Why humanitarian action must promote healthier homes for all

by 19th Aug 2020
Shangurai, a CARE-trained toilet builder in Chivi District, rural Zimbabwe Shangurai, a CARE-trained toilet builder in Chivi District, rural Zimbabwe

Co-authored by Emma Weinstein-Sheffield and Sue Webb

World Humanitarian Day on 19th August reminds us that “in 2020, nearly 168 million people will need humanitarian assistance and protection. This represents 1 in about 45 people in the world, and is the highest figure in decades” (UN website). The ongoing COVID-19 pandemic has brought into focus how poor housing quality and overcrowding can be detrimental to both mental and physical health.

Housing and humanitarian shelter programmes can contribute to the Global Humanitarian Response Plan to COVID-19, especially its strategic priorities to “contain the spread of the COVID-19 pandemic and decrease morbidity and mortality”. Leilani Farha, the UN Special Rapporteur on the right to adequate housing, noted recently that “housing has become the front-line defence against the coronavirus”. Currently though, many aspects of inadequate housing, in rich countries as well as poorer ones, contribute to significant inequalities in mortality and morbidity.

Prioritising indoor air quality in building design can mitigate future airborne viral outbreaks, discussed in recently published research on how poor indoor air quality can amplify the effects of airborne viruses such as COVID-19:

“Rather than promoting health and wellbeing, our built environment often worsens air quality through inadequate ventilation, air recirculation, material specification and the additional pollution load from mechanical heating and cooling.”

This is arguably particularly true in humanitarian settings where people are frequently living in poorly ventilated, crowded conditions and with insufficient access to clean water and sanitation facilities. Responses to humanitarian crises can provide an opportunity to ensure that ‘healthy housing’ is an integral part of future shelter responses. Indeed, good humanitarian shelter programming can have beneficial impacts on mental and physical health that can reach beyond the current pandemic and contribute to healthier lives in the short- and long-term.

Housing and health

The connections between housing and health have only recently been recognised by humanitarian organisations. These important connections were explored in a multi-sectoral Shelter and Health Learning Day which took place online in May 2020. It was instigated and organised by the Self-recovery from Humanitarian Crisis research project, led by CARE International UK and CENDEP at Oxford Brookes University.

The project is working to better understand broad impacts of humanitarian shelter such as on health, particularly in projects that support the inevitable process of ‘self-recovery’. The important, but currently opaque, relationships between emergency shelter provision, long-term housing recovery and consequent health outcomes were explored during the Learning Day.

The aim of the workshop was to bring humanitarian health, WASH and shelter practitioners and researchers together with academics working on health/housing interactions in informal and development settings. These groups do not normally meet, but all have valuable insights to contribute to knowledge about the multiple ways in which housing and settlement conditions can affect mental and physical health.

Poor ventilation, overcrowding and reliance on biomass fuels lead to high rates of respiratory infections such as childhood pneumonia, especially in crisis-affected locations such as South Sudan. Lack of accessible and affordable clean water and sanitation increases rates of diarrhoeal diseases. Vectors of disease such as mosquitoes enter inadequately protected homes and spread malaria. Overcrowded and poor quality housing can contribute to poor mental health. Unhealthy living environments disproportionately affect women, girls, the elderly and people living with disabilities, due to socio-economic inequalities and these groups spending more time within the home.

Yet in humanitarian settings following conflict displacement and disaster, the provision of emergency shelter has usually focused on protection from the elements and physical safety, rather than on other, wider impacts such as health and wellbeing. As Brett Moore, Chief, Shelter and Settlements at UNHCR and Co-lead, Global Shelter Cluster, emphasised in his presentation at the Learning Day:

“There’s an ample body of evidence of the relationship between housing and health but work to be done in translating this common bedrock knowledge into the humanitarian system.”

Shelter and Health Learning Day

The increasing recognition that emergency shelter can play an important role in long-term recovery following crises, and that most people ‘self-recover’, has prompted a desire within the shelter sector to better understand the ways in which housing reconstruction can contribute to physical and mental wellbeing in the short- and long-term.

The Shelter and Heath Learning Day in May 2020 began with an introduction to the connections between housing and health and the current state of knowledge of these connections in the humanitarian sector. Subsequent speakers were organised into panels; two on the connections between housing and physical health, one on mental health and psychosocial support and one on the context of ‘game-changing crises’: conflict and displacement, the climate emergency and COVID-19. These crises are shining a light on the increasing need to harness the co-benefits of improved housing for all.

