Water, Sanitation and Hygiene (WASH) Index: Development and Application to Measure WASH Service Levels in European Humanitarian Camps


The Humanitarian Agents (HAs), are among the first entities dealing with the impacts of natural and man-made disasters. This is more than essential in areas, where the National governments and associated economies are either overwhelmed to respond or unprepared to act. Under such pressing conditions, the agents, as any other similar entity, depend on a variety of monitoring and assessment tools in order to reach the most suitable decisions per case. These tools are mostly employed for the scope definition and the content of their responses, the communication of the information among the various agents, and the reporting to their donors and other beneficiaries. To this end, several field tools have been developed worldwide. Building on such a background, the present effort describes a new tool and it argues towards the development and implementation of a WASH related Composite Index. The purpose of the Index is to facilitate the WASH related assessments in refugee camps, by capturing and reflecting the actual WASH conditions and provide the necessary information for efficient program planning and implementation. Starting with Europe and specifically the humanitarian camps in Greece, the development of the Index may allow its worldwide application, while adhering to the necessary and essential standards that govern the work of all HAs operating in the sector.


Humanitarian Agents (HAs) as the Inter-Governmental Agencies and the Non-Governmental Organizations, are among the first entities that deal with the impacts of natural hazards (earthquakes, floods or droughts) and man-made disasters (social unrest, conflicts, and wars). These interventions are particularly required in areas where the local governments and the related economies are either overwhelmed to respond or unprepared to act. In such pressing instances, a clearly-defined and effective information flow is crucial for the efficient planning, decision making and implementation of the respective mitigation programs (Morcol 2006; Adam 2008).

By reviewing also the relevant literature, among those programs, Water, Sanitation and Hygiene (WASH) related actions have been recognized as crucially important for almost every aspect of human recovery and development (Mills and Cumming 2016). That is mainly due to the fact that “people affected by disasters are generally much more susceptible to illness and death from disease, which to a large extent are related to inadequate sanitation, inadequate water supplies and inability to maintain good hygiene” (Finnveden and Moberg 2005). Additionally, according to UNICEF (UNICEF 2016), the importance of WASH within the Global Development Agenda is highlighted by an increasingly robust body of evidence. Finally, in addition of being crucial, “WASH is highly cost effective; yielding on average four dollars in benefits for every dollar invested” (Hutton 2015).

However, during emergencies, various HAs are called to act fast and often with incomplete and erratic information regarding the actual conditions that they are called to respond to. Usually, the information flows become structured and steady, when the situation starts to normalize. In such cases, the HAs and most decision makers, largely rely on a number of tools, techniques and methods (Sullivan 2002; Johannessen et al. 2014) including simplified heuristics, rules of thumb and the haphazard crisis management techniques in order to design, plan and implement their responses (De Martino et al. 2006; ten Brink 2012).

In the literature, the tools that are being used in the decision-making process are built around and adjusted to various elements, which have been usually elicited from previous experiences in other contexts, not necessarily similar and yet trying to contribute confronting a crucial aspect of the complex reality. In this regard, the indicators and indices related approaches, concepts and tools, applied throughout various fields (Segnestam 2002; Bandura 2005, 2008; ten Brink 2012) may serve as an implementable example to better understand on how HAs realize and define the context of WASH service levels in humanitarian camps and in confronting the difficulties that they are facing particularly with incomplete, conflicting and incomparable data and information. The various sets of indicators, as well as their composite relatives, derive from the appropriate selection and elaboration of primary or secondary data (Segnestam 2002). These tools are usually employed for the simplification, quantification and provision of complex conditions, to assess and to rank national / regional/ local performance of various sites towards achieving specified goals (Bandura 2005, 2008; Rogge 2012; Davies and Isakjee 2015). According to the related literature, their overall objective is to facilitate communication among the respective authorities / agents and foster decision and policy-making as well as implementation monitoring and evaluation (European Environment Agency 2005; Rogge 2012; Deen 2015).

