands in a timely manner Figure 3.45: Percentage of people who don t wash their hands according to each practice Figure 3.46: Percentage of people who do and don t shower sufficiently Figure 3.47: Percentage of households that changed hygiene practices post Figure 3.49: Percentage of households with children < five years old infected by waterborne diseases Figure 3.50: Percentage of households with members > five years old infected by waterborne diseases Figure 3.51: Percentage of households that noticed an appearance of new diseases post Figure 3.52: Percentage of women with no access to appropriate materials for menstruation preand post Figure 3.53: Percentage of households that received hygiene kits in Figure 3.54: Percentage of households with need for hygiene materials Figure 3.55: Variation of needs priorities of hygiene in Gaza Strip pre- and post

15 LIST OF TABLES Table 1.1: Destroyed WASH facilities during the armed conflict in Table 2.1: Actual time framework Table 2.2: WASH and socio-economic aspects included in the questionnaire form Table 2.3: Number of the implemented questionnaires and valid questionnaires after cleaning process Table 2.4: Focus groups information Table 2.5: List of indicators Table 3.1 Coping mechanisms used by people related to water problems in Gaza Strip Table 3.2 Coping mechanisms used by people related to sanitation problems in Gaza Strip Table 3.3 Coping mechanisms used by people related to hygiene problems in Gaza Strip Table 4.1: Water interventions Table 4.2: Sanitation interventions Table 4.3: Hygiene interventions Table B.1: List of conducted meetings and workshops Table D.1: Planned minimum number of questionnaires Table E.1: Indicators formulation Table F.1: Total number of implemented and valid questionnaires based on the target group per governorate/locality Table F.2: Number of questionnaires based on sex and age of interviewee Table F.3: Number of questionnaires based on land type Table F.4: Number of questionnaires based on shelter type Table F.5: Number of questionnaires based on average HH monthly income Table F.6: SE1: Percentage distribution of population based on sex and age Table F.7: SE2: Average housing density Table F.8: SE3: Percentage of households headed by women Table F.9: SE4: Percentage of internally diplaced families planning to go back to their home Table F.10: SE5: Percentage of internally displaced families and war-affected families having negative variation of income post Table F.11: SE6: Percentage of variation of monthly WASH items expenses per household preand post Table F.12: SE7: Average monthly WASH items expenses post-2014 in NIS/capita/month (USD/capita/month) Table F.13: W1: Variation of source of drinking water pre- and post Table F.14: W2: Percentage of women and men who have/have no knowledge about the origin of the safe drinking water Table F.15: W3: Variation of source of domestic water pre- and post Table F.16: W4: Variation of capacity of the drinking water storage pre- and post Table F.17: W5: Variation of capacity of the domestic water storage pre- and post Table F.18: W6: Average of storage capacity of drinking water per household member pre- and post-2014 (litre/capita) Table F.19: W7: Average of storage capacity of domestic water per household member pre- and post-2014 (litre/capita)

16 Table F.20: W8: Variation of perception about the drinking water quality pre- and post Table F.21: W9: Variation of perception about the domestic water quality pre- and post Table F.22: W10: Percentage of women and men who use drinking water for domestic use Table F.23: W11: Percentage of women and men who use domestic water as an alternative source for drinking use Table F.24: W12: Percentage of households engaging children in drinking water collection Table F.25: W13: Percentage of households engaging women in drinking water collection Table F.26: W14: Cleaning conditions of the drinking water storages Table F.27: W15: Cleaning conditions of the domestic water storages Table F.28: W16: Percentage of households that don t pay for domestic water Table F.29: W17: Variation of needs priorities of drinking water pre- and post Table F.30: W18: Variation of needs priorities of domestic water pre- and post Table F.31: W19: Different coping mechanisms carried out by women and men related to water problems Table F.32: S1: Percentage of households without toilets or without sufficient toilets pre- and post Table F.33: S2: households without access to wastewater networks pre- and post Table F.34: S3: Percentage of households without proper surrounding storm water drainage. 134 Table F.35: S4: Percentage of households that need access to safe solid waste disposal Table F.36: S5: Change in need priorities in sanitation pre- and post Table F.37: S6: Different coping mechanisms by women and men related to sanitation problems Table F.38: H1: Variation of source of water heating pre- and post Table F.39: H2: Percentage of households without or with poor hand washing facilities post Table F.40: H3: Percentage of households without or with poor shower facility post Table F.41: H4: Percentage of households without or with poor kitchen sink post Table F.42: H5: Percentage of people who are untimely in their hand washing practice Table F.43: H6: Percentage of people who do and don t do sufficient showering practice Table F.44: H7: Change of hygiene practices post Table F.45: H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks Table F.46: H9: Percentage of households with members above five years of age infected by waterborne diseases in the past two weeks Table F.47: H10: Percentage of households that noticed appearance of new diseases post Table F.48: H11: Percentage of women with no access to appropriate materials for menstruation pre- and post Table F.49: H12: Percentage of households that received hygiene kits in the last period (2015) Table F.50: H13: Percentage of households with need for hygiene materials Table F.51: H14: Variation of needs priorities of hygiene pre- and post Table F.52: H15: Different coping mechanisms carried out by women and men related to hygiene problems Table F.53: Focus groups findings and discussion (based on attendee perception)

17 LIST OF MAPS Map 1: War-affected areas Map 2: WASH-affected areas Map 3: INT1: Enhancing drinking water storage capacity Map 4: INT2: Enhancing domestic water storage capacity Map 5: INT3: Improving drinking water quality Map 6: INT4: Improving domestic water quality Map 7: INT5: Public awareness campaign about the quality of safe drinking water (A) Map 8: INT5: Public awareness campaign about the quality of safe drinking water (B) Map 9: INT6: Public awareness about the importance of the cleaning domestic water storage 165 Map 10: INT7: Installation of toilets for vulnerable households (A) Map 11: INT7: Installation of toilets for vulnerable households (B) Map 12: INT8: Installation of household wastewater connections Map 13: INT9: Installation of storm water drainage systems Map 14: INT10: Enhancing solid waste management Map 15: INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households (A) Map 16: INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households (B) Map 17: INT12: Installation/Rehabilitation of shower facilities for vulnerable households (A) Map 18: INT12: Installation/Rehabilitation of shower facilities for vulnerable households (B) Map 19: INT13: Installation/Rehabilitation of kitchen sinks for vulnerable households (A) Map 20: INT13: Installation/Rehabilitation of kitchen sinks for vulnerable households (B) Map 21: INT14: Public awareness about proper hygiene practices (A) Map 22: INT14: Public awareness about proper hygiene practices (B) Map 23: INT15: Identification of the hot spot areas of waterborne diseases (A) Map 24: INT15: Identification of the hot spot areas of waterborne diseases (B) Map 25: INT16: Enhancing the menstrual hygiene management of vulnerable women

18 LIST OF ABBREVIATIONS ACF CMWU GDP GVC GRM HH HK ICRC INGO IRPAL ISC l/c/d MCM MoHPW MoSA NRC NGO OCHA OXFAM GB PCBS PHG PWA RO ToR UNICEF UNRWA UNSCO WASH WASH-MWG WHO Action Against Hunger (INGO) Coastal Municipalities Water Utility (water service provider in Gaza) Gross Domestic Product Gruppo di Volontariato Civile (INGO) Gaza Reconstruction Mechanism Household Hygiene Kit International Committee of the Red Cross International non-governmental organization Islamic Relief in Palestine (INGO) Save the Children (INGO) litres per capita per day million cubic metres Ministry of Housing and Public WorkS Ministry of Social Affairs Norwegian Refugee Council (INGO) Non-Governmental Organization Office for Coordination of Humanitarian Affairs (UN agency) (INGO) Palestinian Central Bureau of Statistics Palestinian Hydrology Group (local NGO) Palestinian Water Authority Reversed Osmosis Term of References United Nations Children's Fund (UN agency) United Nations Relief and Works Agency for Palestine Refugees (UN agency) United Nations Special Coordinator Office (UN agency) Water, Sanitation and Hygiene WASH monitoring working group World Health Organization 16

19 INTRODUCTION Background The Gaza Strip is facing a challenging and precarious situation. Water, sanitation and hygiene (WASH) conditions pose significant health risks for its 1.8 million residents and constrain socioeconomic development. Groundwater from a coastal aquifer is the only water resource available in the Gaza Strip. Abstraction from the aquifer reached four times the recharge rate amounting to 200 MCM/year and is expected to reach 260 MCM/year by More than 96 per cent of abstracted water is polluted and not fit for human consumption because of high salinity from sea water intrusion due to over-pumping, and high nitrate levels from excessive use of agrochemicals and infiltration of wastewater. Water supply in the Gaza Strip is estimated at 90 l/c/d, below acceptable water quantity standards of 100 l/c/d recommended by WHO 1. Furthermore, with the absence of sufficient wastewater treatment facilities, approximately 35 MCM/year of untreated/partially treated wastewater is discharged into the sea along the Gaza coast 2. This deteriorated WASH situation has been compounded by nine years of blockade and three consecutive destructive wars. Consequences of the last armed conflict in 2014 ( Protective Edge ) are still affecting the WASH sector in direct and indirect ways, limiting the capacity to develop and deliver basic needs and services to people living in the Gaza Strip. Fifty days of continuous attacks caused large scale destruction, devastation and displacement. Extensive damage to water and wastewater facilities was preliminary reported by CMWU/PWA, estimated at around US$ 34 million, highlighted in Table 0.1. Table 0.1: WASH facilities destroyed during the armed conflict in 2014 Facility Totally destroyed Partially destroyed Water filtration and treatment plants 10% 19% Water distribution centres 24% 25% Water wells 5% 7% Water pumping stations - 38% Water storage tanks 19% 42% Wastewater treatment - 60% Wastewater disposal systems - 10% Wastewater pumping station - 27% 1 Palestinian Water Authority, Gaza Water Resources Status Report 2013/2014, Palestinian Water Authority, Gaza Strip: Water Crisis Deepens: Without Sustainable Solutions, Future at Stake,

20 The damage assessment report further identified over 33,000 metres of damage to the water and wastewater networks. The damage mentioned above does not include unseen damage which can t be identified until the removal of rubble. Approximately half a million people were directly affected by damage to water facilities and around one million people were affected due to damage to wastewater facilities 3. Moreover, the electrical system was severely damaged when the only power plant in the Gaza Strip was hit during the conflict. Electrical generators supplying water and wastewater facilities are heavily used and overloaded by long hours of operation. Consequently, supplied water is rarely sufficient and most raw sewage collected is being discharged into the environment because of difficulties with proper disposal. During the winter season, intense storms could cause raw sewage trapped under the rubble to mix with rainwater, increasing health risks because of a lack of adequate collectors and drainage infrastructure. As a consequence, repairing and reinforcing WASH conditions at both the municipal and household level is urgently required. The reconstruction process is slow and restricts a humanitarian response or a development plan. Problems arising from slow implementation of the Gaza Reconstruction Mechanism (GRM), prohibition on entry of dual-use materials, inadequate power supplies and lack of government regulation have seriously worsened the WASH situation in Gaza Strip. GVC, PHG and UNICEF, supporting the WASH cluster in defining the most appropriate strategic approach for responding to WASH needs in the Gaza Strip, are undertaking an exercise to assess clearly the dimensions and outlines of the problem. This need was recognized by the WASH cluster, and GVC, PHG and UNICEF offered to take the lead on this assessment analysis for the current WASH situation at household level in the Gaza Strip. General socio-economic situation in the Gaza Strip One million and eight hundred thousand people (896,542 females and 923,438 males) live in the Gaza Strip on 365 km2 of land. They live in poor socio-economic conditions, hampered severely by high population density, limited land access, strict internal and external security controls, Israeli military operations, and restrictions on labour and trade access across the borders. The socio-economic situation in the Gaza Strip has been one of chronic need, de-development and donor dependency. The situation has been worsened by blockades imposed on the Gaza Strip. Since 2007, Israel has imposed a land, sea and air blockade on the territory. Also, Rafah Crossing into Egypt has been continuously closed by the Egyptian government since 2014, including crossings of those needing humanitarian assistance. Farming activities within several hundred meters of the Israeli fence surrounding the Gaza Strip are risky and prohibited. Fishermen are allowed to access less than one-third of the 20 miles allocated to them under Oslo Accords. This total blockade has reduced the Gross Domestic Product (GDP) of the Gaza Strip by 50 per cent, while the unemployment rate has risen to become the highest in the world. On the other hand, most of the funding for the Gaza Strip administration comes from outside in 3 Office for the Coordination of Humanitarian Affairs, Gaza Crises Appeal,

21 the form of foreign humanitarian aid, and around 80 per cent of the people in Gaza Strip are receiving international assistance 4. UNSCO reports on the socio-economic situation in the Gaza Strip on a quarterly basis. Based on the report of Q3/2015 5, the Gaza Strip economy constituted 23 per cent of the overall Palestinian economy, whereas the real GDP was $US million and the nominal GDP per capita was $US and rate of change in real GDP (year-on-year) was 33.3 per cent. The final consumption in the Gaza Strip in Q3/2015 was per cent of GDP. Final household consumption was 79.6 per cent of GDP and the government s final consumption was 48.4 per cent of GDP. Gross capital formation was negative to the tune of 6.0 per cent of GDP during the Q3/2015, though gross fixed capital formation was positive with 15.2 per cent of GDP. Exports from the Gaza Strip amounted to 3.3 per cent of GDP, while imports amounted to 39.1 per cent, resulting in a trade deficit equal to 35.9 per cent of GDP in Q3/2015. The business cycle index contracted throughout Q3/2015. The labour force participation rate was 45.3 per cent and was much higher for men than for women. Similarly, 42.7 per cent of the labour force was unemployed in the Gaza Strip in Q3/2015 and the employment rates for women were higher than men, 63.3 per cent of women compared to 37.4 per cent of men. Refugees had a marginally higher unemployment rate than non-refugees in the Gaza Strip. Justifications Until September 2015, no household assessment had been carried out assessing the destruction affecting WASH conditions after the last armed conflict in 2014 and consequent impacts. The current situation is similar to the period post- Operation Cast Lead, when a WASH household survey report was elaborated by PHG with the support of UNICEF 6. The survey was carried out in all of the Gaza Strip to identify areas requiring critical WASH interventions, thus avoiding potential public health outbreaks. The report was a great support for agencies interested in supporting the urgent WASH needs of the Gaza population and it allowed more strategic, effective and efficient approaches to the response. The current situation is much more dire than after the Cast Lead operation (2009), resulting from a wider amount of destruction of WASH infrastructure and delays in emergency reconstruction response. In light of this, the WASH Cluster expressed the need to carry out a contextual assessment. GVC and PHG, with the support of UNICEF, proposed to undertake a thorough assessment as an urgent need in order to evaluate the WASH conditions in the Gaza Strip at the household level, as well as public health risks. This assessment highlights the diverse consequences suffered by women, men, girls and boys. The proposal is more extensive, however, generating a detailed analysis by comparing three sets of data: 4 Office for the Coordination of Humanitarian Affairs, THE GAZA STRIP: The Humanitarian Impact of the Blockade United Nations Special Coordinator Office, UNSCO Socio-Economic Report: Overview of the Palestinian Economy in Q3/2015, Palestinian Hydrology Group and United Nations Children's Emergency Fund, Water, Sanitation and Hygiene Household Survey, Gaza,

22 post-cast Lead data included in the PHG report, - New data covering the pre-2014 Protective Edge operation, and - New data on the current situation. Goal and objectives Goal To assess WASH conditions at the household level in Gaza Strip, identifying the real status of drinking water, domestic water, wastewater, solid wastes and hygiene. Objectives To generate a comparative analysis that informs the identification of critical responses and actions that will contribute positively and efficiently to ensuring minimum WASH standards for the Gaza Strip population, thereby reducing health risks. In addition, the assessment s purpose emphasizes the insufferable situation that the population of Gaza Strip is compelled to endure because of repeated military activity. These objectives will be achieved through: a. Identifying WASH needs in the Gaza Strip. b. Designing a framework for data comparison of WASH needs at the household level for the WASH cluster, drawing upon 2010 post-cast Lead, 2014 pre-protective Edge and 2015 post-protective Edge data. c. Distinguishing and suggesting priority lines of actions and responses. d. Expanding the information network related to WASH and gender. e. Contributing to labour market entry by employing fresh graduates, especially women graduates. Wash monitoring working group The WASH monitoring working group (WASH-MWG) is a Technical Working Group that is part of the WASH Cluster. It was established to harmonize and coordinate the assessment proposed by GVC and PHG. It is supported by UNICEF, using the competences and experiences of the PWA, CMWU and all WASH focal points and key agencies that work in the Gaza Strip. The structure of the group consists of: - Chair: PWA and CMWU, as they are the WASH sector regulator and service provider respectively in Gaza Strip. - Facilitator: WASH Cluster acts as facilitator towards WASH agencies with the support of GVC and PHG. - Members: WASH Focal Points; Save the Children, Oxfam GB, ACF and IRPAL, UNICEF, UNRWA, NRC with the support of ICRC. The main tasks and responsibilities of the WASH-MWG are as follows. The complete ToR is detailed in: WASH-MWG ToR. - Creating an open and accessible database of information gathered through different surveys, based on format and methodologies set up during the assessment carried out by GVC and PHG and supported by UNICEF. 20

23 - Advising the process of the WASH assessment at the household level, by ensuring that the relevant standards, procedures and approaches are formulated and agreed within all members of the WASH-MWG. - Collecting and addressing information on hazards and risks at each location, and identifying the gaps and priorities of intervention. - Providing a link between the infrastructure damage assessment done by CMWU/PWA and the WASH situation at the household level. - Promoting adopted and verified standards to be used in future interventions as part of indication by the Cluster Coordinator. - Ensuring effective and coherent WASH assessment and analysis that is accessible to all relevant partners in order to prevent any overlap with other WASH actors activities/assessments. - Promoting information sharing activities both as seminars and documents about results of the assessments and to collect feedback and comments. 21

24 METHODOLOGY Assessment framework The framework adopted for this assessment consists of four main consequent stages implemented over seven months as shown in Table 0.1: 1) preparation 2) data collection, 3) data analysis and 4) report writing. The preparation stage included pre-meetings with WASH-MWG to agree on the final objectives, structure and required outputs, and included selection of the work team. On the other hand, the data collection stage included a field survey consisting of three phases, conducted through a prepared questionnaire and supported with other data collection tools, focus groups, observatory reports and secondary data from previous implemented assessments. The data analysis included the elaboration of indicators addressing household socio-economic conditions and the WASH situation. Finally, all methodology steps and output results were elaborated in the final report during the last stage. All the methodology steps and scope of work (including sampling, data collection, data analysis and findings) were discussed during the WASH-MWG meetings. The methodology was developed and finalized based on recommendations of the WASH-MWG. The key WASH-MWG meetings are listed in Table B.1 ANNEX B. Table 0.1: Actual time framework # Stage Sep Preparation 2 Data collection 3 Data analysis 4 Report writing Oct 2015 Nov 2015 Dec 2015 Jan 2016 Feb 2016 Mar 2016 Data Collection Questionnaire design A survey questionnaire was specifically designed for the assessment to tackle different aspects of WASH in the Gaza Strip. The questionnaire is divided into four sections; general information about households including the socio-economic conditions, water, sanitation and hygiene, including the aspects listed in Table 0.2. The questionnaire includes two types of questions; close-ended questions followed by answer options, and open-ended questions to explore answers that better explain the WASH situation in the Gaza Strip. A discussion workshop was conducted by WASH-MWG during the preparation stage to discuss the questionnaire structure and to plan the work progress and data analysis in all stages. Their purpose was to ensure the highest quality of output data and a fluent exchange of information. The final version of the questionnaire was prepared and uploaded on tablet devices. The final version of the questionnaire in English language is shown in ANNEX C. 22

25 Table 0.2: WASH and socio-economic aspects included in the questionnaire form Sector Items Socio-economic Target group (internally displaced persons, war-affected, WASHaffected, non-affected) identification General information (household address, interviewee name, interviewee phone number) Interviewee sex and age Interviewee marital status Interviewee occupation Family members (number, sex and age) Family income Disability (number, sex and age) Education Shelter conditions (ownership, type, area, no. of rooms) Monthly WASH material expenses Water (drinking Source of water and domestic) Accessibility (household connection, storage capacity and affordability to pay the fees) Storage cleaning conditions Water collection and storage management Perception about water quality Perception about water uses Perception about water needs priorities Perception about the coping mechanism to alleviate the water issue at the household level Sanitation Status of wastewater system Availability of drainage system Solid waste disposal management Surrounding cleanliness conditions (garbage, insects, rodents, etc.) Perception about sanitation needs priorities Perception about the coping mechanism to alleviate the sanitation issue at the household level Hygiene Source of water heating Sanitary facilities conditions Household cleaning conditions Availability of hygiene materials Hygiene practices (hand washing and showering) Waterborne diseases Perception about hygiene needs priorities Perception about coping mechanisms to alleviate the hygiene issue at the household level 23

26 Sampling approach Sample size Determination of sample size is very important because samples that are too large may waste time and available resources, while samples that are too small may lead to inaccurate results. A correct sample size is necessary to produce results accurate to a specified confidence and margin of error. The following statistical equation 7 was used to determine the required minimum sample size that represents households throughout the Gaza Strip. The result was 2,382 households which represents the total of 303,330 Gaza Strip households. n = Nσ 2 Z 2 N 1 e 2 + σ 2 Z 2 Where: n= Sample size (using the finite population correction factor) N = σ = Z = Population size = 303,303 households (total population in 2015 = 1,819,980 8, household = 6 members 9 ) Response distribution = 50 per cent Z-score = 1.96 (confidence level of 95 per cent) e= Margin of error = 2 per cent Sample size = 303, , = 2,382 The required minimum sample size was rounded to 2,500 households. Taking into consideration that 20 per cent of the total questionnaires to be implemented will be excluded in the cleaning process due to bias errors and improper household responses, the appropriate minimum sample size was identified to be 3,125 households. Sample stratification The selected sample size was stratified based on governorates and localities and classified into four target groups to portray and investigate the socio-economic and WASH conditions in Gaza Strip: 1. Non-affected (normal): households that were not affected by the 2014 armed conflict or were slightly or indirectly affected. 7 Berenson, M., Levine, D., and Szabat, K., Basic Business Statistics: Concepts and Applications, 13 th Ed., Pearson, UK., Palestinian Central Bureau of Statistics, Population Projections, en/803/default.aspx, Palestinian Central Bureau of Statistics, Demographic Indicators,,

27 2. Most affected (war-affected): households that were deeply affected by the 2014 armed conflict while their households remained habitable afterwards. The number of war-affected households per governorate was obtained by the Ministry of Housing and Public Work (MoHPW), estimated at 6,205 households in all Gaza Strip. 3. Internally displaced persons: households that were completely destroyed or severely destroyed where residents moved out from their houses or were still living in the location of their destroyed homes inside tents or caravans. The number of internally displaced families was obtained per governorate by the United Nations Office of Coordination and Humanitarian Affairs (OCHA), and was estimated at 17,872 households in all Gaza Strip. 4. WASH-affected: households that were living in very poor WASH conditions. This target group was not in the proposal plan and was adopted by WASH-MWG to replace the nonaffected households group in the second phase of the field survey (see sub-section Field survey implementation). The stratification approach included statistical calculation to stratify the total required number of questionnaires (3,125 households) to each locality and governorate. The calculation determined the percentage of total number of households for each group in each locality in relation to the total number of households in the same governorate. The calculation then applied the percentage to obtain the required number of households of each target group per locality. The minimum representing number of questionnaires for each group per locality is shown in Table D.1 in ANNEX D Field survey implementation The time frame of field work was limited by available time and resources. In addition, the initial data analysis was to be submitted to the WASH Cluster for the HNO 2016 process. Due to these constraints, field work was divided into three main phases that began with field training for the work team. A work team consisting of one coordinator supported by three supervisors and 23 surveyors conducted the assessment with management staff from GVC and PHG. All team members participated in the first and second phase, while only three supervisors and one surveyor continued the work alongside the coordinator in the third phase Training phase Three days of training were held before field work commenced to explain the questions included in questionnaires and their related terminologies. Training included the proper way to ask questions and how to use tablets to fill in questionnaires. Subsequently a field test was conducted that included 624 questionnaires targeting only non-affected households. The field team held other meetings to follow-up on the field work and to give feedback and recommendations Field work phases Phase 1: The main required output of this phase was to submit initial data to the WASH Cluster as a first estimation of WASH needs in the Gaza Strip, providing a basis for recommendations to the HNO 25

