Special Report – Human Waste Management Systems by The Magazine Production Company

SPECIAL REPORT

Human Waste Management Systems

Human Waste: Management and Solutions for Today’s Military Human Waste Management Systems – why good hygiene practices are vital during training and operations The Soviet experience in Afghanistan – a lesson to be learned The professional United States army approach to hygiene and human waste The specific challenges presented by the Afghanistan environment

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

SPECIAL REPORT

Human Waste Management Systems

Contents

Human Waste: Management and Solutions for Today’s Military Human Waste Management Systems – why good hygiene practices are vital during training and operations

Foreword

The Soviet experience in Afghanistan – a lesson to be learned

Martin Richards, Editor

The professional United States army approach to hygiene and human waste The specific challenges presented by the Afghanistan environment

Human Waste: Management and Solutions for Today’s Military

Valerie Erwin and Marci Yamasaki, Cleanwaste Inc. Sponsored by

Published by Global Business Media

Published by Global Business Media Global Business Media Limited 62 The Street Ashtead Surrey KT21 1AT United Kingdom Switchboard: +44 (0)1737 850 939 Fax: +44 (0)1737 851 952 Email: info@globalbusinessmedia.org Website: www.globalbusinessmedia.org Publisher Kevin Bell Business Development Director Marie-Anne Brooks Editor Martin Richards Senior Project Manager Steve Banks Advertising Executives Michael McCarthy Abigail Coombes Production Manager Paul Davies For further information visit: www.globalbusinessmedia.org

Human Waste Management Systems – why good hygiene practices are vital during training and operations

Meredith Llewellyn, Lead Contributor, Defence Industry Reports

The rising trend of diarrheal disease in the British Army in Afghanistan Lessons from the professional Roman Army two thousand years ago An assessment of the liability of ISAF forces to infectious and diarrheal disease in Afghanistan

The Soviet experience in Afghanistan – a lesson to be learned

Marushka Dubova, Defence Correspondent

Preventative measures are only effective if properly implemented

The professional United States Army approach to hygiene and human waste

Don McBarnett, Staff Writer

Diseases and infections have had a more debilitating effect on soldier wellbeing than combat Technical information on latrines for sandy or rocky desert locations

The opinions and views expressed in the editorial content in this publication are those of the authors alone and do not necessarily represent the views of any organisation with which they may be associated.

The Field Sanitation Team and the Modular Initial Deployment Latrine (MIDL)

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Waste disposal in desert locations

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Working towards public health improvements in Afghanistan

Waste disposal options

The specific challenges presented by the Afghanistan environment

Guy Pendleton, Staff Writer

Partnering with the Afghan National Army and mentoring others: the role of the “toilet butler”

References

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

Foreword

HE INTRODUCTION to this report covers the importance of the control of diarrheal disease through effective human waste management systems on military operations. It covers not just the facilities, but also the need for soldier health education to ensure the maintenance of good hygiene practices during training and on operations, even away from sources of running water and on the march. Central to the maintenance of good hygiene practices is the use of effective methods for the disposal of human waste. The report opens by examining various traditional options such as cat-holes, straddle trench, deep pit, pail and burn-out latrines, as well as chemical toilets. All of these methods carry a degree of risk, either to health or through possible detection. The better alternative is a system which is light in weight, can be included with the rest of troops’ supplies and, after use, leaves nothing behind for dogs or chemical sensors to find. The report looks at evidence given by the British Surgeon General at 2010 hearings of the Chilcot inquiry that reveal a rising trend in diarrheal disease among British troops in Afghanistan because of the increasing intensity of operations there. Assessing briefly the history of army construction of latrines and sanitary practices from Roman times, through to the Crimean War and the Soviet invasion of Afghanistan 1979-1989, the report reveals the “lessons learned” of the incapacitating effects of disease on the conscript Soviet army. Their weakly enforced field sanitation regulations, an ineffective non-commissioned officer corps and the soldiers’ failure to take prophylactics resulted in very high levels of incapacity and hospitalization of combat troops. After looking at the success of the American water bottling plant at Camp Bastion in Afghanistan, the report reviews United States Army Engineers Field Manual, FM 4-25.12 (2002) which gives clear instructions to unit commanders to enforce field sanitation and set up Field Sanitation Teams to ensure appropriate latrine placement, construction, and waste water management on operations of varying lengths. The detailed specifications of United States Army preferred latrines are examined as are the range of problems that need to be addressed when setting them up in desert, rocky or sandy locations. The 2005 Technical Information Paper assessing alternative human wastewater management systems in desert locations is noted. The report also gives a glimpse of the work of USAID and the World Bank towards improving public health education and infrastructure in cities and rural areas in Afghanistan. In conclusion, of the report notes that while intentions and systems are sound, the rising trend in the incident of digestive disorders noted by the British Ministry of Defence between 2006-2009, attributed to increasing intensity of operations, allows little room for complacency. Martin Richards Editor

