In the French department of Mayotte, certain groups are threatened by waterborne diseases caused by shortcomings in the water management and sanitation systems. Research by Aude Sturma, a doctor in sociology, aims to improve the capacity of the population and of health workers to respond to this risk.

Can you shed some light on the particular context of Mayotte?

Aude Sturma: Mayotte is a French department, located on the Mozambique Channel to the west of Madagascar, very far from mainland France. This little island is theoretically subject to the same regulations as the rest of the country. Nevertheless, the Mahoran context is very different. More than 80% of the population lives under the poverty line, 29% of households do not have access to running water, and 60% of housing has no toilets. The island’s backwardness in matters of water management and sanitation policies have put the population in a vulnerable situation with regard to diarrhoeal diseases such as typhoid fever, and also to other diseases such as malaria and leptospirosis. Access to drinking water for all as a fundamental human right, as recognised by the UN, is not inscribed in French law as such. In this period of crisis, with Covid-19, we can clearly see the difficulties in applying the instructions and norms imagined in Paris to the local context. Without running water, it is difficult to respect lockdown or adopt preventive behaviours.

Drinking fountains were installed a few years ago, and the ARS (Regional Health Agency) is continuing to install them in collaboration with community elected officials, but there are not enough of them to meet the needs of vulnerable groups. The repressive treatment of ghetto residents under normal circumstances also has a counterproductive effect. The border police have been known to carry out identity checks in front of these fountains, compromising the action of associations who are precisely aiming to raise awareness about the health risk. Mass immigration from neighbouring Comoros further adds to the complexity of the situation. According to Insee, four out of ten adults in Mayotte are foreigners, and half are in an irregular situation in the country and therefore effectively exist under the radar of regulation and public policy. 

What can be done to improve users’ capacities to deal with the epidemic risk linked to water pollution?

AS: My research is based on a concrete case: the Kierson neighbourhood in the commune of Koungou, where the ARS and Santé Publique France had noticed recurring outbreaks of typhoid fever. My first aim was to gather data, both on the material conditions of access to water and on inhabitants’ practices and representations linked to water and health risks. I wanted to make these vulnerable populations visible and to report on the logics and strategies they referred to in relation to their management of water. This was to enable a better targeting of audiences in order to adapt prevention and awareness-raising messages. The first interviews and focus groups revealed a certain reactivity on behalf of the residents, who easily mobilised to answer questions about water and health. Globally speaking, they know the basic rules of hygiene – boil water, wash your hands – but they do not apply them. For perfectly rational reasons: when it takes 20 minutes to go and fetch two containers of water, washing your hands can be seen as a waste. In the same way, gas is generally saved for cooking needs. The awareness of health risks is also quite good, but the management of these risks is not a priority compared to other daily concerns: meeting the family’s basic needs, dealing with insecurity or the risk of “décasage”[1]… It would also appear that diarrhoea has become an ordinary risk: one gets used to the disease.

Secondly, with a view to raising awareness, the study aims to identify the community intermediaries who could serve to relay prevention messages. Nevertheless, this aim appears to be tenuous in view of the situation. The community organised around the water resource remains limited to a common usage. It is a community which does not always experience itself as such, made up in part of illegal immigrants in extremely precarious situations.

Your study also reveals the institutional bottlenecks that hinder more efficient water management. Can you tell us more?

AS: Health sector stakeholders – elected officials, associations, the ARS – sometimes have diverging preoccupations or constraints which prevent solutions from emerging. Installing a drinking fountain is a perilous decision for local elected officials. Beyond the logistical challenge (creation of a road suitable for motor vehicles, water networks, land pressure), this kind of installation meets with opposition from certain residents who see it as a pull factor for illegal immigrants.

Conversely, the ARS has difficulty in applying the norms from mainland France to the local context. Hence, certain proposals by NGOs and associations, like filtering water or collecting rainwater, come up against the local judicial and health frameworks. In this regard, the Covid-19 epidemic has served as an accelerator to overcome the reluctance of certain parties and install water bars in a matter of weeks.

How can your research have a concrete impact on the work of practitioners in the field?

AS: First of all, my role as a researcher is to make the needs and perceptions of the populations visible, so that they are not overlooked by health workers. But there might also be a need to formalise and reinforce very concrete projects carried by field practitioners, by means of the scientific approach. For example, with a designer, ARS agents and other researchers, we are working on a socio-technical project to improve handwashing practices. The system, made of a robust, recycled water container, which can be suspended, and a pedal, enables the user to control a thin stream of water. This kind of mechanism has already been tested and implemented in Mayotte, namely at the water fountains. The idea here is to test its implementation at home, and to study the conditions of its appropriation, with a view to standardising it and making it widely available thanks to the joint action of institutional and associative stakeholders. A simple mechanism, but one that truly responds to local needs.

In reality, in the context of a research-action, the separation between research and action is not so clear. The researcher acts upon their object of study. For example, during the focus groups with the populations, I am led to answer their questions, thereby informing them (on matters of health and risk). When I organise meetings with stakeholders in water management and health risks, I try to create an institutional dynamic, to raise awareness and to get them talking. There again, this is a way of acting directly to ease the bottlenecks. My aim is also to make the scientific results intelligible so that decision-makers can use them.

Finally, although the study is focused on one neighbourhood in Mayotte, the observations can easily be extended beyond the borders of the island. Very similar questions are being asked in mainland France, and namely in Lille and Toulouse where I am hoping to continue my research in migrant camps, and the solutions from Mayotte could well be experimented with there.

[1] Décasage is a punitive expedition organised by Mahorans against the illegal constructions inhabited by illegal immigrants from Comoros.

Photo du haut : @IFRC/Moustapha Diallo