Science Camp

Back late last year in Jamam, we had been doing some ad hoc monitoring of the water that people store in their homes, and what we saw surprised us. Oxfam chlorinates the camp’s water supply before distribution, and because of the on-going Hepatitis E outbreak out here, chlorination levels had even been doubled in order to offer better protection. What we found, despite these outbreak measures being in place, was that many households — 40% to 60% – had no detectable free residual chlorine (FRC) in their stored water. This was corroborated by more systematic surveys done by Oxfam and CDC [Centre for Disease Control].

Water and sanitation, South Sudan, MSF

On the look out for that data © Imran Ali


No doubt this was cause for concern. If the drinking water in people’s homes was unprotected, it could be an active pathway for the transmission of Hep E and acute watery diarrhoea — both water-related diseases and leading causes of morbidity and mortality amongst the refugee population. In partnership with Oxfam, we had been implementing a bunch of outbreak control measures to combat Hep E — water container disinfection campaigns, scaling up hygiene promotion activities in the camp, big sanitation build projects. Oxfam had been working hard too on improving the performance of the water system in order to stabilize chlorine levels at the tapstands. But the household FRC finding had got me wondering. Even if the chlorine was on point at the tapstand, what was happening to it by the time it was consumed at the household?

Sample collected © Imran Ali



I started to dig around in the literature on this question. The guidelines for safe water supply in humanitarian responses, from MSF, from SPHERE, from others, stipulate acceptable ranges for FRC at distribution points. As far as I could find out, these guidelines were derived experientially and assumed that some residual chlorine would remain in the water to protect it until consumed. But studies had shown that water can be (re-)contaminated during collection and transport from distribution points, as well as during storage and drawing of water in the home, contributing to the diarrhoeal disease burden amongst vulnerable populations — especially those in refugee/IDP camp settings. This question of what happens to the protective FRC in camp water supplies, between distribution and consumption, had never been explored before.

Water and sanitation, South Sudan, MSF

The team at work © Imran Ali



This was a big question on all our minds out here, all the people and organizations involved in WASH [Water, Sanitation and Hygiene] in the Maban camps, so I proposed a study to investigate the fate of FRC to HQ in Amsterdam. I was curious to see what happens to the FRC — from the tapstand, to just after collection in the container, after being transported to people’s homes, and after several hours of storage and use in the household — and how different water handling practices correlate with different outcomes.

Amsterdam was down with the idea, so they shipped me the testing equipment I needed—turbimeters, photometers, chemical analyzers. For the past month now, I’ve been collecting data in the field with my team—Simon, Thomas, Kahlil, Issa, Abdalbagi, and Alfaki—first in Jamam camp, then in Batil, and now in Gendrassa. Today is our last day of data collection in the field (so I finally have some time to write about it!), and we’ve got more than 200 unique samples completed now.

Water and Sanitation, South Sudan, MSF

Science class © Imran Ali



After so many months here, and so many different projects, I’m finally wrapping up my time here in Maban. Next week I’m headed back to Toronto. End of mission … finally! But I’ve got a several weeks of work ahead of me once back to analyze the data and write up the research. I don’t know yet what kind of patterns will emerge from the data. Since it’s the first time this kind of investigation has been done in the field, it’ll at least help to build the evidential base on the safe water guidelines. But maybe, the research might even help to improve best practices for safe water supply in refugee and IDP camps the world over.

Maybe getting a PhD and heading out to the field was a good idea after all. Ha!

Water and sanitation, South Sudan, MSF

Job well done. The team (L to R); Simon, Issa, Thomas, Khalil, me



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I’ve stopped thinking. The last time I stopped to think something out, to parse it, to give it a name, was months ago. The last time I wrote anything in this cheap plastic book was November 7th. Almost three months ago. I mostly use this book for keeping track of my laundry now. HA! How ’bout that.

I haven’t written ‘cos I haven’t stopped for a moment. Almost three months now… damn. What the hell happened?

The whole damned world happened. Influx. Trying to fill bigger shoes. People. Leaving this place for a moment, and being reminded that there’s still a rest of the world out there. Mundane things we do or we see here every day that won’t seem so mundane once I’m able to think about them again. So much has happened.