Additionally, in the pertinent literature several different methods and approaches may facilitate the development of such indicators-based tools. Information technology tools including Artificial Neural Networks (ANNs) is one example. Briefly, these are computing systems for information processing inspired by the biological neural networks and they are used to approximate the relationship between input and output signals of a system (Rebizant et al. 2011; Sibanda and Pretorius 2012). In the case of the composite indicators / indices, the ANNs can be used for the calculation of the weights of the individual indicators and sub-indices instead of other approaches such as the Principal Component Analysis (PCA) (OECD 2008). Finally, the development of composite indicators may employ synthetic data. Among other useful approaches synthetic data generation has taken place in recent years for its capability to support applications which need data which is not directly available (Christen and Pudjijono 2009; Surendra and Mohan 2017). In the present effort, the synthetic data generation approach is facilitating the development of datasets from virtual camps with the ANN have being trained with real data.

Overall, indicators being seen as tools are quite valuable, which in terms of its usefulness increases in cases presenting a lack of direct empirical knowledge. In such cases, they may be the only means towards obtaining a fracture of the required information (Haines-Young et al. 2012; Karon et al. 2017). Thus, several related efforts have been presented concerning various field applications of WASH assessment, monitoring and evaluation tools (WHO, UNICEF 2006; Webb et al. 2006; Cohen and Sullivan 2010; Pérez-Foguet and Giné Garriga 2011; Giné Garriga and Pérez Foguet 2013a, b; Baquero et al. 2017). The mechanics behind those can be as simple as ordinary registration of data on existing WASH services (e.g. Rapid WASH Assessments) or as complex as the Rural Water and Sanitation Information System (SIASAR) developed by the World Bank. Such a system includes data collection, indicator processing, ranking and dissemination that simultaneously fulfils different stakeholder needs (Akpabio and Takara 2014; Requejo-Castro et al. 2017). Each of those tools and frameworks is used on different occasions, phases of planning, conditions and contexts depending on the amount of information that is necessary or available each time.

In the literature, among the developed tools, Rapid WASH Assessment and/or WASH Assessment Questionnaires are some of the most frequently applied in camps. These tools are composed of both quantitative and qualitative indicators classified into the different sections of WASH sector (e.g. water, sanitation, hygiene, solid waste, etc.). The WASH Rapid Assessment questionnaire developed by the United Nations High Commissioner for Refugees / UNHCR (http://wash.unhcr.org/download/unhcr-rapid-assessment-wash/) provides a pertinent example of tools. Indicatively, during the emergency phase in Greece, the majority of the Has, as the Médecins du Monde / MdM, Médecins Sans Frontières / MSF, the International Rescue Committee / IRC, the International Medical Corps / IMC, etc., used simple forms defined as Rapid WASH Assessment questionnaires, while at a subsequent stage, UNHCR started providing updated related information via its Data Portal.

In this regard, and building on the Rapid WASH Assessment background, the present effort demonstrates the development and implementation of a composite indicator in the WASH sector. According to the Sphere standards, this field engulfs three critical determinants for survival in the initial stages of a disaster (Sphere Project 2018). The purpose of the Index is to facilitate the WASH related assessments in refugee humanitarian camps, by capturing and reflecting the actual WASH conditions, and provide the necessary information for efficient program planning and implementation.

Specifically, the proposed index is a development from the Rapid WASH Assessment and/or WASH Assessment Questionnaires. Overall, the index is as simple to use as its predecessors are, but at the same time, it can provide a risk measurement per camp, as well as a camp risk ranking, when more than one camps are included in the assessment. The index seems simple to use in the field, and to provide a quick assessment. In this context, it would feel the gap, given the existing paucity of similar tools. It may provide more information compared to existing tools in the emergency responses options (i.e. Rapid WASH Assessment and/or WASH Assessment Questionnaires).