2 | WWW.DEFENCEINDUSTRYREPORTS.COM

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

Human Waste: Management and Solutions for Today’s Military

“When plumbing’s not available ” ®

Cleanwaste #1 supplier of human waste management systems. Proudly serving the military community for more than 12 years.

Valerie Erwin and Marci Yamasaki, Cleanwaste Inc.

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Human waste management is one of the most important tools that we can provide our soldiers. In fact, only 20% of hospital admissions are a result of combat injuries. The other 80% result from Disease and Non-Battle Injury.

Disease and Non-Battle Injury (DNBI) is a ‘disease or injury due to accidents directly related to the operation or mission in which they are deployed.’ DNBI rates are directly related to the effectiveness of a mission and determining the health of soldiers in an operation. Proper human waste management and sanitation is vital to preventing these kinds of injuries and illnesses. The following example shows why sanitation is so important: Merrill’s Marauders: Disease was an important detractor to this famous unit. The medical threat faced by the Marauders in the jungles of Burma was great. Everyone was sick, but some had to stay and fight. Evacuation was limited to those with high fever and severe illness. One entire platoon cut the seats from their pants because severe diarrhea had to be relieved during gunfights. After a bold and successful attack on a major airfield, Merrill’s Marauders were so decimated by disease that they were disbanded. Many options for alleviating the problems associated with human waste have been developed, yet sanitation remains an issue. In this article I will take you through the traditional methods for human waste management in the field and show how Cleanwaste® the maker of the original Wag Bag® has developed the most sanitary products specifically designed to deal with human waste. From cat-holes to pit latrines, straddle trenches to burn-out latrines, this story will discuss former, current and future options for military personnel in the US and abroad. As we delve further into the issues that Field Sanitation Teams (FSTs) deal with on a consistent basis, we need to understand why sanitation remains an issue. With limited supplies, resources and access, some troops

find themselves without sanitary latrines or any latrines at all. Health safety for soldiers is a tough problem with an often messy solution. But, there shouldn’t be any excuse for a failed mission because soldiers didn’t have a sanitary way to dispose of waste. Many times dozens to hundreds of soldiers are placed in close quarters with limited or no facilities available. In these situations, human waste borne bacteria spreads quickly and has a high potential to affect an entire unit. Regular methods of open waste in 55 gallon drums, ammo cans, or open pits significantly increase the risk of transmission of diseases from human waste. Let’s take a look at the options.

Cat-Hole Very simple. Dig a hole 6-12” deep and 12” diameter. Conduct one’s business. Immediately cover the hole with dirt. This is typically used for troops only on the march and when waste collection bags are not available. Not considered a solution for short or extended bivouac situations. FSTs also need to know federal, state, local and host-nation regulations which may prohibit burial of waste. In certain situations, cat-holes aren’t even viable. In situations when cat holes are usable, proper coverage of the waste is imperative. If the cat hole is not covered properly, chemical sensors or dogs used by the opposing force will be able to detect a unit’s position. Just as a soldier cannot leave candy bar and gum wrappers behind, waste cannot be left behind either.

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Straddle Trench Latrine This type of latrine is intended for short bivouacs or field training exercises. Four tent walls are constructed with trenches dug next to each other. Each trench should be 2 ½’ deep 4’ long and 1’ wide. They are intended for a soldier to straddle

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS’

Health safety for soldiers is a tough problem with an often messy solution. But, there shouldn’t be any excuse for a failed mission because soldiers didn’t have a sanitary way to dispose of waste.

and covered back with dirt when leaving that post. It is recommended to have 2 trenches per 100 males and 3 trenches per 100 females dug. Not intended for highly mobile troops, terrain with a high water table, where the ground is too hard or where laws or regulations prohibit the burial of waste.