A few days ago I saw a plane, way up there. Just a graceful white silhouette moving against the blue, no sound, no cloudy trail in its wake. You don’t see them too often here. Growing up in Toronto, right under Pearson’s flight path, there was never a day where you didn’t see or hear a dozen. I was always fascinated by the machinery, the roar of the jets, the way the wheels unfolded from their bellies, the excitement of having its shadow rush over and around you if the sun was in the right place. But it was those other planes, the ones way up, the ones you didn’t know where they were going to or where they were coming from that really got me. Those ones that sometimes left a fragile white wake of exhaust, or that sometimes didn’t. I used to stare at those ones, way up there, wondering where they were going, wondering where those people were headed. I wanted to be up there, moving, moving mostly for the sake of itself.

I saw that plane up there, and that feeling came back to me. I felt that unnamable yearning that has always been so familiar to me. And in that moment, I realized where I was, where I had been for the past five months, where I had come to and forgotten there was any other way of being. I realized I was totally used to shitting in a latrine (Toilets?! What an extravagance waste!). I was totally used to eating boiled goat, lentils and rice for every meal. I was totally used to calling everybody “Kawaja!” all the time (it’s what the little kids in the camps shout at us, while waving their little hands at the wrist, meaning something like “foreigner”). I was totally used to living out of a backpack, sleeping on the ground in a shared tent, two feet away from my former Swedish military sergeant of a lovely tent-mate. Totally used to burning in the sun, swatting the flies away, used to trying to take up smoking. I’d forgotten that there was any other way of being.

And as I remembered that there were other ways of being, I was reminded that I had a home that was not this place. That I had a home to go home to, that I missed if I ever let myself think about it. A reminder that this was a place that I’m just passing through, just as that plane passed through overhead, silently.  This strange, inhospitable, impossible place that is now home for 15,000, 65,000, 115,000 people who had to run here. And from where it seems like they won’t leave for a long time still, for the abode of war still reigns in their hills.

I don’t think about this a lot, because it seems like an impossible thought. To try to understand what it might feel like to have no home to go to anymore. It’s hard to think about, so I don’t really do it. I’m told that the Ingessana are deeply tied to their lands, their hills. Many of the surrounding peoples are pastorialist, nomadic, they move through back and forth. But the Ingessana are of their place, very much so. I can’t see it in the faces or the eyes of the people who I work with here, the people on my team who come from the refugee population. Because I can’t understand them, I can’t ask. My Arabic remains limited to “put this here, there’s no work tomorrow, time for lunch, give me the shovel, bring me that knife”. Strangely, they seem happy, in such good spirits. I’m confused by a lot of my staff actually. If I was bombed out  of my home, I would be shit mad, totally crushed.

But I do have a home to go back to, and soon I will. For now I remain here. When I think of home, I miss it. I think of how I’ve always been moving. For the past ten years, always moving. I feel a pull for the deep relationships – a sense of place and community – that many of my friends who have been at home in Toronto for some time have. I envy that, it seems attractive to me. I want it. But I wonder about myself. That unnamable feeling I have when I see a plane way up there is something that will always pull at me, I think. I can’t resist it, that feeling of incompleteness. Of having to move just for the sake of it. I have a home to go back to and I will go soon, but I wonder how long I’ll keep myself there.

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The road had closed in-between the tall grass and it felt like we were standing in a long, narrow room when we meet them. We had been driving for about five hours along this muddy road, going north from the Doro refugee camp, headed up to a place called Guffa at the border of the two Sudans. We were on explo looking to see if any refugees were coming down now that the dry season was approaching. It was here, about ten kilometres from the border, that we met some refugees coming south.