All in all, the originality of the approach is twofold. The first one was to develop an index based on the WASH Rapid Assessment questionnaire composed by UNHCR (excel file available in the UNHCR Portal) using application data from twelve (12) refugee camps all over Greece, as well as from synthetic data based on the extensive collection of UNHCR site profiles from various camps around the world. Compounded to this novelty is the use of ANN, which although a known technology, it has not been applied before in this context. This novel Index should offer quick and handy decision support to stakeholders’ groups, in an effort to assess in emergency refugee camps Water, Sanitation and Hygiene risk. Furthermore, the second novel objective was to apply this Index in the diverse 12 study sites in Greece. Greece offers an almost ideal case site, where a sudden, unexpected and huge influx of refugees was unprecedented since the Greek genocide of 1922 in Asia Minor and left no time for preparation. In this way, its application will be demonstrated in the pertinent Greek sites. Such an assessment may prove its applicability in the study area and by extension to similar areas in the world facing such problems. Nevertheless, its future application in other conditions and different locales may offer additional insights and strengthen its development with additional input.


Methodological Phases

The methodology incorporated twelve (12) refugee camps all over Greece. Hence, the development of the WASH index involved two main phases. First, the phase of data collection from the established refugee humanitarian camps and the creation of Synthetic Data Sets corresponding to virtual camps using statistic and logic-based constraints. The second phase was data processing pertaining the following steps:

  • Development of individual indicators from both the collected and the synthetic data;

  • Classification of the indicators’ input ranging from “Best to Worst” performance;

  • Classification of indicators sets to three (3) sub-indices;

  • Weighting of the individual indicators within the sub-indices;

  • Weighting of the three (3) sub-indices within the WASH Index;

  • Aggregation of the individual indicators for the calculation of the sub-indices’ scores;

  • Aggregation of the sub-indices for the calculation of the WASH Index scores;

All these steps are presented in the following sections, while the methodological approach as well as the research steps followed are presented in Graph 1.

Graph 1

General methodological research approach

Camp Data Collection

Data from twelve (12) humanitarian camps around Greece were gathered. A snapshot of the existing water, sanitation and hygiene conditions per camp is presented in Appendix 1. The data gathering form which was used for this purpose is available online (URL: https://ee.humanitarianresponse.info/::YQLb).

Overall, the selected sample is representative of the diversity of the quality of the provided WASH services that observed around Greece. This diversity has been shaped by a number of factors, including, but not limited to, camp management (government ministries, municipalities or private entities), involved actors, coordination quality, beneficiary population, local social and economic conditions and the initial state of the areas, which have been used as camps (e.g. warehouses, open spaces, etc.). However, the most significant shaping factors are the observed delays in terms of decision-making and efficiently/orderly planned actions and their implementation, as well as the constantly and haphazard changing context (e.g. closure of camps, relocation of beneficiaries, etc.).

The data collection took place from April to December 2016. After that period and until recently (April 2019), the selected camps passed through various stages. Some of those remained functional and were improved in terms of various services and infrastructure, while others ceased to exist (e.g. Eidomeni, EKO Gas Station, SK Market, etc.) since the Greek Government decided to relocate the refugees at better-organized and more coordinated humanitarian camps. That decision came into force after neighboring countries closed their borders and cut the refugees’ route to the rest of Europe. However, the conditions which had been shaped in those camps particularly health and protection related issues, as well as constant and strong civil unrest played a crucial role in the outgrowth of the refugee crisis in Greece and this was the predominant reason to included them in the data collection group. In addition, the purpose of the present effort is to display the WASH Index and as thus, the quality of the data was more important than the state of the camps. Updated details on the camps in Greece are available in the UNHCR Operational Portal (UNHCR 2019).

Synthetic Data Sets

Eighty (80) sets of synthetic data were created. These are representing various potential WASH related conditions in hypothetical camps ranging from the “Best” to the “Worst” scenarios. The synthetic data used are from the extensive collection of UNHCR site profiles from various camps around the world and they were used as the initial “information pool” (UNHCR 2017a, b). General and arithmetic data on the WASH conditions were studied to identify the quality of the provided services per case and estimate the potential values that the pertinent indicators could receive in each of those camps, particularly those pertaining in the development of the proposed Index. In this context, some statistic and logic-based constraints were introduced for the data generation to avoid picturing conditions that are either very unlikely to occur or impossible to be sustained for extended periods, particularly towards the “Worst” scenarios spectrum. The latter is a reasonable approximation, since conditions in the camps tend to improve with time. The synthetic datasets employed to train a Radial Basis Function (RBF) Network. These networks are Artificial Neural Networks that use the radial basis function as activation function. The output of such networks is a linear combination of radial basis functions of the inputs and of the neuron parameters. The selection of the RBF network was based on the fact that those “are distinguished from other neural networks due to their universal approximation and faster learning speed” (Sharif Ahmadian 2016). In turn, the ANN applied to provide the weighting of the main and sub-indices as described in the following sections. For this purpose, 1000 simulations were created. It is believed that the ANN may be more appropriate to use instead of other approaches, as they are also described in the Handbook on Constructing Composite Indicators by OECD (2008). More specifically, the ANN replaced Principal Component Analysis (PCA) for the weighting of the individual indicators and they served in the sensitivity analysis of the whole methodological paradigm.