28 2016. With available resources, the plan was to implement 1,755 of the required number of questionnaires expected to guarantee a minimum response of 1,404 households. The total number of questionnaires implemented in this phase was 1,343, from 28 September 2015 to 11 October As shown in Table 0.3, 93 per cent of the total implemented questionnaires in this phase targeted non-affected groups as the coordination was ongoing to get the data of war-affected households from MoHPW and the data of internally displaced persons from OCHA. Phase 2: The plan was to continue carrying out the assessment with a minimum of 1,370 questionnaires to guarantee a minimum response of 1,096 households, with the goal of reaching 2,500 valid questionnaires as minimum in both the first phase and second phases. In this phase, the planned methodology of the assessment was changed based on the field observations of surveyors and recommendations by UNICEF, the WASH cluster and other WASH-MWG members, to better reflect the WASH situation in Gaza Strip and to avoid any incoherence in identifying the needs of the households most vulnerable in terms of WASH. The changes to the methodology resulted in the following: 1. Surveyors stopped filling out more questionnaires for the non-affected group. 2. Surveyors initiated a new target group, WASH-affected households. 3. Surveyors allocated the remaining number of questionnaires of the non-affected group to WASH affected, war affected and internally displaced person groups. Due to OCHA s data sharing protocol, the long process required to get data of new internally displaced persons resulted in numerous nonworking days. Consequently, the number of implemented questionnaires in this phase was 2,634 during the period from 12 October 2015 to 30 November The total number of implemented questionnaires in both the first phase and second phase reached 3,977 as shown in Table 0.3. Phase 3: This phase was crucial in order to clean the data and to exclude the surveys where meaningful biases were identified. During the cleaning process, implemented during the period from 1 December 2015 to 11 February 2016, 3,166 questionnaires were cleaned (out of the 3,977 questionnaires total), as shown in Table 0.3. The steps undertaken in the cleaning process, in keeping with the representativeness percentage of each target group per locality were as follows: 1. Highlighting and sorting the questionnaires based on missing answers. 2. Excluding questionnaires with many missing answers. 3. Excluding questionnaires missing answers of observatory questions. 4. Calling interviewees again by phone to get missing answers or to re-correct incoherent answers. 5. Classifying and limiting narrative answers of comprehensive questions (open-ended questions). 6. Translating answers from Arabic to English. 26

29 Table 0.3: Number of the implemented questionnaires and valid questionnaires after cleaning process Group # of questionnaires in training phase # of implemented questionnaires # of valid Phase 1 Phase 2 Total questionnaires Non-affected 624 1, , War-affected , Internally displaced persons WASH-affected Total 624 1,343 2,634 3,977 3,166 During implementation of the assessment, several meetings, workshops and other bilateral discussions were conducted with different stakeholders for consultation and to update them on different aspects of the assessment. Five workshops have been conducted with WASH-MWG in order to discuss progress of the assessment. The key meetings and workshops are listed in Table B.1 in ANNEX B. Households selection The selection process for each target group of households followed specific criteria. Different criteria were identified because of the coordination mechanism related to data sharing protocols and the change in methodology adopted in the second phase. 1. Non-affected: non-affected households were selected randomly in each locality. The selection process involved selecting a certain household and then skipping over the subsequent 20 households before approaching another one. 2. War-affected: a list of households was prepared randomly from the database of the MoHPW of war-affected households from the 2014 armed conflict. Prior to going out in the field, surveyors called selected households to be sure of the data and to arrange for a field visit. In the second phase, because of the change in methodology, specific areas were identified for surveying war-affected households (shown in Map 1 in). The areas were different in terms of level of WASH conditions, area size, and number of assigned households. The selection was done at random for households. 3. Internally Displaced Persons: all internally displaced households were selected randomly from the OCHA database. Field coordination was done with OCHA to approach the required number of internally displaced persons in each area. While carrying out this assessment, OCHA was also conducting the field assessment. Because of the differing amount of time that the OCHA and GVC-PHG field teams took to fill their questionnaires, a work mechanism for this purpose was agreed on. OCHA and GVC-PHG teams met in household (A), then GVC-PHG team skipped household (B), and then both teams met again in household (C), and so on. At the end of the second phase, when OCHA finished their field survey, this mechanism could not be applied anymore. After a long process of coordination among the WASH Cluster, OCHA and GVC-PHG, OCHA provided the GVC-PHG team with contact information for the remaining required number of internally displaced households that were visited by the GVC-PHG team without being accompanied by an OCHA team. 4. WASH-affected: specific areas were identified for surveying WASH affected households based on field observations and WASH-MWG recommendations (shown in 27

30 5. Map 2 in Selected areas were different in level of WASH conditions, area size, and number of assigned households. The surveyors used their observations to reach households in specified assigned areas. The selection of a household was made randomly every households. Complementary data In addition to data collected by questionnaires filled out in the field, other data collection tools were applied in order to validate, compile and integrate the whole dataset. Three other tools have been used; conducting focus group sessions, preparing specific reports about the general WASH conditions of households based on the observations of surveyors, and collecting secondary data from previous assessments and researches. Focus groups Four focus groups were conducted in four different governorates. The selection methodology of these groups was based on the variations of target groups, location and sex of attendees. The four groups were recommended by the WASH-MWG and field team in order to spotlight more of the most affected areas of each target group. The discussion during the sessions was about the general WASH situation at household level. WASH aspects that were discussed included; drinking and domestic water conditions (water quality and accessibility), sanitation conditions (wastewater system, storm water drainage and solid waste management) and hygiene conditions (including diseases that appeared and cleanliness of households). The discussion was based on attendee s perception and included priorities and solutions required to solve and/or mitigate the WASH problems at household level. Table 0.4 summarizes the general information about each focus group. Table 0.4: Focus groups information # Locality/Governorate Target group 1 Ash Shati' Camp - Gaza governorate WASH-affected 2 Beit Hanoun - North governorate Internally Displaced Persons 3 Khuza a - Khan Younis governorate War-affected 4 An Nuseirat - Middle Area governorate Non-affected Observatory reports In order to have a clear and consolidated overview of WASH conditions at the household level, it was necessary to understand the whole WASH situation in the community surrounding the households. It was determined that each surveyor should prepare a brief report describing the general WASH conditions in the area that she/he was conducting the survey. In the end, the most WASH affected localities/neighbourhoods were reported and assessed in the second phase (see MAP 2). 28

31 Secondary data To save available resources, time, and to abbreviate the questionnaire, the methodology relied on other data sources for further details. Therefore, some secondary data was collected from other assessments and studies implemented by other agencies that provided additional details not originally obtained during the field survey. The sources of secondary data were: - PWA: for data on domestic water resources, quality, and public health. - CMWU: for data on domestic water and wastewater networks and drainage system. - NRC: for data on drinking water quality. Data analysis Indicators elaboration Forty-seven indicators were developed to capture the socio-economic situation and WASH conditions at the household level for the whole Gaza Strip, before and after the 2014 armed conflict. The indicators were elaborated as follows: 1. Preparing the list of required indicators, and then reviewing and discussing the list with the WASH-MWG. The final list is shown in Table Elaborating the indicators based on data collected through questionnaires. Table E.1 in ANNEX E shows question(s) and formulas used to elaborate each indicator. 3. Validating the findings of each indicator by complementary data (see Section 0 Complementary data). 4. Reviewing and discussing the findings of each indicator with the WASH-MWG. Table 0.5: List of indicators # Indicator 1 Socio-economic indicators SE1 Percentage distribution of population based on sex and age SE2 Average housing density SE3 Percentage of households headed by women SE4 Percentage of internally displaced families planning to go back to their homes SE5 Percentage of internally displaced persons and war-affected families having negative variation of income post-2014 SE6 Percentage of variation of monthly WASH items expenses per household pre- and post SE7 Average monthly WASH items expenses post Water indicators W1 Variation of source of drinking water pre and post-2014 W2 Percentage of women and men who have/have no knowledge about the origin of the safe drinking water W3 Variation of source of domestic water pre and post-2014 W4 Variation of capacity of the drinking water storage pre and post-2014 W5 Variation of capacity of the domestic water storage pre and post-2014 W6 Average of storage capacity of drinking water per household member pre- and post W7 Average of storage capacity of domestic water per household member pre- and post W8 Variation of perception about the drinking water quality pre and post

32 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 Variation of perception about the domestic water quality pre and post-2014 Percentage of women and men who use drinking water for domestic use Percentage of women and men who use domestic water for drinking use Percentage of households engaging children in drinking water collection Percentage of households engaging women in drinking water collection Cleaning conditions of the drinking water storage sites Cleaning conditions of the domestic water storage sites Percentage of households that don t pay for domestic water Variation of needs priorities of the drinking water pre- and post-2014 Variation of needs priorities of the domestic water pre- and post-2014 Different coping mechanisms used by women and men related to water problems 3 Sanitation indicators S1 Percentage of households without toilets or without sufficient toilets pre- and post-2014 S2 Households without access to wastewater networks pre- and post-2014 S3 Percentage of households without proper surrounding storm water drainage S4 Percentage of households that need access to safe solid waste disposal S5 Variation of needs priorities of the sanitation pre- and post-2014 S6 Different coping mechanisms carried out by women and men related to sanitation problems 4 Hygiene H1 Variation of source of water heating pre- and post-2014 H2 Percentage of households without or with poor hand washing facility post-2014 H3 Percentage of households without or with poor shower facility post-2014 H4 Percentage of households without or with poor kitchen sink post-2014 H5 Percentage of people who do untimely proper hand washing practice H6 Percentage of people who do and don t do sufficient showering practice H7 Change of hygiene practices post-2014 H8 Percentage of households with children under five years old infected by waterborne diseases in the last two weeks H9 Percentage of households with members above five years old infected by waterborne diseases in the last two weeks H10 Percentage of households that noticed appearance of new diseases H11 Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post-2014 H12 Percentage of households that received hygiene kits in the last period (2015) H13 Percentage of households with need for hygiene materials H14 Variation of needs priorities of hygiene pre- and post-2014 H15 Different coping mechanisms used by women and men related to hygiene problems Analysis limits The data was analysed to measure the WASH vulnerability and needs at household levels. The findings were addressed and interpreted in CHAPTER 3 in detail to provide clear and general pictures about the WASH situation. However, further assessments may be needed to explore deeper detail and correlation. 30

33 FINDINGS AND DISCUSSION General In total, 3,166 valid questionnaires were analysed according to governorates and localities. Figure 0.1 shows the summary, the total number of valid questionnaires per governorate based on the target group and the sex of interviewees, while Table shows in detail the total number of implemented and valid questionnaires per governorate and locality based on target group. In addition, the total number of valid questionnaires is disaggregated based on the sex and age of interviewees in Figure 0.2 and in detail in Table All the findings were analysed to furnish an overall representation of WASH conditions in Gaza Strip with a link to the socioeconomic situation. Therefore, the findings were not divided based on target group (internally displaced persons, WASH-affected, war-affected and non-affected) since the purpose of sample division, as mentioned in CHAPTER 2, was mainly performed to highlight the most vulnerable areas recommended by the WASH-MWG to better represent the field situation and to avoid any incoherence in final elaboration of WASH assessed needs in the whole Gaza Strip. 31

34 Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Figure 0.1: Number of the valid questionnaires per governorate based on target group and sex of interviewee Women 19< Men 19< North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate 32

35 Figure 0.2: Number of the valid questionnaires per governorate based on sex and age of the interviewees Sixty-three per cent of interviewees were men and 37 per cent were women. This difference is significant because in the local culture, families prefer that men meet with outsiders. The age of interviewees ranged from years, while the majority (91 per cent) was in the range of years. Sixty-nine interviewees had a physical disability (seven women, and 62 men). The survey considered variations in land types and life levels (type of shelter, income, education, etc). Regarding land type, 2,137 questionnaires (67.5 per cent) out of the total valid questionnaires were implemented in urban areas, while 624 (19.7 per cent) and 405 (12.8 per cent) were implemented in camp and rural areas respectively. The number of valid questionnaires implemented per land type and governorate is detailed in Table In terms of shelters, 1,562 questionnaires (49.3 per cent) were implemented inside separated houses, 956 (30.2 per cent) inside asbestos/zinco houses, 601 (19.0 per cent) inside apartments in a building/tower and 47 (1.5 per cent) inside tents and caravans. The number of questionnaires implemented per shelter type and governorate is detailed in Table Income of the interviewed households ranged from 0-9,000 NIS (US$ 0-2,368) 10 ; As such, 86.7 per cent of the interviewed households were under the poverty line, while 91.8 per cent were under the deep poverty line. PCBS guidelines of 2011 indicate that the relative poverty line and the deep poverty line of one household is 2,293 NIS (US$ 603), and 1,832 NIS (US$ 482) respectively 11. The average household monthly income in each governorate is shown in Figure 0.3 and detailed in Table Forty-seven indicators were elaborated and validated by the complementary data; seven indicators related to socio-economic situation, 19 indicators related to water conditions, six indicators related to sanitation conditions, and 15 indicators related to hygiene and public health. 10 Currency rate: USD/NIS = Palestinian Central Bureau of Statistics, (

36 Percentage (%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 100 ) USD NIS ( )USD1053 NIS (> 4000> North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.3: Number of the valid questionnaires per governorate based on average HH monthly income Socio-economic indicators SE1: Percentage distribution of population based on sex and age This indicator portrays the percentage distribution of interviewed household members based on sex and age. The results show that the sex ratio among interviewees in the Gaza Strip is (women is 48.6 per cent and men is 51.4 per cent) which resembles PCBS statistics of 2014 that indicated the sex ratio as Figure 0.4 shows the percentage distribution of age of interviewed household members per governorate, which is very close in all governorates. In the Gaza Strip, the percentage of children aged 0-5 years is 16.2 per cent and the percentages of people aged 6-18, 19-35, and > 60 years is 34.0 per cent, 29.3 per cent, 17.3 per cent and 3.2 per cent respectively. Results related to this indicator are detailed in Table ) USD263 NIS (< 1000< ) USD NIS ( )USD NIS ( yrs 5-0 yrs 18-6 yrs yrs yrs 60> North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.4: Percentage distribution of household members based on age 12 Palestinian Central Bureau of Statistics, Demographic Indicators, (

37 # of person Per Room Average area Per Person (m2) Average HH area (m2) Average # of rooms per HH 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP SE2: Average housing density This indicator portrays the average housing density of interviewed households in terms of average household area, number of rooms per household, number of persons per room, and average area per person. Figure 0.5 shows that the average household area in Gaza Strip is m 2, the largest is in the Gaza governorate with m 2 and the smallest is in the Rafah governorate with m 2. Governorates did not differ much on the other indicators. In Gaza Strip, the average number of rooms per household is 2.87, the number of persons per room is 2.20, and the average area per person is 20 m 2. Results related to this indicator are detailed in Table )2Average HH area (m Average # of rooms per HH North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Rafah Younis Gaza Strip Governorate Governorate of persons per room # )2Average area per person (m North Gaza Middle Area Khan Rafah Younis Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.5: Average housing density SE3: Percentage of households headed by women This indicator shows the percentage of interviewed households headed by women. Figure 0.6 shows the percentage of households headed by women per governorate, all hovering around 35

38 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 8.7 per cent as an average for the whole Gaza Strip. The percentage in Khan Younis is the highest at 10.7 per cent of female-headed households, due to the presence of rural areas where women usually are the heads of the household, while Rafah is the lowest at 5.8 per cent. The average according to the PCBS was 8.4 per cent in Results related to this indicator are detailed in Table of HHs headed by women % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.6: Percentage of households headed by women SE4: Percentage of internally displaced families planning to go back to their homes Figure 0.7 portrays that almost all interviewed internally displaced families in all governorates (99 per cent) are planning to go back to their houses and they are just waiting until the reconstruction process is finished. Most remaining interviewed families who preferred not to return (one per cent) mentioned that they can t go back because they were living in hot spot zones (mainly at the border) and there is a high risk that their houses will be targeted again. Results related to this indicator are detailed in Table of families coming back % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.7: Percentage of internally displaced families going back to their home 13 Palestinian Central Bureau of Statistics, (

39 Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP SE5: Percentage of internally displaced persons and war-affected families with negative variation of income (less purchase power) post-2014 This indicator shows the percentage of interviewed internally displaced persons and waraffected families who had a negative variation of income due to the 2014 armed conflict. Figure 0.8 illustrates that the average percentage of affected families that had a negative income variation in the Gaza Strip is 45 per cent, while the percentage living in the Middle Area is highest with value of 61 per cent. The proportion with a negative variation in Rafah was at 29 per cent. Results related to this indicator are detailed in Table 0.10 in of IDPs and war-affected families having negative variation of income % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.8: Percentage of internally displaced persons and war-affected families that had negative variation of income SE6: Percentage of variation of monthly WASH items expenses per household pre- and post-2014 This indicator shows variations in monthly WASH expenses of interviewed households before and after Figure 0.9 indicates that the WASH expenses of most interviewed households in the Gaza Strip were not affected by the 2014 armed conflict, as their needs remained the same. The trend in variation was almost the same in all governorates. Results related to this indicator are detailed in Table

40 NIS USD Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 100 of HHs with no paying variation HHs paying less HHs paying more % Drinking water Domestic water Hygiene materials Female hygiene items Cleaning materials Solid waste disposal WASH items Figure 0.9: Percentage of variation of monthly WASH items expenses per household in Gaza Strip SE7: Average monthly WASH items expenses post-2014 This indicator shows the monthly WASH item expenses of interviewed households after Figure 0.10 shows the results (in NIS and US$ 14 ), reflecting the expense amounts of each item as nearly the same across governorates. The highest portion of WASH expenses (around 2/3) is spent on cleaning materials at a rate of NIS/C/M ( USD/C/M) and the lowest part is spent for solid waste disposal with rate of NIS/C/M ( USD/C/M), while the other expenses are in between; NIS/C/M ( US$/C/M), NIS/C/M ( USD/C/M), NIS/C/M ( US$/C/M) and NIS/C/M ( USD/C/M) for drinking water, domestic water, hygiene materials and feminine hygiene items respectively. Figure 0.11 shows the total WASH expenses across governorates in the range of NIS/C/M ( US$/C/M) with an average value of 33.8 NIS/C/M (8.9 US$/C/M) for the whole Gaza Strip. The amount of each WASH item refers to the cost of the WASH item in the local market and the practices of the household. Results related to this indicator are detailed in Table North Gaza Middle Area Khan Younis Rafah Gaza Strip Drinking water Domestic water Solid waste Hygiene materials Female hygiene items Cleaning materials WASH item Figure 0.10: Average WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month) 14 Currency rate: USD/NIS =

41 Percentage (%) NIS USD 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Total WASH expenses North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.11: Total WASH expenses (left-axis: NIS/capita/month, right-axis: USD/capita/month) Water indicators W1: Variation of source of drinking water pre- and post-2014 This indicator describes the sources of drinking water for the interviewed households before and after the 2014 armed conflict. Figure 0.12 shows the source of drinking water of interviewed households in Gaza Strip, illustrating no considerable change due to the 2014 conflict. The results show that around 85 per cent of interviewed households are dependent mainly on water vendors to get their drinking water, while public filling points are the second most used drinking source with 11 per cent. The manner is almost the same across governorates, where percentages of households dependent on water vendors and public filling points are (79.4 per cent, 9.8 per cent in the North), (90.4 per cent, 6.3 per cent in Gaza), (95.6 per cent, 3.5 per cent in the Middle Area), (78.8 per cent, 18.0 per cent in Khan Younis) and (78.8 per cent, 17.5 per cent in Rafah). The remaining households are getting drinking water from other sources; public filling points, private wells, municipal networks, RO home filters and bottled water. The average percentage of interviewed households who obtain their drinking water from municipal or private wells is very low (less than three per cent) since more than 96 per cent of groundwater is contaminated 15. Some households are obtaining drinking water from more than one source. Results related to this indicator are detailed in Table Pre 2014Post Bottling RO home filters Municipal network Private well Public filling points Water truck Water Source 15 Palestinian Water Authority, Gaza Water Resources Status Report 2013/2014,

42 Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Figure 0.12: Variation of source of drinking water in Gaza Strip pre- and post-2014 W2: Percentage of women and men who know the origins of safe drinking water This indicator measures the perception of interviewed people about safe sources of drinking water. Figure 0.13 shows the results according to the sex of interviewees. Taking into consideration that bottled water, RO filters, water trucks and public filling points are safe sources for drinking water, while water coming from municipal networks and private wells is not safe, the results show that the percentage of interviewed people who don t know which are sources of safe drinking water is 7.7 per cent of women and 6.4 per cent of men. The highest percentage of interviewees who don t know is in the North governorate, where 13.3 per cent of women and 17.5 per cent of men did not indicate safe sources of drinking water. This is because the quality of domestic water coming from municipal and private wells in the North governorate is better than other governorates (see indicator W9), and so the answers there are in fact different. The perception of women and men is similar across governorates. Results related to this indicator are detailed in Table Have no knowledge Women Have knowledge Men Sex Figure 0.13: Percentage of people who know the source of the safe drinking water in Gaza Strip W3: Variation of sources of domestic water pre- and post-2014 This indicator shows the variation in sources of domestic water of interviewed households before and after the 2014 armed conflict. Figure 0.14 shows the source of domestic water of interviewed households in Gaza Strip and reflects no considerable change due to the 2014 conflict. The results show that around 84 per cent of interviewed households are dependent on the municipal network and 16 per cent are dependent on their own private wells, while less than two per cent of households are dependent on other sources such as water trucks and public filling points which are used mainly as a domestic water source in case the municipal water is unavailable due to power outage. Some households are getting domestic water from more than one resource mainly those that have a connection to both a municipal network and a private well at the same time. This manner is almost the same for all governorates. The main anomaly was in the Middle Area governorate, where the percentage of households that use municipal networks and private wells is 63.6 per cent and 37.1 per cent respectively, i.e. with significantly less network use. For the other governorates, the percentage of households using municipal 40

43 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP networks and private wells are (90.2 per cent, 8.3 per cent), (88.2 per cent, 11.7 per cent), (93.4 per cent, 7.0 per cent) and (74.7 per cent, 26.1 per cent) for the North, Gaza, Khan Younis and Rafah governorate respectively. Results related to this indicator are detailed in Table Pre 2014Post Municipal network Private well Public filling points Water truck Water Source Figure 0.14: Variation of source of domestic water in Gaza Strip pre- and post-2014 W4: Variation in capacity of drinking water storage pre- and post-2014 This indicator shows the variation in the capacity of drinking water storage of interviewed households before and after the 2014 armed conflict. Figure 0.15 describes results in each governorate, where most interviewed households in Gaza Strip had no change in the storage capacity of drinking water (85 per cent). Some households had an increase in storage capacity due to tank distribution interventions carried out after the 2014 conflict or for indirect reasons (such as moving to another place or increase in family members). The situation is similar across all governorates. In some localities, the percentage of households that faced a decrease in the storage capacity of drinking water is a bit higher than the others, mainly in Al Nasser, Al Maghazi Camp and An Nuseirat Camp where the percentage was 30.8 per cent, 21.4 per cent and 19.3 per cent respectively. Results related to governorates/localities for this indicator are detailed in Table No Change Decreased Increased North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.15: Variation of capacity of the drinking water storage pre- and post

44 Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP W5: Variation in capacity of the domestic water storage pre- and post-2014 This indicator protrays the variation in domestic water storage capacity of interviewed households before and after the 2014 armed conflict. Figure 0.16 shows results in each governorate, where most interviewed households in Gaza Strip had no change in storage capacity for domestic water (74 per cent). Some households had increases in storage capacity due to tank distribution interventions carried out after the 2014 conflict or for indirect reasons (such moving to another place or increase of family members). On the other hand, the percentage of households that faced a decrease in storage capacity of domestic water is highest in Khan Younis and Gaza governorates with a value of 31.3 per cent and 24.9 per cent respectively. In some localities the percentage of households that had reduced storage capacity of domestic water was more than one-third of interviewed households, mainly in Khuza a, Abasan al Kabira and Juhor ad Dik where the percentages were 67.2 per cent, 45.7 per cent and 33.3 per cent respectively. Results related to this indicator for all governorates/localities are detailed Table No Change Decreased Increased North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.16: Variation of capacity of the domestic water storage pre- and post-2014 W6: Average storage capacity for drinking water per household member pre- and post This indicator shows the average capacity of drinking water storage of interviewed households per household member before and after the 2014 armed conflict. Figure 0.17 describes the results; the difference in storage capacity before and after the 2014 conflict is not significant as already explained for indicator W4, except in Rafah governorate where there was a considerable variation before and after 2014 in the rural areas. The average storage capacity per capita in the Middle Area is highest for all land types while it is lowest in Khan Younis for all land types. The current average capacity of drinking water storage of interviewed households in Gaza Strip is 56.5 l/capita in the urban areas (the lowest is in Khan Younis with 41.5 l/capita and the highest is in Middle Area with 65.6 l/capita), 49.9 l/capita in the rural areas (the lowest is in Khan Younis 42