They were all members of a single family—a man in his forties, a woman about the same age, a young girl in her mid-teens, and four young boys, from about twelve to three years age. The man wore a thin beard on his chin and a tattering plaid shirt in brown. The knife and scabbard that the Ingessana tribesmen customarily wore around their arms protruded from the torn sleeve of his shirt. The woman carefully adjusted and balanced a wicker basket, covered with another wicker lid, upon her head. The younger girl too carried a basket on her head in which she had placed a muddied jerrycan half full of water they had collected at a stream just up the road. She had a solemn, quiet beauty; around her neck she wore a pink plastic compact on a string, hanging open reflecting the world back at itself, a straight crack running across the surface of the glass. Two of the older boys moved around us and into the tall grass after their goats, gently rustling it, as the wind did too. And atop a donkey sat the two younger boys who deftly manoeuvred the animal with an ease and control that seemed beyond their years. Between them lay a tiny newborn goat, its umbilical cord still attached and slowly drying out.

Upon spotting the family on the road, we left our vehicles and approached to see how they were doing. The nurse in our team did a quick check to see if they were injured or unwell and, fortunately, they seemed to be physically fine. We asked them where they were coming from, about what had happened.

They told us that their village had been bombed. They had fled and been on the road ever since, walking for four days now. The man explained that when the bombing began, all of the households of their village scattered into the bush carrying what they could. He didn’t know what had become of the others; they hadn’t encountered any of them since. As we were speaking to the family, the woman bounced gently on her knees, rocking the basket. It wasn’t enough and the shrill cry of a newborn rang out from beneath the wicker lid. She cajoled the basket until the baby within fell back to sleep.

We thanked the family for the information, filled up their jerrycan with the clean water that we were carrying, and told them that there was a village some ten kilometres down the road. They headed south and we continued on our way north, up towards the border.

We arrived at Guffa at about midday. That left us a half hour in the village before we had to leave so that we could make it back to base before nightfall. We quickly carried out an assessment of the village’s healthcare facilities, water points, and airstrip. The military authorities in the town told us they had been seeing aircraft in the skies to the north for the past week, streaking in and leaving plumes of smoke rising from the earth. Refugees had been coming through the town sporadically, but they couldn’t give us a number of how many had passed through recently. With time running short, we loaded up to make the run back to base.

On the road south it wasn’t long before we met the refugee family again. As we slowed down to pass them, not so far from where we had first met them, the older woman gestured for us to stop while the man yelled something to us in Arabic, but the lead car kept moving. I was confused and asked the logistician riding in front what was going on. He told me that they were asking us to stop and take the kids with us down the road to the village. I asked him why we didn’t. Sadly, he said, our security regulations prohibited us from picking up people, notwithstanding a medical emergency of course, but there was none here. Besides we had only space for a few of the kids, and what would we do once we got to the village…just leave them there? He was right; there wasn’t much we could’ve done in the situation.

Still, the thought of that baby in that wicker basket made me question whether we had made the right decision. The family was fine for sure, and they would make it to the village by the end of the day or the next, but still, it just felt strange to pass refugees, having fled what they had fled, and kept going. I guess sometimes you can’t do anything about what you see, and that’s a hard lesson to take in.


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The Taps Run Dry

On Thursday we rose with the sun and headed out to the surface water treatment site to see if we could get the system to produce clean water. A day earlier, the pumps at the Bamtiko borehole — the main source of water for Jamam refugee camp — had failed. The NGO that was responsible for water supply in the camp had made an urgent request to MSF to set up emergency water treatment capacity. Waterborne disease had always been one of the primary threats for the refugee population in this place, but with hepatitis E now also spreading in the camp, ensuring safe water supply was more critical than ever. MSF agreed to do what we could to fill the gap.

My team and I had brought the six crates of the water treatment system to the field the day before and set it up, but I still couldn’t get it working right.

The water treatment system is an assisted direct pressure filtration unit featuring three stages of treatment:

  1. In-line flocculation – a water treatment process by which suspended particles in the water clump together to become larger so that they can more quickly sediment or be filtered out.
  2. Filtration
  3. Chlorination

Water filtration set-up © Imran Ali


The system is designed to treat water with turbidity – cloudiness or haziness of water – up to 200 NTU with spikes of 300 NTU (Nephelometric Turbidity Units – a measure of the cloudiness or haziness of a water sample caused by suspended solids) but the turbidity in the kheffir* we were trying to treat was much higher, around 350 NTU. It seemed to be more than the system could handle and the water coming out was still too dirty to effectively disinfect with chlorine.