Deep Pit Latrine Deep pit latrines are intended for situations in which troops are stationed for longer periods of time and in areas that have been more established. These are built by digging a pit 6’ deep by 7 ½’ long by 2 ½’ wide. A strip of 4 toilet seats are built upon a box-like structure. Waste is disposed into a deep pit and eventually filled with dirt. As with the straddle trench, this type of latrine is not intended for highly mobile troops, terrain with a high water table, where the ground is too hard or where laws or regulations prohibit burial of waste. Without chemicals, these pits fill with human waste and human waste borne bacteria will flourish. Seats and areas that soldiers will come into physical contact with need to be cleaned on a frequent basis. 4 | WWW.DEFENCEINDUSTRYREPORTS.COM

Pail Latrine The seat and box-like design of the pail latrine is similar to the deep pit latrine, but no digging is required. Pails are inserted under each seat instead and emptied. These are intended for more permanent situations, but where the water table is too high and the ground is too hard to dig. Pails can then be taken out of the latrine and the waste can be disposed of in a pit elsewhere or burned. Again, these pails fill with waste and human waste borne bacteria will flourish. Seats and all other surfaces on this latrine need to be sanitized frequently.

Burn-out Latrine This type of latrine is designed literally to be a 55 gallon drum with a lid on top. No digging required and intended to be used like the pail latrine when digging into the ground is not feasible. When the drum is full, it must be transported to a designated area mixed with diesel fuel and burned. Just like the pit and pail latrines the seat and all surfaces must be sanitized frequently to prevent exposure to bacteria and is increased during transport.

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

Chemical Toilets Chemical toilets are typically known as porta potties. This type of latrine is signified by the chemicals used to deodorize waste. Chemical toilets are used when a location is not permanent, not highly mobile and easily accessible. The military typically contracts companies to bring in the toilets and to clean and maintain them. This, of course doesn’t happen as much as it should, and the chemical toilets are left unsanitary, therefore spreading waste borne bacteria and increasing instances of gastroenteritis and other diseases. “We had the WAG BAG®s for a while, then they brought in the porta johns for bathrooms, and we suddenly had dozens more cases of gastroenteritis in the hospitals because those porta johns just weren’t as sanitary. I love the WAG BAGs – it keeps the Marines out of the hospitals.” – HM2 Marco Mendoza, USMC Troops stationed in remote FOBs and training areas may have no waste management in place. In these cases, it is inconvenient and often inadvisable to contract out someone to bring porta potties in. Contractors may not be willing to go to hazardous areas to bring in and service porta potties and troops may not properly clean them. In other situations, some training areas are inaccessible by road to bring in a full-size porta potty. Each type of human waste management system has its applicable uses and in certain circumstances, work better than others. However, each of these pose some sort of threat and whether it is sanitation or concealment, the downsides are apparent.

What is the solution?

The WAG BAG® made by Cleanwaste is the ideal solution for military troops in any situation or location they find themselves. Here are the reasons why: During field training exercises or patrols, catholes are often the most popular solution. But, as discussed before, concealment is of the utmost importance. WAG BAG’s and the Pee-Wee® Unisex Urine Bag allow a soldier to do his or her business, seal up the bag and carry the waste

out with them. Nothing left behind for dogs or chemical sensors to find. Waste collection bags do not require any digging or construction of any kind, thus saving time, resources and equipment. When burial of waste is prohibited, any sort of pit toilet is not usable. With pail latrines or burn-out latrines, the waste fills a bucket or drum, it can be burned and no digging is required, but the potential for the spread of human waste borne bacteria such as E. coli is high. In simple terms, someone has to touch the bucket or drum, possibly move it to an approved burn area and, in the process, most likely come into some kind of contact with the waste itself. Taking account of all of those considerations, the seats and all surfaces of these latrines also need to be properly sanitized on a frequent basis. When flying in a fixed-wing aircraft or helicopter for any period of time, there are often no facilities at all. In these cases, soldiers either have to go in their flight suits, relieve themselves in a water bottle (while risking someone accidentally drinking it) or find some other way to go in front of their superiors. For men, the solution to urination is often a simple ‘point and shoot’ strategy. This is not the case for women. While sparing the readers an anatomy lesson, these close-quarter situations with no privacy prove difficult for men and even more so for women. During Counter-Insurgency missions, collateral damage is an unfortunate part of the package deal. In these cases, infrastructure, buildings, water systems and sewage systems are damaged or demolished. A product such as the WAG BAG and the Pee-Wee would provide a way for waste to be properly handled and help keep E. coli away from the civilians of the region. Let’s face it; porta-potties are filthy. In 140o F heat, a porta-potty is a cesspool of bacteria with no ventilation and an awful smell. With dozens to hundreds of soldiers using the porta-potties per day, each unit would need to be sanitized multiple times a day. This is often impractical and doesn’t happen. The WAG BAG, the GO anywhere toilet® and the GO anywhere privacy shelter offer the same privacy and function as a porta-potty but with some major advantages. First, an entire system, comprised of toilet, tent and WAG BAG’s weighs 18 lbs. It can be packed up and moved wherever it’s convenient. Second, the system can come with the rest of the troops supplies, not separately contracted out to a company. Third, the WAG BAG is designed to fit over the entire seat of the portable toilet creating a physical barrier between the seat and the soldier. When used this way, the WAG BAG is