45 Average of storage capacity (l/capita) Average of storage capacity (l/capita) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP with 12.0 l/capita and the highest is in Middle Area with l/capita) and 37.8 l/capita in the camp areas (the lowest is in Khan Younis with 16.4 l/capita and the highest is in the Middle Area with 50.9 l/capita). The high value in rural areas in the Middle Area governorate results from the low number of carried questionnaires. Results related to this indicator are detailed in Table 0.3 and Table 0.18 of 0. Pre 2014 Post 2014 Urban Rural Camp Urban Rural Camp North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.17: Average of storage capacity of drinking water per household member pre- and post-2014 (litre/capita) W7: Average of storage capacity of domestic water per household member pre- and post This indicator shows the average capacity of domestic water storage of interviewed households per household member before and after the 2014 armed conflict. Figure 0.18 illustrates the results, where the difference in storage capacity before and after the 2014 conflict was not high, except in rural areas (especially Khan Younis governorate). The current average capacity of domestic water storage of interviewed households in Gaza Strip is l/capita in urban areas (the lowest is in Khan Younis with l/capita and the highest is in Gaza with 330 l/capita), l/capita in rural areas (the lowest is in Rafah with l/capita and the highest is in Middle Area with 315 l/capita) and l/capita in the camp areas (the lowest is in Khan Younis with l/capita and the highest is in Rafah with 284 l/capita). Results related to this indicator are detailed in Table 0.3 and Table 0.19 of 0. 43

46 Average of storage capacity(l/capita) Average of storage capacity(l/capita) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Pre 2014 Urban Rural Camp Post 2014 Urban Rural Camp North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.18: Average of storage capacity of domestic water per household member pre- and post-2014 (litre/capita) W8: Changes in perception about drinking water quality pre- and post-2014 This indicator shows the perception of interviewed people about their drinking water quality before and after the 2014 armed conflict. Figure 0.19 shows whether interviewed people perceive the drinking water quality as acceptable or not. There was no considerable difference in people s perception of water quality before and after 2014, and the perception was similar across governorates. About 94.2 per cent of interviewed households in Gaza Strip were satisfied with the quality of their drinking water while the remaining percentage complained from one or more problems shown in Figure The main problem of quality was salinity and taste which resulted from posttreatment processing. NRC in cooperation with PWA conducted an assessment to evaluate the drinking water quality based on lab analysis, rather than on people s perception 16. Based on that assessment, 68 per cent of drinking water at the household level is biologically contaminated. Results related to this indicator are detailed in Table Norwegian Refugee Council, Desalinated Water Chain in the Gaza Strip From Source to Mouth',

47 Percentage (%) Percentage (%) Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Pre 2014 Post 2014 Acceptable Not Acceptable Acceptable Not Acceptable North Middle Area Rafah North Middle Area Rafah Governorate Governorate Figure 0.19: Variation of perception about the drinking water quality pre- and post Pre 2014 Salinity Odour Turbidity Taste Post 2014 Salinity Odour Turbidity Taste Governorate Governorate Figure 0.20: Aspects of drinking water quality pre- and post-2014 W9: Changes in perception of domestic water quality pre- and post-2014 This indicator protrays the perception of interviewed people about domestic water quality before and after the 2014 armed conflict. Figure 0.21 illustrates whether interviewed people perceived the quality of domestic water as acceptable or not. There is no large difference in people s perception before and after 2014 except in the Khan Younis governorate where water quality became much worse after Overall, 56.7 per cent of interviewed households in Gaza Strip are not satisfied with the quality of supplied domestic water, while the worst situation is in Khan Younis governorate where 82.8 per cent of interviewed households viewed the supplied water as being of unacceptable quality. Negative perceptions were lowest in the North governorate (27.7 per cent of the households) where the quality of the groundwater is better. In general, the unsatisfactory percentage is high in most of the localities. On the other hand, Figure 0.22 describes interviewed people s perception about aspects of the unacceptable domestic water quality. Salinity is the main problem, and in some localities the percentage reaches 100 per cent. The water taste is also a considerable problem resulting mainly from the infiltration of wastewater, excessive chlorine doses, rusted pipes and the rancidity of the intruded seawater. Results related to this indicator for all governorates/localities are detailed in Table

48 Percentage (%) Percentage (%) Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Pre 2014 Post 2014 Acceptable Not Acceptable Acceptable Not Acceptable North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.21: Variation of perception about the domestic water quality pre- and post-2014 Pre 2014 Post 2014 Salinity Odour Turbidity Taste Salinity Odour Turbidity Taste North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.22: Aspects of domestic water quality pre- and post-2014 W10: Percentage of women and men who use drinking water for domestic use This indicator portrays the percentage of interviewed women and men who use drinking water for domestic purposes. Figure 0.23 shows that five per cent of women and 6.2 per cent of men in the Gaza Strip reported using drinking water for domestic purposes. In Figure 0.24, the highest percentage of those who use drinking water for domestic use is in Rafah and Khan Younis governorates with a value of 10.3 per cent and 8.1 per cent respectively for both women and men. The main reason is because the salinity of drinking water in most places makes the water inappropriate for domestic purposes (see indicator W9). Results related to this indicator are detailed in Table

49 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Women Men Women+Men North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.23: Percentage of women and men who use drinking water for domestic use Bathing Cleaning Washing Dishes Ablution Showering the children North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.24: Domestic uses of drinking water W11: Percentage of women and men who use domestic water for drinking and cooking This indicator shows the percentage of interviewed women and men who use domestic water as an alternative source for drinking and cooking purposes. Figure 0.25 shows that 19.9 per cent of women and 16.7 per cent of men in Gaza Strip mentioned that they use domestic water for drinking and cooking purposes as shown in Figure The highest percentage of interviewees who use domestic water for both drinking and cooking is in Khan Younis governorate with a value of 25.5 per cent for both sexes. In the North governorate, the highest percentage (11.4 per cent of the interviewed households) of interviewed people who use domestic water for drinking when it should not be can be explained because the quality of groundwater there is better (see indicator W9). Results related to this indicator are detailed in Table

50 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Women Men Women+Men North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.25: Percentage of women and men who use domestic water for drinking and cooking Drinking Cooking North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.26: Misuses of domestic water W12: Percentage of households engaging children in drinking water collection This indicator shows the percentage of interviewed households that engage children in the drinking water collection process. Figure 0.27 indicates that 10.9 per cent of interviewed households in Gaza Strip engage children in drinking water handling. The highest percentage is in Gaza governorate at 14.1 per cent, and the lowest percentage is in the Middle Area governorate with three per cent. It is fairly common in the the Gaza Strip for households to engage children in some logistics, especially simple ones like drinking water handling. Results related to this indicator are detailed in Table

51 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP of HHs % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.27: Percentage of households engaging children in drinking water management W13: Percentage of households engaging women in drinking water collection This indicator shows the percentage of interviewed households that engage women in drinking water collection. Figure 0.28 illustrates results which indicate that only 2.3 per cent of households in all Gaza Strip engage women in drinking water handling. This is also not surprising, given that Gaza Strip households prefer men or children conduct such outdoor logistics. All the results related to this indicator are detailed in Table of HHs % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.28: Percentage of households engaging women in drinking water management W14: Cleaning of drinking water storage vessels This indicator portrays perceptions of interviewed women and men regarding cleaning drinking water storage vessels, i.e. the frequency of cleaning processes and the existence of a tight cover. Figure 0.29 describes results which indicate good awareness among interviewed women (94.1 per cent) and men (91.9 per cent) in the Gaza Strip regarding the importance of cleaning drinking water storage vessels. The highest percentage of poor perceptions about drinking water storage vessels is found in Rafah governorate where 11.1 per cent of interviewed women and 13 per cent of interviewed men responded with improper cleaning. In some specific localities, this percentage is even higher, mainly in Beit Lahia, Wadi as Salqa, Al Naser and Shokat as Sufi. On the other hand, there is no significant difference between the perceptions of women and men across governorates. Results related to this indicator for all governorates/localities are detailed in Table

52 Percentage (%) Percentage (%) Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Women Men Bad Good Bad Good North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.29: Cleaning conditions of drinking water storage W15: Cleaning conditions of domestic water storage vessels This indicator shows the perception of interviewed women and men regarding the importance of cleaning domestic water storage, as per the frequency of the cleaning process and the existence of a tight cover. Figure 0.30 shows that the percentage of interviewed households that don t clean their domestic water storage vessels properly is high in all governorates/localities. In some localities, this percentage reaches 100 per cent. Likewise, 76 per cent of interviewed women and 79 per cent of interviewed men described poor cleaning of domestic water storage vessels; there is no significant difference between the perception of men and women across all governorates. Results related to this indicator for all governorates/localities are detailed in Table Women Men Bad Good Bad Good North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.30: Cleaning conditions of domestic water storage vessels 50

53 Percentage Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP W16: Percentage of households that don t pay for domestic water This indicator shows the percentage of interviewed households that don t pay for domestic water. Figure 0.31 shows the percentage of interviewed households that don t pay while Figure 0.32 shows the reasons why they don t pay. The reasons could be a result of the household s economic situation or lack of social responsibility, or because the household is not connected to a municipal network/well (getting water from private/illegal wells or public filling points). The percentage of interviewed households in Gaza Strip who don t pay is 57 per cent, of which 87 per cent don t pay because of their economic situation or lack of social responsibility. However, the data obtained from CMWU shows even higher percentages of non-payment. This is mainly because it was collected based on registration and not based on people s perception. Results related to this indicator for all governorates/localities are detailed in Table HHs that don't pay North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.31: Percentage of households that don t pay fees for domestic water 100 Don t pay because of economic situation or lack of social responsibility Don t pay because they are not connected to municipal network/well North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.32: Reasons why households don t pay fees for domestic water W17: Changes in need priorities related to drinking water pre- and post-2014 This indicator shows the perception of interviewed women and men regarding priorities related to drinking water before and after the 2014 armed conflict. Figure 0.33 shows that there has 51

54 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP been no significant change in interviewed people s perception before and after The highest priority needs for interviewed people are providing additional tanks (35.5 per cent of women and 25.9 per cent of men), rehabilitating water pipelines (21.2 per cent of women and 28 per cent of men), building more desalination plants (18.8 per cent of women and 26 per cent of men) and distributing home RO filters (16.4 per cent of women and 13.8 per cent of men). The results also show that the majority of interviewed people are satisfied with the cost of drinking water as only three per cent prioritized the need for low-cost water. On the other hand, interviewed people didn t prioritize the need for public awareness (only 3.5 per cent prioritized this need) although the above indicators clearly show the need to conduct awareness-raising campaigns. The results of all governorates are detailed in Table Pre 2014 Women Men Women+ Men Distributing home desalination filters Extra water tanks Low cost water Public awareness on potable water Rehabilitation of water pipelines Building more desalination plants No priority Priority Post 2014 Women Men Women+ Men Distributing home desalination filters Extra water tanks Low cost water Public awareness on potable water Rehabilitation of water pipelines Building more desalination plants No priority Priority Figure 0.33: Variation of needs priorities of the drinking water in Gaza Strip pre- and post

55 Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP W18: Changes in need priorities related to domestic water pre- and post-2014 This indicator reflects changes in need priorities related to domestic water before and after the 2014 armed conflict. Figure 0.34 describes the results, which indicate that there has been no significant change in interviewed people s perception before and after The priorities for interviewed people are rehabilitating water pipelines (36.7 per cent of women and 61.3 per cent of men), providing additional tanks (40.5 per cent of women and 20.3 per cent of men) and building more desalination plants (17.3 per cent of women and 12.5 per cent of men). On the other hand, interviewed people did not prioritize the need for public awareness (only 2.4 per cent prioritized this need) although the above indicators show the need for awareness raising campaigns. The results of all governorates are detailed in Table Pre 2014 Women Men Women+ Men Distributing home desalination filters Extra water tanks Low cost water Public awareness on non-potable water Rehabilitation of water pipelines Building more desalination plants No priority Priority. Post 2014 Women Men Women+ Men Distributing home desalination filters Extra water tanks Low cost water Public awareness on non-potable water Rehabilitation of water pipelines Building more desalination plants No priority Priority Figure 0.34: Variation of needs priorities of domestic water in Gaza Strip pre- and post

56 W19: Different coping mechanisms used by women and men related to water problems This indicator presents the coping mechanisms used by interviewed households to mitigate or to solve problems related to water. Table 0.1 shows the key results in Gaza Strip which are ordered according to the perceptions of interviewed women and men together. The results show that around 8.6 per cent of interviewed people are doing nothing to mitigate the problems related to water, and this may be because they have no problem with their water or because they don t care about problems with water. Results related to this indicator are in detailed in Table Table 0.1 Coping mechanisms used by people related to water problems in Gaza Strip # Mechanism women men women and men 1 Saving water through reducing the water consumption Increasing the storage capacity of domestic water though using enough tanks Using small tanks and jerry cans to store water for emergencies Purchasing drinking water for domestic use when the domestic water is not available Doing no action Others Sanitation indicators S1: Percentage of households without toilets or without sufficient toilets pre- and post This indicator describes the interviewed households that have no toilet or without sufficient toilets before and after the 2014 armed conflict. Based on local experience and recommendations of WASH-MWG, the household does not have sufficient toilets if there are more than eight family members per one toilet. Figure 0.35 shows the results, indicating no significant difference before and after the 2014 conflict. There has been a small increase in the percentage of interviewed households that don t have any toilet after 2014, however the percentage is very small and does not exceed one per cent in the whole Gaza Strip. On the other hand, the percentage of interviewed households without sufficient toilets is 11 per cent. Results related to this indicator for all governorates/localities are detailed in Table

57 Percentage(%) Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Pre 2014 Post 2014 No toilets Not sufficient toilets No toilets Not sufficient toilets North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.35: Percentage of households without toilets or with no sufficient toilets pre- and post-2014 S2: Variation in households without access to wastewater networks pre- and post-2014 This indicator shows the difference in interviewed households without access to wastewater networks before and after the 2014 armed conflict. Figure 0.36 shows that there is no considerable variation before and after However, there is a small increase in household connections after 2014 due to implemented interventions that followed the conflict. The present average wastewater coverage in Gaza Strip, based on households interviewed, is 70.3 per cent. Khan Younis is the governorate covered by the fewest wastewater networks where 53.5 per cent of interviewed households are connected to conventional cesspits. The best situation is in the North governorate where 87.4 per cent of interviewed households are connected to a wastewater network. The results were checked against data obtained from CMWU and few differences were found. Results related to this indicator for all governorates/localities are detailed in Table Pre 2014Post North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.36: Percentage of households without access to wastewater networks pre- and post

58 Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP S3: Percentage of households without proper surrounding storm water drainage This indicator shows the availability of proper drainage surrounding interviewed households. Improper drainage depends mainly on the size and conditions of urban (if existing) surroundings of the household, and could be caused by bad conditions of roads (presence of many holes), a type of soil that doesn t allow storm water to infiltrate, or topography that allows storm water to accumulate around households. Figure 0.37 describes the results: 51 per cent of interviewed households in Gaza Strip suffer from poorly drained storm water. The best situation (which is also bad) is in Gaza governorate where 38.4 per cent of interviewed households are without proper storm water drainage. The worst situation is in Rafah governorate where 67.4 per cent of interviewed households don t have access to proper surrounding storm water drainage. In some localities, especially rural ones, the situation is much worse (see Table 0.3 0). Results related to this indicator for all governorates/localities are detailed in Table of HHs % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.37: Percentage of households without proper surrounding drainage S4: Percentage of households that need access to safe solid waste disposal This indicator shows the percentage of interviewed households that don t have access to safe solid waste disposal. Most households in Gaza don t have safe means to dispose of solid waste and have to burn, bury or leave the garbage outside a proper container. Figure 0.38 describes a situation that is universally bad across governorates. The average percentage of interviewed households in Gaza Strip that don t have safe means of solid waste disposal is 71.5 per cent. Results related to this indicator for all governorates/localities are detailed in Table

59 Activate the rule of the local municipalities in check-up and Awareness raising of the risk of bad Sewege disposal Building wastewater treatment plants Increase the quality of toilets Increase the quantity of toilets Installation/exten sion of wastewater.network No priority Other Percentage (%) Percentage 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP of HHs % North Gaza Middle Area Rafah Khan Younis Gaza Strip Governorate Figure 0.38: Percentage of households that need access to safe solid waste disposal S5: Changes in need priorities related to sanitation pre- and post-2014 This indicator describes changes in the perception of interviewed women and men regarding need priorities related to sanitation before and after the 2014 armed conflict. Figure 0.39 indicates no considerable variation in need priorities before and after the 2014 conflict. The highest priority for interviewed people is to extend or install wastewater networks (48.4 per cent), while 23.8 per cent of interviewed households prioritizing the need to increase toilets units. On the other hand, interviewed people saw as unimportant the need for public awareness related to sanitation, despite that previous indicators show great need for increased awareness. The results for all governorates are detailed in Table Pre 2014 Women Men Women+Men Priority 57

60 Activate the rule of the local municipalities in check-up and Awareness raising of the risk of bad Sewege disposal Building wastewater treatment plants Increase the quality of toilets Increase the quantity of toilets Installation/exten sion of wastewater.network No priority Other Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Post 2014 Women Men Women+Men Priority Figure 0.39: Variation of needs priorities of sanitation in Gaza Strip pre- and post-2014 S6: Different coping mechanisms used by women and men to resolve sanitation problems This indicator presents the coping mechanism used by interviewed households to mitigate or solve problems related to sanitation. Table 0.2 shows the key results in the Gaza Strip, which were ordered according to the perception of interviewed women and men together. The results show that around 12.5 per cent of interviewed people are doing nothing to mitigate problems related to sanitation, and this may refer to the fact that they don t face any problem or they don t care about the problem. All results related to this indicator are detailed in Table Table 0.2 Coping mechanisms used by people related to sanitation problems in Gaza Strip # Mechanism women men women and men 1 Cleaning and maintaining the household internal wastewater pipes and strainers Avoid throwing solid wastes, cooking oil and sands inside the wastewater strainers Doing no action Covering the household wastewater strainers very well Vacuuming the cesspits regularly Connecting only the toilets to the cesspits to avoid cesspit overflow (the grey water is used for irrigation or discharged into the street) Drilling new cesspits when the existing one is full Reducing water consumption to decease wastewater quantity to avoid cesspits overflow NA (no Knowledge about the required coping mechanisms)

61 Percentage (%) Percentage (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 10 Using insecticide to combat the insects available due to the wastewater Hygiene indicators H1: Variation of source of water heating pre- and post-2014 This indicator shows changes in water heating sources among the interviewed households before and after the 2014 armed conflict. Figure 0.40 shows that the proportion for each source is almost the same in each governorate. There is no significant difference before and after However, the percentage of interviewed households that were using solar heating decreased after 2014, while the percentage of interviewed households that were using gas heating increased after There are some households using more than one heating source at the same time. Electricity is the main source of water heating, in spite of an electricity deficit, with 61.5 per cent in Gaza Strip after The reason may refer to the high capital cost of a solar heating system, which can be unaffordable. Gas is more risky than electricity for water heating and is not available all the time. Some interviewed households are still using wood to heat water (15.2 per cent of the households in Gaza Strip). Results related to this indicator for all governorates/localities are detailed in Table Pre 2014 Post 2014 Solar heating Electrical heating Solar heating Electrical heating Gas heating Wood Gas heating Wood North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governortae Governorate Figure 0.40: Variation of source of water heating pre- and post-2014 H2: Percentage of households entirely without or with poor hand washing facilities post This indicator shows the availability and conditions of hand washing facilities in interviewed households after the 2014 armed conflict. Figure 0.41 illustrates the results, in which the percentage of interviewed households in Gaza Strip without hand washing facilities is 8.8 per cent, while the highest percentage is in Khan Younis governorate with 14.8 per cent. The percentage is higher in specific localities, mainly Omm Al Nasser (39.6 per cent), Al Qarara (36.8 per cent) and Bani Suheila (25.8 per cent). On the other hand, the percentage of interviewed households in Gaza Strip that have poor hand washing facilities is 27.9 per cent, which is higher in some localities such as Khan Younis Camp (54.3 per cent), An Nuseirat Camp (46.2 per cent), Omm Al Nasser (45.3 per cent), Ash Shati' Camp (44.6 per cent) and Khuza'a (40.9 per cent). Results related to this indicator for all governorates/localities are detailed in Table

62 Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 100 Not available Available with poor conditions Available with good conditions North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.41: Percentage of households without or with poor hand washing facility post-2014 H3: Percentage of households entirely without or with poor shower facilities post-2014 This indicator shows the availability and condition of shower facilities in interviewed households after the 2014 armed conflict. Figure 0.42 describes the results: the percentage of interviewed households in the Gaza Strip without shower facilities is 16.6 per cent, while in Omm Al Nasser locality, 88.7 per cent of interviewed households don t have shower facilities. On the other hand, the percentage of interviewed households in Gaza Strip that have poor shower facilities is 23.7 per cent, which is higher in some localities such as Al Qarara (44.7 per cent), Ash Shati' Camp (44.6 per cent), Khuza'a (44.5 per cent) and Khan Younis Camp (40.7 per cent). Results related to this indicator for all governorates/localities are detailed in Table Not available Available with poor conditions Available with good conditions North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.42: Percentage of households without or with poor shower facility post-2014 H4: Percentage of households entirely without or with a poor kitchen sink post-2014 This indicator shows the availability and condition of kitchen sinks in interviewed households after the 2014 armed conflict. Figure 0.43 describes the results: the percentage of interviewed households in Gaza Strip without kitchen sinks is 10.6 per cent. The percentage is higher in specific localities, mainly Omm Al Nasser (56.6 per cent) and Juhor ad Dik (28.9 per cent). On the other hand, the percentage of interviewed households in the Gaza Strip that have poor shower facilities is 27.3 per cent, which is higher in some localities such as Khan Younis (55.0 per cent), Ash Shati' Camp (54.4 per cent), Al Qarara (50.0 per cent), Khuza'a (46.7 per cent) and An Nuseirat Camp (42.3 per cent). Results related to this indicator for all governorates/localities are detailed in Table

63 Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 100 Not available Available with good conditions Available with poor conditions North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.43: Percentage of households without or with poor kitchen sink post-2014 H5: Percentage of people who don t wash their hands in a timely or proper manner This indicator portrays the percentage of interviewed women and men who don t wash their hands in a timely manner mainly after using the toilet, after changing diapers, before eating and before cooking. The indicator was measured based on the perception of interviewed women and men. Figure 0.44 illustrates the percentage of interviewed women and men who don t wash their hands properly; the situation is similar across all governorates and for both women and men. In general, the situation is bad across all the Gaza Strip in terms of hand washing practices. The results show that 72.2 per cent of interviewed women and 74.7 per cent of interviewed men in Gaza Strip don t wash their hands properly, while this percentage reaches 100 per cent or close to it in some localities. On the other hand, Figure 0.45 shows the percentage of interviewed women and men who don t wash their hands according to each practice. The perceptions of women and men are similar regarding hand washing practices, except a lack of hand washing before cooking is higher for men than women, since cooking is usually a task carried out by women. The percentage of those who do not wash their hands after changing diapers is the highest for both women and men (in Gaza Strip: 64.7 per cent and 66.9 per cent respectively), while the lowest percentage is the lack of hand washing after using the toilet (in Gaza Strip: 0.65 per cent and 2.6 per cent respectively). The other practices fall in between: lack of hand washing before cooking (10.8 per cent of women and 28.6 per cent of men) and before eating (5.8 per cent of women and 9.7 per cent of men). Results related to this indicator for all governorates/localities are detailed in Table

64 Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Women Men North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.44: Percentage of people who don t wash their hands in a timely manner Men After using toilet Before cooking After changing diapers Before eating Governorate Figure 0.45: Percentage of people who don t wash their hands according to each practice H6: Percentage of people who shower sufficiently This indicator portrays the percentage of interviewed women and men who do and don t shower sufficiently, i.e. less than four times per week. The indicator was measured based on the perceptions of interviewed women and men. Figure 0.46 shows no significant difference between the perceptions of women and men across governorates. The percentage of interviewed women and men in the Gaza Strip who don t shower adequately is 12.3 per cent and 15 per cent respectively, while the highest percentage is in Rafah with 23.9 per cent and 34.9 per cent respectively. Results related to this indicator for all governorates/localities are detailed in Table

