Sanitation facilities need to be disability-accessible, culturally appropriate, well-maintained (including cleaning, re-stocking of anal cleansing material and minor repairs) and close to where people live. They should provide privacy in line with user expectations and a handwashing facility in the vicinity P.2. The technology chosen should be based on a systematic assessment of the local conditions and existing sanitation practices (including anal cleansing practises and preferences for sitting or squatting) as well as of existing infrastructure that can be quickly rehabilitated.

Given the time and resource limitations during an acute response, the progression from open defecation to adequate facilities may be gradual. If acceptable to users, sanitation facilities may initially be communal or shared to rapidly provide for large numbers of people. For example, toilet blocks which include toilets accessible to persons with disabilities. A minimum of 15% of all public toilets must be disability accessible, with all other latrines built as barrier-free and as accessible as possible. Communal or shared toilets should be converted into household sanitation facilities over time, wherever possible. Household toilets are considered ideal in terms of user safety, security, convenience and dignity; they also strengthen the links between ownership and maintenance. The suggested Sphere indicator for a communal gender-segregated toilet is 50 people per toilet (during the acute phase), which must quickly be improved to a maximum of 20 people per toilet. The suggested maximum distance between a dwelling and a communal toilet is 50 metres.

The provision of sanitation facilities must allow for adequate menstrual hygiene management P.7 and safe child excreta management. It includes the provision of female-friendly facilities (e.g. clearly labelled, lockable doors, good lighting, provision of disposal bins and washing facilities inside the cabin), separate safe containment options for children’s and babies’ faeces or the provision of hygiene items such as disposable or reusable sanitary pads, nappies or potties. Facilities also need to ensure children’s safety and acceptable use (e.g. smaller holes to protect children from falling into pits). Sanitation facilities need to be designed and sited, in close consultation with all at-risk groups, to reduce safety and security threats to users (particularly women and girls).

Special consideration should be given to the culturally appropriate design and implementation of the facilities, particularly if people from different cultural, ethnic and/or religious groups are living together. Sanitation is culture and people always have the choice whether to use a toilet facility or not. They may not use it if it is considered inappropriate, is not convenient or does not correspond to the user’s customs and habits. A culturally appropriate design considers an appropriate user interface (for sitters or squatters), anal cleansing materials that users find acceptable (e.g. toilet paper, water, sticks or stones), the willingness of different cultural groups to use the same latrines, the existing taboos related to toilet use, handling of waste or potential reuse options as well as local preferences and practices for managing menstruation and disposing of menstrual products. Cultural beliefs and norms may also affect the siting (people may not want to be seen visiting the toilet) and the orientation of facilities (e.g. religious rules that the toilet should face away from the prayer point). It may also limit technology choices e.g. urinals in Muslim societies may not be an option. Cultural issues can be manifold and must be addressed during the Assessment (chapter  A ) to understand and respond adequately to people’s needs, habits and practices.

Safely managed sanitation goes beyond initial onsite excreta containment and provision of toilets. It also considers effective faecal sludge management and the entire sanitation service chain. It needs to be aligned with local systems and authorities responsible for excreta management and to follow national standards if existing. The ‘Compendium of Sanitation Technologies in Emergencies’ provides a structured overview and in-depth information on all relevant technologies and their applicability. The exact combination of technologies depends on various parameters such as the local context, response phase, available resources, skills and materials, costs, intended resource recovery/reuse or the longer-term operation and maintenance (O&M) requirements. It may also involve market-based approaches P.8 such as engaging local desludging service providers, training local manufacturers, sanitation marketing to create demand for sanitation services F.21 or involving the community in cash for work programmes.