Part of  a week-long series about different aspects of the Red Cross’ work in Haiti.

It’s easy to take clean water, working toilets, a good sewage system and regular waste disposal for granted. Barring the odd breakdown, these things tend to just work in the UK, without the people who use them thinking very much about them.

So it’s easy to forget that, as well as being convenient, this infrastructure plays a vital role in protecting us from diseases like malaria, dengue fever, diarrhoea, dysentery and cholera.

When the earthquake hit Haiti last January, it devastated water and sanitation systems near the epicentre. It left more than 1.5 million people without access to safe drinking water or a toilet, placing them at risk of diseases. Some found host families further away from the epicentre, but many are still living in sprawling camps where, without adequate sanitation, they would be extremely vulnerable to disease.

Generally after a major disaster, talk centres around what needs to be done to restore pre-disaster levels of water and sanitation service. In Haiti’s case, this won’t be enough. Even before the earthquake, the country’s water and sanitation facilities were chronically under-developed.

In 2008, Haiti’s coverage rate for safe sanitation facilities was the 11th worst in the world, according to the World Health Organisation. Fewer than 70 per cent of people living in cities had regular access to safe water.

The water regulatory agencies had no responsibility for sanitation, meaning there were no sewage systems and individual families made their own arrangements for sanitation according to their economic means. There were also few rubbish collections or street cleaning services in Haiti’s cities, including Port-au-Prince.

Health problems were inevitable with such poor sanitation coverage. Haitian children had on average four to six episodes of diarrhoea a year, several times higher than normal for industrialised countries. Watery diarrhoea caused between five and 16 per cent of child deaths in the country.

There were signs that these problems were being addressed before the earthquake – a new water and sanitation regulatory authority, DINEPA, was created in 2009, but its reform programme had only just begun when the quake hit.

People whose access to clean water and good sanitation was already inadequate suddenly found it was even worse – or in many cases non-existent.

Credit: Claudia Janke

Shortly after the earthquake, the Red Cross started trucking 2.4 million litres of water to displaced person camps in Port-au-Prince every day, enough for around 300,000 people. A year on, this is still happening and is around 40 per cent of all water distributed in the capital.

The Red Cross has also built latrines in camps in Port-au-Prince, Jacmel, Léogâne, Petit-Goâve and Grand-Goâve, used by 265,400 people. The British Red Cross is principally working in two camps in Port-au-Prince – La Piste (50,000 households) and Automeca (4,000 households).

Red Cross volunteers continue to provide extensive hygiene promotion messages to people living in the camps, including messages tailored for children. In the initial stages of the cholera outbreak in November, the Red Cross sent 2 million text messages to Haitians telling them how to take simple hygiene measures to prevent disease.

None of this amounts to a permanent solution to Haiti’s sanitation problems, however. Haiti’s water and sanitation infrastructure needs long-term, sustainable development. DINEPA will work with the Red Cross and other agencies to deliver a three-year water strategy providing this. One of the key goals of this plan needs to be the transferring of municipal services from the Red Cross to the public authorities.

It is likely, however, that the Red Cross will continue to provide safe water to up to 200,000 people in camps, makeshift settlements and the surrounding neighbourhoods in Port-au-Prince for at least the next 18 months.

And as people start to move into transitional shelters, it will be important to make sure they have a sustainable water supply. Water supplies in outlying areas, where there are many host families, will also need to be improved or new water sources created (through the drilling of boreholes, for example).

So there’s a huge amount of challenging work ahead. But there’s also a major opportunity. Over the next few years, aid and development agencies, along with the Haitian authorities, can make sure large numbers of Haitians have access to safe and reliable sanitation for the first time.