65 Percentage(%) Percentage(%) Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Women Men Do enough practice Don t do enough practice Do enough practice Don t do enough practice North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.46: Percentage of people who do and don t shower sufficiently H7: Change in hygiene practices post-2014 This indicator shows the percentage of interviewed households reported a change in hygiene practices after the armed conflict The indicator was measured based on the perception of interviewed women and men. Figure 0.47 shows that 9.2 per cent of interviewed women and 7.5 per cent of interviewed men changed their hygiene practices. The highest proportion of those who changes is in the Middle Area governorate where 15.1 per cent of interviewed women and 13.1 per cent of interviewed men stated that they have changed their hygiene practices. On the other hand, Figure 0.48 presents reasons for change, which vary between the governorates. The main reason is because sanitary facilities were targeted during the 2014 armed conflict. Other reasons include the economic situation, bad condition of sanitary facilities, unavailability of water and change in residence. Results related to this indicator are detailed in Table Women Men Changed Not changed Changed Not changed North Gaza Middle Area Khan Younis Rafah Gaza Strip North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Governorate Figure 0.47: Percentage of households that changed hygiene practices post

66 Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Economic situation Sanitary facilities have been targeted during the war Water is not available most of the time Changing the place of residence Sanitary facilities need for rehabilitation North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.48: Reasons for change in hygiene practices H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks This indicator shows the percentage of interviewed households with children under five years old infected by waterborne diseases (such as skin diseases, diarrhoea and giardiasis) during the two weeks before the survey. Figure 0.49 shows that 25 per cent of interviewed households with children under five years old in the Gaza Strip were infected by waterborne diseases. North and Gaza governorates had the highest percentage of infections at 31.7 per cent and 31.4 per cent respectively. On the other hand, Rafah governorate had the lowest percentage with a value of 12.5 per cent. The reason could be because Rafah governorate has the lowest percentage of households that use domestic water for drinking use (see indicator W11). In addition, the results are compatible with findings of the public health baseline study conducted by PWA in Results related to this indicator for all governorates/localities are detailed in Table Presence of WASH related diseases Absence of WASH related diseases North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.49: Percentage of households with children < five years old infected by waterborne diseases 64

67 Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP H9: Percentage of households with members above five years old who were infected by waterborne diseases in the past two weeks This indicator shows the percentage of interviewed households with members above five years old who were infected by waterborne diseases (such as skin diseases, diarrhoea and giardiasis) during the two weeks before the survey time. Figure 0.50 shows that 22.1 per cent of interviewed households with members above five years old were infected by waterborne diseases. The North governorate has a high percentage with an average value of 33.4 per cent, especially in Omm Al Nasser locality where the percentage is the highest with a value of 52.8 per cent. On the other hand, Rafah governorate has the lowest percentage of infections with 9.8 per cent, likely for the same reason mentioned above. In addition, the results are compatible with findings from the public health baseline study conducted by PWA in Results related to this indicator for all governorates/localities are detailed in Table Presence of WASH related diseases Absence of WASH related diseases North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.50: Percentage of households with members > five years old infected by waterborne diseases H10: Percentage of households that noticed an appearance of new diseases post-2014 This indicator shows the percentage of interviewed households that noticed an appearance of new diseases after the 2014 armed conflict. The new diseases include cancer, skin diseases, stomach aches, fever, eyes diseases, heart diseases, pectoral diseases, meninges, asthma, epilepsy and psychosocial diseases. The interviewed people correlated the appearance of these diseases to the increase of insects and garbage, while other explanations included wastewater, water pollution and war after-effects. Figure 0.51 shows that 49.3 per cent of interviewed households in Gaza Strip noticed that appearance of new diseases after the 2014 conflict. The highest percentage is in the North governorate where around 70.6 per cent of interviewed households noticed an appearance of new diseases, especially in Omm Al Nasser where the percentage reached 98 per cent. On the other hand, Middle Area governorate has the lowest percentage of 30 per cent. Results of all governorates/localities are detailed in Table Palestinian Water Authority, Baseline Study on Water Quality & Public Health in the Gaza Strip,

68 Percentage (%) Percenatge (%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 80 HHs % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.51: Percentage of households that noticed an appearance of new diseases post-2014 H11: Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post-2014 This indicator shows the percentage of women of reproductive age who didn t have appropriate sanitary materials for menstruation before and after the 2014 armed conflict. Figure 0.52 shows little change before and after The percentage of women of reproductive age in Gaza Strip who don t have appropriate menstrual materials is 3.7 per cent after The North governorate has the highest percentage of five per cent, especially in Omm Al Nasser locality which has the highest percentage of 15.6 per cent. On the other hand, the Middle Area governorate has the lowest percentage of 1.4 per cent. Results related to this indicator for all governorates/localities are detailed in Table Pre 2014Post North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.52: Percentage of women with no access to appropriate materials for menstruation pre- and post H12: Percentage of households that received hygiene kits in the recent period (in 2015) This indicator shows the percentage of interviewed households that received hygiene kits in 2015 as assistance after the 2014 armed conflict. Figure 0.53 describes the results, where only 7.1 per cent of interviewed households in Gaza Strip received hygiene kits after However, after discussing these results with the WASH-MWG, it was found that the percentage of interviewed households that received hygiene kits in 2015 is much less than the actual percentage and doesn t reflect the actual situation. This may indicate that interviewees were hesitant to mention that they already received hygiene kits so they would not lose the chance to receive another one in any future interventions. Results related to this indicator for all governorates/localities are detailed in Table

69 Percentage(%) Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP 10 of HHs received hygiene kits % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.53: Percentage of households that received hygiene kits in 2015 H13: Percentage of households with a need for hygiene materials This indicator shows the percentage of interviewed households that need hygiene materials, because sanitary conditions inside the household are poor and their economic situation is bad. Figure 0.54 shows that 16.8 per cent of households in Gaza Strip are in need of hygiene materials, and this percentage is in the same range across governorates. However, the percentage is higher in some localities, mainly Omm Al Nasser (47.2 per cent), Al Qarara (39.5 per cent) and An Nuseirat Camp (30.8 per cent). Results related to this indicator for all governorates/localities are detailed in Table of HHs % North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Figure 0.54: Percentage of households with need for hygiene materials H14: Changes in need priorities for hygiene pre- and post-2014 This indicator shows the perceptions of interviewed women and men regarding need priorities related to hygiene before and after the 2014 armed conflict. Figure 0.55 shows no considerable variation in need priorities between before and after the 2014 conflict, while the perception of women and men is similar. The highest priority of interviewed people is their desire to be provided with hygiene kits HK (57.5 per cent), while 25 per cent of the interviewed households prioritized the need for cheap cleaning materials. On the other hand, people are attentive to the need for public awareness related to hygiene (17.4 per cent). Results related to this indicator are detailed in Table

70 Percentage(%) 2017 WASH ASSESSMENT AT HOUSEHOLD LEVEL IN THE GAZA STRIP Post 2014 Women Men Women+Men Cheap cleaning materials HK Public awarnness Other Priority Figure 0.55: Variation of needs priorities of hygiene in Gaza Strip pre- and post-2014 H15: Different coping mechanisms used by women and men for hygiene This indicator presents the coping mechanisms used by the interviewed households to mitigate or solve problems related to hygiene. Table 0.3 shows the key results in Gaza Strip, which were ordered according to the perception of interviewed women and men together. The results show that around 5.8 per cent of interviewed people are doing nothing to mitigate the problems related to hygiene, and this may indicate that they don t face any problems or they don t care about the problems. Results related to this indicator are detailed in Table Table 0.3 Coping mechanisms used by people related to hygiene problems in Gaza Strip # Mechanism women women men and men 1 Cleaning the house regularly Using sufficient cleaning materials and tools Safe and regular management of solid waste by using tight garbage bags and putting the garbage outside the house Doing nothing Learning good hygiene practices Using enough water for personal and household cleaning Others Focus group findings Table 0.53 in 0 summarizes the discussion during four focus groups sessions related to WASH conditions and needs. As shown in the table, the number of women who attended was more than men. This is because the number of women interviewees during implementation of the field survey was fewer than the number of men interviewees, and it was necessary to get additional input from women. The WASH needs addressed by attendees were similar in all sessions, mainly: improvement of domestic water quality, increasing hours of domestic water supply, adding additional domestic water storages, installation/rehabilitation of wastewater networks, and obtaining household garbage containers and hygiene materials. 68

71 POTENTIAL INTERVENTIONS 4.1. General All findings arising from the present assessment describe the need for a variety of interventions in the Gaza Strip and a strong holistic approach. All sectors (water, sanitation and hygiene) are in need of serious urgent intervention and efforts must be made in all fields. Generally, the main problems related to WASH are the same throughout the Gaza Strip but more critical in some localities. Hereafter, the main actions that need to be implemented will be defined, specifying the sensitive and priority areas of intervention. Seventeen interventions have been proposed based on the findings addressed in CHAPTER Water interventions All households in the Gaza Strip have access to domestic water with different levels of service depending on power availability, location, topography and number of beneficiaries. All households are connected either to a municipal water network or to a private well. The main problem related to domestic water is the poor quality of supplied water due to salinity. The presence of nitrates in the water is also considerable but it is perceived as less of a problem by the people because it is without odour or taste. In addition, there is need for enhancing water storage capacity since people need more water supply tanks for domestic use in all of the Gaza Strip as a main mitigation measure against irregular supply. In regards to drinking water, improvements are necessary to increase the quality of drinking water by adding private desalination plants. In addition, there is need for enhancing drinking water storage capacity. On the other hand, around 8.6 per cent of households in the Gaza Strip are doing nothing to cope or solve problems related to water in general. Public awareness campaigns should be conducted to promote awareness regarding water issues, mainly regarding drinking water quality and the importance of water storage cleaning and maintenance. The main interventions related to the water problem in Gaza strip are listed below, and detailed in Table 0.1. INT1: Enhancing drinking water storage capacity Intervention: Increasing the storage capacity of drinking water at vulnerable households by providing additional water tanks and jerry cans. Indicators: Key findings: W4: Variation of capacity of the drinking water storage pre- and post-2014 W6: Average of storage capacity of drinking water per household member preand post-2014 W17: Variation of needs priorities of drinking water pre- and post-2014 Many households in the Gaza Strip face declining drinking water storage capacity after 2014 as a direct result of the armed conflict and/or as a natural increase in household members, with a financial inability to supply additional storage. The worst situation exists in Al Naser, Al Maghazi Camp, An Nuseirat Camp, Gaza City and Deir Al Balah where the percentage of households that need additional drinking water storage is 30.8 per cent, 21.4 per cent, 19.2 per cent, 15.4 per cent and 15.0 per cent respectively. Furthermore, the needs of 69

72 other localities are addressed in Table 0.1, and Map 3 in. On the other hand, around 30 per cent of households in the Gaza Strip identify the supply of additional water storage as their greatest need related to drinking water, and this priority is distributed homogeneously across all governorates. This intervention can also include drinking water distribution and should be accompanied by intervention INT5 (a public awareness campaign about the quality of safe drinking water) to raise the awareness of beneficiaries about the importance of cleaning drinking water storage and the quality of safe drinking water. INT2: Enhancing domestic water storage capacity Intervention: Increasing the storage capacity of domestic water at the household level by providing additional water tanks. Indicators: Key findings: W5: Variation of capacity of domestic water storage pre- and post-2014 W7: Average of storage capacity of domestic water per household member preand post-2014 W18: Variation of needs priorities of domestic water pre- and post-2014 Many households in the Gaza Strip face decreasing domestic water storage capacity after 2014 as a direct result of the armed conflict and/or a natural increase in household members, with a financial inability to supply additional storage. The worst situation is found in Khan Younis governorate, where the percentage of households in need of additional domestic water storage is significant in several localities, mainly in Khuzaa (67.2 per cent), Abasan al Kabira (45.7 per cent), Bani Suheila (32 per cent), Al Qarara (31.6 per cent) and Al Fukhari (25 per cent). The percentage is also high in other specific localities in the other governorates, mainly in Juhor ad Dik (33.3 per cent) and Gaza city (28.6 per cent) in Gaza governorate and Beit Lahia (25.5 per cent) in the North governorate. Furthermore, the needs of other localities are addressed in Table 0.1, and Map 4 in. On the other hand, around 28 per cent of households in the Gaza Strip identify the supply of additional water storage as their highest need priority related to domestic water. This intervention should be accompanied with intervention INT6 (public awareness about the importance of cleaning domestic water storage) to raise awareness of beneficiaries about the importance of cleaning domestic water storage. INT3: Improving drinking water quality Intervention: Improving the quality of drinking water by licensing and monitoring private desalination plants (service providers), improving the capacity of desalination plants and training staff (plants owners and trucks owner). Indicators: Key findings: W1: Variation of source of drinking water pre- and post-2014 W8: Variation of perception about drinking water quality pre- and post-2014 More than 97 per cent of households in the Gaza Strip are using desalinated water for drinking purposes from private desalination plants (water trucks) and other sources such as public filling points, RO home filters and bottled water. Based on the water chain assessment conducted by PWA-NRC 19, 68 per cent of 19 Norwegian Refugee Council, Desalinated Water Chain in the Gaza Strip From Source to Mouth',

73 drinking water at the household level is biologically contaminated. However, most households in Gaza Strip are satisfied with the quality of drinking water they use, while only a few households are complaining about water salinity, odour, colour or taste, or a combination of two or more items. This is a critical negative indicator as it means that most of the people are not aware that their water is contaminated. This is a critical public health issue since unsafe drinking water can cause serious waterborne diseases. The perception of people about drinking water quality by governorate is addressed in Table 0.1, and Map 5 in. This intervention should be accompanied with intervention INT5 (a public awareness campaign about the quality of safe drinking water) to raise awareness of beneficiaries about the importance of cleaning drinking water storage and the quality of safe drinking water. INT4: Improving domestic water quality Intervention: Improving the quality of domestic water by rehabilitating water networks, monitoring municipal water wells, licensing unregistered wells in the areas unserved with municipal water supply services to ensure the water disinfection, removing illegal wells affecting the supply system, building/upgrading desalination plants, harvesting storm water, protecting groundwater from contamination by wastewater and agricultural fertilizers, and raising public awareness about water saving approaches. Indicators: Key findings: W3: Variation of source of domestic water pre- and post-2014 W9: Variation of perception about the domestic water quality pre- and post-2014 W18: Variation of needs priorities of the domestic water pre- and post-2014 Most of the households in the Gaza Strip are not satisfied with the quality of domestic water due to salinity (which is the major issue), odour, colour or taste or a combination of two or more items. The percentage of dissatisfaction is significant across all governorates. The worst situation is in Khan Younis and Middle Area governorate, where the percentage of households suffering from a bad quality of supplied domestic water is very high across all localities. The percentage is also high in Ash Shati Camp in Gaza governorate (79 per cent). Furthermore, the perception of people about supplied domestic water quality in all localities is addressed in Table 0.1, and Map 6 in. On the other hand, around two-thirds of households in Gaza Strip identify the improvement of domestic water quality as their highest need priority related to domestic water, since they prioritize the rehabilitation of water networks and building new desalination plants. INT5: Public awareness campaign about the quality of safe drinking water Intervention: Raising public awareness about the quality of safe drinking water that can be used for drinking and cooking purposes. The objective includes raising awareness about the importance of cleaning drinking water storage vessels and the proper way to clean. The objectives would be achieved by conducting awareness campaigns targeting both women and men, especially those who are in charge of the management of drinking water supply. Indicators: W1: Variation of source of drinking water pre- and post-2014 W2: Percentage of women and men who have/have no knowledge about the origin of the safe drinking water W11: Percentage of women and men who use domestic water for drinking and cooking W14: Cleaning conditions of drinking water storage W17: Variation of needs priorities of the drinking water pre- and post

74 Key findings: Although more than 97 per cent of households in the Gaza Strip are using desalinated water for drinking purposes, many households are using domestic water as an alternative resource for cooking (mainly) as well as for drinking. In addition, around seven per cent of households in Gaza Strip aren t aware which water sources are safe for drinking and cooking. The situation is more significant in Khan Younis and North governorates, where around 25 per cent of households use domestic water for cooking and drinking. This is a critical indication as, based on the PWA report 20, 96 per cent of groundwater is not drinkable, and therefore this misuse of domestic water can cause serious waterborne diseases. Moreover, many households in some localities don t clean their drinking water storages properly, especially in Shokat as Sufi (19 per cent), Wadi as Salqa (18.5 per cent), Al Nasser (15.4 per cent) and Khan Younis city (13.6 per cent). Unclean storage can contaminate drinking water, increasing the prevalence of waterborne diseases (such as diarrhoea and giardiasis). Based on results of the water chain assessment conducted by PWA-NRC 21, 11 per cent of supplied drinking water is contaminated during water handling at the household level. On the other hand, only 3.5 per cent of people prioritize public awareness related to drinking water aspects. This is an indication that people are downplaying the seriousness of the problems stated above, which makes the this intervention a high priority. The situation in all governorates/localities is addressed in Table 0.1, and in Map 7 and Map 8. INT6: Public awareness about the importance of cleaning domestic water storage Intervention: Raising public awareness about the importance and proper method of cleaning domestic water storage, by conducting awareness campaigns targeting both women and men, especially men usually in charge of this task. Indicators: Key findings: W15: Cleaning conditions of domestic water storages The percentage of households that don t clean domestic water storage in a proper way is very high in the whole Gaza Strip, reaching 100 per cent in some localities. Unclean storage can pollute water and cause serious skin diseases. The situation in all localities is addressed in Table 0.1, and in Map Sanitation interventions The biggest sanitation problem that households face in the Gaza Strip is related to the unhealthy surrounding environment where most of the Gaza Strip population live. Most households in Gaza are suffering from a lack and/or insufficiency of wastewater infrastructure, storm water drainage, and safe solid waste disposal, which may cause serious diseases. The main interventions related to sanitation problems in Gaza strip are listed below and detailed information is shown in Table 0.2. INT7: Installation of toilets for vulnerable households Intervention: Enhancing sanitation conditions of vulnerable households that don t have a toilet or don t have sufficient toilets by supplying and installing new toilets. Indicators: S1: Percentage of households without toilets or without sufficient toilets pre- and post-2014 S5: Variation of needs priorities of sanitation pre- and post Palestinian Water Authority, Gaza Water Resources Status Report 2013/2014, Norwegian Refugee Council, Desalinated Water Chain in the Gaza Strip From Source to Mouth',

75 Key findings: There remain some households in Gaza Strip that don t have a toilet inside the house. The family members of these households have to defecate and urinate inside the house in a simple hole or outside the house in the open, which causes a critical hygiene issue. These households are frequently located in slums in some localities, mainly in Beit Lahia, Beit Hanoun, Gaza city, Al Mughraqa, Juhor ad Dik, Wadi as Salqa, Khan Younis city, Bani Suhaila, Abasan al Kabira and Khuza a. Moreover, many households in Gaza Strip don t have a sufficient toilet to person ratio. More than eight persons per toilet is not enough to ensure adequate hygiene conditions (according to WASH-MWG recommendations). This can cause urinary problems and/or stool retention due to the long waiting time to use the toilet. The worst cases are in Deir al Balah Camp, Al Maghazi, Al Fukhari, Al Qarara, Shokat as Sufi and Al Mughraqa, where the percentage of households that don t have sufficient toilets is 25 per cent, 23.1 per cent, 25 per cent, 15.8 per cent, 17.4 per cent and 15.6 per cent respectively. On the other hand, households in Gaza Strip identify that an increase of the quantity and quality of toilets is a top priority related to sanitation needs. However, intervention depends mainly on the ability to install infrastructure for the new toilet unit inside the house. The situation in all localities is addressed in Table 0.2, and Map 10 and in Map 11. INT8: Installation of household wastewater connections Intervention: Installation and/or extension of wastewater networks and getting rid of cesspits to protect groundwater and avoid environment pollution. Indicators: Key findings: S2: Variation of households without access to wastewater networks pre- and post-2014 S5: Variation of needs priorities of sanitation pre- and post-2014 Many localities in Gaza Strip are still only partially covered by wastewater network services, especially in the Middle Area, Khan Younis and Rafah governorates. This problem is critical since households that don t have access to wastewater networks have to use cesspits which are not well isolated in most cases and enable wastewater to infiltrate groundwater. In addition, in some areas mainly where WASH-affected households are, the cesspits are in bad condition and overflow continuously, polluting the surrounding environment and enhancing the appearance and spread of insects and rodents that can cause serious illnesses. On the other hand, households in Gaza Strip across all governorates identify the need for access to a reliable wastewater system as their highest priority related to sanitation needs, since they prioritize the installation and/or extension of new wastewater networks and the building and/or upgrading of a wastewater treatment plant. The situation in all localities is addressed in Table 0.2, and in Map 12. INT9: Installation of storm water drainage systems Intervention: Protecting households from storm water accumulation by installing and upgrading storm water drainage systems at the household and municipal levels. Indicators: Key findings: S3: Percentage of households without proper surrounding storm water drainage Many households across the Gaza Strip are suffering from undrained storm water due to improper or insufficient drainage systems. The worst situation is found in un-urbanized and downstream areas where storm water accumulates, surrounding households due to the profile of roads and topography respectively. 73

76 The problem becomes worse when storm water mixes with garbage and/or flooded wastewater, polluting the environment and causing hygiene problems from an increase in mosquitoes and other vectors. The situation in all localities is addressed in Table 0.2, and in Map 13. INT10: Enhancing solid waste management Intervention: Enhancing solid waste management at household and community levels, by supporting municipal services, providing solid waste containers, providing household garbage containers, combating insects and rodents and raising public awareness. Indicators: Key findings: S4: Percentage of households that need access to safe solid waste management Most households in the Gaza Strip have no access to a safe means of disposal for their solid wastes, and have to burn, bury or leave the garbage in open spaces on a daily basis, which leads to environmental pollution and enhances the spread of disease vectors such as insects and rodents. The situation is critical across all governorates and requires urgent intervention. The situation in all localities is addressed in Table 0.2, and in Map Hygiene interventions The need for intervention related to hygiene issues in the Gaza Strip is essential in terms of facilities, materials and awareness. The percentage of people who experience waterborne disease is significant mainly due to poor hygiene conditions. Many households in the Gaza Strip are suffering from the unavailability or poor condition of hygiene facilities (hand washing sinks, showers and kitchen sinks). Financially, many households are not able to obtain sufficient hygiene materials for personal and/or cleaning use. Regarding hygiene practices, habits and attitudes, the picture is clear in terms of the need for raising awareness. The main bottlenecks are hand washing and showering practices, which are not performed properly. The main interventions related to hygiene problems in Gaza strip are listed below, while detailed information is shown in Table 0.3. INT11: Installation/Rehabilitation of hand washing facilities for vulnerable households Intervention: Enhancing hygiene practices by installing hand washing facilities for vulnerable households that don t have one, and by rehabilitating hand washing facilities for vulnerable households that have hand washing facilities in poor condition. Indicators: Key findings: H2: Percentage of households without or with poor hand washing facilities post There remain households in Gaza Strip that don t have a hand washing facility inside the home. The worst situation is in Omm Al Nasser, Al Qarara, Bani Suheila, Juhoe ad Dik and Al Mughraqa where the percentage of households without a hand washing facility is 39.6 per cent, 36.8 per cent, 25.8 per cent, 20.0 per cent and 14.6 per cent respectively. Moreover, many households in Gaza Strip have hand washing facilities that are in poor condition. The situation is critical in several localities. The worst is in Khan Younis Camp, An Nuseirat 74