Data Processing

Both the data that were gathered as well as the created ones were processed to represent individual indicators. Every individual indicator is classified into four (4) scale categories ranging from 0 to 3 (Appendix Table 6) for the various components to be quantified into a uniform and simultaneously simple and practical way, based also on pertinent literature (Skondras et al. 2011; Karavitis et al. 2014; Tsesmelis et al. 2019a, b). The various indicators are divided into three (3) categories to exactly represent each one of the three components of the WASH sector namely Water, Sanitation and Hygiene. Such components consist the three individual sub-indices.

The aggregation of each individual indicator in the structure of the sub-indices was based on the “Weighted Arithmetic Mean” as presented in Eq. 1. This also applies for the calculation of the WASH Index, since it incorporates three sub-indices.

$$ \overline{x}=\frac{\sum_{i=1}^n{w}_i{x}_i}{\sum_{i=1}^n{w}_i} $$

Then, in the final phase for the calculation of the WASH Index, the scores of the sub-indices are classified into six (6) risk categories (Table 1). The classification ranges were produced through the virtual calculation of the indices (1.000 times with synthetic indicator values while following statistic and logic based constraints) and presented in more detail in the next sector.

Table 1 Classification of the final scores

Risk Classification

The classification of the produced sub-indices’ simulations scores as well as the score of the WASH Index to six (6) risk classes, was performed by using Fisher’s Linear Discriminant Analysis, which is a classical method for jointly classification and dimension reduction (Tu et al. 2014). The segmentation in six risk classes followed the logic of similar risk indices development in pertinent literature (Skondras et al. 2011; Karavitis et al. 2014; Tsesmelis et al. 2019b). The results / risk classes derived from these processes are displayed in Table 3. Overall, this step is used to translate a quantitative parameter (score), consisting of multiple individual features, in a descriptive qualitative way stating the risk level of individual camps (ranging from No Risk to Extreme Risk).

Weighting of the Indices

As stated, the weighting of the main and sub-indices was achieved through the application of a Radial Basis Function (RBF) Network. The main operation of the artificial networks is to increase or decrease the importance of the input values for a problem to be solved. That process is refined as training and learning proceeds. The synthetic data were produced using application data from twelve (12) refugee camps all over Greece, as well as extensive collection of UNHCR site profiles from various camps around the world and they were used to train the ANN to produce the weighting of the individual indicators. The network was trained using eighty (80) sets of synthetic data created. The resulted weighs are portrayed in Appendix Table 6.

Overall, the weighting of the indicators per se do not account for social, environmental and economic impacts. The weighting supports the visualization of the WASH related risk potential in a camp. Specifically, the index and its components, help the HAs identify potential implications in the health of the People of Concern that may lead to the generation of unsafe conditions (for both the people and the environment) and social unrest in a camp. Additionally, it helps the HAs identify the problematic areas and decide on the necessary budget allocation for the rehabilitation of those areas.

Results and Discussion

Generally, the indices are sensitive to the data that are being used for their development. This means, that a different set of indicators may generate different results. Some may differ a lot and others may not. Such a problem is usually solved when a great number of actual cases is being examined and used. The following subsections present the Index performance on and its intended use according to the approach described in the Methodology section and compared to the observations of the WASH related conditions in the camps during the data collection of phase. The risk related Index ranking capacity is displayed and assessed at an indicator, sub-index and index level.

