WASH for Ebola Treatment Units: Field Requirements as DRC and Uganda Face a PHEIC

On 17 May 2026, WHO declared the Ebola outbreak in the Democratic Republic of the Congo and Uganda a Public Health Emergency of International Concern — the highest alert level in international public health — after 746 suspected cases and 176 deaths were reported in DRC, with confirmed spread across the Ugandan border. The Bundibugyo strain involved has no approved vaccine and no specific treatment, which means WASH infrastructure at treatment facilities is not a supporting function — it is a frontline intervention.

WASH officers and NGO programme managers deploying to Ituri Province and northern Uganda right now face a specific, urgent problem: Ebola Treatment Units (ETUs) and Community Care Centres (CCCs) require water supply, sanitation, and decontamination systems that differ significantly from standard emergency WASH. The volumes are higher, the disinfection concentrations are stricter, and structural errors carry direct mortality risk — for patients, caregivers, and responders.

This post sets out the technical requirements, draws on WHO and peer-reviewed field evidence from previous Ebola responses, and identifies the procurement gaps that field teams need to close quickly.

Quick answers for field teams:

• ETUs require up to 400 litres of water per bed per day — more than 20 times the Sphere minimum for displaced persons

• All surfaces and materials contaminated with blood or body fluids must be treated with a 0.5% chlorine solution

• P&G Purifier of Water sachets treat turbid surface water to near-zero turbidity before chlorination, making them the correct primary product where source water quality is compromised

• Hallgruppen modular structures can be erected in under 72 hours and provide the separated high-risk/low-risk zones essential to ETU infection prevention and control

• Pre-positioned stock in Juba and Kampala means lead times for South Sudan and Uganda programmes are measured in days, not weeks

Why WASH Determines Ebola Outcomes

Ebola is transmitted through direct contact with the bodily fluids of infected persons. This means every moment a health worker spends in an ETU without a functioning handwashing station, safe water source, or chlorine solution creates transmission risk. The 2014–2016 West Africa outbreak, the largest in history, infected over 500 health workers in Sierra Leone alone, and post-outbreak analyses consistently identified inadequate infection prevention and control (IPC), including WASH failures, as a primary driver.

Peer-reviewed field assessments of ETUs in Sierra Leone documented critical WASH deficiencies including insufficient handwashing points, inconsistent chlorine preparation, inadequate waste management, and insufficient water volumes to sustain decontamination protocols. These were not supply problems alone — they were planning failures, often rooted in teams applying standard emergency WASH logic to a pathogen that requires a different operational framework.

The current DRC outbreak is occurring in Ituri Province, a humanitarian crisis zone with pre-existing displacement, insecurity, and an infrastructure deficit. Only 43% of DRC's population uses at least basic water services — the lowest rate in Africa — and basic sanitation coverage sits at 15%. Field teams cannot assume any baseline infrastructure. Every litre of safe water must be generated on-site.

Water Volume Requirements for ETUs and CCCs

The Sphere Handbook minimum for emergency water supply — 15 litres per person per day, targeting 20 litres — applies to displaced populations with basic hygiene needs. ETUs operate under completely different parameters.

International Medical Corps, drawing on field experience across multiple Ebola responses, estimates water requirements for an ETU at up to 400 litres per bed per day. This covers patient care, regular decontamination of all surfaces in the high-risk zone, personal protective equipment (PPE) doffing protocols, laundry of contaminated materials, and staff hygiene. Community Care Centres, which handle lower-acuity suspected cases, operate at lower volumes but still require continuous supply.

For a 20-bed ETU, that implies a minimum daily water requirement of 8,000 litres. A 40-bed facility would need 16,000 litres per day. Meeting these volumes in a remote, access-constrained province where water trucking may be the only supply option demands logistics planning from day one — not as an afterthought once the facility is operational.

Where water is drawn from surface sources — rivers, ponds, or unprotected boreholes — turbidity is the first problem. Chlorine disinfection loses effectiveness in water with turbidity above 5 NTU. WHO's technical notes on emergency water treatment specify that turbidity should be reduced below 5 NTU before chlorination and note that even at 20 NTU, chlorine efficacy degrades significantly. In Ituri Province and northern Uganda, field teams should assume high-turbidity sources by default.

This is where P&G Purifier of Water sachets become operationally critical. Each sachet combines ferric sulphate — a coagulant that causes suspended particles to clump and settle — with a sodium dichloro-s-triazinetrione disinfectant. The coagulation stage reduces turbidity to near-zero before disinfection begins, delivering a 10-litre batch of treated water within 30 minutes. Sachets treat 99.99999% of common waterborne bacteria, 99.99% of waterborne viruses, and 99.9% of protozoa, and they require no electricity, no specialist equipment, and minimal training.

Chlorine Concentration: ETU Standards vs Sphere Standards

Standard emergency WASH programmes maintain free residual chlorine (FRC) at 0.2–0.5 mg/L at the point of delivery, which is the Sphere Handbook threshold for cholera and general disease prevention. ETU decontamination protocols require higher concentrations for specific applications.

For surface decontamination of all areas contaminated with blood or other body fluids — including faeces and urine — the WHO standard is a 0.5% chlorine solution. This translates to 5,000 mg/L — far above drinking water thresholds. A 1% solution (10,000 mg/L) is used for soaking contaminated personal protective equipment before safe disposal.

Preparing and maintaining these solutions at scale, consistently, across 12-hour shifts in a high-stress environment, requires reliable supply of chlorine stock in appropriate forms. HTH Calcium Hypochlorite at 65–70% available chlorine is the standard bulk product for ETU decontamination — it dissolves cleanly in water, has a stable shelf life when stored correctly, and produces predictable concentrations. MSF's cholera management guidelines, which share many disinfection protocols with Ebola response, specify calcium hypochlorite as the preferred product for bulk treatment applications.

