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P.4 Access to Sanitation Facilities

Access to sanitation facilities is a precondition allowing the affected population to practise safe and dignified sanitation-related behaviours and ensure a safe environment. In an acute response, it includes instant and safe excreta management measures (particularly excreta containment); they are critical to survival and reduced public health risks. It includes the entire sanitation service chain from the toilet via collection, storage, transport and treatment to final safe disposal and/or reuse. It starts at the outset of an emergency and continues through all response phases.

Sanitation facilities need to be disability-accessible, culturally appropriate, well-maintained (including cleaning, re-stocking of anal cleansing material and minor repairs) and close to where people live. They should provide privacy in line with user expectations and a handwashing facility in the vicinity P.2. The technology chosen should be based on a systematic assessment of the local conditions and existing sanitation practices (including anal cleansing practises and preferences for sitting or squatting) as well as of existing infrastructure that can be quickly rehabilitated.

Given the time and resource limitations during an acute response, the progression from open defecation to adequate facilities may be gradual. If acceptable to users, sanitation facilities may initially be communal or shared to rapidly provide for large numbers of people. For example, toilet blocks which include toilets accessible to persons with disabilities. A minimum of 15% of all public toilets must be disability accessible, with all other latrines built as barrier-free and as accessible as possible. Communal or shared toilets should be converted into household sanitation facilities over time, wherever possible. Household toilets are considered ideal in terms of user safety, security, convenience and dignity; they also strengthen the links between ownership and maintenance. The suggested Sphere indicator for a communal gender-segregated toilet is 50 people per toilet (during the acute phase), which must quickly be improved to a maximum of 20 people per toilet. The suggested maximum distance between a dwelling and a communal toilet is 50 metres.

The provision of sanitation facilities must allow for adequate menstrual hygiene management P.7 and safe child excreta management. It includes the provision of female-friendly facilities (e.g. clearly labelled, lockable doors, good lighting, provision of disposal bins and washing facilities inside the cabin), separate safe containment options for children’s and babies’ faeces or the provision of hygiene items such as disposable or reusable sanitary pads, nappies or potties. Facilities also need to ensure children’s safety and acceptable use (e.g. smaller holes to protect children from falling into pits). Sanitation facilities need to be designed and sited, in close consultation with all at-risk groups, to reduce safety and security threats to users (particularly women and girls).

Special consideration should be given to the culturally appropriate design and implementation of the facilities, particularly if people from different cultural, ethnic and/or religious groups are living together. Sanitation is culture and people always have the choice whether to use a toilet facility or not. They may not use it if it is considered inappropriate, is not convenient or does not correspond to the user’s customs and habits. A culturally appropriate design considers an appropriate user interface (for sitters or squatters), anal cleansing materials that users find acceptable (e.g. toilet paper, water, sticks or stones), the willingness of different cultural groups to use the same latrines, the existing taboos related to toilet use, handling of waste or potential reuse options as well as local preferences and practices for managing menstruation and disposing of menstrual products. Cultural beliefs and norms may also affect the siting (people may not want to be seen visiting the toilet) and the orientation of facilities (e.g. religious rules that the toilet should face away from the prayer point). It may also limit technology choices e.g. urinals in Muslim societies may not be an option. Cultural issues can be manifold and must be addressed during the Assessment (chapter  A ) to understand and respond adequately to people’s needs, habits and practices.

Safely managed sanitation goes beyond initial onsite excreta containment and provision of toilets. It also considers effective faecal sludge management and the entire sanitation service chain. It needs to be aligned with local systems and authorities responsible for excreta management and to follow national standards if existing. The ‘Compendium of Sanitation Technologies in Emergencies’ provides a structured overview and in-depth information on all relevant technologies and their applicability. The exact combination of technologies depends on various parameters such as the local context, response phase, available resources, skills and materials, costs, intended resource recovery/reuse or the longer-term operation and maintenance (O&M) requirements. It may also involve market-based approaches P.8 such as engaging local desludging service providers, training local manufacturers, sanitation marketing to create demand for sanitation services F.21 or involving the community in cash for work programmes.

Process & Good Practice

  • Start the planning and decision-making for the whole sanitation service chain at the onset of the response and in consultation and collaboration with all involved stakeholders to ensure that human excreta is managed safely and does not pose any public health or environmental risks.

  • Plan and design facilities by actively involving the affected population to ensure that facilities are continuously used by all and to achieve an acceptable level of ownership and buy-in from users. Include all segments of the population (such as women and men, older people, people with disabilities and children) during the assessment, planning and decision making. Engagement may include user-centred design, consultation with different user groups or contributions of labour and time from users (e.g. digging of pits, O&M). 