Water Sub-Index

On one hand, according to Appendix Table 6, “Water Pressure (overall)” in the water distribution system is the indicator with the highest significance in the Water Sub-Index structure (0.216). This seems to stand since water pressure can affect most of the activities in the camps, especially in cases when the population density is quite high and there is usually a simultaneous use of many taps. On the other hand, the “Distance from the Taps” indicator displays the lowest significance. The rationale behind such result is that the distances are not inconvenient for the beneficiaries, if the water distribution system is properly designed, constructed, operated and maintained. Thus, it delivers water according to the desired parameters and distance from the mains becomes irrelevant. An additional reason is that when the camps are designed appropriately with the proper walkways, lighting, etc., or they occupy a small well-structured and organized area, distance is far less relevant. It is also pointed out that the “Distance from the Taps” is a significant Protection related indicator and its value is not undermined by its lower weight.

Overall, regarding the water sub-index, the existing conditions in the Greek camps, it has to be stated that 83.33% of those were under “No Risk (58.33%)” and “Low Risk (25.00%)” condition with a score ranging from 0.00 to 1.09 at the time of the assessment. The remaining ones (Eidomeni and Chara Hotel), display “Very High” and “Extreme” Water-related Risks. The detailed results are displayed in Table 2. According to that table, the Chara Hotel accumulates the worst scores for the 71% (5 out of 7) of the indicators. On the other end, the Skaramagkas Camp (Attica) displays almost ideal water-related conditions and is followed by the Kara Tepe Camp (Lesvos). Indicatively, from the actual data, it is underlined that:

  • 75% of the examined camps are connected to the municipality water network and the quantity of the available water exceeds the minimum standard of 50lt/person/day;

  • Almost 67% of the camps provide high quality of water (in compliance with the international standards), with significant pressure (> 2 bar at the tap), and are supplied with adequate number of taps;

  • Almost only 17% of the camps provide hot water during the winter – which was a major issue during the winter of 2016–2017;

Table 2 The scores of the Water Sub-Index for the Greek Camps

Sanitation Sub-Index

According to Appendix Table 6, the “Type of Sewerage system” is the indicator with the highest value in the Sanitation Sub-Index structure (0.214). Similar to the results for the Water Sub-Index, such an outcome seems reasonable since the type of sewerage system and its associated capacity reflect the risk of an epidemic burst. On the other hand, the “Distance from Latrines and Showers” indicator displays the lowest score (0.019). Once more, and similar to the Water Sub-Index, the rationale behind the result is that such distances may not be inconvenient for the beneficiaries.

Compared to the Water Sub-Index, the 66.66% of the selected camps is under “No Risk (50.00%)” and “Low Risk (16.67%)” conditions with a score ranging from 0.53 to 0.98. The remaining four camps (EKO Gas Station, Eidomeni and Chara Hotel) display “Medium” and “Very High” Sanitation related Risks. The detailed results are displayed in Table 3. According to the table, Eidomeni accumulated the worst conditions in the 25% of the indicators while it performed quite poorly in the 41.66% of the remaining indicators. For this Sub-index, the camp of Malakasa (Attica) displays almost ideal Sanitation related conditions. Indicatively, from the actual data, it is underlined that:

  • 100% of the camps have garbage bins with wheels (that are more convenient for the collection) and a capacity that exceeds 360lt/bin;

  • 41.67% of the camps display adequate number of showers in compliance with the international standards;

  • 33.33% of the camps are equipped with adequate number of latrines in compliance with the international standards and are connected with holding and septic tanks;

  • 16.67% of the camps is equipped with permanent latrine infrastructure, designed with the minimum distances between the sanitation infrastructure and the dwellings, and display high quality of infrastructure maintenance and cleaning;

Table 3 The scores of the Sanitation Sub-Index for the Greek Camps

Hygiene Sub-Index

From Appendix Table 6, the “Gender Showers” is the indicator with the highest significance in the Hygiene Sub-Index structure (0.139,) while the “Gender Toilets” indicator displays the lowest one (0.065). Again, as in the case of the other sub-indices, this result seems quite reasonable since the shower related indicator is more related to the concept of hygiene, while the latrine related indicator is more towards the concept of sanitation.

