Left alone and behind: Experiences of living with incontinence in a Sudanese refugee camp and how WASH practitioners can support

Being able to manage incontinence with dignity is intrinsically linked to access to appropriate water, sanitation, and hygiene (WASH) services; yet it is overwhelmingly overlooked in humanitarian contexts and not consistently included in WASH interventions. A mixed-methods study (including market assessment) was conducted in two refugee camps in eastern Sudan in late 2022. Tigrayan refugees with incontinence faced extreme challenges to managing it, including no or limited access to necessary hygiene products (such as mattress protectors, toilet chairs, and soap), a lack of water for personal hygiene and washing, and long distances to communal sanitation facilities and distribution sites (or markets) where they often needed to queue or lacked privacy. Refugees with incontinence faced high levels of stigma, shame, and isolation. WASH practitioners need increased awareness of incontinence to carry out quality WASH assessments, to better understand and support people with incontinence. WASH interventions must include appropriate hygiene and non-food items (NFIs) to enable people to manage incontinence at home, and accessible toilets, water points and hygiene and washing facilities. A mixed modality of both in-kind and cash or voucher support can help to ensure hygiene and NFI items are accessible and meet the needs of people living with incontinence.