That morning, as the rains came in and lightning touched the earth around us, I tried experimenting with different system arrangements, coagulant doses, flow rates and water pressures — anything to make it go, but it still wasn’t working. I was nearing wits end when Eve arrived with the tanker coordinator from the water supply NGO; the taps in the camp had run dry. We needed water as soon as possible.

Line 1 backwash © Imran Ali


Quickly, we moved to disconnect the water treatment system and begin just batch flocculation and chlorination (a simplified emergency water treatment method) in the 30,000 litre tanks that we’d already set up, to get water of some kind of quality out to the camp. We dosed aluminum sulphate coagulant (a chemical agent that accelerates the agglomeration of suspended solids in the water) directly into the tanks and stirred it with a broken shovel that we found. The water began to flocculate immediately but it was still settling too slowly. The water supply NGO had in fact tried batch flocculation at this site before but they found that it took more than six hours settling time to get the water below 5 NTU, what it needed to be for effective chlorination. We didn’t have that kind of time; the camp needed water, and lots of it, right now. After two hours, the water in the tanks was still more than 30 NTU. It struck me that it was likely the high turbidity of the raw kheffir water that was exceeding the treatment system’s in-line flocculation capacity; if we could somehow clarify the raw water just a little bit before the filtration stage, it just might work.

Moving quickly, we disconnected the in-line flocculation apparatus from the treatment unit and shifted the system intake from the kheffir to the tanks in which the water had already been settling. We powered up the pumps, and there we had it — beautifully clear water of 2 or 3 NTU. The tanker coordinator radioed for his water tankers, and we spent the rest of that day pumping clean water directly into the trucks, batch chlorinating them, and sending them into the camp.

Clean water, dirty water © Imran Ali


Every day since then, the system has been producing more than 120,000 litres of safe water for the camp, about half of the total need. We’ve just handed it over to the water supply NGO who’ll be operating it until a newly-constructed pipeline to the Bamtiko borehole has been stabilized.

Clean water © Imran Ali


It’d been good fun getting that system going. By the time evening came around that first wet day, I was covered in mud, exhausted, hungry, my clothes bleached by spilled chlorine — a day well-lived. I’m looking forward to doing it again.

*A kheffir is a small surface water body where rain collects during the rainy season, that people use as a source of household water.

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Vast wetland of the Nile

It’s been ten days since I arrived here in Jamam camp, and I haven’t seen rain like this yet. Every evening out here the clouds gather and rise along the horizons, putting on a light and thunder show until the rains reach us, later at night. Today as I was setting up a surface water treatment unit at a kheffir* near the camp, I could see a thunderhead forming to the south so grey and immense, it seemed to make up the entire height of the sky.

We had to pack up quick, as the winds picked up suddenly and the sky blackened before the rain. It’s still going as I write this, several hours later. Most of our compound is flooded now, and I’m filled with dread when I think of what it’s like in the camp. The refugee camps in this region have suffered immensely in the rainy season. This whole region is a vast wetland of the Nile – beautiful in a way, but a terrible place for a refugee camp.

Waterborne diseases have exacted a great toll on the population of the camp. In the previous months, diarrhoea was one of the primary threats. Right now, there’s Hepatitis E spreading in the camp, which is really tragic as there isn’t much that the medical team can do for those really hit hard by it. The past couple of weeks have been grim in the hospital, with several patients dying in the wards. Since there isn’t much that can be done in terms of curative care, we’ve been intensifying efforts with the other actors here on the ground to prevent disease before it can strike.

Azat, the water and sanitation (watsan) specialist focusing on the camp has just completed a massive program of latrine building and hand-washing promotion. Eve, our watsan focal point, has been coordinating safe water supply in the camp with the other actors. She sent me out today to set up the same kind of surface water treatment unit that I had used during the floods in Pakistan 2010, to increase the supply of safe water in the camp as other sources go offline in the coming weeks. We hope that these works will do something to limit the spread of Hep E, diarrhoea, and other waterborne illnesses, now we just have to wait and see.

*A kheffir is a small surface water body where rain collects during the rainy season, that people use as a source of household water.

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