Access to Sanitation

Naomi Long Excerpts

Monday 26th November 2012 Commons Chamber

[Naomi Long (Belfast East) (Alliance)]

Each year, 19 November marks world toilet day. While that might, at first hearing, sound rather comical, the issue it seeks to highlight is extremely serious—that of the continued lack of access to basic sanitation for about one third of the world’s population—and it was to mark that event and highlight again this important issue in Parliament that I sought this debate.

I acknowledge the work that the Government have been doing as part of the UK’s overall international development agenda, and I will refer to that further later, but water and sanitation still suffers from a lack of overall priority in political and investment terms, both nationally and internationally, compared with other aid portfolios, such as health and education, despite the fact that it impacts heavily on the achievement of other development objectives. The former Secretary-General of the United Nations, Kofi Annan, has noted that

“no other issue suffers such disparity between its human importance and its political priority.”

Clearly, without access to water, sanitation and hygiene, the progress that can be achieved in other areas is significantly constrained. The importance of access to clean water and sanitation cannot be understated. In the UK, the biggest step change in public health and mortality rates came as a result not of medical advances but of widened access to clean drinking water and adequate sanitation. During the late 19th century, as both water and sewerage infrastructure expanded dramatically, the life expectancy of an average member of the population in this country rose by 15 years—a remarkable increase delivered over a relatively short period. Indeed, the British Medical Association has recognised the commissioning of the sewerage system in London as the most important breakthrough in public health—of more significance even than the discovery of penicillin or the development of vaccines.

As a direct result of poor or non-existent sanitation infrastructure, people—the majority of them children—are dying of diseases that, with the provision of potable water and sustainable sanitation, are preventable. In fact, they could be almost entirely eliminated. By way of illustration, I point to the fact that the biggest killer of children under five in sub-Saharan Africa, and the second-biggest killer globally, are diarrhoeal diseases, the vast majority of which are entirely preventable conditions caused by inadequate sanitation and hygiene. More children under five die annually as a result of these diseases than from HIV/AIDS, malaria and measles combined. Indeed, the disease burden of malaria itself is also impacted on by the availability of open drainage channels and sewers, providing environments conducive to the breeding of mosquitoes that spread the disease.

Every day 2,000 mothers lose a child due to an illness caused solely by poor sanitation and dirty water. Even vaccines that hold out the hope of progress are less effective in the absence of water, sanitation and hygiene—WASH. But the impact of inadequate sanitation infrastructure is not limited to disease; it extends to the one in three women worldwide who risk shame, harassment and even physical attack simply seeking somewhere to defecate. This debate is timely, then, not only in the context of world toilet day but because yesterday marked the international day for the elimination of violence against women.

I want to draw on the everyday ordeal that the lack of access to sanitation is for people, especially women, who are the most acutely affected. Globally, 2.6 billion people lack access to basic sanitation, 1.25 billion of them women—one in three women in the world lack access to safe sanitation. Put simply, privacy, modesty, cleanliness and safety are almost impossible for those who have no access to sanitation facilities. Their experience often involves trading those factors against each other simply to survive. The reality is often shame, indignity, disease and even violence.

Some 526 million girls and women are without access to any form of sanitation. They are forced to defecate in bushes or ditches, or even in the open, their choice being between doing so in broad daylight, compromising their modesty and risking shame, or waiting until dark to cling to their dignity but risk their personal safety. A 2005 UN development programme report confirmed that the need to travel further from home to secure the family’s water can expose women and girls to sexual harassment and rape, which can also happen when women who lack safe nearby sanitation move about at night in search of privacy. It is estimated that women and girls in developing countries spend 97 billion hours each year searching for a place to go to the toilet—more than double the total hours worked every year by the entire UK labour force. An 18-year-old mother from Mozambique has described her arduous journey each day to defecate in the bush. Her ordeal involves crossing a dangerous bridge that has claimed the lives of many people who have fallen through it. Sometimes she feels so ashamed that she returns home without being able to reach the point she needs to reach, or she waits until dark to go, so that no one will see her. However, at night the journey is even more dangerous. A woman and a boy have been stabbed to death on that bridge, and one woman she knows of has been raped on the journey.

Even where public latrines are available, provision is rarely adequate. In the Kifumbira slum in Kampala, there are only four toilets for every 2,000 people, these consisting merely of holes into a cesspit, covered in faeces and maggots. Women worldwide have reported incidents of men hiding in public latrines at night, waiting to rob or assault those who enter them. In two slum districts in India, women reported incidents of girls under 10 being raped while on their way to use public toilets. In work carried out by WaterAid in Bhopal in India, 94% of the women interviewed said they had faced violence or harassment when going in search of a toilet, and more than a third had been physically assaulted. Amnesty International has also reported that women and girls in the slums of Nairobi were staying away from communal toilet facilities at night because of their fear of physical violence and rape. A WaterAid poll of women in Lagos in Nigeria revealed that 67% of women interviewed said they did not feel safe using a shared or community toilet in a public place.