The speakers were a mixture of academics and practitioners from humanitarian and development settings, with backgrounds ranging from epidemiology to architecture. They included: Andy Bastable, WASH Lead at Oxfam; Ilan Kelman, Professor of Disasters and Health at UCL; and Dr Lucy Tusting from the London School of Hygiene and Tropical Medicine. The panel presentations and discussions were extended into ‘breakout room’ conversations with the wider audience, who were also invited to contribute written comments and suggestions. The proceedings of the Learning Day have now been published in a report.

‘Healthier Homes in Humanitarian Settings’ report

The workshop report, ‘Towards Healthier Homes in Humanitarian Settings’, published to mark World Humanitarian Day, August 2020, includes summaries of the presentations made on the Learning Day. The discussions about how best practice from development fields and from different humanitarian sectors can be applicable for the humanitarian shelter sector, and suggestions and feedback following the workshop were coded and organised into themes within the Findings chapter. Participants urged for ‘out-of-the-silo’ multi-sectoral working and a more holistic approach to programming.

The workshop also highlighted that humanitarian practitioners must learn from the principal stakeholders, the home-makers themselves, who are often missing from these discussions. Cecilia Schmölzer (Global Shelter Cluster Focal Point for Technical Coordination, IFRC), in her presentation, emphasised that:

“Humanitarian Shelter activities are not about merely providing emergency shelter but about helping to ‘build up’ safer and healthier living conditions that provide the base for recovery and prepare the ground towards long term housing.”

Recommendations in the report include the following next steps that aim to inform humanitarian action and enhance the wellbeing of crisis-affected populations:

  1. An ‘Environmental Health’ Inter-cluster Working Group should be formed, including health, shelter and WASH experts.
  2. The shelter sector, working in collaboration with other humanitarian and development actors and academics, should develop evidence of the beneficial impacts of improved shelter on mental and physical health. This report identifies a non-exhaustive list of further research that can inform practice.
  3. A priority list of health-related standards and/or indicators should be developed, along with the means to allow it to be context-specific.
  4. Context analyses should incorporate prevailing health risks and their relationship to housing, including community perceptions, plans and priorities.
  5. The Shelter and Settlements Sector should use the current public interest in global health generated by COVID-19 to reinforce an understanding of the impacts of living conditions on mental and physical health.

environmental health lens graphic

If Shelter practitioners use a wide-angled ‘Environmental Health lens’ in programming, this will encourage and enable a holistic approach that can benefit people affected by crisis who are rebuilding their homes and livelihoods. Shelter, Health and WASH humanitarian practitioners must work together and in collaboration with development actors as well as the affected populations themselves.

The interest generated by the workshop is already leading to further research initiatives and active advocacy for policy change. With only 10 years left to achieve the Sustainable Development Goals, we must leverage the benefits of inter-sectoral cooperation and use every opportunity to link humanitarian response to long-term development.

Operating in the so-called ‘nexus’ is difficult, not least with ever-increasing pressure on aid budgets and the reluctance of humanitarian donors to engage in long-term recovery; yet it is necessary if we are to achieve healthier homes, with all the co-benefits that would entail. The challenges ahead are considerable, yet, with collaboration and learning between sectors, and putting the plans and priorities of affected populations first, homes and communities can be healthier as well as safer following crises.

Download the report Towards Healthier Homes in Humanitarian Settings

Blog co-authored by Emma Weinstein-Sheffield and Sue Webb

Sue Webb is a Research Assistant at the Centre of Development and Emergency Practice (CENDEP) at Oxford Brookes University, working with the ‘Self-recovery from Humanitarian Crisis’ project.

Emma Weinstein-Sheffield

I joined CARE in March 2020 as the shelter research assistant working on the Self-recovery from Humanitarian Crisis project. The project focuses on the priorities and agency of people affected by conflict or disaster and seeks to better understand how the humanitarian community can holistically support people’s own recovery plans. During my time at CARE I have been engaged with research that considers the wider impacts of shelter programming, specifically the relative impact of housing on different aspects of recovery, including health, protection and livelihoods.

Prior to CARE, I worked with an NGO providing long-term solutions to forced migration for refugees and asylum seekers in the UK, including access to education, finance and employment. I managed a number of emergency response projects across Northern France in response to the ongoing EU migration crisis and have worked on development and recovery projects in Nepal.

One good thing I’ve read:

The big truck that went by by Jonathan M. Katz provides a complex, compassionate and dynamic insight into the international community’s response to the Haitian earthquake in 2010, based on the author’s first-hand experience of surviving the earthquake. An important and thought-provoking read.

Email: weinstein-sheffield@careinternational.org

Twitter: emma_ws1