WASH Logistics for Ebola Treatment Units: Chlorine, Water Storage, and Supply Planning in the DRC and Uganda Outbreak

When the World Health Organization declared the Bundibugyo Ebola outbreak in the Democratic Republic of Congo and Uganda a Public Health Emergency of International Concern on 17 May 2026, procurement teams and WASH officers across the region faced an immediate question: how much chlorine, water storage capacity, and consumable stock does a functioning Ebola Treatment Unit actually require?

The outbreak, centred in the Mongwalu, Rampart, and Bunia health zones of Ituri Province in eastern DRC, had reached 598 suspected cases and 139 suspected deaths within days of the PHEIC declaration, including 66 laboratory-confirmed cases. Cross-border spread to Uganda has been confirmed, triggering a high-level ministerial coordination meeting and activating WASH surge responses from UNICEF, IOM, and national health authorities. For NGO WASH officers and procurement managers now sourcing supplies for treatment unit operations, the gap between field need and available stock in Juba, Kampala, and Nairobi is the operational problem that requires urgent attention.

The Bundibugyo virus strain adds complexity to the supply picture. Unlike the more familiar Zaire Ebola strain, no approved vaccine exists for Bundibugyo, making environmental decontamination — the WASH function — even more central to outbreak containment. Every confirmed or suspected case requires high-volume chlorine use, protected water supply, and bladder or tank infrastructure sufficient to sustain multi-shift operations in conditions where the local supply chain cannot be relied upon.

Quick answers for field teams

• WHO and UNICEF recommend 0.5% chlorine solution (5,000 mg/L) for all surface and equipment disinfection in an ETU, and 0.05% (500 mg/L) for handwashing and skin contact.

• Empirical data from International Medical Corps ETUs in Sierra Leone recorded a median daily high-concentration (0.5%) chlorine consumption of 2,490 litres — equivalent to 133 litres per admitted patient per day.

• A minimum 30-minute contact time is required for chlorine solutions to effectively inactivate Ebola virus on contaminated surfaces.

• Calcium hypochlorite (HTH) is the field-standard chlorine source for making both concentrations on site; stable at high pH (10–11), it is logistically easier to store and transport than liquid sodium hypochlorite.

• Water bladders and collapsible tanks are the standard infrastructure solution for ETU water storage where fixed supply is absent or compromised.

Why WASH Infrastructure Is the Non-Negotiable First Line of Defence

Ebola virus disease transmits through direct contact with the blood and bodily fluids of infectious patients. As patients progress through the disease course, viral load increases, making the immediate environment of an ETU — patient beds, latrines, laundry, floors, and PPE — progressively more contaminated. The WASH function in an ETU is therefore not supplementary to clinical care: it is the mechanism that prevents nosocomial infection among healthcare workers and contains transmission within the facility boundary.

WHO's 2025 IPC and WASH Rapid Assessment Tool for health facilities during Ebola or Marburg outbreaks sets out the minimum requirements for any inpatient facility identified as high-risk for suspected or confirmed cases. Facilities must be able to demonstrate continuous safe water supply in both the high-risk and low-risk zones, functional chlorine mixing and dosing capacity, appropriate PPE laundering and disinfection infrastructure, and a waste management system that segregates and safely disposes of contaminated material. Gaps in any of these areas create transmission pathways that undermine clinical containment.

The physical design of an ETU — with a clearly demarcated high-risk zone for confirmed and suspected patients and a low-risk zone for staff support activities — defines the WASH workflow. Chlorine solutions must be prepared, tested, and distributed separately for the two zones. Staff donning and doffing PPE in the low-risk zone require access to 0.05% chlorine handwash stations. The high-risk zone requires 0.5% solutions available at every cleaning point, disinfection sprayer station, and patient exit. This is not a single mixing exercise: it is a continuous daily production operation.

Chlorine Quantities: What the Empirical Data Tells Procurement Teams

The most rigorous published data on ETU chlorine consumption comes from a retrospective study of two International Medical Corps facilities in Sierra Leone operating between December 2014 and December 2015, covering 369 days of WASH/IPC activity records (Mallow et al., PLoS ONE, 2018).

The numbers are larger than most procurement assumptions. Across both ETUs, the median daily high-concentration (0.5%) chlorine solution consumption was 2,490 litres. In linear regression analysis, 133 litres of 0.5% chlorine was used per admitted patient per day, while each high-risk zone staff entry corresponded to an average of 67 additional litres. Low-concentration (0.05%) chlorine usage ran at a median of 2,000 litres per day for handwashing, skin decontamination, laundry, and kitchen activities in both zones.