77 Camp, Omm Al Nasser, Ash Shati' Camp and Khuza'a where the percentage of households that have poor hand washing facilities is 54.3 per cent, 46.2 per cent, 45.3 per cent, 44.6 per cent and 40.9 per cent respectively. The unavailability or poor condition of hand washing facilities can discourage people from washing their hands properly and sufficiently, which can cause serious disease. In addition, grey water may leak and accumulate on the ground without drainage, which can attract mosquitoes that may cause serious illness. This intervention is a high priority because of the importance of frequent use of hand washing facilities for ablution purposes. The situation in all localities is addressed in Table 0.3, and Map 15 and in Map 16. This intervention should be accompanied by intervention INT14 (public awareness about proper hygiene practices) to raise awareness of beneficiaries about proper hand washing practices. INT12: Installation/Rehabilitation of shower facilities for vulnerable households Intervention: Enhancing hygiene practices by installing shower facilities for vulnerable households that don t have a shower facility, and by rehabilitating shower facilities for vulnerable households that have shower facilities in poor condition. Indicators: Key findings: H3: Percentage of households without or with shower facilities in poor condition post-2014 There remain households in Gaza Strip that don t have a shower facility inside the house. The worst situation is in Omm Al Nasser, Khan Younis Camp, Wadi as Salqa, Al Qarara, An Nuseirat Camp and Bani Suheila where the percentage of households with no shower facilities is 88.7 per cent, 34.3 per cent, 32.6 per cent, 31.6 per cent, 30.8 per cent and 29.9 per cent respectively. Moreover, many households in Gaza Strip have shower facilities in poor condition. The worst can be found in Al Qarara, Ash Shati' Camp, Khuza'a and Khan Younis Camp where the percentage of households that have shower facilities in poor condition is 44.7 per cent, 44.6 per cent, 44.5 per cent and 40.7 per cent respectively. The unavailability or the poor condition of showers can discourage people to shower properly and sufficiently, increasing the prevalence of skin diseases. The situation in all localities is addressed in Table 0.3, and in Map 17 and Map 18. This intervention should be accompanied with intervention INT14 (public awareness about proper hygiene practices) to raise awareness of beneficiaries about proper showering practices. INT13: Installation/Rehabilitation of kitchen sinks (dish washing basins) for vulnerable households Intervention: Enhancing hygiene practices by installing kitchen sinks for vulnerable households that don t include a sink, and by rehabilitating kitchen sinks for vulnerable households that have sinks in poor condition. Indicators: Key findings: H4: Percentage of households without or with kitchen sinks in poor condition post-2014 There remain some households in Gaza Strip that don t have a kitchen sink inside their homes. The worst situation is in Omm Al Nasser, Juhor ad Dik and Al Qarara where the percentage of households with no kitchen sink is 56.6 per cent, 28.9 per cent and 23.7 per cent. Many households in the Gaza Strip have kitchen sinks in poor condition. The situation is critical in several localities. The 75

78 Worst are in Khan Younis Camp, Ash Shati' Camp, Al Qarara, Khuza a and An Nuseirat Camp where the percentage of households that have kitchen sinks in poor condition is 55.0 per cent, 54.4 per cent, 50.0 per cent, 46.7 per cent and 42.3 per cent respectively. The unavailability and poor condition of kitchen sinks can discourage washing dishes properly and sufficiently, which in turn may contaminate food. In addition, grey water may accumulate on the ground and stay without drainage and attract mosquitoes that might cause serious illness to people. The situation in all localities is addressed in Table 0.3, and Map 19 and in Map 20. INT14: Public awareness about proper hygiene practices Intervention: Raising the awareness of women, men, girls and boys about the importance of hand washing, especially by using soap, and improving showering practices. Indicators: H5: Percentage of people who don t wash hands frequently enough H6: Percentage of people who shower frequently enough H14: Variation of needs priorities of hygiene pre- and post-2014 Key findings: A high percentage of people in the Gaza Strip don t wash their hands properly with soap after using the toilet, after changing diapers, before eating, and touching or preparing food. The situation is critical in all localities, considering the adverse impact of lack of hand washing on the prevalence of diarrhoeal and respiratory diseases which are among the leading causes of child mortality and morbidity. Moreover, a considerable percentage of people in Gaza Strip don t practice proper body hygiene, including proper showering. The worst situation is in Rafah governorate where the percentage of people who don t shower properly is significant in all localities, while the most critical is Al Naser with a percentage of 53.9 per cent. In Omm Al Nasser the percentage is high with a value of 28.3 per cent. The percentage is considerable in Al Qarara and Abassan al Jadida in Khan Younis governorate with a value of 23.7 per cent and 21.4 per cent respectively. The opportunity to shower infrequently can encourage inactivity and cause serious skin disease. On the other hand, most people don t identify awareness promotion about proper hygiene practices as a high need priority, which leads intervention to be a key public health issue and a top priority in the whole Gaza Strip. The situation in all localities is addressed in Table 0.3, and Map 21 and in Map 22. INT15: Identification of hot spots of waterborne diseases Intervention: Identifying the hot spots of waterborne diseases, such as skin diseases, diarrhoea and giardiasis; recognizing water quality (from source to mouth), environmental conditions, and people s attitudes and practices. The objective includes conducting public awareness promotion campaigns regarding the reasons, symptoms and treatment of waterborne diseases. Indicators: H8: Percentage of households with children under five years old with diseases H9: Percentage of households with members above five years old with diseases Key findings: Many households in the Gaza Strip, especially those that have children under five years old, have been infected by waterborne diseases, such as diarrhoea, giardia and skin diseases. The situation is significant in several localities, where the worst is found in Omm Al Nasser and Juhor ad Dik. In addition, these results are compatible with findings from the public health baseline study conducted by PWA in The situation in all localities is addressed in Table 0.3, and Map 23 and in Map Palestinian Water Authority, Baseline Study on Water Quality & Public Health in the Gaza Strip,

79 INT16: Improving the menstrual hygiene management of vulnerable women Intervention: Improving the menstrual hygiene management of vulnerable women by providing them with appropriate menstrual materials and promoting awareness about proper menstruation practices. Indicators: Key findings: H11: Percentage of women with no access to appropriate sanitary materials menstruation pre- and post-2014 Not all women of reproductive age in Gaza Strip have appropriate materials for menstruation. Although the percentage of those without is not high, it is considered a critical hygiene issue. Omm Al Nasser is the worst case where 15.6 per cent of women have improper menstruation management. The percentage is also significant in Khan Younis Camp, Deir al Balah and Beit Hanoun with 8.9 per cent, 7.7 per cent and 7.4 per cent respectively. The situation in all localities is addressed in Table 0.3, and Map 25. INT17: Distribution of hygiene kits Intervention: Enhancing hygiene conditions of households, through the distribution of hygiene kits (including the basic materials, such as soap, shampoo, tooth paste, detergents, etc.) and prompting public awareness about sufficient household cleaning. Indicators: Key findings: H13: Percentage of households in need of hygiene materials Many households in Gaza Strip are in need of hygiene items since they are suffering from poor hygiene conditions inside their houses and financially are not able to obtain sufficient hygiene materials. The need is high in many localities, while the worst situation is found in Omm Al Nasser where 47.2 per cent of households need hygiene materials. The situation is also very dire in Al Qarara, An Nuseirat Camp, Ash Shati' Camp and Khan Younis Camp, where the percentage is 39.5 per cent, 30.8 per cent, 29.4 per cent and 29.3 per cent respectively. The need in all localities is addressed in Table

80 Table 0.1: Water interventions Locality INT1 INT2 INT3 INT4 households (1) households (2) North Beit Lahia households (3) households (4) (A) households (5) INT5 (B) households (6) INT6 households (7) Jabalia Jabalia Camp Beit Hanoun Omm Al Nasser Gaza Gaza Madinat Ezahra ( * ) 0.0 * 0.0 * * * 80.0 * Al Mughraqa Ash Shati' Camp Juhor ad Dik Middle Area An Nuseirat Al Bureij Camp Al Maghazi An Nuseirat Camp Az Zawayda Al Bureij Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar ( * ) 0.0 * 0.0 * 50.0 * 0.0 * * Wadi as Salqa Khan Younis Al Qarara Bani Suheila Abasan al Jadida Abasan al Kabira Khan Younis Khan Younis Camp Khuza'a Al Fukhari Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Remarks: (*) Representative sample size is small (1) households that faced a decrease in drinking water storage capacity after (2) households that faced a decrease in domestic water storage capacity after (3) households supplied by unacceptable drinking water quality (based on people perception not on lab analysis). (4) households supplied by unacceptable domestic water quality (based on people perception not on lab analysis). (5) households using domestic water as alternative source for drinking and cooking. (6) households that don t clean drinking water storage properly. (7) households that don t clean domestic water storage properly. 78

81 Table 0.2: Sanitation interventions Locality (A) households (1) INT7 (B) households (2) INT8 INT9 INT10 households (3) households (4) households (5) North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Gaza Gaza Ash Shati' Camp Madinat Ezahra ( * ) 0.0 * 0.0 * 0.0 * 0.0 * 60.0 * Al Mughraqa Juhor ad Dik Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar ( * ) 0.0 * 0.0 * 50.0 * * 0.0 * Wadi as Salqa Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Remarks: (*) Representative sample size is small (1) households that don t have toilets. (2) households that don t have sufficient number of toilets. (3) households that need access to a wastewater network. (4) households suffering from storm water accumulation/floods surrounding their houses. (5) households that don t have safe means of solid waste disposal. 79

82 Table 0.3: Hygiene interventions INT11 INT12 INT13 INT14 INT15 (A) (B) (A) (B) (A) (B) (A) (B) (A) (B) INT16 INT17 Locality house holds (1) house holds (2) house holds (3) house holds (4) house holds (5) house holds (6) house holds (7) house holds (8) house holds (9) house holds (10) Wome n (11) house holds (12) North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Gaza Gaza Ash Shati' Camp Madinat Ezahra ( * ) 0.0 * 0.0 * 0.0 * 0.0 * 20 * 0.0 * 40 * 0.0 * 0.0 * 0.0 * 0.0 * 0.0 * Al Mughraqa Juhor ad Dik Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp * Al Musaddar ( * ) 0.0 * 0.0 * 0.0 * 0.0 * 0.0 * 0.0 * 100 * 0.0 * 0.0 * 100 * 0.0 * 0.0 * Wadi as Salqa Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Rafah Rafah Rafah Camp Shokat as Sufi Al Naser * Remarks: (*) Representative sample size is small (1) households that don t have hand washing facilities. (2) households that have hand washing facilities in poor condition. (3) households that don t have shower facilities. (4) households that have shower facilities in poor condition. (5) households that don t have kitchen sinks. (6) households that have kitchen sinks in poor condition. (7) households that don t wash hands frequently. (8) households that don t shower frequently. (9) households with children under 5 years old infected by waterborne diseases. (10) households with members above 5 years old infected by waterborne diseases. (11) women of reproductive age that don t have appropriate materials for menstruation. (12) households that need hygiene kits. 80

83 CONCLUSION AND RECOMMENDATIONS 5.1. Conclusion General The deteriorated WASH situation in Gaza Strip has been compounded by nine years of blockades during three consecutive destructive wars, posing significant health risks to 1.8 million residents and constraining socioeconomic development. The consequences of the armed conflict in 2014 are still affecting the WASH sector. Fifty days of continuous attacks caused a huge scale of destruction, devastation and displacement. Extensive damage to water and wastewater facilities has been preliminary reported by CMWU/PWA, estimated at around US$ 34 million. The reconstruction process is going very slowly, restricting any humanitarian response or development plan. Problems arising from the slow implementation of the Gaza Reconstruction Mechanism (GRM), prohibition on entry of dual-use materials, inadequate power supplies and lack of government regulation have seriously worsened the WASH situation in Gaza Strip. Supporting the WASH cluster in defining the most appropriate strategic approach to respond to WASH needs in the Gaza strip, GVC, PHG and UNICEF offered to take the lead and propose an assessment for the current WASH situation at the household level in all Gaza Strip. The objective of this assessment was to generate a comparative analysis that informs identification of critical responses and actions that contribute positively and efficiently to assure minimum WASH standards of all Gaza Strip population and thereby reducing health risks. The assessment was monitored regularly by the WASH-monitoring group, Technical Working Group, which is a part of the WASH Cluster, in order to advise the assessment process and to guide work progress and data analysis in all stages to ensure the highest quality of output data Methodology The framework adopted for this assessment consisted of four main consequent stages implemented in seven months; 1) preparation 2) data collection, 3) data analysis and 4) report writing. The preparation stage included pre-meetings with the WASH-MWG to agree on the final objectives, structure and required outputs, and also included selection of the work team. The data collection stage included a field survey conducted through a prepared questionnaire and supported by other data collection tools; focus groups, observatory reports and secondary data from previous implemented assessments. The data analysis included the elaboration of indicators. The last stage included the writing of this report. The required minimum sample size that represents households in all Gaza Strip was calculated by using a statistical equation. The result was 2,382 households which represent the total of 303,330 households in Gaza Strip. The minimum sample size was then adjusted to be 3,125 households, considering that 20 per cent of total questionnaires to be implemented would be excluded in the cleaning process due to bias errors and improper household responses. The sample was stratified based on governorates and localities and targeted four groups: internally displaced persons, non-affected, war-affected and wash-affected. Data collection was performed in three phases in which 3,977 questionnaires were implemented, after carrying out a testing phase including 624 questionnaires. Three thousand one hundred and sixty six questionnaires 81

84 were validated during the data cleaning process while the remaining questionnaires were excluded from the data analysis process. Forty-seven indicators have been elaborated to explain the findings of the socio-economic and WASH conditions at household level over the whole Gaza Strip, before and after the 2014 armed conflict. The elaborated indicators include seven indicators related to socio-economic, 19 indicators related to water, six indicators related to sanitation, and 15 indicators related to hygiene Key findings Three thousand one hundred and sixty-six valid questionnaires out of the total number of filled out questionnaires (3,977) were analysed according to governorates and localities. Sixty-three per cent of interviewees were men and 37 per cent were women, while the age of interviewees ranged from years. The survey also considered the variation of land types and life levels (type of shelter, income, education, etc). Forty-seven indicators were elaborated to indicate the key WASH conditions at household level before and after the 2014 armed conflict; seven indicators related to socio-economic, 19 indicators related to water, six indicators related to sanitation, and 15 indicators related to hygiene. In general, variation of the investigated situation before and after 2014 was not significant in most indicators. The reason may be traced back to the period that intervened between the 2014 conflict and the survey time, in which people set up mitigation measures of their own in fast response to the crisis. In addition, there was no significant difference between the perception of women and men regarding the WASH needs. 1. Socio-economic indicators The households participating in the Gaza Strip reflected the following age groups: children aged 0-5 years is 16.2 per cent and aged 6-18, 19-35, and > 60 years is 34.0 per cent, 29.3 per cent, 17.3 per cent and 3.2 per cent respectively, while the sex ratio is In terms of housing density in the Gaza Strip, the results show that the average household area is m 2, the average number of rooms per household is 2.87, number of persons per room is 2.20 and the average area per person is 20 m 2. The results show that 8.7 per cent of interviewed households in the Gaza Strip are headed by women. The percentage of interviewed internally displaced persons and war-affected families that had a negative income variation in the Gaza Strip due to the 2014 armed conflict is 45 per cent, while 99 per cent of interviewed internally displaced families in the Gaza Strip are planning to go back to their original houses. With regard to the monthly WASH expenses, the results show that the interviewed households are spending 33.8 NIS/C/M (8.9 USD/C/M) on WASH items. The highest portion is spent on cleaning materials with a rate of 10.6 NIS/C/M (2.8 USD/C/M) and the lowest portion is spent on solid waste disposal with rate of 1.6 NIS/C/M (0.4 USD/C/M), while the other WASH expenses are in between; 4.9, 4.2, 7.3 and 5.2 NIS/C/M (1.3, 1.1, 1.9 and 1.4 USD/C/M) for drinking water, domestic water, hygiene materials and feminine hygiene items respectively. 82

85 2. Water indicators The main source of drinking water for interviewed households is desalinated water supplied mainly from water trucks (85 per cent) and public filling points (11 per cent). 84 per cent of interviewed households are supplied by domestic water from municipal networks and 16 per cent from private wells. Regarding water quality, results show that 94 per cent of interviewed households in the Gaza Strip are satisfied about drinking water quality. In regard to domestic water quality, the situation is bad across all governorates/localities. Only 43 per cent of interviewed households are satisfied about domestic water quality. The households complained mainly of salinity of supplied domestic water and they didn t recognize the presence of nitrate which has no odour or taste. The results show that around seven per cent of interviewed households don t know of a safe water source for drinking purposes. Around 18 per cent of interviewed households are using domestic water as an alternative source for drinking and cooking purposes, while around six per cent of interviewed households are using drinking water for domestic purposes mainly because of the salinity of supplied domestic water. In terms of water storage, results show that around eight per cent of interviewed households in the Gaza Strip reported a decrease in drinking water storage capacity after 2014, while 20 per cent of interviewed households had a decrease in domestic water storage facilities. Each family member s proportion of water storage capacity corellates with land type. For drinking water, the results show that the average storage capacity of interviewed households in the Gaza Strip after 2014 is 57, 50 and 38 litre/capita in urban, rural and camp areas respectively. The results for domestic water are 283, 254 and 237 litre/capita respectively. On the other hand, most interviewed women and men were aware of the importance of cleaning drinking water storage vessels (94 per cent of interviewed women and 92 per cent of interviewed men). People s perceptions about the importance of cleaning domestic water storage are alarming, as 76 per cent of interviewed women and 79 per cent of interviewed men don t recognize the importance. In regards to the handling of drinking water, most interviewed households prefer not to involve children and women in the process; only 11 per cent of interviewed households in Gaza Strip engage children and 2 per cent engage women in the collection of drinking water. The results show that 57 per cent of interviewed households in the Gaza Strip don t pay for domestic water, of which 87 per cent don t pay because of their economic situation or lack of social responsibility while the remaining households don t pay because they are not connected to a municipal network or well (they get water from private/illegal wells or public filling points). Of the water needs priorities of interviewed people, the highest priority is to have additional storage for both drinking water and domestic water, and secondly to have better water quality through the rehabilitation of water pipes and building of more water desalination plants. In regards to coping mechanisms used to mitigate the water problem in the Gaza Strip, interviewed households mainly applied the approach of water saving through reducing water consumption inside the household and also increasing available storage capacity. 83

86 3. Sanitation indicators Regarding the availability of toilets inside households, the results show that only one per cent of interviewed households don t have toilets, while 11 per cent of interviewed households don t have a sufficient number of toilets. In term of wastewater networks coverage, the results show that 30 per cent of interviewed households in the Gaza Strip are not connected to wastewater networks and they are using insulated cesspits and small holes that pollute the groundwater and the environment. On the other hand, the results show that 51 per cent of interviewed households have no access to a proper drainage system and are suffering from the accumulation of polluted storm water surrounding their houses during intense rainfalls. The worst finding on sanitation is related to solid waste management, where around 72 per cent of interviewed households don t have access to a safe means of solid waste disposal. Regarding sanitation needs priorities of interviewed people, the highest priority for interviewed people is to extend/install wastewater networks (48 per cent), while 24 per cent of interviewed households prioritized the need to increase toilet units. 4. Hygiene indicators The main source of water heating that interviewed households use in the Gaza Strip is electricity (62 per cent), while other households are using mainly a gas heating system or a solar panel heating system. Regarding the availability of sanitary facilities, the results show that around nine per cent of interviewed households in the Gaza Strip don t have any hand washing sink, and 17 per cent don t have a shower, while 11 per cent don t have a kitchen sink. Regarding the condition of available sanitary facilities, the results show that around 28 per cent of interviewed households in Gaza Strip have a hand washing sink in poor condition, and 24 per cent have a shower in poor condition, while 27 per cent have a kitchen sink in poor condition. In regard to hygiene practices, the situation is bad in the Gaza Strip (considering the perception of interviewees) in terms of hand washing. 72 per cent of interviewed women and 75 per cent of interviewed men don t wash their hands properly. In terms of showering practices, the results show that 12 per cent of interviewed women and 15 per cent of interviewed men in the Gaza Strip don t shower sufficiently. Moreover, 3.7 per cent of women of reproductive age don t have appropriate materials for menstruation. Regarding sanitation related diseases, the percentage of interviewed households infected by waterborne diseases is significant, 25 per cent of households with children under five years and 22 per cent of households with members above five years have been infected by waterborne diseases. Also 49.3 per cent of interviewed households in the Gaza Strip noticed the appearance of other new diseases after the 2014 conflict. Finally, the highest need priority of interviewed people regarding hygiene is to provide free hygiene kits (58 per cent) and to obtain cheap cleaning materials (25 per cent). 84

87 Potential interventions All findings arising from the present assessment show the need for different kinds of interventions in the whole Gaza Strip for all sectors; water, sanitation and hygiene. In general, the main problems related to WASH are similar in the whole Gaza Strip, but more critical in some localities. Seventeen interventions have been proposed based on WASH needs found by the assessment. The main interventions related to water are to enhance storage capacity and improve quality of both drinking and domestic water and to promote public awareness about the importance of cleaning water storage. For sanitation problems, proposed interventions are urgent in order to protect the surrounding environment and promote hygiene conditions. The proposed sanitation interventions include installation of new toilets for vulnerable households, installation of wastewater household connections, installation/upgrade of storm water drainage systems and improvement of solid waste disposal means. Regarding hygiene interventions, all proposed interventions are very important as they mitigate or solve key public health issues. The proposed hygiene interventions include installation and maintenance of sanitation facilities, hand washing sinks, showers and kitchen sinks. The interventions also include awareness promotion campaigns on proper hand washing and showering practices, enhancement of menstruation management for vulnerable women and distribution of hygiene kits. The interventions entail the identification of hot spots of waterborne disease Recommendations Top priorities of interventions 1. All the proposed interventions are considered crucial in order to recover the WASH situation in the Gaza Strip. However, priorities should be elaborated based on findings of the assessment that relate to the main needs of the population. The following interventions are considered priorities, as the need percentage is high in the whole Gaza Strip and/or greatly affecting public health: - INT4: Improving domestic water quality (especially in Gaza, Middle Area, Khan Younis and Rafah). - INT5: Public awareness campaign about the quality of safe drinking water - INT6: Public awareness about the importance of cleaning domestic water storage. - INT7 (A): Installation of toilets for vulnerable households that don t have a toilet. - INT8: Installation of household wastewater connections (especially in Khan Younis and Rafah governorates). - INT9: Installation of storm water drainage systems. - INT10: Enhancing solid waste disposal management. - INT14 (A): Public awareness about proper hand washing practices. - INT15: Identification of hot spot areas of waterborne disease. 85

88 2. Based on findings of the assessment concerning the main needs of the population, the following localities are considered a priority because they are the most affected localities in term of WASH conditions at household level: - North governorate: Omm Al Nasser. - Gaza governorate: Ash Shati Camp and Juhor ad Dik. - Middle Area governorate: An Nuseirat Camp and Wadi as Salqa. - Khan Younis governorate: Al Qarara, Khan Younis Camp and Khuza a. - Rafah governorate: Shokat as Sufi and Al Naser Further assessments 1. The localities of Madinat Ezahra and Al Musaddar were represented by a small sample size because the number of households there is small compared to other localities in Gaza Strip. Therefore, for some interventions, further assessments may be needed, especially for hygiene interventions which should be deeper developed after a comprehensive investigation of people s practices and attitudes. 2. Further data cross-checking accompanied by on-the-spot assessments are needed considering that some interventions could have been carried out since completion of the current assessment. 3. Further assessments should be carried out to establish possible correlations and linkages between household WASH conditions and the education level of household members. 4. The regular supply of domestic water in the Gaza Strip is challenging as it is highly affected by availability of electrical power. Further assessments should be conducted to gain a better understanding of water delivery conditions considering relevant scenarios, hours of power availability, applied zoning systems, production rate and number of connected households Suggested approach for interventions 1. Future interventions should be incorporated into the planning strategy of PWA, CWMU and the WASH Cluster. 2. Coordination within the WASH Cluster and key WASH stakeholders should be ensured before any intervention is undertaken in order to avoid duplication. 3. The proposed interventions should be integrated with other related interventions planned and/or undertaken by other agencies. 4. Interventions should be coordinated with CMWU and/or municipalities to ensure feasibility to carry out proposed activities. For example, installation of wastewater networks could be necessary in some localities but capacity of the treatment plant might be insufficient to receive additional quantities of wastewater. 5. Solid waste interventions including the provision of bins, trash containers and machineries need to be cross-checked with Solid Waste Management Councils. 6. Wastewater interventions must be accompanied by more compressive interventions, such as wetland treatment, condominium septic tanks, improvement of main wastewater treatment plant, re-use of water and recharge of the aquifer. Some repairs are temporary solutions and can create a misuse of the system if not considered part of a more compressive plan of intervention. 7. One of the main obstacles to improving water and sanitation services in the Gaza Strip is the deteriorated electricity situation. This should be considered during the design and planning 86

89 phase of interventions in order to implement mitigation measures with an aim of furnishing affordable and reliable services. 8. Public awareness and hygiene promotion campaigns are a top priority and should always accompany any related hard (physical) intervention. 9. Information activities such as media campaigns targeting rural communities should accompany any proposed intervention Advocacy The proposed interventions will be more effective if they are accompanied with advocacy activities at both local and international levels. The advocacy interventions should be employed at household level to enable the people and local NGOs to demand the official line parties of the WASH sector in Gaza Strip to provide sufficient and reliable services. This can be achieved by improving the technical and managerial capacities of the WASH sector in Gaza Strip, paralleled with a real and worthy intervention from the concerned international community, donors and INGOs. For this purpose, there is a need to push the donors and third member states to invest more and to give their pledged donations to the local community to rehabilitate and develop the WASH sector in Gaza Strip. The major stakeholders should work toward the recovery of the Gaza Strip as well, ensuring the cost-effectiveness of their financial support and upholding their obligations by urging Israel to lift the blockade, facilitate the entry of construction materials and also to take WASH materials off the dual use list. It is extremely important to advocate to the donor communities a financial plan that is assured to overcome any interruptions due to external interference and to provide timing and continuity in the development process of a regular supply in Gaza Strip. Any intervention is hampered by the deteriorated environmental situation of water sources in Gaza should become a fundamental advocacy message. 87