  • Pay particular attention to short and longer-term O&M requirements: what cannot be maintained should not be built. Responsibilities for all relevant O&M tasks should be jointly discussed and agreed upon. Individual toilet O&M should be carried out by the household itself, using cleaning materials which can be provided in-kind or through cash and voucher assistance or multi-purpose cash assistance, if households cannot afford P.8

  • Make decisions about the management of shared toilets with the communities (chapter  E ) which could involve a dedicated structure such as a WASH Committee T.55. Cleaners (voluntary or paid) will be needed for communal toilets in e.g. schools or markets. Cleaning materials and training should be included in the budget.

  • Create an annual budget to fund longer-term O&M of shared toilets. Consider tariffs for toilet entrance where the humanitarian community does not (or no longer) fund O&M (e.g. markets and transport hubs).

  • Address privacy and safety issues to enable access to all sanitation facilities and services. Locks on toilet doors, adequate lighting, high doors, no windows at human eye-level, solid walls, roof coverage for terraced structures, screened unit blocks, reduced distance to where people live and segregation of facilities can help reduce the risk of abuse and violence. In schools, adult and child toilets must be separated for child safeguarding.

  • Follow the RECU principle (reach, enter, circulate and use) for disability-accessible or inclusive design: reaching the facility may include minimising the distance to homes and shelters or improving the access through ramps, wider or string-guided paths, or the provision of mobile devices like potties, buckets or diapers. Entering and circulating inside the facility may require a wider entrance area for wheelchairs, slip-resistant surfaces, easy to handle locks and space inside the facility for wheelchair manoeuvre. Using the facilities may need handrails to support sitting and squatting, movable seats and sitting aids, or handwashing facilities at a reachable height.    

  • Design to make sanitation facilities more gender and menstrual hygiene management-friendly. Include access to a sustainable supply of locally acceptable menstrual products P.7 including information, provision of culturally appropriate discrete disposal options for menstrual products, privacy and the provision of washing facilities with water and soap either inside the cabin and/or other possibilities for discreet washing, drying and drainage.

  • Monitor the use of facilities by different users and seek feedback on their acceptability. Accessibility and Safety Audits T.1 are useful ways to stimulate discussion on these issues.



To ensure that adequate and enabling sanitation facilities are available so that the affected population has the means to carry out hygiene and sanitation practices.


  • Access to sanitation is a human right and essential for people’s health, dignity and safety. For the affected population to carry out adequate hygiene and sanitation-related behaviours, sanitation facilities have to be accessible to all, safe, inclusive, well-maintained, culturally appropriate, gender-segregated, close to where people live and provide privacy in line with user expectations.

  • The involvement of different users in the design, siting and management of sanitation facilities is crucial; hygiene promoters can facilitate this by working closely with communities and other team members and stakeholders.

  • The selected technologies must respond to the needs and preferences of different users so that they are continuously used and managed for the benefit of all.

  • The sanitation requirements of babies, young girls and boys, persons with disabilities and those who are incontinent are often neglected - especially in emergencies. Hygiene promoters must advocate P.10 for their needs to be better addressed.

  • The provision of sanitation facilities must address the entire sanitation service chain from the toilet, via collection, emptying, transport, treatment to safe disposal and reuse.


Manual and decision-support for sanitation technologies in emergencies

Gensch, R. et al. (2018): Compendium of Sanitation Technologies in Emergencies, German WASH Network, Eawag, GWC, SuSanA

Collection of sanitation best practices

Oxfam (2018): Sani Tweaks. Best Practices in Sanitation

Sphere minimum standards related to excreta management

Sphere Association (2018): The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response 4th Edition

Disability accessible, MHM-friendly and inclusive design of sanitation facilities

Jones, H., Wilbur, J. (2014): Compendium of Accessible WASH Technologies, WEDC, WaterAid and Share

Jones, H., Reed, B. (2006): Water and Sanitation for Disabled People and Other Vulnerable Groups: Report of Conference and Workshop in Cambodia, WEDC

IFRC (2019): Checklist: Minimum Standards for Inclusive, MHM-Friendly Latrines (Available in different languages, and for bathing areas and solid waste facilities)

Columbia University, IRC (2020): Menstrual Disposal, Waste Management and Laundering in Emergencies. A Compendium

Guidance on faecal and urinary incontinence

Rosato-Scott, C., Barrington, D. et al. (2020): Incontinence: We Need to Talk About Leaks. Frontiers of Sanitation Issue 16, IDS