Cultural responses to water shortage among Palestinians in Jordan: The water crisis and its impact on child health

Human Organization, Fall 1998 by Arar, Nedal Hamdi

Jordan is facing a serious problem with regard to its water supply. This problem has implications for the distribution of childhood diarrhea. Previous anthropological studies have related diarrheal illnesses to both water quality and quantity. This project has applied an integrative biocultural model to the study of the cultural responses to the water crisis among Palestinians living in two urban sites in Amman-Jordan. This study was carried out over a one-year period. Research phases included: an ethnographic phase, baseline censuses, morbidity surveys, and collection of water samples for microbial analysis. Participant observation and structured and semi-structured interviews in households provided information about the different cultural and environmental factors that influenced the distribution of diarrhea. These factors covered: mothers' age, educational levels, parity, income, household structure, breastfeeding and gender ideology. The biological factor was investigated by analyzing water specimens taken during family visits. Morbidity data indicated that the occurrence of diarrhea among children under five in Hassan site was two and a half times as great as that in Mahatta. In both sites, females infants accounted for the highest number of diarrheal cases. Income, mother's age, and education showed no significant impact on the spread of diarrhea, while lack of water, parity, breastfeeding, and household structure were significantly associated with the occurrence of diarrhea.

Key words: diarrhea, biocultural approach, medical anthropology, water, Palestinians; Jordan

Jordan is facing an ever greater water crisis. Its population has grown to more than 4 million and has been swollen by the arrival of many Palestinians who were forced to leave Kuwait after the Gulf war in 1991 (Zoubi et 1992). The total amount of water production for 1990 in Jordan was 880 million cubic meter, and the per capita share was 255 cubic meter per annum. This can be compared with 10,230 cubic meter per capita per annum in the United States. It is worth noting that the World Resources Institute considers a country to be short of water if its per capita share of water falls below 1000 cubic meter per annum (The Hashemite Kingdom of Jordan 1992).

Palestinians living in low-income squatter areas have less access to water. The average per capita daily supply of water is just 8.96 liters, less than the average of 24 liters for all the Palestinians in the region, and far below the national Jordanian average of 90-110 liters (UNICEF 1992).

Mosley (1984) has argued that water quality and quantity are both important factors in child survival. The most practical means of assessing the relative intensity of water contamination is to measure the incidence of a group of acute and chronic infectious diseases of known water origin in a cohort of children under study. For example, frequency of diarrheal diseases is the best measure for water contamination.

Childhood diarrhea remains a major concern worldwide (De Zoysa 1985; Bentley 1988; Mull 1990; Malik et al 1992; Smith et aL 1993). In developing countries diarrheal dehydration is a leading cause of death among children under five; estimates by the UNICEF (1995) have shown that three million deaths among under-five children were caused by diarrheal dehydration each year.

This study examined how the conditions of an insufficient and contaminated water supply affect the health status of Palestinian children living in Amman-Jordan. Also, it analyzed cultural responses to the water crisis at two different urban sites, Hassan and Mahatta. Residents in these two sites are composed of the same ethnic group. However, people in Mahatta have a higher standard of living compared to those in the Hassan camp. Additionally, people in both sites differ in many other characteristics that can affect child health. These include household structure, fathers' occupation, and water facilities.

Factors Affecting the Spread of Diarrhea

ENVIRONMENTAL FACTORS

The use of untreated, or inadequately disinfected water is responsible for waterborne outbreaks. Hamdan et al. (1989) have studied the prevalence and seasonal fluctuations of intestinal parasitic infections in the Nablus area, West Bank of Jordan. They suggested pathogens that cause diarrhea are passed through the fecal/oral route, and sources of contamination include cooking and eating utensils, food, and water.

The impact of developmental, behavioral, and environmental risk factors on childhood diarrhea has been the emphasis of recent research. For example, Zeitlin et al. (1995) have suggested that educational intervention is important to alter water-sanitation behaviors in order to reduce childhood diarrhea in rural Bangladesh. Similarly, the present research studied cultural responses to the water crisis, and examined people's management of their drinking water.

CULTURAL FACTORS

The impact of household structure on child health has been studied by many researchers. For example, Deeb (1987) investigated the effect of social and physical change in household structure on childhood mortality and morbidity in low-income areas in Jordan. She found that the presence of resource woman (such as mother-in-law) had a negative impact on child health. Doan and Bishara (1990) argued that in the context of the Arab Middle East, a woman's structural position within the household is a good indicator of her relative autonomy.