90 REFERENCES Berenson, M., Levine, D., and Szabat, K., Basic Business Statistics: Concepts and Applications, 13th Ed., Pearson, UK, Norwegian Refugee Council, Desalinated Water Chain in the Gaza Strip From Source to Mouth', Office for the Coordination of Humanitarian Affairs, Gaza Crises Appeal, Office for the Coordination of Humanitaritan Affairs, THE GAZA STRIP: The Humanitarian Impact of the Blockade, Palestinian Central Bureau of Statistics, Demographic Indicators ( Palestinian Central Bureau of Statistics, ( Palestinian Central Bureau of Statistics, Population Projections, ( en/803/default.aspx), Palestinian Central Bureau of Statistics, ( version=staging), Palestinian Hydrology Group and United Nations Children's Emergency Fund, Water, Sanitation and Hygiene Household Survey, Gaza, Palestinian Water Authority, Baseline Study on Water Quality & Public Health in the Gaza Strip, Palestinian Water Authority, Gaza Strip: Water Crisis Deepens: Without Sustainable Solutions, Future at Stake, Palestinian Water Authority, Gaza Water Resources Status Report 2013/2014, United Nations Special Coordinator Office, UNSCO Socio-Economic Report: Overview of the Palestinian Economy in Q3/2015,

91 ANNEX A : WASH-MWG ToR 1. Introduction In the Gaza Strip, the longstanding blockade has created an unsustainable water and sanitation situation for the 1,819,980 people (896,542 females and 923,438 males) who are living there. As a result of the last Israeli military operation in July and August 2014, water and wastewater services were further hampered, having direct consequences on serious deteriorating living and hygiene conditions in these households. Moreover, the electricity system was severely damaged when the only power plant in Gaza was hit during the war. Electrical generators supplying water and wastewater facilities are heavily used and overloaded by long hours of operations. The supplied water is rarely sufficient and most collected raw sewage is discharged into the environment because of the difficulty to booster it. In light of this critical situation, the WASH cluster essentially desired a clear picture of the whole situation. Therefore, GVC and PHG proposed to carry out an assessment in order to identify the WASH conditions at the household level, mapping and prioritizing areas of the intervention as well as linking the consequences of infrastructure damage (and later rehabilitation and reconstruction) and household conditions. The WASH-MWG has been established in order to harmonize and coordinate the survey proposed by GVC and PHG and supported by UNICEF using competences and experiences of PWA, CMWU and all WASH agencies focal points that work in the Gaza Strip. The WASH-MWG is chaired by PWA/CMWU, under the overall collaboration of UNICEF, Wash Cluster, GVC and PHG and along with the Water Quality Working Group (WQWG) and other working groups. 2. Objectives - To work towards a coordinated and integrated approach in the all WASH assessments and monitoring processes at household level. - To work alongside the appropriate Palestinian Authorities in order to plan and coordinate all activities. - To ensure links and communication between the water sector and other relevant sectors in particular shelter/nfi and health cluster. - To work towards and ensure prioritization, evidence based actions, and gap filling. - To ensure gender mainstreaming in all WASH assessment process. - To set up a common approach in monitoring WASH household conditions to be used by all the actors involved in the WASH and Public Health sectors. 3. Structure - WASH-MWG is a Technical Working Group and part of the WASH Cluster, chaired by PWA/CMWU. - WASH Cluster Coordinator will act as facilitator of the WASH-MWG for WASH agencies working in the Gaza Strip and with the support of GVC and PHG. - Members of the WASH-MWG: ISC, Oxfam GB, GVC, ACF and IRPAL (as they are the WASH Focal Points of the different Governorates in Gaza Strip), UNICEF, UNRWA, NRC along with PWA and CMWU and with the support of ICRC. - WASH-MWG has no time limit, and its confirmation and ToRs will be revised among the members of the WASH cluster. 89

92 4. Tasks and responsibilities - Create an open and accessible database of information gathered by different surveys, based on format and methodologies set up during the assessment carried out by GVC and PHG and supported by UNICEF. - Advise the process of the WASH assessment at household level, by ensuring that relevant standards, procedures and approaches are formulated and agreed upon by all members of the WASH-MWG. - Collect and address information on hazards and risks at each location, identifying the gaps and priorities of interventions. - Provide a link between the infrastructure damage assessment done by CMWU/PWA and the WASH situation at household level. - Promote adopted and verified standards to be used in future similar intervention as part of indication by the Cluster Coordinator. - Set up tools to implement future studies/assessments on WASH conditions household level, through an accessible database of competences and skills from various agencies. - Ensure effective and coherent WASH assessment and analysis, accessible to all relevant partners in order to prevent any overlapping with other WASH actors activities/assessments. - Promote information sharing activities both as seminars or documents about results of the assessments and to collect feedback and comments. 5. Principles of Partnership - Equality: Equality requires mutual respect between members of the partnership irrespective of size and power. The WASH-MWG members respect each other s mandates, obligations and independence and recognize each other s constraints and commitments. Mutual respect however will not preclude organizations from engaging in constructive dissent. - Transparency: Transparency is achieved through dialogue between all members on an equal footing, with an emphasis on early consultations and early sharing of information. Communication and transparency, including financial transparency, increase the level of trust among organizations. - Result-oriented approach: Effective humanitarian action must be reality-based and actionoriented. This requires result-oriented coordination based on effective capabilities and concrete operational capacities. - Responsibility: WASH-MWG members have an ethical obligation to each other to accomplish their tasks responsibly, with integrity and in a relevant and appropriate way. They will commit to activities only when they have the means, competencies, skills and capacity to deliver on their commitments. - Complementarity: The diversity of the WASH-MWG members is an asset if they build on their comparative advantages and complement each other s contributions. 90

93 ANNEX B : List of meetings and workshops Table B.1: List of conducted meetings and workshops # Date Partner Main agenda 1 23/03/2015 WASH-MWG - To present and discuss the WASH assessment proposal and the ToR of the WASH-MWG 2 05/08/2015 WASH-MWG 3 09/09/2015 WASH-MWG 4 14/09/2015 MoHPW 5 20/09/2015 OCHA 6 28/09/2015 MoSA 7 29/09/2015 NRC 8 30/09/2015 OCHA 9 30/09/2015 CMWU - To present and discuss the final draft of the WASH assessment proposal - To review and finalize the methodology of the assessment, focusing on the sample size - To update the partners about the assessment progress - To present the findings of the 1 st phase - To discuss the next steps - To introduce the assessment objectives - To ask to get access to the database of the war-affected households and internally displaced persons - To introduce the assessment objectives - To ask to get access to the database of the internally displaced families - To introduce the assessment objectives - To ask to get access to the database of the war-affected households and internally displaced persons - To update NRC about the assessment progress - To identify the internally displaced persons and war affected areas - To ask the support of OCHA to reach the required number of internally displaced persons in all governorates of Gaza Strip - To update CMWU about the assessment progress - To identify the war-affected areas in term of WASH - To get update and recommendations about the CMWU assessment of customers satisfaction 10 04/10/2015 MoHPW - To get the data of the war-affected households 11 04/10/2015 PWA 12 13/10/2015 CMWU 13 19/10/2015 UNRWA 14 20/10/2015 CMWU 15 20/10/2015 NRC 16 27/10/2015 ACF 17 28/10/2015 IRPAL 18 28/10/2015 Oxfam - To update PWA about the assessment progress - To consult PWA about the recommended sampling approach - To update CMWU about the assessment progress - To ask CMWU to support and facilitate the field work in cooperation with the local municipalities - To identify the WASH-affected areas - To update UNRWA about the assessment progress - To ask UNRWA about the recommendations needed during the implementation of the survey in the Camps - To update CMWU about the assessment progress - To discuss about the WASH-affected areas - To update NRC about the assessment progress - To ask NRC about the findings of the water chain assessment - To update ACF about the assessment progress - To identify the WASH and war affected areas in Khan Younis governorate - To update IRPAL about the assessment progress - To identify the WASH and war affected areas in Rafah governorate - To update Oxfam about the assessment progress - To identify the WASH and war affected areas in Gaza governorate - To update ISC about the assessment progress 19 28/10/2015 ISC - To identify the WASH and war affected areas in the North governorate - To present the main problems found in the Camps based on the assessment findings 20 04/11/2015 UNRWA - To inquiry about UNRWA and other agencies interventions 21 30/11/2015 WASH-MWG - To discuss the progress of the assessment and get feedback and recommendations 22 02/03/2016 WASH-MWG - To discuss the findings of the assessment and get feedback and recommendations 91

94 ANNEX C : Questionnaire template Date of survey (dd/mm/y) Time of starting interview Time of finishing interview Questionnaire no. GPS coordinates Interviewer Name GENERAL INFORMATION Supervisor name HH address Tel. or mobile Governorate Locality Area per municipality Type Rural Camp Urban SECTION (1) households AND SOCIO-ECONOMIC INFORMATION Name of interviewee Sex of the interviewee Female Male Age Do you have any kind of physical disability (OBSERVATORY QUESTION BY THE SURVEYOR)? yes No Are you the head of the HH? yes No Marital status of the HH head Single Married Divorced Widow Occupation of the HH head of family Information about the Interviewee after 2014 My home was affected by 2014 Attack but I still leave in my place Please indicate which one of the following you are: IDP from the last 2014 Attack My home was not affected by 2014 Attack If your home was affected or you are an IDP, was your home repaired/reconstructed? If yes please indicate when and how: Yes No If the answer is yes, please indicate when 1 month later 2-6 months 6-10 months Currently My house was repaired/reconstructed by: INGO, Local NGO UN Agency Palestinian Authority Private money If you are an IDP away from original place, when do you expect to go back? Unknown Less than 1yr 1-2yrs 3yrs+ Never If you are an IDP and moved to another place, please indicate your original housing governorate If you are an IDP and moved to another place, please indicate your original housing locality If you are an IDP and moved to another place, please indicate your original housing area per municipality If you are not affected, do you host other family/ies? yes No If yes, how many families are you hosting without money? Sex Female Male Information about HH Members/Shelter 92

95 Total No. of HH members: Age and Sex of HH Family Members Sex / Age Female Male Income Average Age of Male family members and income average Income average less than 1000 Male Age of female family members and income average less than Female Estimate total income per HH How much money (NIS) do you allocate from your income for the following materials per month before 2014 attack? None >500 Drinking Water Non drinking water Solid waste disposal Hygiene materials Female Hygiene items Cleaning materials Food Electricity Telecommunications Transportation How much money (NIS) do you allocate from your income for the following materials per month after 2014 attack? None >500 Drinking Water Non drinking water Solid waste disposal Hygiene materials Female Hygiene items Cleaning materials Food Electricity 93

96 Telecommunications Transportation Source of Income Governmental Private Social affairs INGOs Donations UNRWA If you are an IDP or affected, was your income changed negatively? Yes No Slightly (I earn almost the same) If answer is yes, Please Specify Medium (I earn a bit more than the half I was earning) Severely (I earn less than the half I was earning before) Completely (I am not earring anything right now) How regular is your income? Not regular Daily Weekly Monthly households with Special Needs Are there any of the family members with special needs (disabilities) If yes please specify # of members with physical disability If yes please specify # of members with mental disability Number of family members with disabilities Female Male Type of Ownership Condition of Shelter Owned Rented Hosted Apartment in a Tower Separate House Type of Shelter Asbestos/ Zinco Caravan Tent Wood No. of rooms without kitchen and toilets/bathrooms Total area (m 2 ) Level of Education Sex Type of Education Kindergarten School University Post Education No. and level of education for males No. and level of education for females Are there any of the family male members over 5 years and did not had any education Yes No If the answer is yes, please specify the no. Are there any of the family female members over 5 years and did not had any education Yes No If the answer is yes, please specify the no. If there is a decline in attendance of the school before and after the 2014 attack? Yes No If the answer is yes, please specify the reasons? Too many children Classrooms are not clean There are not clean toilets There are not toilets for girls and boys No drinking water available Others: (open) SECTION (B) households AND WATER households and Water System Infrastructure Please indicate your water network system condition before 2014 Please indicate your water network system condition after

97 Not existing Not functioning Not existing Not functioning Poorly function Functioning Poorly function Functioning Water coming from the pipes Water coming from the truck What is in your opinion source of "drinking water"? Desalinated water Bottled water Wells Water Sources Sources of drinking Water pre & post-2014 conflict Pre Post Sources of domestic Water pre &post-2014 conflict Pre Post Municipal network (Mekarot) Municipal network (Mekarot) Municipal network (Wells) Municipal network (Wells) Municipal network (Mekorot blended) Municipal network (Mekorot blended) Private well Private well Tanker delivery (vendors) Tanker delivery (vendors) Desalination Unit (home filters) Desalination Unit (home filters) Public filling points Public filling points Bottling Bottling Rain Water Collecting and Uses Do you harvest Raining water? Yes No If yes, for what use/s? Drinking use Domestic use Farming Animal use Water Uses The different uses of drinking water, please select from the The different uses of domestic water, please select from the Priority Selection following following Priority Selection Drinking Drinking Bathing Bathing Cleaning Cleaning Cooking Cooking Washing the dishes Washing the dishes Showering the children Showering the children Ablution Ablution Others (Specify) Others (Specify) Water Accessibility Drinking Water Accessibility Accessibility level Before 2014 After 2014 Is there a change in level of accessibility Yes No Easily Accessible If there is a change in the accessibility, what are the reasons? It is more expensive Medium Accessible It is cheaper It is closer Hardly Accessible It is further Others (Specify) Are there children engaged in a process of collecting water? Yes No If yes, how far does it take to reach the water source? ( please specify in minutes) less than Are there women engaged in a process of collecting water? Yes No 95

98 If yes, how far does it take to reach the water source? ( please specify in minutes) less than Domestic Water Accessibility Accessibility level Before 2014 After 2014 Is there a change in level of accessibility Yes No Easily Accessible If there is a change in the accessibility, what are the reasons? It is more expensive Medium Accessible It is cheaper It is closer Hardly Accessible It is further Others (Specify) Are there children engaged in a process of collecting water? Yes No If yes, how far does it take to reach the water source? ( please specify in minutes) less than Are there women engaged in a process of collecting water? Yes No If yes, how far does it take to reach the water source? ( please specify in minutes) less than Water Frequency Does your water come through the municipality? Yes No If the answer is yes, How frequently does your household receive Drinking water Domestic water water from the municipality? Before 2014 After 2014 Before 2014 After 2014 Not Connected daily: Less than 4 hrs/ day 5 to 12 hrs/day more than 12 hrs/day Once a week I do not know Drinking Water Do you pay for your drinking water before Yes Yes Do you pay for your drinking water after 2014? 2014? No No Daily Daily If yes, how frequent before 2014? Weekly Weekly If yes, how frequent after 2014? Every two weeks Every two weeks Every one month Every one month Less than 100 NIS Less than 100 NIS How much do you pay for drinking water per How much do you pay for drinking water per month before 2014? month after 2014? Domestic water Do you pay for your non drinking water before Yes Do you pay for your non drinking water after Yes 2014? No 2014? No Daily Daily If yes, how frequent before 2014? Weekly If yes, how frequent after 2014? Weekly Every two weeks Every two weeks 96

99 Every one month Every one month Less than 100 NIS Less than 100 NIS How much do you pay for domestic water per How much do you pay for domestic water per month before 2014? month after 2014? Water Storage Methods and Capacities Drinking Water Storage and Capacities Do you store your drinking water before 2014? Yes Yes Do you store your drinking water after 2014? No No Jerry Cans Jerry Cans Plastic Tanks Plastic Tanks If yes, please specify the methodology before Metal Tanks If yes, please specify the methodology after 2014 Metal Tanks 2014 Concrete cistern Concrete cistern Bottles Bottles Is the drinking water shared with other Yes Is the drinking water shared with other households Yes households before 2014? No after 2014? No Capacity of the Water Storage (drinking water) liters before Capacity of the Water Storage (drinking water) liters after Do you store your domestic water before 2014? If yes, please specify the methodology before 2014 Is the drinking water shared with other households before 2014? Capacity of the Water Storage (drinking water) liters before 2014 Capacity of the Water Storage (drinking water) liters after 2014 yes No Jerry Cans Plastic Tanks Metal Tanks Concrete cistern yes No Domestic Water Storage and Capacities Do you store your domestic water after 2014? yes No Jerry Cans If yes, please specify the methodology after 2014 Plastic Tanks Metal Tanks Concrete cistern Is the drinking water shared with other households yes after 2014? No Do you clean /wash your drinking water tank/s? Is there a tight cover for your drinking water tanks Water Storage Condition Drinking Water Storage Condition Yes 1 If yes, how often monthly? No 2 Yes 3 No 4 Domestic Water Storage Condition 97

100 Do you clean /wash your drinking water tank/s? Is there a tight cover for your drinking water tanks What do you think of the quality of the drinking water before 2014? Where do you think the safest drinking water comes from before 2014 What do you think of the quality of the drinking water after 2014? Where do you think the safest drinking water comes from after 2014 How do you prioritize the following needs of drinking water at your level from 1 to 6, 1 is the most important before 2014 How do you prioritize the following needs of drinking water at your level from 1 to 6, 1 is the most important after 2014 What do you think of the quality of the domestic water before 2014? Where do you think the safest domestic water comes from before 2014 What do you think of the quality of the domestic water after 2014? Where do you think the safest domestic water comes from after 2014 Yes 0 If yes, how often monthly? No 1 Yes 2 No 3 Water Quality Drinking Water Quality Acceptable If not acceptable please indicate the reason Salinity Odor Not acceptable before 2014 Color Taste Municipal network (Mekarot) Municipal network (Wells) Municipal network (Mekorot blended) Private well Tanker delivery (vendors) Desalination Unit (home filters) Public filling points Bottling Acceptable If not acceptable please indicate the reason after Salinity Odor Not acceptable 2014 Color Taste Municipal network (Mekarot) Municipal network (Wells) Municipal network (Mekorot blended) Private well Tanker delivery (vendors) Desalination Unit (home filters) Public filling points Bottling Rehabilitation of water pipelines Extra water tanks Cleaning of water source Low cost water Distribute Home desalination filters Public Awareness on Water Are there any other important needs not mentioned above, please specify: Rehabilitation of water pipelines Extra water tanks Cleaning of water source Low cost water Distribute Home desalination filters Public Awareness on Water Are there any other important needs not mentioned above, please specify: Domestic Water Quality Acceptable If not acceptable please indicate the reason Salinity Odor Not acceptable before 2014 Color Taste Municipal network (Mekarot) Municipal network (Wells) Municipal network (Mekorot blended) Private well Tanker delivery (vendors) Desalination Unit (home filters) Public filling points Acceptable If not acceptable please indicate the reason after Salinity Odor Not acceptable 2014 Color Taste Municipal network (Mekarot) Municipal network (Wells) Municipal network (Mekorot blended) Private well Tanker delivery (vendors) Desalination Unit (home filters) Public filling points How do you prioritize the following needs of domestic water at Rehabilitation of water pipelines Extra water tanks 98

101 your level from 1 to 6, 1 is the most important before 2014 Cleaning of water source Low cost water Distribute Home desalination filters Public Awareness on Water Are there any other important needs not mentioned above, please specify: Rehabilitation of water pipelines Extra water tanks How do you prioritize the following needs of domestic water at Cleaning of water source Low cost water your level from 1 to 6, 1 is the most important after 2014 Distribute Home desalination filters Public Awareness on Water Are there any other important needs not mentioned above, please specify: What are coping mechanisms and mitigation measures to alleviate the problems related to water in your House? What do you think you can do on personal level and community level to contribute to the problems related to Water? SECTION(3) households AND SANITATION households and Sanitation Infrastructure Please indicate your sanitation network system condition before 2014 Please indicate your sanitation network system condition after 2014 Not existing Not functioning Not existing Not functioning Poorly function Functioning Poorly function Functioning Toilets and Sanitation System Do you have toilets before 2014? Yes If yes, How many toilets do you No have before 2014? What Type of toilet do you have before 2014? Sit down toilet with water flush Squat toilet with water flush Pit latrines others Is the toilet pre 2014 shared with other families before 2014? Yes No If the answer is yes, please specify the sex and age before 2014 Sex / Age Female Male If it is shared with other families, are there toilets for males and Yes If it is shared with other families, are the toilets divided per each yes for females before 2014? No family before 2014? No Do you have toilets after 2014? yes If yes, How many toilets do you No have after 2014? What Type of toilet do you have after 2014? Sit down toilet with water flush Squat toilet with water flush Pit latrines Others Is the toilet pre 2014 shared with other families after 2014? Yes No If the answer is yes, please specify the sex and age after 2014 Sex / Age Female Male If it is shared with other families, are there toilets for males and Yes If it is shared with other families, are the toilets divided per each yes for females after 2014? No family after 2014? No Condition of the walls, floor cleanliness? OSERVATION BY THE SURVEYOR REQUREID Poor Medium Clean Is the toilet connected to a wastewater system? if yes specify Pipelines Cesspits 99

102 If cesspits or septic tank, please select one of the following? I get rid of the sewage water from my private money for a private company I call the local municipality to vacuum the sewage water Before 2014 After 2014 Weekly If you call the municipality to vacuum the sewage water, please specify the time before & after 2014? Every two weeks Every one month Every two months more than two months Are there proper drainages surrounding the HH? Yes No How do you manage your household garbage before 2014? I burn it I bury it I leave it in an empty field close to my house, if this one: what is the distance from your less than m m 50-75m m >100m more than200 house to the field? I leave it in a container for the municipality to collect it before 2014, if this one: how often do they collect it? two weeks 3 times a week once a week once every two weeks others Others, please specify How do you manage your household garbage after 2014? I leave it in an empty field close to my house, if this one: what is the distance from your house to the field? I leave it in a container for the municipality to collect it before2014, if this one: how often do they collect it? I burn it I bury it less than m m 50-75m m >100m more than200 two weeks 3 times a week once a week once every two weeks others Others, please specify SURVEYOR OBSERVATION: how clean are the home surroundings? Clean With some garbage around Full of garbage Has there been a flood of sewage network in your area near your Yes Summer Winter If yes, when did it happen? home for the last 12 months, No Winter and Summer What are the priority needs in terms of sanitation? From 1 (the most important) till 6 the less before 2014 What are the priority needs in terms of sanitation? From 1 (the most important) till 6 the less after 2014 Increase the quantity of toilets Increase the quantity of toilets Increase the quality of toilets Increase the quality of toilets Improve sewage system Improve sewage system Awareness raising of the risk of bad sewage disposal Awareness raising of the risk of bad Sewage disposal Building wastewater treatment plants Building wastewater treatment plants Activate the rule of the local municipalities in check-up and taking actions Activate the rule of the local municipalities in check-up and taking actions Are there any other important needs not mentioned above, please specify: Are there any other important needs not mentioned above, please specify: What are coping mechanisms and mitigation measures to alleviate the problems related to Sanitation in your House? What do you think you can do on personal level and community level to contribute to the problems related to Sanitation? SECTION (4) households AND HYGIENE 100

103 What is the main source for heating water for bathing before 2014? What is the main source for heating water for bathing after 2014? Solar Heating Solar Heating Electrical heating Electrical heating Gas heating Gas heating Wood Wood Other Other Hygiene Facilities Facility (Before 2014) non existing poor medium good Facility (After 2014) non existing poor medium good Hand sinks Hand sinks shower shower Washing machines Washing machines Washing dishes sink Washing dishes sink If any of them does not exist nowadays, what do you do? I do it outside the house I go to my family members house I pay someone to do it I do not do it as often as before Others: (open question) Cleaning Materials and Practices ( OBSERVATIONAL BY THE SURVEYOR) Before 2014 Yes No After 2014 Yes No Are toilets cleaning items available? Are there communal solid waste bins? Are there communal solid waste bins? Does household have access to shower? Does household have access to shower? Is shower shared with other households? Is shower shared with other households? Is shower shared with other households? Do the women and girls in your household have appropriate materials for menstruation? Do the women and girls in your household have appropriate materials for menstruation? Are the women and girls in your household able to keep clean during menstruation? Are the women and girls in your household able to keep clean during menstruation? Is condition of shower sanitary good? Is condition of shower sanitary good? Do you have soap at home? (Observation!!) Yes Expensive If not, what is the reason? No Others Please answer the following behavior questions: How many times family members have a shower in Summer? How many times family members have a shower in winter? Every day Every day 4 times or more per week 4 times or more per week At Least 1 time per week At Least 1 time per week Less often Less often When do you use to wash your hands in Summer? When do you use to wash your hands in Winter? before eating before eating after eating after eating before cooking before cooking after cooking after cooking before going to the toilet before going to the toilet after going to the toilet after going to the toilet 101