Compared to the previous sub-indices, the Hygiene Sub-index displays higher scores than them and consequently higher risks. Indicatively, 8.33% of the selected camps are under “Low Risk” conditions while 83.33% of those are under “Very High” and “Extreme” Hygiene related Risks. The detailed results are displayed in Table 4. According to the results, Eidomeni and Chara Hotel display the worst conditions respectively while the camps of Kara Tepe and Skaramagkas stand on the highest categorization scale. From the campsite analysis, it may be also underlined that:

  • 16.67% of the camps are equipped with washing machines;

  • 8.33% of the camps provide hygiene items on a daily basis through pertinent services (hygiene kiosks), organize hygiene promotion activities and information sessions, have the proper in-house ventilation system, and finally, are equipped with gender segregated latrines and showers;

Table 4 The scores of the Hygiene Sub-Index for the Greek Camps

WASH Index

The aggregation of the three sub-indices into the calculation of the WASH Index is presented in Table 5. Generally, 75.00% of the selected camps display either “No Risk (58.33 %)” or “Low Risk (16.67%)” conditions. According to such results, Chara Hotel and Eidomeni display the worst WASH related conditions while Kara Tepe and Skaramagkas picture the best-encountered ones close to the ideal.

Table 5 The scores of the WASH Index for the Greek Camps

From all the above argumentation, it may be pointed out that the Index is performing appropriately not only when purely quantitative data were used as input, but also when such data were not available and hence having to infer reasonable approximations.


The attraction of “conflict” as both a concept and condition can be seen in the “problems” approach of recent years, the confrontational character of socio-political differences, and the strident voices of militant groups representing competing and conflicting interests in streamlining the “refugees’ crises”. However, more recent developments and increasing sensitivity to the need of integrating competitive civic demands, ethical and religious systems and beliefs, stakeholders’ interests, the evolving need for political accommodation, and, proactive posture towards avoiding conflicts, have also contributed to a shift from confrontation to cooperation, from monologue to dialogue, and from dissent to consensus. In this context, the purpose of the WASH index is to improve the pertinent decision-making efforts through also improving the technical efficiency and efficacy of WASH assessments in refugee camps, by using a structured index. Additionally, and similarly to its predecessors (Rapid WASH Assessment / WASH Assessment Questionnaire), the index is handy and simple to use in the field while providing more information compared to the aforementioned tool.

The index development was presented and the methodological process described. The index by its structure tried to embed simple indicators, which at the same time are easy to quantify in a variety of operating conditions and environments, particularly during emergencies where timely actions are of great importance.

The index tried to incorporate a plethora of organizational, operational, social, technical and physical WASH related indicators. Then, the Index application showed that it may describe well the encountered conditions at the refugees’ camps in Greece. By capturing near actual water, sanitation, and hygiene conditions in the selected camps (compared to on-site observations, the index proved that it might be of some significant value for the WASH experts. In this regard, the index users can communicate the necessary information to multiple levels of operation from field to donor level and use this information in the program planning and implementation processes. Furthermore, the index can be incorporated into the monitoring and evaluation process (e.g. progress over time or cost effectiveness when combined with budget expenditure data) for internal and external purposes. The ranking feature provided by the WASH index can be used in a meaningful comparison among the camps in various spatial and temporal scales. Such comparison may be used for both HAs as well as local, regional or national government, authorities and agencies to understand the “bigger picture” in terms of WASH conditions and formulate the necessary strategies and tactics towards implementable management actions for the mitigation of the deficiencies among various refugee humanitarian camps or their improvement. Finally, it is essential for any pertinent research towards the identification of effective and reliable WASH related indicators and tools to continue and to be applied in different locales, so as corresponding interventions to improve in an appropriate manner both for the beneficiaries’ well-being and for employing a cost-effective, socially acceptable and policy successful way for the HAs.

