Assessment of water, sanitation, and hygiene service accessibility, utilization, and associated factors among refugees in Nguenyiel refugee camp, Gambella, Ethiopia

Abstract

ABSTRACT Access to safe water, sanitation, and hygiene (WASH) is a fundamental human right and a critical public health challenge in refugee camps like Nguenyiel. This community-based cross-sectional study of 398 households assessed WASH service utilization in Nguenyiel Refugee Camp from March to April 2024. While 74.9% of respondents reported nominal access to at least one WASH service, only 25.1% had access to both functional water points and latrines. The study revealed stark inequalities and critical utilization gaps: 79.9% of households lacked hand-washing stations, and only 2.5% consistently used soap after toilet visits. Multivariate analysis identified significant demographic disparities, with females 48% less likely to have adequate WASH access than males (Adjusted odds ratio 0.518, p = 0.035). Water collection burdens fell exclusively on women (62.8%) and girls (37.2%), exposing them to gender-based violence risks and lost opportunities. Additionally, 92.7% of households experienced weekly water scarcity. Factors such as marital status, disease awareness, and the availability of hand-washing areas significantly predicted service accessibility. Targeted interventions must prioritize gender-equitable infrastructure and behavioral shifts to move beyond nominal access toward safe, reliable WASH utilization.