“When plumbing’s not available ” ®

Cleanwaste #1 supplier of human waste management systems. Proudly serving the military community for more than 12 years.

GO safe GO clean GO anywhere

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS’

99.9% effective against the spread of viruses and bacteria. Fourth, every WAG BAG comes preloaded with Poo Powder, a NASA developed superabsorbent and decay catalyst that instantaneously absorbs liquid waste and encapsulates solid waste. No splashing, sloshing, leaking or contact with the waste. The bag is then sealed within another disposal bag and can be placed in any normal trashcan (because it’s biodegradable) or burned. On a scale of 1 to 10, how important is it we implement human waste management systems and keep our soldiers out of hospitals because of DNBI? I think you already know the answer. It is obviously a 10. A frightening 80% of soldiers admitted to hospitals are there because of non-battle injuries or disease. Gastroenteritis, salmonella and E. Coli are just a few treatable, yet costly diseases that can be prevented by simply protecting our soldiers from their own human waste.

Waste collection bags do not require any digging or construction of any kind, thus saving time, resources and equipment. When burial of waste is prohibited, any sort of pit

Citations United States. Department of the Army and Commandment, Marine Corps. Field Hygience and Sanitation. MCRP 4-11.1D ed. Vol. FM 21-10. Washtington, DC. 21 June 2000. Web. 4 Mar. 2011. <https://rdl.train.army.mil/soldierPortal/ atia/adlsc/view/public/6656-1/fm/21-10/fm2110.pdf>. Palma, Sal. “Interview with Sal Palma, Freelance Writer for Twobirds Flying Publication and Former Military Man.” Telephone interview. 8 Mar. 2011.

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toilet is not usable.

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

Human Waste Management Systems – why good hygiene practices are vital during training and operations

“When plumbing’s not available ” ®

Cleanwaste #1 supplier of human waste management systems. Proudly serving the military community for more than 12 years.

GO safe GO clean GO anywhere

Meredith Llewellyn, Lead Contributor, Defence Industry Reports

“Dysentery... has been more fatal to armies than powder and shot “ Sir William Osler, one of the founding medical professors at Johns Hopkins Hospital in the United States is quoted as saying in 1892. This is still proving to be true, even in the twenty first century.

he theme of this report is how diarrheal disease kills soldiers and limits an army’s fighting capability through the failure to use and enforce prevention measures through public and military health education and the use of appropriate human waste management systems. The practical aspects of human waste management, the digging of latrines, the use of clean running water and basic hygiene measures like hand and clothes washing have been known for millennia by armies. However, modern armies need to relearn and reinforce these measures consistently on a daily basis throughout the forces when on operations. This daily enforcement of hygienic procedures can be as important to the success of a military operation as the combat the army is engaged in.

The rising trend of diarrheal disease in the British Army in Afghanistan From the UK perspective, according to evidence given to the Sir John Chilcot Inquiry by Surgeon General, Lt Gen Louis Lillywhite in London in July 2010, the improvement in the Killed in Action rates and died of wounds rates are now the health issues at the top of the British Surgeon General’s agenda. However, while attention is turned to the effect of IEDS, mental health and the epidemic of minor injuries, there is still a worrying rising trend in the incidence of diarrheal diseases, which can directly be l inked to the role of human waste management facilities and the increasing intensity of

combat in modern counterinsurgency warfare. Gastrointestinal illness is the second most common reason for attending the field hospital, accounting for between 10 and 20 per cent of attendances in Afghanistan. Further, while the ISAF 2011 campaign is based on the concept of partnering with and mentoring the Afghan National Army, crosscultural education and sensitivity needs to be practised in the provision of military toilet facilities and in hygiene education.