These figures have direct procurement implications. At 133 litres of 0.5% solution per patient per day, a 30-bed ETU running at 50% occupancy will consume approximately 2,000 litres of high-concentration chlorine solution daily — every day the facility operates. Multiply that across a four-week activation period and the chlorine feedstock requirement becomes substantial. Calcium hypochlorite powder (HTH, typically 65–70% available chlorine) is the standard source for making these solutions on site. Precise dilution ratios from the HTH feedstock depend on the product's active chlorine percentage, which must be verified at point of use.

The Sierra Leone data also underscores an often-missed procurement point: high-concentration chlorine usage is correlated more strongly with high-risk zone staff entries than with patient occupancy. A well-staffed ETU decontaminates more aggressively and goes through more stock even before patient numbers peak. Procurement planning based on patient projections alone will consistently underestimate actual consumption.

Water Storage: Bladders, Tanks, and Supply Continuity

An ETU requires continuous, reliable water across multiple use points simultaneously: chlorine solution mixing, patient care, staff bathing and handwashing, PPE laundering, and low-risk zone kitchen and sanitation activities. Where municipal or borehole supply is unavailable, compromised, or cannot be guaranteed under emergency conditions, collapsible water bladders and rigid storage tanks are the primary infrastructure solution.

Field experience from multiple ETU deployments confirms that collapsible pillow tanks and frame-supported bladders from manufacturers such as Butyl Products (UK) provide the most deployable solution for rapid-onset operations. These units can be positioned close to the high-risk zone perimeter, filled by tanker or pump, and connected to gravity-fed distribution networks that supply chlorine mixing stations and tap points. Bladder capacity selection depends on daily water demand, refill frequency, and the operational tempo of the ETU.

For WASH procurement managers currently scoping supply for Ituri Province or cross-border response points in Uganda, the following considerations apply. First, the water supply serving the chlorine mixing point must be calculated separately from the water supply serving patient care areas — the volumes and schedules differ. Second, collapsible tanks must be positioned on stable, levelled ground away from high-risk zone contamination pathways. Third, spare bladder repair kits and pump fittings should be included in the initial procurement because damaged sprayers are a daily operational reality: the Sierra Leone data recorded a median of two sprayers requiring repair each day.

The pumps and equipment range available through Specialized Logistics Solutions (SLS) includes Aussie Pumps dewatering units and Multiquip pump sets that can transfer water from tanker to bladder storage or from borehole source to distribution point under field conditions. These units are compatible with the flow rates required to fill large-capacity bladder tanks within acceptable operational time windows.

PPE Laundering and Decontamination: The Underplanned WASH Load

One operational reality that catches ETU planners short is the volume of PPE laundering and disinfection that a functioning treatment unit generates every day. The Sierra Leone data recorded a median of 126 scrubs laundered daily, 200 pairs of boots, 59 aprons, and 52 pairs of heavy-duty gloves — alongside approximately 37 pairs of goggles requiring disinfection. This laundry demand requires a dedicated infrastructure within the low-risk zone: laundry basins or machines, continuous hot or chlorinated water supply, drying space, and storage for clean items.

Low-concentration chlorine solution — prepared from the same HTH feedstock used for high-risk zone operations — is the disinfectant used for boot washing, goggle disinfection, and the rinse step in PPE laundering. Aquatabs 67mg can supplement field chlorination requirements for point-of-use water treatment at staff rest and hydration stations, where the priority is providing safe drinking water to personnel who are physically stressed by full PPE use in tropical temperatures.

WHO guidance is explicit that the contact time for chlorine solutions to effectively inactivate Ebola virus is a minimum of 30 minutes (WHO/UNICEF EVD WASH Q&A, updated July 2021). This means laundry and decontamination cycles cannot be shortened under operational pressure. Adequate water volume and chlorine stock must be available to sustain the full cycle without compromise.

WASH officers procuring for ETU operations can access the full WASH products catalogue from Specialized Logistics Solutions (SLS), which holds pre-positioned stock of HTH Calcium Hypochlorite drums and Aquatabs 67mg in Juba and Kampala.

Modular Warehousing and Supply Chain Infrastructure for ETU Support

A functioning ETU generates and consumes large quantities of consumable supplies: chlorine feedstock, PPE, waste bags, disinfection sprayers, spare parts for water distribution equipment, and personal hygiene items for patients and staff. Managing this supply requires adequate covered storage close to the facility perimeter, with separate areas for clean supplies and used or contaminated materials awaiting disposal.