Overall, the WASH Index has still to undergo further development in order to incorporate information that is more situational as well as to be applied different locales. Specifically, the index, as the WASH Rapid Assessment questionnaire developed by UNHCR, may be further developed to include more types of facilities apart from camps or settlements, i.e. transit centers (like the Apanemo Transit Center of IRC in Molyvos, Lesvos Island), schools, health centers and urban sites. Additionally, the body of the index may be refined by using actual data instead of synthetic ones from camps around the world. This will have an effect on the identification of the importance / weighting of the individual indicators and thus, will make the index less sensitive to less significant parameters and more accurate in presenting the different cases Finally, the index may also be further developed to include the access of vulnerable and marginalized groups to WASH services and thus, provide integrated essential information to relief workers.


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Appendix 1 - Generic description of the selected camps

  1. 1.

    Kara Tepe (Prefecture of North Aegean) – Date: 07/11/2016

Kara Tepe camp is located in Mytilene City and is managed by the Municipality of Lesvos Island. It is considered to be among the best camps in Greece. At the time of the data collection, the camp was undergoing shelter replacement from Refugee Housing Units (RHU) to prefabricated units (containers). In terms of WASH:

  • It is connected to the municipal water supply and sewage networks;

  • Hot water is always available – olive kernel burner;

  • Gender segregated semi-permanent showers and latrines;

  • Hygiene promotion activities and daily distribution of hygiene items;

  • Relatively good drainage conditions;

  • Cleaning, maintenance and pest control services are provided;

  1. 2.

    Skaramagkas (Prefecture of Attica) – Date: 16/05/2016

Skaramagkas is an official camp populated by 3118 people. Camp management is delivered by the Hellenic War Navy in collaboration with the Municipality of Chaidarion and the Hellenic Army regarding to infrastructure issues. In terms of WASH:

  • It is equipped with 400 prefabricated housing containers. Each hosts two families with common showers – bath;

  • Connected to the municipal water supply network and the sewage system is connected to septic tanks;

  • Desludging, garbage collection and cleaning services are provided;

  1. 3.

    SK Market (Prefecture of Macedonia) – Date: 17/04/2016

SK Market site is located at the prefecture of Macedonia and is managed by the Hellenic army. It was opened as an emergency reception site at the end of May 2016 to host refugees from unofficial camps like Eidomeni and has a capacity of 500 persons. In terms of WASH:

  • Connected to the municipal water supply and sewage networks;

  • The water availability is less than 15lt/person/day;

  • No Hygiene promotion activities or garbage collection services;

  • Adequate number of chemical toilets and portable showers – all gender segregated.

  1. 4.

    Frakapor (Prefecture of Macedonia) – Date: 17/04/2016

Frakapor site is located in the prefecture of Macedonia and is managed by the Hellenic Air Force. It was opened as an emergency reception site at the end of May 2016 to host refugees from unofficial camps like Eidomeni and has a capacity of 600 persons. In terms of WASH:

  • It is not connected to the municipality network. 25m3 of water is trucked in the camp on a daily basis;

  • Hot water is only available via electric boilers;

  • Disludging and cleaning services are provided and 20 garbage bins are allocated around the camp;

  • Hygiene promotion activities and regular hygiene kits distributions are taking place;

  • The camp is equipped with chemical toilets and portable showers.

  1. 5.

    Vasilika (Prefecture of Macedonia) – Date: 20/04/2016

Vasilika (Radestos) camp is located in the prefecture of Macedonia and is managed by the Hellenic Air Force. It was opened as an emergency reception camp middle of June 2016 to host refugees from unofficial camps and has a capacity of 1500 persons. In terms of WASH:

  • Water supply comes from municipal network;

  • Availability of hot water via electric boilers spread across the camp;

  • 4 water points with each of one having 10 tabs with adequate pressure;

  • The camp is connected to the municipal sewage system and is also equipped with septic tanks;

  • The camp is equipped with chemical toilets and portable showers;

  • Desludging and cleaning services are provided;

  • Hygiene promotion activities and regular hygiene kits distributions are taking place;

  1. 6.

    EKO Gas Station (Prefecture of Macedonia) – Date: 21/04/2016

The camp was prepared as a temporary solution to the crisis and it was managed by the Hellenic Police. It reached a capacity of 1237 persons. In terms of WASH:

  • It was connected to the municipal water supply network;

  • No connection to the sewage system;

  • It was equipped with chemical toilets and portable showers – gender segregated;

  • No hygiene promotion and messaging;

  • No pest control services were provided;

  • Cleaning and maintenance services were provided;

  1. 7.