Lessons from the professional Roman Army two thousand years ago It was the professional Roman army with their counter insurgency campaign against the rebellious Scots in AD 124 who demonstrated their mastery of human waste management in a forward operating base of the Imperial Roman Army at Housesteads at Hadrian’s Wall in Northumberland, UK (Vercovicium). In a stone built facility, which still stands, the soldiers sat on wooden boards with holes, under which rainwater from nearby collection tanks ran to remove waste. Officers used a nearby building. These stone built latrines offer a marked c ontrast to the conditions faced by soldiers in the Crimean War in 1853-56 before the arrival of Florence Nightingale at Scutari. “Mortality rates in the armies that participated in the Crimean War, in what is now Turkey, were horrific: 1 in 5 men sent to Crimea died there. Notably, infections killed far more soldiers than did bullets, saber-thrusts, or shells In contrast, the US Army’s crude mortality rate in Vietnam was 2.6%”1

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS’

The diseases were largely ones now known to be dependent on good hygiene, cleanliness, clean water and good waste management. “Intestinal infections were rampant and devastating. Whereas only 29% of patients at Scutari were admitted for treatment of bowel disease or fever, dysentery contributed to nearly 50% of deaths. At least 3 outbreaks of cholera occurred during the war: between April and September 1855, a total of 2368 patients with cholera were admitted to one of the Scutari hospitals, of whom 1423 (60%) died. For these patients, tincture of opium was the best treatment medical science had to offer.” The cause of these deaths in Florence Nightingale’s view was the British Army. For Florence Nightingale, the greatest tragedy of the Crimean War was the British Army’s failure, through bureaucratic inertia, to protect the soldiers’ health or to assist in their recovery. In her words: “The three things which all but destroyed the army in Crimea were ignorance, incapacity, and useless rules”. In an attempt to prevent the spread of what she saw as preventable diseases: “She set up huge boilers to destroy lice and found honest washerwomen who would not steal the linens. She shamed hospital orderlies into removing buckets of human waste, to clean up the raw sewage that polluted the wards, and to unplug latrine pipes.” There is a debate about the legacy of Florence Nightingale in nursing, but her use of the valuable and then modern ideas drawn from the Sanitarian Movement and Victorian ideas to improve public health were tried, tested and found good for the British, Russian and French soldiers under her care. The reduction in deaths from diarrheal diseases under her management in Scutari makes her case.

An assessment of the liability of ISAF forces to infectious and diarrheal disease in Afghanistan In an article assessing the relationship between the geography and infrastructure of the country, a group of American doctors noted its potential for endemic infectious diseases. This has been taken, acknowledged and acted on by the ISAF forces in Afghanistan. “Much of Afghanistan, in south-central Asia, is mountainous, with windswept high desert plains in the north and southwest. The total area is about the size of Texas (647,5000 km2) and supports a population of 26 million. Two decades of war and civil unrest have led to massive infrastructure destruction and both internal and external population displacements on a vast scale. Infant mortality is high (147 deaths/1000 live births) 8 | WWW.DEFENCEINDUSTRYREPORTS.COM

For Florence Nightingale, the greatest tragedy of the Crimean War was the British Army’s failure, through bureaucratic inertia, to protect the soldiers’ health or to assist in their recovery. and life expectancy short (46 years). Less than one-third of the total adult population can read and write; women have literacy rates of 15%. Per capita income is estimated at $800 (in US dollars) per year. The public health infrastructure has been severely disrupted by recent events, leaving ample opportunity for epidemics of infectious disease.”2

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

The Soviet experience in Afghanistan – a lesson to be learned

“When plumbing’s not available ” ®

Cleanwaste #1 supplier of human waste management systems. Proudly serving the military community for more than 12 years.