The only alternative for those women—if it could be called that—is to defecate at home. However, that too carries huge health risks and social consequences. One woman living in Kampala in Uganda has said that

“when someone knows you defecate in your house, your household is hated and people”

will not visit. In addition to the stigma attached to this choice, resorting to so-called “flying toilets”—plastic bags or buckets used at home—carries significant health risks, not only for the woman but for her family, as storing and disposing of waste and maintaining even basic hygiene is almost impossible. Women are more susceptible to urinary tract infections and dehydration by trying to limit going to the bathroom for long periods and drinking less water over the course of the day, and as a result are more likely to become seriously ill.

Further, as women are generally responsible for the disposal of human waste when provision is inadequate and for caring for others in the family who are affected by communicable hygiene-related diseases, they are more exposed to diseases such as dysentery and cholera than their male counterparts. This caring role and enhanced risk of contracting disease significantly restricts the degree to which women can be economically active and financially independent, and provide for the most basic needs of their family. That compounds the effect that a lack of provision of proper and private sanitation facilities has on girls’ ability to access education, particularly as they reach puberty.

Having outlined the problem, I want to turn my attention in the time remaining to the progress being made towards achieving millennium development goal 7, target 10—halving the proportion of people without sustainable access to safe drinking water and improved sanitation by 2015. Although we have met the target of halving the proportion of people without access to improved sources of water, the sanitation target is significantly off track. At the current rate of progress, it will be over 25 years before south Asia meets its sanitation MDG target and 70 years to achieve universal access. Even more starkly, it will be the 23rd century before sub-Saharan Africa meets its sanitation MDG target and 350 years before universal access is achieved. The failure to meet the water and sanitation target threatens the progress of many other millennium development goals and undermines wider development efforts. Without water and sanitation, nothing else really works.

I welcomed the UK Government’s commitment in April 2012 to double, to 60 million, the number of people whom they plan to reach with water, sanitation and hygiene promotion by 2015. I remain concerned, however, at the lack of clarity as to how the Government intend to ensure that that commitment will effectively target the areas and the people in the greatest need and as to how DFID will effect delivery on this scale through DFID’s current WASH budget.

Good governance and stewardship of international assistance by foreign Governments also remains a challenge to the effective implementation of the Government’s plans—a matter to which I am sensitive. For example, the freezing of international assistance to Uganda due to the risk of corruption will mean that people living in the slums of Kampala who have benefited from DFID projects will see no further improvement in their circumstances in the short term. Urgent consideration must therefore be given to how the most needy can be targeted on the ground, even in the most volatile and unstable regions, and to how this increased commitment can be accompanied by an increased number of advisers dedicated to WASH, in order to maximise the impact and value for money of WASH sector support. I believe that the UK should take the lead on this issue, encouraging multilateral partners—particularly the World Bank, the European Community and the African Development Bank—to increase investment and better to target WASH investments.

I believe that this is the time to give consideration to how the current trends will be addressed after the millennium development goals have expired in 2015. If present trends continue, 2.4 billion people will still lack access to safe sanitation facilities in 2015, so it is imperative to construct a post-2015 goal framework to include a commitment to universal access to basic water and sanitation services, including a specific target date of 2030. I also believe that post-2015 goals should better reflect the central importance of WASH to human health, education, welfare, economic productivity and gender equality, as well as reflecting the interdependence of those goals. Water, sanitation and hygiene targets and indicators must focus explicitly on reducing inequalities by targeting resources at poor and disadvantaged groups as a top priority.

The United Nations human development report estimates that for every £1 invested in this sector, £8 is returned in saved time, increased productivity and reduced health costs. It is therefore a wise investment as well as a necessary one, and its impact can be multiplied if the Government also collaborate with non-governmental organisations and charities, as well as with Governments, who can assist in providing education to local communities through church and community networks and supporting increased capacity among state and non-state players.

I therefore urge the Department for International Development to outline how it will achieve its commitment to improve WASH for 60 million people in its budget, how it will ensure that the neediest can be prioritised, even in volatile and difficult countries, and how it will take the lead in framing the goals for the post-2015 agenda and ensure that a goal for universal access to basic water and sanitation services remains a key priority.