FY 10: Understanding Hand Washing Behavior in Protracted Refugee Situations (International Rescue Committee)

Bureau of Population, Refugees, and Migration
May 9, 2012

For full report, go to: http://www.rescue.org/resource-file/understanding-hand-washing-behavior.


Diarrheal diseases are one of the leading causes of sickness and death in refugee settings. Hand washing with soap at the appropriate times can reduce the risk of diarrhea by half. With funding from PRM, the International Rescue Committee (IRC) carried out research with protracted refugee situations in Kenya (Kakuma), Ethiopia (Shimelba), and Thailand (Ban Mai Nai Soi) to understand the motivations, barriers, and enabling factors behind hand washing behaviors, and to develop recommendations at camp and global levels. The research project employed five methods of collecting data:

· Structured observation to determine how frequently refugees washed their hands after defecation, after washing a child who had defecated and before eating or preparing food.

· Household surveys to reveal the level of access to materials needed for hand-washing.

· Semi-structured interviews to gather information on hygiene practices, communication within camps and general information on life within the camps.

· Focus groups to investigate motivations for hand-washing, disposal practices for children’s feces and motivation levels of staff toward different activities.

· Behavior trials revealed the barriers and benefits refugees perceive regarding hand washing.


Refugee priorities for soap were found to be laundry first, bathing second, and hand washing third. Hygiene promotion messages were determined to be most effective when tailored to refugees’ motivations, their rural or urban origins, and conveyed through multiple channels. Other key findings and recommendations include:

· If refugees do not have continual access to laundry soap, they will prioritize hand soap for washing clothes. Therefore, Sphere standards for both hand and laundry soap must be met.

· Review hand washing stations to determine if existing equipment is effective. If not, support the development of alternatives.

· Hygiene promoters need training, mentoring, and monitoring in order to develop innovative messages that resonate with the refugee population.

· Investigate sources of information relating to hygiene and evaluate whether information is reaching everyone in the camp, including socially isolated people or families. Untapped communication channels include religious services, schools, and health care staff.

· Closed containers are preferable to open containers for storing water. For example, although water in Ban Mai Nai Soi is chlorinated, 83% of households had contaminated water (from unwashed hands).

· Structured observation is the most reliable way of gathering information on hand washing rates.

· Behavior trials and focus groups should be included in all formative research efforts.

For the full report, contact Bryan Schaaf at schaafbj@state.gov