Marushka Dubova, Defence Correspondent

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t was the Soviet invasion and attempted occupation of Afghanistan ordered by President Leonid Brezhnev on Christmas Eve 1979 that best demonstrates the effect of poor field sanitation and preventive military health education on a conscript army that was not inclined to obey orders or obeyed the wrong orders. The Soviet army paid a high price for not acknowledging the importance of good human waste management in conducting a military campaign. “Throughout the Soviet war in Afghanistan, up to 33% of the personnel in the Soviet 40th Army were affected by an infectious disease every year. Of the 620,000 Soviets deployed to Afghanistan during the conflict, 415,932 or 67% were hospitalized for some kind of serious illness or disease. These illnesses included infectious hepatitis, typhoid fever, plague, malaria, cholera, diphtheria, meningitis, dysentery, heat stroke, and pneumonia. A great number of these casualties were directly related to poor hygiene, poor waste removal, or poor drinking water.”3

Preventative measures are only effective if properly implemented Although some effort was made to take preventive measures, many were ignored or only partially implemented. Many Soviet soldiers caught malaria during the Afghan campaign, despite being given prophylactics, because 70% of Soviet soldiers failed to take the tablets. Worse than that, many fell sick from following orders: “Active leadership by a professional noncommissioned officer corps could have prevented many of the sources of disease. For example: Soviet troops were often forced or chose to drink from natural water sources or local wells. The quality of these sources in many cases was very poor and contained high bacteria levels, typhus, and amoebic dysentery. To combat the spread of illnesses caused from drinking from local sources, the Soviets issued a pantocide, water-purification tablet. These tablets were effective when used properly. However, soldiers in many cases failed to wait the required 30 minutes for the tablet to purify the water while others simply found the taste of the treated water to be repulsive and

Over 60% of the Soviet service personnel were hospitalized for disease during their normal two-year tour of duty. Shigellosis, amoebiasis, typhus, cholera, hepatitis, and other water-born diseases plagued the force. Pee-Wee refused to use them. Many of these casualties may have been prevented if small unit leaders had enforced discipline in their soldiers regarding such disciplines as field sanitation and drinking from approved water sources.”4 The frequent incapacity of Soviet conscript troops to fight due to ill health was one contributing factor to the military stalemate that resulted after the invasion. This inefficient use of Soviet armed forces was kept secret from the Soviet people, because no Soviet journalists were allowed to travel to accompany the Soviet troops and few, if any, Western writers wanted to take the risk. “Over 60% of the Soviet service personnel were hospitalized for disease during their normal twoyear tour of duty. Shigellosis, amoebiasis, typhus, cholera, hepatitis, and other water-born diseases plagued the force. Malaria was also a problem. However, Soviet casualties and disease were hidden from the Soviet people.”5

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMSâ&#x20AC;&#x2122;

The professional United States Army approach to hygiene and human waste Don McBarnett, Staff Writer

The American led invasion of Afghanistan in 2001 introduced a professional army to Afghanistan; however, the learning curve to establish effective health protection by good human waste management in a country whose infrastructure had been destroyed by decades of war was steep.

Soldiers must be isolated from contact with human waste, especially from contaminated food and water. Vectors also must be denied access to human waste and to standing water that would allow them to feed and breed

ne of the first prerequisites for modern 20th/21st century hygiene and human waste management is potable and clean water. This alone in Afghanistan is a constant problem. In response to the expense of trucking water into Afghanistan, the army decided to develop their own water treatment and bottling plant at Camp Bastion. Four 150 metre bore holes and a treatment plant that produce 100,000 litres a day were established. But only 40 per cent of the water goes through the full treatment process. The drinking water is compliant with the Natural Mineral Water, Spring Water and Bottled Water (England) Regulations 2007, and the Water Supply (Water Quality Regulations) 2000. Other clean water is used for onsite water closet flush toilets, but much is sent out in containers to forward operating bases as drinking water and for washing.

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Diseases and infections have had a more debilitating effect on soldier wellbeing than combat Human Waste Management practise is encapsulated in Field Manual FM 4-25.12 Unit Field Sanitation Team, January 2002. Item 1.1 in the Field Manual emphasises the importance the US army places on the prevention of diseases, non-battle injury and infection. Each unit commander is ordered to appoint a Field Sanitation Team to work and train the troops on a daily basis. It reiterates the lessons learned from military history, that diseases and infections have had a more debilitating effect on soldier wellbeing, than combat. Furthermore, it lays out training procedures for all unit commanders to ensure hygiene among their troops, by drinking only potable water in sufficient quantities to maintain health in hot weather. It also expands in

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

detail on the type of latrines to be used and their management during operations.