For household and community-level point-of-use treatment in high-risk zones outside the ETU — affected households, contact households, and the catchment population — Aquatabs 67mg tablets are the appropriate product. Each tablet treats 20 litres of clear water to a disinfected standard, is distributed without cold chain requirements, and can be deployed by community health workers with a brief training session. Authorised distribution by Specialized Logistics Solutions (SLS) means procurement officers can access stock directly in-region through the WASH products page.

Structural Requirements: Separated Zones and Modular Infrastructure

ETUs function on a hard zoning principle: a low-risk zone (administration, staff areas, PPE donning) and a high-risk zone (suspect and confirmed patient wards, triage, waste management). The physical barrier between these zones is not a courtesy — it is an infection control mechanism. Any ETU design that allows movement between zones without formal donning/doffing protocols, handwashing stations at transition points, and chlorine footbaths creates nosocomial transmission risk.

Most Ebola responses do not have the luxury of purpose-built permanent structures. The practical solutions are pre-engineered, rapidly erectable modular buildings. Hallgruppen modular warehouses and shelters — available through Specialized Logistics Solutions (SLS) — are designed for exactly this operational requirement: fast deployment in access-constrained environments, adaptable floor plans that can accommodate zone separation, and structural integrity across tropical conditions. They can be erected in under 72 hours with a small local labour team, without heavy machinery. This is directly relevant when the outbreak epicentre is Ituri Province and partners are racing to establish treatment capacity ahead of case acceleration.

Explore the full warehouses and shelters range for technical specifications and configurations suitable for health facility applications.

Logistics: Pre-Positioning and Lead Times

WHO's PHEIC declaration on 17 May 2026 triggered immediate partner mobilisation. In practice, the first 72 hours after PHEIC declaration determine whether the early response can contain transmission before exponential growth begins. Imperial College London's modelling estimate of the DRC outbreak size, published on 18 May 2026, underscored the risk of undercounting in a dense, movement-active province.

Procurement cycles that assume 14–21 day international shipping timelines are not compatible with this operational window. NGO teams and UN agencies deploying to DRC or Uganda need in-region stock that can move within 48–72 hours of a purchase order.

Specialized Logistics Solutions (SLS) holds pre-positioned stock of P&G Purifier of Water sachets, Aquatabs 67mg, and HTH Calcium Hypochlorite at its Juba and Kampala facilities. The UNGM vendor registration (No. 380716) means UN agencies can issue purchase orders directly against existing vendor records without additional onboarding steps. For urgent ETU supply requirements, the correct first call is to the logistics team, not a catalogue request.

Contact SLS to confirm stock availability and dispatch timelines for your programme's location.

What This Means for Your Programme

The DRC-Uganda Ebola PHEIC changes the operational calculus for any NGO or UN agency working in Central or East Africa right now. Even programmes not directly working in the Ebola response area need to review whether their WASH supply chains — chlorine stock levels, point-of-use treatment quantities, and storage infrastructure — are sufficient to support an accelerated response if cases spread to programme areas in Uganda, Kenya, or South Sudan.

For teams deploying directly to the response, the requirements outlined here — high water volumes, dual-purpose chlorine products, separated structural facilities, and point-of-use treatment for the surrounding community — should be translated into procurement orders this week, not next month.

Specialized Logistics Solutions (SLS) holds pre-positioned stock of P&G Purifier of Water sachets, Aquatabs 67mg, HTH Calcium Hypochlorite drums, and Hallgruppen modular shelters in Juba and Kampala, available for rapid dispatch. Contact the team at sales@maji-safi.org.

Frequently Asked Questions

How much water does an Ebola Treatment Unit need per day?

Field guidance from International Medical Corps estimates up to 400 litres per bed per day for an active ETU. A 20-bed facility therefore requires a minimum of 8,000 litres daily. This covers patient care, decontamination of high-risk zones, PPE doffing protocols, and staff hygiene — the volume is significantly higher than Sphere minimums for displacement settings.

What chlorine concentration is needed to decontaminate an ETU?

WHO recommends a 0.5% chlorine solution for decontaminating surfaces and materials contaminated with blood or body fluids. A 1% chlorine solution is used for soaking contaminated PPE before disposal. These concentrations are far above drinking water standards and require a separate, consistently prepared stock of calcium hypochlorite solution, distinct from the supply used for drinking water treatment.

Can P&G Purifier of Water sachets be used in an Ebola response context?

Yes. P&G Purifier of Water sachets are appropriate for treating source water for use within the ETU and for point-of-use treatment in affected households and community distribution points. Their two-stage action — coagulation followed by disinfection — makes them particularly suitable where source water is turbid, which is the default condition for surface water in Ituri Province and similar settings.

What is the difference between a Community Care Centre and an Ebola Treatment Unit for WASH planning?

An ETU is a fully equipped clinical facility for confirmed and probable cases, requiring full IPC infrastructure including separated high-risk and low-risk zones, PPE stations, decontamination corridors, and waste management systems. A Community Care Centre is a lower-acuity holding facility for suspected cases awaiting test results, with lower water volume requirements but still requiring dedicated handwashing infrastructure, chlorine solution for surface decontamination, and safe waste disposal. Both require significant WASH investment — they are not equivalent to standard health post requirements.

How quickly can modular shelter structures be deployed for an ETU?

Hallgruppen modular structures, available through Specialized Logistics Solutions (SLS), can be erected within 72 hours using a small local labour team and basic tools, without the need for heavy machinery. This deployment speed is critical in an outbreak response where every day of operational delay increases transmission risk. Pre-positioning of structures in Kampala means teams in northern Uganda can access them with minimal transport time.