In outbreak-response contexts, modular warehouses from manufacturers such as Hallgruppen (distributed by Specialized Logistics Solutions) provide deployable covered storage that can be erected on unprepared ground within days. These structures are designed for exactly the environmental and logistical conditions present in Ituri Province and cross-border zones in Uganda: high humidity, challenging access, and the need for rapid erection without heavy plant or specialist construction teams. A correctly sized modular storage unit adjacent to the ETU low-risk zone keeps WASH consumables dry, organised, and accessible without the logistical burden of daily restocking runs from a distant warehouse. The full warehouses and shelters range includes specifications suited to both short-deployment and longer-term operational timelines.

The wider supply chain picture for the DRC/Uganda outbreak response reinforces the value of pre-positioned stock. With 598 suspected cases reported within the first weeks of the outbreak, demand for WASH consumables in Ituri Province and Ugandan border districts is rising faster than regional supply chains can respond from zero. Organisations that have not yet placed procurement orders for chlorine, water storage, and ETU WASH supplies face lead times that will not align with the operational tempo of the current outbreak.

What This Means for Your Programme

The DRC/Uganda Bundibugyo outbreak is an active, declared PHEIC with confirmed cross-border spread and no approved vaccine. WASH infrastructure — chlorine supply, water storage, PPE decontamination capacity, and covered supply storage — is the operational backbone of any ETU response. Procurement planning must account for empirically validated consumption figures, not minimum estimates: at 133 litres of 0.5% chlorine per patient per day, a 20-bed ETU running for 30 days requires over 80,000 litres of high-concentration solution before accounting for staff decontamination needs.

Specialized Logistics Solutions (SLS) holds pre-positioned stock of HTH Calcium Hypochlorite drums, Aquatabs 67mg, Butyl Products water bladders and tanks, and Multiquip pump sets in Juba and Kampala, available for rapid dispatch. Contact the team at sales@maji-safi.org.

Frequently Asked Questions

What chlorine concentration is required for surface disinfection in an Ebola Treatment Unit?

WHO and UNICEF recommend 0.5% chlorine solution (equivalent to 5,000 mg/L) for disinfecting all non-living surfaces, equipment, PPE, and patient environment areas within an ETU. This concentration applies to floors, patient beds, latrines, and any surface in the high-risk zone that may be contaminated with bodily fluids. A minimum contact time of 30 minutes is required before surfaces are considered safe.

How much chlorine does an Ebola Treatment Unit use per day?

Empirical data from two ETUs in Sierra Leone, published in PLoS ONE by Mallow et al. (2018), recorded a median daily high-concentration (0.5%) chlorine consumption of 2,490 litres. Linear regression analysis found approximately 133 litres of 0.5% solution was used per admitted patient per day. Low-concentration (0.05%) chlorine for handwashing and skin contact ran at a median of 2,000 litres per day.

Can calcium hypochlorite (HTH) be used to prepare Ebola decontamination solutions on site?

Yes. Calcium hypochlorite powder — typically sold as HTH or pool-grade granular chlorine at 65–70% available chlorine — is the standard feedstock for preparing both 0.5% and 0.05% chlorine solutions in ETU field settings. It is more stable for transport and storage than liquid sodium hypochlorite and can be mixed with water on site to the required concentration. Solutions should be tested daily using a chlorine test kit to verify concentration before use.

What water storage infrastructure is recommended for a field-deployed Ebola Treatment Unit?

Collapsible pillow bladders and frame-supported flexible tanks are the standard deployable solution where fixed water supply is absent or unreliable. These units can be filled by tanker or pump, positioned close to the facility perimeter, and connected to gravity-fed tap and mixing point distribution. Capacity selection should account for total daily water demand across all ETU functions: chlorine solution preparation, patient care, staff PPE decontamination, laundry, and sanitation.

How should chlorine solution shelf life be managed in an ETU setting?

Chlorine solutions degrade over time, with the rate of degradation accelerating at higher temperatures and lower pH. WHO guidance notes that hypochlorite solutions should be tested daily in ETU settings to verify concentration. Calcium hypochlorite (HTH) solutions at high pH (10–11) are more stable than NaDCC solutions but should still be prepared fresh for each shift where possible. Stockpiling pre-mixed solutions is not recommended; stockpile the dry HTH feedstock and mix as required.