Technical information on latrines for sandy or rocky desert locations In an additional Technical Information Paper issued after FM 4-25.12 there is detailed discussion of the problems of setting up latrines in desert locations or on rocky ground, which might be found in Forward Operating Bases in Afghanistan. “Soldiers must be isolated from contact with human waste, especially from contaminated food and water. Vectors also must be denied access to human waste and to standing water that would allow them to feed and breed.”6 It acknowledges particular challenges in the desert environment: “These include: extreme temperatures, particularly heat; winds; dust; desert soils and terrain; lower than expected evapo-transpiration rates at some locations; desert insects/vectors; water availability; and limited infrastructure and support services.”

The Field Sanitation Team and the Modular Initial Deployment Latrine (MIDL) FM 4-25.12 describes three types of new specification latrine for use in US Army operations. For early deployment up to 30 days the Modular Initial Deployment Latrine (MIDL) is specified. This can be set up extremely quickly and is a readily available, portable, highly mobile system that can accompany deploying personnel. The MIDL consists of a privacy screen/tent and a folding or collapsible toilet, into which a disposable bag is placed to contain human waste. Each bag is manually sealed and disposed of after each use, in a collection receptacle provided for that purpose. A single module supports up to 25 soldiers and may be set up and operated on the ground or in a shelter. For 30 to 120 days on operations there is the Maturing Theater Latrine (MTL). This is a more stable, durable system that is made available in the theater following initial deployment. The MTL is similar to modular individual portable chemical toilets used at outdoor events. However, the capability to burn the waste is necessary in the event that waste removal is not available in the theater of operation. The final latrine for the mature theatre is the Follow On Latrine (FOL) for the rear area of operations lasting longer than 120 days. A range of Commercial-Off-The-Shelf (COTS) products and non-developmental items have been identified as possible options for the latrine systems. They are usually containerized, linked to

Liquid and solid waste produced under field

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conditions may amount to 100 pounds (45Kilograms)

Cleanwaste #1 supplier of human waste management systems. Proudly serving the military community for more than 12 years.

per person per day

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especially when shower facilities are available. running water and offer flush toilets, hand washing facilities and heating or air conditioning. The latrines themselves are only part of the sanitation system because each latrine has to be linked to a waste disposal system that is appropriate for warfare and the terrain on which operations are conducted. “Liquid and solid waste produced under field conditions may amount to 100 pounds (45Kilograms) per person per day especially when shower facilities are available. A camp or bivouac area without proper waste disposal becomes an ideal breeding ground for flies, rats and other vermin and may result in disease (amoebic and bacillary), typhoid, paratyphoid, and cholera among soldiers.”7

Waste disposal options Field facilities for human waste disposal demand a range of options. The preferred method is chemical latrines, but they provide logistic problems on operation. During short halts when troops are on a march each soldier uses a brief relief bag or digs a 30 cm deep hole, a so–called “cat hole” latrine that is completely covered with earth and packed down after use. When setting up a temporary camp a deep pit latrine and temporary urine soakage pits are usually constructed. Alternatives are the burn out, mound, bored-hole or pail latrine. The numbers of latrines are based on one urinal for 25 male soldiers and one commode for 17 female soldiers.

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Waste disposal in desert locations The burn out latrine is useful on rocky ground. It is constructed from half an oil drum with welded handles. The human waste is then burnt daily, where incineration and smoke are possible. Burnout is not always possible in military situations because the smoke plume and the smell advertise the presence of troops in the area.

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WWW.DEFENCEINDUSTRYREPORTS.COM | 11

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS’

The specific challenges presented by the Afghanistan environment Guy Pendleton, Staff Writer

The battle to sustain good hygiene in high intensity combat conditions where short-term survival appears in an adrenaline fuelled moment to be more important than cleanliness will always be a hard fight to win.

n Afghanistan there is a range of other environments that present human waste removal/dispersal challenges to Field Sanitation Teams. For latrines for use in sandy desert locations for immediate use for periods of up to 3 months, burnout is recommended. For longer periods of time, chemical units and ablution huts dependent on using leach fields, lagoons or sewage treatment plants for sewage disposal are preferred. However, in Iraq and Afghanistan these options do not always work well. In some areas wastewater does not always percolate well into sand or marl, nor does it necessarily evaporate well because of cloudy weather combined with high humidity. There is also the occasional presence of caliche in desert sands, which hardens as water evaporates from it to form a thick and durable cement layer, through which water does not percolate, causing a potential hazard prone to flies, arthropods and attendant disease. The Technical Information Paper discusses the pros and cons for engineers of a range of options for human waste management in desert conditions and isolates the advantages of each. For many desert locations the Technical Information Paper argues in favour of burnout, chemical toilets, containerized latrines with pump truck disposal and leach fields or sewage treatment plants for optimum capability in hot desert locations. However, all options have

12 | WWW.DEFENCEINDUSTRYREPORTS.COM

critical logistic or environmental implications that need to be considered.