104 before changing the diapers after changing the diapers Others Are there any change in the previous behaviors pre and post the attack before changing the diapers after changing the diapers others If yes, please specify the reason: Has anyone in your household <5 year of age had unusual disease symptoms such as Skin, diarrhea and Giardiasis in the past two weeks? Has anyone in your household >5 year of age had unusual disease symptoms such as Skin, diarrhea and Giardiasis in the past two weeks? Yes No Yes No Diseases Has anyone in your household <5 year of age had unusual disease symptoms such as Skin, diarrhea and Giardiasis in the past four weeks? Has anyone in your household >5 year of age had unusual disease symptoms such as Skin, diarrhea and Giardiasis in the past four weeks? Did you receive any assistance as hygiene kits? if yes when was Yes If yes when was the last time the last time No During the last one month During the last two months 2-5 months ago since 6 months from 6-12 months before 2014 attack Was the assistance you find it useful? Yes No If yes, why? If yes, please Increased amount of garbage in the surrounding area Did you notice the appearance of new diseases after the 2014 Yes specify the Appearance of insects that were not existing attack? No reason Others, please specify What are the priority needs in terms of Hygiene before 2014? (from 1 to 3) What are the priority needs in terms of Hygiene after 2014? (from 1 to 3) Lower prices of hygiene kits Lower prices of hygiene kits Public awareness Public awareness Hygiene kits Hygiene kits Are there any other important needs not mentioned above, please specify: Are there any other important needs not mentioned above, please specify: What are coping mechanisms and mitigation measures to alleviate the problems related to Hygiene in your House? What do you think you can do on personal level and community level to contribute to the problems related to Hygiene? Yes No Yes No 102

105 ANNEX D : Households sampling Table D.1: Planned minimum number of questionnaires Governorate/Locality Total population (1) Total households (2) # of IDPs (3) # of waraffected (4) # of nonaffected (5) internall y displace d persons waraffected nonaffected Total househ olds Minimum number of questionnaires # of total househ olds # of internall y displace d persons # of waraffected North Beit Lahia 86,526 14,421 1, ,002 8 % 2 % 90 % 23.9 % Beit Hanoun 51,073 8, ,675 8 % 2 % 90 % 14.1 % Jabalia 165,110 27,518 2, ,811 8 % 2 % 90 % 45.5 % Jabalia Camp 56,290 9, ,459 8 % 2 % 90 % 15.5 % Omm Al Nasser 3, % 2 % 90 % 1.0 % Total 362,772 60,462 4,704 1,245 54,513 8 % 2 % 90 % 19.9 % Gaza Gaza 566,331 94,389 5, ,399 5 % 2 % 93 % 90.5 % Ash Shati' Camp 43,681 7, ,741 5 % 2 % 93 % 7.0 % Madinat Ezahra 3, % 2 % 93 % 0.6 % Al Mughraqa 8,241 1, ,272 5 % 2 % 93 % 1.3 % Juhor ad Dik 3, % 2 % 93 % 0.6 % Total 625, ,304 5,544 2,180 96,580 5 % 2 % 93 % 34.4 % 1, Middle Area An Nuseirat 47,177 7, ,249 6 % 2 % 92 % 17.8 % An Nuseirat Camp 36,146 6, ,554 6 % 2 % 92 % 13.7 % Az Zawayda 21,795 3, ,349 6 % 2 % 92 % 8.2 % Al Bureij 12,671 2, ,947 6 % 2 % 92 % 4.8 % Al Bureij Camp 30,889 5, ,746 6 % 2 % 92 % 11.7 % Al Maghazi 8,412 1, ,293 6 % 2 % 92 % 3.2 % Al Maghazi Camp 20,682 3, ,178 6 % 2 % 92 % 7.8 % Deir al Balah 70,045 11, ,763 6 % 2 % 92 % 26.5 % Deir al Balah Camp 8,284 1, ,273 6 % 2 % 92 % 3.1 % Al Musaddar 2, % 2 % 92 % 0.9 % Wadi as Salqa 5, % 2 % 92 % 2.2 % # of nonaffected 103

106 Total 264,455 44,076 2, ,637 6 % 2 % 92 % 14.5 % Khan Younis Al Qarara 24,906 4, ,804 5 % 3 % 92 % 7.3 % Khan Younis 179,701 29,950 1, ,446 5 % 3 % 92 % 52.6 % Khan Younis Camp 47,503 7, ,255 5 % 3 % 92 % 13.9 % Bani Suheila 39,941 6, ,100 5 % 3 % 92 % 11.7 % Abasan al Jadida 7,642 1, ,167 5 % 3 % 92 % 2.2 % Abasan al Kabira 23,198 3, ,543 5 % 3 % 92 % 6.8 % Khuza'a 11,524 1, ,760 5 % 3 % 92 % 3.4 % Al Fukhari 6,978 1, ,066 5 % 3 % 92 % 2.0 % Total 341,393 56,899 3,079 1,678 52,142 5 % 3 % 92 % 18.8 % Rafah Rafah 158,414 26,402 1, ,851 5 % 1 % 94 % 70.2 % Rafah Camp 44,956 7, ,053 5 % 1 % 94 % 19.9 % Shokat as Sufi 13,961 2, ,190 5 % 1 % 94 % 6.2 % Al Naser 8,206 1, ,287 5 % 1 % 94 % 3.6 % Total 225,537 37,590 1, ,382 5 % 1 % 94 % 12.4 % Gaza Strip Total 1,819, ,330 17,872 6, ,253 6 % 2 % 92 % 1 % 3, ,877 Remarks: (1) Total population was obtained from Palestinian Central Bureau of Statistics (Ref: Palestinian Central Bureau of Statistics, Population Projections, en/803/default.aspx), (2) Household size = 6 members (Ref: Palestinian Central Bureau of Statistics, Demographic Indicators, ), (3) Total number of internally displaced persons was obtained from Office for the Coordination of Humanitarian Affairs per each governorate (then stratified per each locality) (4) Total number of war-affected households was obtained from MoHPW per each governorate (then stratified per each locality) (5) The original plan in the proposal included only non-affected households without targeting specific WASH-affected households. 104

107 ANNEX E : Indicators formulation Table E.1: Indicators formulation # Indicator Involved questions/data Formulation 1 Socio-economic indicators SE1 Percentage distribution of population based on sex and age 1. Sex and age of households members 1. Data filtering based on governorate 2. Governorate SE2 Average housing density 1. Number of households members 2. Total area of shelter 3. Number of rooms 4. Governorate SE3 SE4 SE5 SE6 SE7 Percentage of households headed by women Percentage of Internally displaced families planning to go back to their home Percentage of Internally displaced families and war-affected families having negative variation of income post-2014 Percentage of variation of monthly WASH items expenses per household pre- and post-2014 Average monthly WASH items expenses post Water indicators W1 Variation of source of drinking water pre- and post-2014 W2 W3 Percentage of women and men who have/have no knowledge about the origin of the safe drinking water Variation of source of domestic water pre- and post Sex of interviewee (female) 2. Head of the HH? (yes) 3. Governorate 1. Target group (internally displaced persons) 2. Time going back home? (all answers except never ) 3. Governorate 1. Target group (Internally displaced persons and waraffected) 2. Income changed negatively? (yes) 3. Governorate 1. Monthly WASH materials expenses pre Monthly WASH materials expenses post Governorate 1. Monthly WASH materials expenses post Number of households members 3. Governorate 1. Source of drinking water pre Source of drinking water post Governorate 1. Opinion about "drinking water" 2. Sex of interviewee 3. Governorate 1. Source of domestic water pre Source of domestic water post Governorate 1. Data filtering based on governorate 1. Data filtering based on governorate 1. Data filtering based on governorate 1. Data filtering based on governorate 1. [Monthly WASH materials expenses post-2014]- [Monthly WASH materials expenses pre 2014]= <0: expenses decreased >0: expenses increased =0: no variation 2. Data filtering based on governorate 1. [Monthly WASH materials expenses post-2014]/[number of households members] (NIS/Capita/Month) 2. Data filtering based on governorate 1. Data filtering based on governorate 1. Know: options (coming from the truck, desalinated water, bottled water) Don t know: options(coming from the pipes, wells) 2. Data filtering based on governorate and sex of interviewee 1. Data filtering based on governorate 105

108 W4 W5 W6 W7 W8 W9 W10 W11 Variation of capacity of the drinking water storage pre- and post-2014 Variation of capacity of the domestic water storage pre- and post-2014 Average of storage capacity of drinking water per HH members pre- and post-2014 Average of storage capacity of domestic water per HH members pre- and post-2014 Variation of perception about the drinking water quality pre- and post-2014 Variation of perception about the domestic water quality pre- and post-2014 Percentage of women and men who use drinking water for domestic use Percentage of women and men who use domestic water for drinking use 1. Capacity of the drinking water storage pre Capacity of the drinking water storage post Governorate 4. Locality 1. Capacity of the domestic water storage pre Capacity of the domestic water storage post Governorate 4. Locality 1. Capacity of the drinking water storage pre Capacity of the drinking water storage post Number of households members 4. Governorate 5. Land type 1. Capacity of the domestic water storage pre Capacity of the domestic water storage post Number of households members 4. Governorate 5. Land type 1. Quality of the drinking water (not acceptable) pre Reasons (salinity, odour, taste, turbidity) pre Quality of the drinking water (not acceptable) post Reasons (salinity, odour, taste, turbidity) post Governorate 1. Quality of the domestic water (not acceptable) pre Reasons (salinity, odour, taste, turbidity) pre Quality of the domestic water (not acceptable) post Reasons (salinity, odour, taste, turbidity) post Governorate 6. Locality 1. The different uses of drinking water: options (bathing, cleaning, dishes washing, children showing, ablution) 2. Sex of interviewee 3. Governorate 1. The different uses of domestic water: options (drinking, cooking) 1. [Capacity of the drinking water storage post-2014]-[ Capacity of the drinking water storage pre 2014]= <0: capacity decreased >0: capacity increased =0: no variation 2. Data filtering based on governorate and locality 1. [Capacity of the domestic water storage post-2014]-[ Capacity of the domestic water storage pre 2014]= <0: capacity decreased >0: capacity increased =0: no variation 2. Data filtering based on governorate and locality 1. [Capacity of the drinking water storage pre 2014]/[Number of households members] (Litre/Capita) 2. [Capacity of the drinking water storage post-2014]/[number of households members] (Litre/Capita) 3. Data filtering based on governorate and land type 1. [Capacity of the domestic water storage pre 2014]/[Number of households members] (Litre/Capita) 2. [Capacity of the domestic water storage post- 2014]/[Number of households members] (Litre/Capita) 3. Data filtering based on governorate and land type 1. Data filtering based on governorate 1. Data filtering based on governorate and locality 1. Data filtering based on governorate 1. Data filtering based on governorate 106

109 W12 W13 W14 W15 W16 W17 W18 W19 Percentage of households engaging children in drinking water collection Percentage of households engaging women in drinking water collection Cleaning conditions of the drinking water storages Cleaning conditions of the domestic water storages Percentage of households that don t pay for domestic water Variation of needs priorities of the drinking water pre- and post-2014 Variation of needs priorities of the domestic water pre- and post-2014 Different coping mechanisms carried out by women and men related to water problems 2. Sex of interviewee 3. Governorate 1. Are there children engaged in a process of collecting drinking water (yes) 2. Governorate 1. Are there women engaged in a process of collecting drinking water (yes) 2. Governorate 1. Do you clean /wash your drinking water tank/s? 2. How often monthly? 3. Is there a tight cove for drinking water tank 4. Sex of interviewee 5. Governorate 6. Locality 1. Do you clean /wash your domestic water tank/s? 2. How often during the last 12 months? 3. Is there a tight cove for domestic water tank 4. Sex of interviewee 5. Governorate 6. Locality 1. Pay for your domestic water? (No) 2. Sources of domestic water 3. Governorate 4. Locality 1. Needs of drinking water before Needs of drinking water after Sex of interviewee 4. Governorate 1. Needs of domestic water before Needs of domestic water after Sex of interviewee 4. Governorate 1. Coping mechanisms and mitigation measures to alleviate the problems related to water 2. Sex of interviewee 1. Data filtering based on governorate 1. Data filtering based on governorate 1. Points: Clean (yes): 3 point Clean (no): 0 point 1 per month: 1 point 2 per month: 2 point 3 per month: 3 point 4 per month: 4 point >4 per month: 4 point Cover (yes): 3 point Cover (no): 0 point Weight (sum): = or < 3 points: bad = or > 4 points: good 2. Data filtering based on governorate and locality 1. Points: Clean (yes): 3 point Clean (no): 0 point 1 per last 12 months: 1 point 2 per last 12 months: 2 point 3 per last 12 months: 3 point 4 per last 12 months: 4 point 5 per last 12 months: 4 point Cover (yes): 3 point Cover (no): 0 point Weight (sum): = or < 3 points: bad = or > 4 points: good 2. Data filtering based on governorate and locality 1. Don t pay because of economic situation or lack of social responsibility: sources (municipal network) Don t pay because of having free source: sources (private well, public filling point) 2. Data filtering based on governorate and locality 1. Data filtering based on governorate 1. Data filtering based on governorate 1. Data filtering based on governorate 107

110 3. Governorate 3 Sanitation indicators S1 Percentage of households without toilets or without sufficient toilets pre- and post-2014 S2 S3 S4 S5 S6 households without access to wastewater networks pre- and post-2014 Percentage of households without proper surrounding storm water drainages Percentage of households that need access to safe solid waste disposal Variation of needs priorities of the sanitation pre- and post-2014 Different coping mechanisms carried out by women and men related to sanitation problems 4 Hygiene H1 Variation of source of water heating pre- and post-2014 H2 H3 Percentage of households without or with poor hand washing facility post-2014 Percentage of households without or with poor shower facility post Do you have toilets before 2014? 2. How many toilets before 2014? 3. Do you have toilets after 2014? 4. How many toilets after 2014? 5. Number of households members 6. Governorate 7. Locality 1. Sanitation system condition before 2014 (does not exist) 2. Sanitation system condition after 2014 (does not exist) 3. Governorate 4. Locality 1. Are there proper drainages surrounding the HH? (No) 2. Governorate 3. Locality 1. How do you manage your household garbage? 2. How clean are the home surroundings? 3. Governorate 4. Locality 1. Needs of sanitation before Needs of sanitation after Sex of interviewee 4. Governorate 1. Coping mechanisms and mitigation measures to alleviate the problems related to sanitation 2. Sex of interviewee 3. Governorate 1. Main source for heating water for bathing before 2014? 2. Main source for heating water for bathing after 2014? 3. Governorate 4. Locality 1. Hand sink after Governorate 3. Locality 1. Shower after Governorate 3. Locality 1. Don t have: Do you have toilets (No) Not sufficient: [number of households members / number of toilet] > 8 2. Data filtering based on governorate and locality 1. Data filtering based on governorate and locality 1. Data filtering based on governorate and locality 1. Need access to safe solid waste disposal: options (bury it, burn it, [leave it in open space & surrounding with some garbage around or full of garbage ]) 2. Data filtering based on governorate and locality 1. Data filtering based on governorate 1. Data filtering based on governorate 5. Data filtering based on governorate and locality 1. Not available: options (not existing) Available with good conditions: options (medium, good) Available with poor conditions: options (poor) 2. Data filtering based on governorate and locality 1. Not available: options (not existing) Available with good conditions: options (medium, good) Available with poor conditions: options (poor) 108

111 H4 H5 H6 H7 H8 H9 H10 H11 H12 Percentage of households without or with poor kitchen sink post-2014 Percentage of people who do untimely proper hand washing practice Percentage of people who do and don t do sufficient showering practice Change of hygiene practices post Percentage of households with children under 5 years old infected by waterborne diseases in the last 2 weeks Percentage of households with members above 5 years old infected by waterborne diseases in the last 2 weeks Percentage of households that noticed appearance of new diseases Percentage of women with no access to appropriate sanitary materials for menstruation pre- and post-2014 Percentage of households that received hygiene kits in the last 1. Dishes sink after Governorate 3. Locality 1. When do you use to wash your hands in summer? 2. When do you use to wash your hands in winter? 3. Sex of interviewee 4. Governorate 5. Locality 1. How many times family members have a shower in summer? 2. How many times family members have a shower in winter? 3. Sex of interviewee 4. Governorate 5. Locality 1. Are there any change in the previous behaviours pre and post the conflict 2. Reason? 3. Sex of interviewee 4. Governorate 1. Has anyone <5 year of age had unusual disease symptoms such as skin, diarrhoea and giardiasis in the past two weeks? 2. Age of household members (<5) 3. Governorate 4. Locality 1. Has anyone >5 year of age had unusual disease symptoms such as skin, diarrhoea and giardiasis in the past two weeks? 2. Governorate 3. Locality 1. Did you notice the appearance of new diseases after the 2014 conflict? 2. Governorate 3. Locality 1. Age and sex of household members (women >5 and <60) 2. Governorate 3. Locality 1. Did you receive any assistance as hygiene kits 2. Data filtering based on governorate and locality 1. Not available: options (not existing) Available with good conditions: options (medium, good) Available with poor conditions: options (poor) 2. Data filtering based on governorate and locality 1. Wash your hands in summer OR wash your hands in winter: Blank options (After going toilet OR After changing diapers OR Before cooking OR Before eating) 2. Data filtering based on governorate and locality 1. Shower in summer? OR shower in winter?: Points: every day: 5 point 4 times: 3 point 1 time: 1 point < 1 time: 0 point Weight (sum): < or = 4: bad >4: good 2. Data filtering based on governorate and locality 1. Data filtering based on governorate 1. Data filtering based on governorate 1. Data filtering based on governorate and locality 1. Data filtering based on governorate and locality 1. Women of reproductive age: 50 per cent of (age 5-18) 100 per cent of (age 19-36) 50 per cent of (age 36-60) 2. Data filtering based on governorate and locality 1. Data filtering based on governorate and locality 109

112 H13 H14 H15 period (2015) Percentage of households with need for hygiene materials Variation of needs priorities of hygiene pre- and post-2014 Different coping mechanisms carried out by women and men related to hygiene problems (yes) 2. When was the last time (all answers except before 2014 ) 3. Governorate 4. Locality 1. Priority needs in terms of Hygiene after 2014 (hygiene kits) 2. Condition of the walls and floor cleanliness? (poor) 3. Governorate 4. Locality 1. Needs of hygiene before Needs of hygiene after Sex of interviewee 4. Governorate 1. Coping mechanisms and mitigation measures to alleviate the problems related to hygiene 2. Sex of interviewee 3. Governorate 1. Priority needs in terms of Hygiene after 2014 (hygiene kits = 1) AND Condition of the walls and floor cleanliness? (poor) 2. Data filtering based on governorate and locality 1. Data filtering based on governorate 1. Data filtering based on governorate 110

113 ANNEX F: Tables of findiings Table 0.1: Total number of implemented and valid questionnaires based on the target group per governorate/locality Governorate/Locality Total # of implemented questionnaires (1) Total # of valid questionnaires IDP WAR WASH NORMAL IDP WAR WASH NORMAL North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 629 1, , Remarks: (1) Total number includes the questionnaires implemented during the training phase (see CHAPTER 2). 111

114 Table 0.2: Number of questionnaires based on sex and age of interviewee Governorate Total <19 years years # of # of # of # of # of # of wome wome wome wome wome men men men men n n n n n North Gaza Middle Area Khan Younis Rafah Gaza Strip 1,184 1, Governorate # of wome n Total years >60 years # of # of # of # of wome wome wome wome men men men n n n n North Gaza Middle Area Khan Younis Rafah Gaza Strip 1,184 1, , Table 0.3: Number of questionnaires based on land type Governorate # of househ olds househ olds # of men men men Total Urban Rural Camp # of # of # of househ househ househ househ househ olds olds olds olds olds househ olds North Gaza Middle Area Khan Younis Rafah Gaza Strip 3, , Locality Type Locality Type Locality Type North An Nuseirat Urban Khan Younis Urban Beit Lahia Urban An Nuseirat Camp Camp Khan Younis Camp Camp Beit Hanoun Urban Az Zawayda Urban Bani Suheila Urban Jabalia Urban Al Bureij Urban Abasan al Jadida Rural Jabalia Camp Camp Al Bureij Camp Camp Abasan al Kabira Urban Omm Al Nasser Rural Al Maghazi Urban Khuza'a Rural Gaza Al Maghazi Camp Camp Al Fukhari Urban Gaza Urban Deir al Balah Urban Rafah Ash Shati' Camp Camp Deir al Balah Camp Camp Rafah Urban Madinat Ezahra Urban Al Musaddar Rural Rafah Camp Camp Al Mughraqa Rural Wadi as Salqa Urban Shokat as Sufi Urban Juhor ad Dik Rural Khan Younis Al Naser Rural Middle Area Al Qarara Urban Al Qarara Urban 112

115 Table 0.4: Number of questionnaires based on shelter type Governorate Total # of househ olds Apartment Asbestos/Zinco Separate house Others # of # of # of househ househ househ househ househ househ olds olds olds olds olds olds # of househ olds househ olds North Gaza Middle Area Khan Younis Rafah Gaza Strip 3, , Table 0.5: Number of questionnaires based on average HH monthly income Governorate <1000 NIS (<263 USD) # of house holds house holds NIS ( USD) # of house house holds holds NIS ( USD) # of house house holds holds NIS ( USD) # of house house holds holds >4000 NIS (1053 USD) # of house holds house holds North Gaza Middle Area Khan Younis Rafah Gaza Strip 1, , Table 0.6: SE1: Percentage distribution of population based on sex and age 0-5 years 6-18 years years Governorate Wome Wome Girls Boys Total Men Total n n Men Total North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate Wome n years >60 years Total Men Total Wome Wome Men Total n n Men North Gaza Middle Area Khan Younis Rafah Gaza Strip Total 113

116 Table 0.7: SE2: Average housing density Governorate Total # of househol ds Total HH area (m 2 ) Total # of rooms Total # of persons Average HH area (m 2 ) Average # of rooms per HH # of persons per room Average area per person (m 2 ) North ,746 1,917 4, Gaza ,946 2,679 5, Middle Area ,613 1,263 2, Khan Younis ,042 1,791 3, Rafah ,958 1,432 3, Gaza Strip 3, ,305 9,082 19, Table 0.8: SE3: Percentage of households headed by women Governorate Total # of households # of interviewed women # of households headed by women households headed by women North Gaza Middle Area Khan Younis Rafah Gaza Strip 3,166 1, Table 0.9: SE4: Percentage of internally diplaced families planning to go back to their home Governorate Total # of households (families) Total # of Internally displaced families # of internally displaced families going back home families going back home North Gaza Middle Area Khan Younis Rafah Gaza Strip 3, Table 0.10: SE5: Percentage of internally displaced families and war-affected families having negative variation of income post-2014 Governorate Total # of households # of internally displaced families and war-affected households internally displaced families and waraffected households having negative income variation # of households households North Gaza Middle Area Khan Younis Rafah Gaza Strip 3,166 1,

117 Table 0.11: SE6: Percentage of variation of monthly WASH items expenses per household pre- and post-2014 WASH item Total # of households households paying more households paying less households with no paying variation North Drinking water Domestic water Hygiene materials Female hygiene items Cleaning materials Solid waste disposal Gaza Drinking water Domestic water Hygiene materials Female hygiene items Cleaning materials Solid waste disposal Middle Area Drinking water Domestic water Hygiene materials Female hygiene items Cleaning materials Solid waste disposal Khan Younis Drinking water Domestic water Hygiene materials Female hygiene items Cleaning materials Solid waste disposal Rafah Drinking water Domestic water Hygiene materials Female hygiene items Cleaning materials Solid waste disposal Gaza Strip Drinking water Domestic water Hygiene materials ,166 Female hygiene items Cleaning materials Solid waste disposal

