At every stage of the sapphire rush—from the initial influx during the rush period to the quiet abandoned sites, women and their children are present: many are in the water sieving and washing gravel, others are providing services and, in some cases, selling the smaller stones. In south-west Madagascar most sapphires are recovered from alluvial gravel deposits in ancient river beds. Sapphires are found in remote areas without infrastructure. There are few wells and women and children are forced to drink from the river; they cannot boil the water but try to drink the clear water from the top not the red muddy water below. Infrastructure for water and sanitation is almost non-existent and the intensity of the mining activity is impacting streams and river and community health. The gem bearing gravel is transported—either by hand or in a cart or truck from the mine to a source of water, usually the river where the gravel is sieved.