Partnering with the Afghan National Army and mentoring others: the role of the “toilet butler” Since the adoption of “partnering” with the Afghan National Army to train and mentor their troops other issues have arisen. The Afghans work beside the American soldiers, they eat together and share the latrines. This has created the further issue of establishing common hygiene practices for all users of latrines. There are anecdotal and blog reports of US soldiers appointed by commanders to act as “toilet butlers” who encourage all to use the flush toilets or latrines in the western style sitting on the seat, rather than squatting on the seat in adaptation of the traditional Afghan practice of defecating while squatting over a hole-in-the-floor Arab toilet.8

Working towards public health improvements in Afghanistan While ISAF forces and the Afghan National Army enjoy the benefits of Field Sanitation Teams and potable water, USAID is working to share the benefits of improved health and hygiene with the Afghan people living in rural areas where only 12% have access to clean drinking water. In October 2010 USAID signed a memorandum

SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS

of understanding with Afghanistan’s Ministry of Rural Rehabilitation and Development to improve cooperation on water supply, sanitation, and hygiene-education projects. The Afghan minister, Jarullah Mansoori noted: “There are two major problems facing the inhabitants of rural areas in Afghanistan, “lack of potable water and sustainability of water quality.” He also emphasized the need to promote a culture of environmental sanitation and hygiene education in rural areas.”9 There are also national public health campaigns to encourage hygiene such as the recent 2010 Global Handwashing Day. These education projects supplement development of infrastructure to provide sustainable water supply by bore wells that can bring potable water to communities. Furthermore, practical mentoring is being given to institutions in cities to facilitate the profitable operation of water provision companies as businesses by training staff to invoice correctly and encourage customers to pay for clean water provision. In conclusion, within ISAF, the measures introduced by the US Army and others to introduce and maintain modern hygiene facilities even in forward bases away from running water have produced good results. Nevertheless, the fight within the army to keep oral-faecal infectious diseases under control can never be finally won. In a Report by the comptroller and auditor general of the British House of Commons 294 Session 2009-2010, new data indicates that more effort needs to be put into human waste management systems: “The rate of digestive disorders has more than doubled in Afghanistan between 2006 and 2009. There are particular spikes around the six-monthly rotations of deployed units.” This rising trend line, which the British Army has not yet been able to bring down is attributed by the British Ministry of Defence to “Intensity of operations”, and “conditions at operational locations”.10 The battle to sustain good hygiene in high intensity combat conditions where short-term survival appears in an adrenaline fuelled moment to be more important than cleanliness will always be a hard fight to win.

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SPECIAL REPORT: HUMAN WASTE MANAGEMENT SYSTEMS’

References: 1

Nightingale in Scutari: Her Legacy Reexamined Christopher J. Gill1 and Gillian C. Gill Center for International Health, Department of International Health, Boston University School of Public Health, Boston, Massachusetts

Oxford JournalsMedicineClinical Infectious Diseases Volume34, Issue Supplement 5Pp. S171-S207. Endemic Infectious Diseases of Afghanistan Mark R. Wallace1, Braden R. Hale, Gregory C. Utz, Patrick E. Olson, Kenneth C. Earhart4 Scott A. Thornton, and Kenneth C. Hyams

http://www.militaryhistoryonline.com/20thcentury/articles/sovietexperience.aspx Lester W. Grau and William A. Jorgensen, “Beaten by the Bugs: The Soviet-Afghan War Experience”, Military Review, VOL LXVII, Nov-Dec 97, (article on-line) accessed 25 September 2003, available at http://www-cgsc.army. mil/milrev/english/NovDec97/indxnd97.htm.

FIELD WASTEWATER MANAGEMENT IN DESERT ENVIRONMENTS TECHNICAL INFORMATION PAPER #32-001-0904

http://blogs.mcclatchydc.com/kabul/2010/08/the-latrine-butlers-of-kandahar.html

://afghanistan.usaid.gov/en/USAID/Article/1399/Afghan_Government_and_USAID_Sign_ Water_and_Sanitation_MoU

http://bit.ly/cH8P6t Report by the comptroller and auditor general HC 294 Session 2009-2010 10.02.2010

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