    Chara Hotel (Prefecture of Macedonia) – Date:26/04/2016

The hotel was occupied by almost 1300 refugees from Eidomeni without prior approval from the local or national authorities or the owner of the hotel. For this reason, the owner cut the water supply of the hotel. However:

  • Chemical toilets and portable showers had been installed;

  • Water was being transported on a daily basis;

  • Due to the lack of water, the sewage system was not operational;

  • Poor hygiene conditions despite the frequent cleaning of the hotel;

  1. 8.

    Eidomeni (Prefecture of Macedonia) – 28/04/2016

Eidomeni was developed immediately after the decision of the neighbor countries to close their borders and cut the refugees’ route to the rest of Europe. Eidomeni was the largest camp in the country reaching a population of approximately 10,000 people. It served as a temporary camp before the people were relocated to other camps. The camp caused many problems for both the local population and the refugees. Specifically, the extended accommodation of the refugees got them into a position of constant unrest, which came to affect the locals due to raids and other related activities. Not all the refugees participated in those actions. Just a small number of them, but that was enough for the national media to misuse the occasions. In terms of WASH:

  • Chemical toilets and portable showers had been installed;

  • There was no connection to municipal water supply or sewage networks;

  • Very poor hygiene conditions;

  • No drainage system;

  1. 9.

    Malakasa (Prefecture of Attica) – Date: 17/05/2016

Malakasa camp has a designed capacity of 1500 people and is managed by the Greek Ministry of Migration and the Greek Army in terms of infrastructure. In terms of WASH:

  • The camp is connected to the municipal water supply;

  • Containers are being used for showers and latrines – gender segregated;

  • No adequate hygiene messaging and promotion;

  • Pest control and cleaning services are provided;

  1. 10.

    Petra Olympou (Prefecture of Macedonia) – Date: 27/04/2016

Petra camp is in Pieria (30 km near Katerini) and the Hellenic Army manages it. The population of this camp is around 1000. The camp is separate in three sectors due to its anaglyph. The camp closed due to the heavy winter in the region and the lack of heating. In terms of WASH:

  • The camp water supply comes from the municipal network;

  • Hygiene promotion activities regarding environment-cleaning practices (garbage collection, food waste treatment, etc.);

  • The camp is equipped with sex segregated chemical toilets but not similarly segregated showers;

  • No drainage system is available.

  1. 11.

    Serres (Prefecture of Serres) – Date: 20/06/2016

The camp has a population of 420 people and is managed by the Ministry of Migration. In terms of WASH:

  • The camp is connected to the municipal water supply and sewage network;

  • It is equipped with chemical toilets and portable showers – gender segregated;

  • No hygiene messaging and promotion;

  • No distribution of hygiene items;

  • Very poor hygiene conditions;

  • No pest control services are provided;

  1. 12.

    Pikpa (Prefecture of North Aegean) – 07/11/2016

Pikpa camp is located in Mytilene, Lesvos Island and is managed by a self-organized group of local and international volunteers under the name of “The Village of All Together.” The camp was a former summer camp for the children for summer vacations. In terms of WASH:

  • The camp is connected to the municipal network but the sewage network is connected to septic tanks;

  • There is a building for gender segregated showers and latrines. Additionally, there are six rooms with individual bathrooms for extremely vulnerable people;

  • Desludging services are provided;

  • The cleaning and the maintenance of the camp is under the responsibilities of the volunteers;

Appendix 2

Table 6 The categorization of the indicators into classes

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Tsesmelis, D.E., Skondras, N.A., Khan, S.Y.A. et al. Water, Sanitation and Hygiene (WASH) Index: Development and Application to Measure WASH Service Levels in European Humanitarian Camps. Water Resour Manage 34, 2449–2470 (2020). https://doi.org/10.1007/s11269-020-02562-z

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  • Humanitarian sector
  • WASH assessment
  • Water, sanitation and hygiene
  • Ranking approaches
  • Refugee crisis - Greece