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WASH
2 Jul 2025
Middle East

Conflict, Climate and Cholera

In a widespread regional outbreak of cholera, Dhruva was deployed as a Water, Sanitation and Hygiene (WASH) Specialist to support 9 countries through the World Health Organisation's Regional Hub in Amman, Jordan.

Access to safe water

As a Civil Engineer, Dhruva started his career focused on access to safe, clean drinking water and sanitation. In the humanitarian sector, this area of expertise is known as WASH (water, sanitation and hygiene).

For the past 17 years, Dhruva has travelled around the world to help communities improve their water, sanitation and hygiene. Today, he is supporting 9 countries in the Eastern Mediterranean region as a WASH Specialist at the WHO’s Regional Hub in Amman, Jordan. The priority countries include Pakistan, Afghanistan, Iraq, Yemen, Syria, Sudan, Somalia, Djibouti and Lebanon.

‘Safe water is the most important. So, you know, working in this field. I feel, sometimes, very proud when I support the community… We know that most of the diseases in developing countries are waterborne diseases. So, when they get safe water, their disease incidence reduces,’ said Dhruva.

Within the region, armed conflict and the effects of climate change have resulted in outbreaks of a waterborne disease known as cholera. Cholera is an acute diarrheal infection which is caused by contaminated food or water, often linked to poor or limited access to safe water, basic sanitation and hygiene.

Despite being preventable and treatable, the effects of diarrhea caused by poor water, sanitation and hygiene remains one of the leading causes of death for children under 5 years old, particularly in humanitarian contexts.

‘Most cholera outbreaks are happening because of conflict. The healthcare facilities and wash facilities are destroyed due to the conflict. And because of that, they’re not getting quality service and quality water supply. Climate change is also another factor, such as flooding, which causes the contamination of sources of water and you can get unwell,’ said Dhruva.

‘Sometimes, a drought is also a severe problem. In some countries, if they do not get access to water, then the people start to rely on contaminated water. The climate change, conflict, and in the context of poverty, those are prominent factors affecting the outbreak of cholera.’

'We know that most of the diseases in developing countries are waterborne diseases. So, when they get safe water, their disease incidence reduces.'

Dhruva
Water, Sanitation and Hygiene Specialist

A regional approach

A critical component of Dhruva’s work has focused on providing specialist advice to the WHO Cholera Regional Strategy, which was endorsed in May 2025. This was a significant first step in ensuring countries have a united approach in addressing the cholera outbreak.

‘The Cholera Regional Strategy was drafted, then we had a three-day workshop. In that workshop, all country teams were in that workshop virtually. The objective of that workshop was to present the strategy, gather feedback across the other country offices and then endorsement. So now, they have endorsed this regional strategy. And every country will also follow those guidelines, and they will develop their own country-based strategy on this to help reduce the burden of cholera,’ said Dhruva.

Dhruva is a Water, Sanitation and Hygiene Specialist who has dedicated the past 17 years supporting communities to access safe, clean drinking water. (Reginald Ramos/ Australia Assists)

To support the strengthening of national systems across the 9 countries, Dhruva has also advocated for the use of WASH Facility Improvement Tool (WASH FIT), which focuses on the improvement of WASH conditions within healthcare facilities.

‘This is a tool jointly developed by UNICEF and WHO. This is an assessment tool, which has a cycle of activities. First, we train people; then we do the assessment in the healthcare facility. Like, what is the current status of their water supply, sanitation, hand hygiene, healthcare waste management, environmental cleaning, energy and environment, management and workforce. There are set up questionnaires and they collect data, which you can automatically upload to a server. From there, you can analyse and identify the priority areas which we have to work on – it’s like a grading system. It gives you the information, you take action, then you do the assessment again and again – so that your score can be upgraded. It’s a continuous process actually, not one shot.’ explained Dhruva.

‘The only challenge is that the financial capacity is lacking in most of the countries. They don’t have enough funding to implement WASH FIT.  At least it can be started in a few healthcare facilities which are in cholera prioritised areas in the country. Those are the focus areas and getting that information would be helpful.’

While Dhruva recognises the limitations and challenges within the broader humanitarian sector, he hopes that his advocacy and expertise can convince people to change their perspectives on the importance of water, sanitation and hygiene.

Disclaimer: The information and views published here are the individual’s own and do not necessarily represent the partner organisation, Australia Assists or the Australian Government’s views, positions or opinions.

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