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Following the earthquake and tsunami in the Indian Ocean in 2004, the emergency response that ensued prioritized the health and wellness of survivors by providing safe drinking water to the affected populations. Despite evidence in emergency settings that household water treatment techniques are effective in improving the quality of drinking water, household-based approaches did not play a significant role in initial phases of emergency response due to the need for water quantity over quality, the lack of human resources to launch household water treatment, and concerns about the sustainability of these methods. Although the focus on quantity over quality is consistent with recent norms, the compromise may not have been necessary since much of the water was supplied in bulk and could have been chlorinated. Disease surveillance was undertaken in the affected areas which yielded little evidence of epidemics of infectious disease. The lack of outbreaks is common following a natural disaster and that an exaggerated risk of waterborne disease may divert attention from other priorities, but it is important to be aware of the increased risk of waterborne diseases while living in crowded camps. The recommendations concluded from this study include continuing to take steps to minimize risks of waterborne diseases, develop and execute practical solutions for special circumstances associated with tsunamis, clarify the conditions under which effective household water treatment techniques may be useful, improve water quality and surveillance without compromising emphasis on quantity, and take advantage of resources committed to the tsunami response to make effective and sustainable improvements in WASH in the affected areas.

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thomas.clasen@lshtm.ac.uk; lucy.smith@lshtm.ac.uk