118 Table 0.12: SE7: Average monthly WASH items expenses post-2014 in NIS/capita/month (USD/capita/month) Governorate North Gaza Middle Area Khan Younis Rafah Gaza Strip Drinking water 4.56 (1.20) 5.33 (1.40) 5.53 (1.46) 4.86 (1.28) 4.34 (1.14) 4.93 (1.30) Domestic water 2.89 (0.76) 5.20 (1.37) 3.97 (1.04) 4.16 (1.09) 4.14 (1.09) 4.16 (1.09) Solid waste 1.35 (0.36) 1.91 (0.50) 1.30 (0.34) 1.52 (0.40) 1.53 (0.40) 1.57 (0.41) Hygiene materials 8.06 (2.12) 8.13 (2.14) 5.62 (1.48) 7.50 (1.97) 5.99 (1.58) 7.29 (1.92) Female hygiene materials 5.78 (1.52) 4.80 (1.26) 5.68 (1.49) 4.79 (1.26) 5.31 (1.40) 5.21 (1.37) Cleaning materials (2.83) (2.90) (2.98) (2.82) (2.38) (2.79) Total WASH materials (8.79) (9.57) (8.79) (8.83) (7.99) (8.89) 116

119 Table 0.13: W1: Changes in source of drinking water pre- and post-2014 Water source Total # of households # of households Pre 2014 households # of households Post-2014 households North Bottling RO home unit Municipal network Private well Public filling points Water trucks Gaza Bottling RO home unit Municipal network Private well Public filling points Water trucks Middle Area Bottling RO home unit Municipal network Private well Public filling points Water trucks Khan Younis Bottling RO home unit Municipal network Private well Public filling points Water trucks Rafah Bottling RO home unit Municipal network Private well Public filling points Water trucks Gaza Strip Bottling RO home unit Municipal network ,166 Private well Public filling points Water trucks 2, ,

120 Table 0.14: W2: Percentage of women and men who can/cannot identify safe drinking water resources Governorate North Gaza Middle Area Khan Younis Rafah Gaza Strip Sex of Total # of Have knowledge Have no knowledge interviewee households # of people people # of people people Women Men Women & Men Women Men Women & Men Women Men Women & Men Women Men Women & Men Women Men Women & Men Women 1,184 1, Men 1,982 1, Women & Men 3,166 2, Table 0.15: W3: Variation of source of domestic water pre- and post-2014 Water source Total # of households # of households Pre 2014 households # of households Post-2014 households North Municipal network Private well Public filling points Water trucks Gaza Municipal network Private well Public filling points Water trucks Middle Area Municipal network Private well Public filling points Water trucks Khan Younis Municipal network Private well Public filling points Water trucks Rafah Municipal network Private well Public filling points Water trucks Gaza Strip Municipal network 2, , Private well ,166 Public filling points Water trucks

121 Table 0.16: W4: Change in capacity of the drinking water storage pre- and post-2014 Governorate/ Locality Total # of househo lds No capacity change Capacity decreased Capacity increased # of househo lds househo lds # of househo lds househo lds # of househo lds househo lds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 2,

122 Table 0.17: W5: Changes in capacity of the domestic water storage pre- and post-2014 Governorate/ Locality Total # of househo lds No capacity change Capacity decreased Capacity increased # of househo lds househo lds # of househo lds househo lds # of househo lds househo lds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 2,

123 Table 0.18: W6: Average storage capacity of drinking water per household member pre- and post-2014 (litre/capita) Total # Pre 2014 Post-2014 Governorate of househo Urban Rural Camp Urban Rural Camp lds North Gaza Middle Area Khan Younis Rafah Gaza Strip 3, Table 0.19: W7: Average of storage capacity of domestic water per household member pre- and post-2014 (litre/capita) Total # Pre 2014 Post-2014 Governorate of househo Urban Rural Camp Urban Rural Camp lds North Gaza Middle Area Khan Younis Rafah Gaza Strip 3, Table 0.20: W8: Changes in perceptions about drinking water quality pre- and post-2014 Governorate Total # of househ olds Water quality Pre 2014 Post-2014 Acceptable Not Acceptable Acceptable Not Acceptable # of househ olds househ olds # of househ olds househ olds # of househ olds househ olds # of househ olds househ olds North Gaza Middle Area Khan Younis Rafah Gaza Strip 3,166 3, , Issues of unacceptable drinking water quality ( %) Governorate Pre 2014 Post-2014 Salinity Odour Turbidit Taste Salinity Odour Turbidit Taste y y North Gaza Middle Area Khan Younis Rafah Gaza Strip

124 Table 0.21: W9: Variation of perception about the domestic water quality pre- and post-2014 Governorate/ Locality Total # of househ olds Water quality Pre 2014 Post-2014 Acceptable Not Acceptable Acceptable Not Acceptable # of househ olds househ olds # of househ olds househ olds # of househ olds househ olds # of househ olds househ olds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser

125 Total Gaza Strip Total 3,166 1, , , , Issues of unacceptable domestic water quality ( %) Governorate/Locality Pre 2014 Post-2014 Salinity Odour Turbidit Taste Salinity Odour Turbidit Taste y y North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total

126 Table 0.22: W10: Percentage of women and men who use drinking water for domestic use Governorate Total # of households (interviewees) Wome n Men Wome n & Men People using drinking water for domestic Women Men Women & Men # of # of # of househ househ househ househ househ househ olds olds olds olds olds olds North Gaza Middle Area Khan Younis Rafah Gaza Strip 1,184 1,982 3, Governorate Total # of households (interviewees) Wome n Men Wome n & Men Wome n For bathing ( %) For cleaning ( %) Men Wome n & Men Wome n Men Wome n & Men North Gaza Middle Area Khan Younis Rafah Gaza Strip 1,184 1,982 3, For washing dishes ( %) For ablution ( %) For children showering ( %) Wome Wome Wome Governorate Wome Wome Wome Men n & Men n & Men n & n n n Men Men Men North Gaza Middle Area Khan Younis Rafah Gaza Strip Table 0.23: W11: Percentage of women and men who use domestic water as an alternative source of drinking water Governorate Total # of households (interviewees) Women Men Wome n & Men People using domestic water for drinking use Women Men Women & Men # of # of # of hous house house house house house ehold holds holds holds holds holds s North Gaza Middle Area Khan Younis Rafah Gaza Strip 1,184 1,982 3,

127 Governorate Total # of households (interviewees) Wome n Men Wome n & Men Wome n For drinking ( %) For cooking ( %) Men Wome n & Men Wome n Men Women & Men North Gaza Middle Area Khan Younis Rafah Gaza Strip 1,184 1,982 3, Table 0.24: W12: Percentage of households engaging children in drinking water collection Governorate Total # of households # of households engaging children households engaging children North Gaza Middle Area Khan Younis Rafah Gaza Strip 3, Table 0.25: W13: Percentage of households engaging women in drinking water collection Governorate Total # of # of households households households engaging women engaging women North Gaza Middle Area Khan Younis Rafah Gaza Strip 3,

128 Table 0.26: W14: Cleaning conditions for drinking water storage vessels Governorate/ Locality Total # of households (interviewees) # of Women # of Men People perception about the cleaning conditions of the drinking water storages Bad cleaning conditions Good cleaning conditions Women Men Women Men # of house holds house holds # of house holds house holds # of house holds house holds # of house holds house holds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Camp Deir al Balah Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Yunis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 1,184 1, , ,

129 Table 0.27: W15: Cleaning conditions for domestic water storage vessels North Governorate/ Locality Total # of households (interviewees) # of Women # of Men People perception about the cleaning conditions of the domestic water storages Bad cleaning conditions Good cleaning conditions Women Men Women Men # of house holds house holds # of house holds house holds # of house holds house holds # of house holds Beit Lahia house holds Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 1,184 1,

130 Table 0.28: W16: Percentage of households that don t pay for domestic water Governorate/ Locality Total # of househol ds households that don t pay # of househol ds househol ds households that don t pay because of economic situation or lack of social responsibility # of househol ds househol ds households that don t pay because they are not connected to municipal network/well # of househol ds househol ds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3, , ,

131 Table 0.29: W17: Changes in need priorities for drinking water pre- and post-2014 Priority Total # of households (interviewees) Women Men Women Pre 2014 %of Men Perception of people Women & Men Women Post-2014 %of Men Women & Men North Distributing home desalination filters Extra water tanks Low cost water Public awareness on drinking water Rehabilitation of water pipelines Building more desalination plants No priority Gaza Distributing home desalination filters Extra water tanks Low cost water Public awareness on drinking water Rehabilitation of water pipelines Building more desalination plants No priority Middle Area Distributing home desalination filters Extra water tanks Low cost water Public awareness on drinking water Rehabilitation of water pipelines Building more desalination plants No priority Khan Younis Distributing home desalination filters Extra water tanks Low cost water Public awareness on drinking water Rehabilitation of water pipelines Building more desalination plants No priority Rafah Distributing home desalination filters Extra water tanks Low cost water Public awareness on drinking water Rehabilitation of water pipelines Building more desalination plants No priority Gaza Strip Distributing home desalination filters Extra water tanks Low cost water ,184 1,982 Public awareness on drinking water Rehabilitation of water pipelines Building more desalination plants No priority

132 Table 0.30: W18: Changes in need priorities of domestic water pre- and post-2014 Priority Total # of households (interviewees) Women Men Women Pre 2014 Men Perception of people Women & Men Women Post-2014 Men Women & Men North Distributing home desalination filters Extra water tanks Low cost water Public awareness on domestic water Rehabilitation of water pipelines Building more desalination plants No priority Gaza Distributing home desalination filters Extra water tanks Low cost water Public awareness on domestic water Rehabilitation of water pipelines Building more desalination plants No priority Middle Area Distributing home desalination filters Extra water tanks Low cost water Public awareness on domestic water Rehabilitation of water pipelines Building more desalination plants No priority Khan Younis Distributing home desalination filters Extra water tanks Low cost water Public awareness on domestic water Rehabilitation of water pipelines Building more desalination plants No priority Rafah Distributing home desalination filters Extra water tanks Low cost water Public awareness on domestic water Rehabilitation of water pipelines Building more desalination plants No priority Gaza Strip Distributing home desalination filters Extra water tanks Low cost water Public awareness on domestic water 1,184 1, Rehabilitation of water pipelines Building more desalination plants No priority

133 Table 0.31: W19: Different coping mechanisms carried out by women and men related to water problems Mechanism Total # of households (interviewees) Women Men Coping mechanisms carried out by people Women Men Women & Men # of # of hous hous hous hous ehold ehold ehold ehold s s s s # of hous ehold s hous ehold s Saving water through reducing the water consumption Increasing the storage capacity of domestic water though using enough tanks Using small tanks and jerry cans to store water for emergencies Purchasing drinking water for domestic use when the domestic water is not available Doing no action Maintaining the household internal water pipes Getting the domestic water from the neighbors when it is not available 1,184 1, Getting the water from own private well Reuse of the grey water for agriculture purposes Reusing the water for ground cleaning Using stand-by power generator when the electricity is not available to pump the water to the roof tanks Using the detergents during the cleaning to reduce the required water quantity Storm water harvesting Using RO filters to desalinate the water Covering the storage tanks tightly to avoid water pollution

134 Table 0.32: S1: Percentage of households without toilets or without sufficient toilets pre- and post-2014 Governorate/Locality Total # of house holds households without sufficient households without a toilet toilets Pre 2014 Post-2014 Pre 2014 Post-2014 # of house holds house holds # of house holds house holds # of house holds house holds # of house holds house holds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Camp Khan Younis Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,

135 Table 0.33: S2: Households without access to wastewater networks pre- and post-2014 North Governorate/ Locality Total # of households Pre 2014 # of households households Post-2014 # of households households Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,

136 Table 0.34: S3: Percentage of households without proper surrounding storm water drainage Governorate/Locality Total # of households households without proper surrounding drainages # of households households North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 1,

137 Table 0.35: S4: Percentage of households that need access to safe solid waste disposal Governorate/Locality Total # of households households without safe solid waste disposal means # of households households North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 2,

138 Table 0.36: S5: Change in need priorities in sanitation pre- and post-2014 Priority Total # of households (interviewees) Women Men Women Pre 2014 %of Men Perception of people Women & Men Women Post-2014 %of Men Women & Men North Activate the rule of the local municipalities Awareness raising about sanitation Building wastewater treatment plants Increase the quality of toilets Increase the quantity of toilets Installation/extension of wastewater network Others No priority Gaza Activate the rule of the local municipalities Awareness raising about sanitation Building wastewater treatment plants Increase the quality of toilets Increase the quantity of toilets Installation/extension of wastewater network Others No priority Middle Area Activate the rule of the local municipalities Awareness raising about sanitation Building wastewater treatment plants Increase the quality of toilets Increase the quantity of toilets Installation/extension of wastewater network Others No priority Khan Younis Activate the rule of the local municipalities Awareness raising about sanitation Building wastewater treatment plants Increase the quality of toilets Increase the quantity of toilets Installation/extension of wastewater network Others No priority Rafah Activate the rule of the local municipalities Awareness raising about sanitation Building wastewater treatment plants Increase the quality of toilets

139 Increase the quantity of toilets Installation/extension of wastewater network Others No priority Gaza Strip Activate the rule of the local municipalities Awareness raising about sanitation Building wastewater treatment plants Increase the quality of toilets 1,184 1, Increase the quantity of toilets Installation/extension of wastewater network Others No priority Table 0.37: S6: Different coping mechanisms used by women and men to improve sanitation Mechanism Total # of households (interviewees) Women Men # of househ olds Coping mechanisms carried out by people Women Men Women & Men househ olds # of househ olds househ olds # of househ olds househ olds Cleaning and maintaining the household internal wastewater pipes and strainers Avoid throwing solid wastes, cooking oil and sands inside the wastewater strainers Doing no action Covering the household wastewater strainers very well Vacuuming the cesspits regularly Connecting only the toilets to the cesspits to avoid cesspit overflow (the grey water is used for irrigation or discharged into the 1,184 1, street) Drilling new cesspits when the existing one is full Reducing water consumption to decease wastewater quantity to avoid cesspits overflow NA (no knowledge about the required coping mechanisms) Using insecticide to combat the insects available due to the wastewater

140 Table 0.38: H1: Changes in source of water heating pre- and post-2014 Pre 2014 Post-2014 Total # Solar Electric. Gas Solar Electric. Gas Wood Governorate/ of heating heating heating heating heating heating Wood Locality househ olds househ olds househ olds househ olds househ olds househ olds househ olds househ olds househ olds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,

141 Table 0.39: H2: Percentage of households without or with poor hand washing facilities post-2014 Governorate/Localit y Total # of househol ds Hand washing sink is not available # of househol househol ds ds Hand washing sink is available With good conditions With poor conditions # of # of househol househol househol househol ds ds ds ds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3, ,

142 Table 0.40: H3: Percentage of households without or with poor shower facility post-2014 Governorate/Localit y Total # of househol ds Shower facility is not available # of househol househol ds ds Shower facility is available With good conditions With poor conditions # of # of househol househol househol househol ds ds ds ds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3, ,

143 Table 0.41: H4: Percentage of households without or with poor kitchen sink post-2014 Governorate/Localit y Total # of househol ds Kitchen sink is not available # of househol househol ds ds Kitchen sink is available With good conditions With poor conditions # of # of househol househol househol househol ds ds ds ds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3, ,

144 Table 0.42: H5: Percentage of people who are untimely in their hand washing practice Governorate/Locality Total # of households (interviewees) # of Women # of Men People don t wash their hands in a timely manner Women Men # of # of household household household household s s s s North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 1,184 1, ,

145 Governorate/Locality Total # of households (interviewees) # of Wom en # of Men People who don t do proper hand washing in timely manner After After using Before changing Before eating toilet cooking diapers Wom en Men Wom en Men Wom en Men Wom en North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total Men 143

146 Table 0.43: H6: Percentage of people who do and don t do sufficient showering Governorate/ Locality Total # of households (interviewees) # of Women # of Men People who do sufficient showering practice People who don t do sufficient showering practice Women Men Women Men # of # of # of # of house house house house house house house house holds holds holds holds holds holds holds holds North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 1,184 1,982 1,

147 Table 0.44: H7: Change of hygiene practices post-2014 Governorate Total # of households (interviewees) # of women # of men People who perceived change in the practices women men People who did not perceive change in the practices men women North Gaza Middle Area Khan Younis Rafah Gaza Strip Governorate # of HH having hygiene practices change Economic situation Changing the place of residence Reasons of change ( %) Sanitary facilities have been targeted during the war Sanitary facilities need for rehabilitati on Water is not available most of the time North Gaza Middle Area Khan Younis Rafah Gaza Strip

148 Table 0.45: H8: Percentage of households with children under five years old infected by waterborne diseases in the past two weeks Governorate/ Locality Total # of households # of households with children <5 Presence of waterborne diseases # of households households Absence of waterborne diseases # of households households North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 1, ,

149 Table 0.46: H9: Percentage of households with members above five years of age infected by waterborne diseases in the past two weeks Governorate/Locality Total # of households # of households with members>5 Presence of waterborne diseases # of households households Absence of waterborne diseases # of households households North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 3,

150 Table 0.47: H10: Percentage of households that noticed appearance of new diseases post-2014 Governorate/Locality Total # of households households that noticed new diseases # of households households North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Kabira Abasan al Jadida Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,166 1,

151 Table 0.48: H11: Percentage of women with no access to appropriate materials for menstruation pre- and post-2014 Governorate/Locality Total # of women of reproduct ive age Women of reproductive age with no access to appropriate materials for menstruation Pre 2014 Post-2014 # of women women # of women women North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total 1, Gaza Gaza 1, Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Kabira Abasan al Jadida Khuza'a Al Fukhari Total 1, Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total

152 Table 0.49: H12: Percentage of households that received hygiene kits in the last period (2015) Governorate/Locality Total # of households households received hygiene kits # of households households North Beit Lahia Beit Hanoun Jabalia Jabalia Camp Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,

153 Table 0.50: H13: Percentage of households with need for hygiene materials Governorate/Locality Total # of households households that need for hygiene kits # of households households North Beit Lahia Beit Hanoun Jabalia Camp Jabalia Omm Al Nasser Total Gaza Gaza Ash Shati' Camp Madinat Ezahra Al Mughraqa Juhor ad Dik Total Middle Area An Nuseirat An Nuseirat Camp Az Zawayda Al Bureij Al Bureij Camp Al Maghazi Al Maghazi Camp Deir al Balah Deir al Balah Camp Al Musaddar Wadi as Salqa Total Khan Younis Al Qarara Khan Younis Khan Younis Camp Bani Suheila Abasan al Jadida Abasan al Kabira Khuza'a Al Fukhari Total Rafah Rafah Rafah Camp Shokat as Sufi Al Naser Total Gaza Strip Total 3,

154 Table 0.51: H14: Variation of needs priorities of hygiene pre- and post-2014 Priority Total # of households (interviewees) Women Men Women Pre 2014 %of Men Perception of people Women & Men Women Post-2014 %of Men Women & Men North Cheap cleaning materials Hygiene kits HK Public awareness Other Gaza Cheap cleaning materials Hygiene kits HK Public awareness Other Middle Area Cheap cleaning materials Hygiene kits HK Public awareness Other Khan Younis Cheap cleaning materials Hygiene kits HK Public awareness Other Rafah Cheap cleaning materials Hygiene kits HK Public awareness Other Gaza Strip Cheap cleaning materials Hygiene kits HK ,184 1,982 Public awareness Other Table 0.52: H15: Different coping mechanisms carried out by women and men related to hygiene problems Mechanism Total # of households (interviewees) Women Men Coping mechanisms carried out by people Women Men Women & Men # of # of house house house house holds holds holds holds # of house holds house holds Cleaning the house regularly Using sufficient cleaning materials and tools Safe and regular management of solid waste by using tight garbage bags and putting the garbage outside the house Doing no action Learning the good hygiene practices ,184 1,982 Using enough water for personal and household cleaning Allowing sun rays and fresh air to enter the house by opening the windows NA (no knowledge about the required coping mechanisms) Burning wastes outside the house

155 Table 0.53: Focus groups findings and discussion (based on attendee perception) # Focus group WASH conditions WASH needs 1 Location: Ash Shati' Camp - Gaza governorate Attendees: 8 women and 11 men - Domestic water quality is very bad due to high salinity and the mixing of water with sewage, which cause skin diseases, damage the clothes and rust the metal cooking tools. The salinity of the water has been increasing for 15 years. The water sometimes has also a bad smell, especially in the summer. This makes the water even not usable for the plants and animals. - Domestic water accessibility is hard. The water is supplied 3 times a week, while most of the time the electricity is off. This forces many people sometimes to buy water from trucks or to use sea water for the cleaning purposes. - The water network is extremely bad. Small stones that block the water flow inside the pipes. - The municipality is performing poorly to fix such problems related to water. - Households are buying drinking water from the water trucks and grocery shops. - The wastewater network is extremely bad. The leakage of wastewater from the network is common. The houses are on a lower level than the streets, which allows the leaked wastewater to flow back to the houses over the roads. - In the winter seasons, the situation gets worse. This is because the rain water flows into the wastewater network and lets the wastewater flood the roads and then houses. - The cleaning service of the camp is not sufficient, where only the main streets are cleaned without considering smaller roads. - The solid waste containers are not distributed properly in the camp, and the wastes are collected - Pumping water from eastern wells with good water quality. - Increasing the hours of water supply. - Distributing additional domestic water tanks. - Providing stand-by power generators to pump the water to the tanks when the electricity is not available. - Distributing drinking water on weakly basis. - Rehabilitating the wastewater network. - Collecting garbage in regular way and covering all the camp. - Distributing garbage bins. - Distributing hygiene materials. 153

156 2 Location: Beit Hanoun - North governorate Attendees: 9 men 3 Location: An Nuseirat - Middle Area governorate Attendees: 21 women after a long time, which causes bad smells especially in the summer. - Insects and rodents are widespread inside the camp. - Domestic water quality is bad due to high salinity. The salinity of the water has been increasing for 5 years. - Domestic water supply is irregular. Some households are not connected to the municipal water network, and the municipality forces those households to install connection to the network on their expenses. - Water pressure is low which hinders the households from filling fully their tanks. - Households are buying drinking water from the water trucks and grocery shops. - The wastewater network is not covering all the area, and some households are depending on the cesspits which are vacuumed on their expenses. The cesspits there are enhancing the appearance and spread of insects in the area. - The municipality is modestly providing its cleaning services to the community, and still it is unsatisfactory. - There are many containers located close to the households which cause bad smells and insect appearance. - The municipality is evacuating the garbage from the main streets only and not from the secondary streets. - Domestic water quality is bad due to the high salinity. Many households are using domestic water for cooking. - Domestic water supply is irregular, especially in the summer. The households located in the higher level are the most affected by this problem. - Increasing water pressure in the network. - Distributing additional domestic water tanks. - Upgrading wastewater network. - Distributing garbage bins with plastic bags. - Distributing additional domestic water tanks. - Providing stand-by power generators to pump the water to the tanks when the electricity is not available. - Distributing garbage bins for with plastic bags. - Rehabilitating household wastewater connections. 154

157 4 Location: Khuza a - Khan Younis governorate Attendees: 26 women - Households are buying drinking water from the water trucks and grocery shops. - Some households are disposing the grey water into the streets or the trees. - Wastewater network is blocked frequently especially in winter. - Lack of municipal evacuation of the solid waste containers. - Insects and rodents are widespread. - Domestic water quality is bad due to the high salinity that causes diseases related to hair and skin. - Domestic water supply is irregular, especially in the summer, while most of the time the electricity is off. The tanks are insufficient to the households. - There is sand in the water network. - The water pressure is low, and households are finding great difficulty to fill their water tanks, and sometimes are doing this manually. - Households are buying drinking water from the water trucks and grocery shops. - There is no wastewater network, and households are depending on cesspits. - Some households are disposing the grey water into the trees. - Insects and rodents are widespread. - Spread of bad smell in the area especially during the night. - Increase of skin diseases. - Combating insects and rodents. - Cleaning the streets. - Awareness raising related to WASH aspects. - Providing stand-by power generators to pump the water to the tanks when the electricity is not available. - Distributing drinking water tanks. - Installing solar water heating systems - Installing wastewater connections. - Distributing cleaning materials. 155

158 ANNEX G: Maps 156

159 Map 1: War-affected areas 157

160 Map 2: WASH-affected areas 158

161 Map 3: INT1: Enhancing drinking water storage capacity 159

162 Map 4: INT2: Enhancing domestic water storage capacity 160

163 Map 5: INT3: Improving drinking water quality 161

164 Map 6: INT4: Improving domestic water quality 162

165 Map 7: INT5: Public awareness campaign about the quality of safe drinking water (A) 163

166 Map 8: INT5: Public awareness campaign about the quality of safe drinking water (B) 164