Why we should all give a s**t about sanitation

14219545019_633d253233_mTwo teenage girls were found hanging from a mango tree outside an Indian village last week. They had been gang-raped after going out to the fields to defecate because their home lacked a toilet.

Such attacks are not uncommon. According to the Times of India, police in one district of Uttar Pradesh reckon 95% of rape and molestation cases take place when women and girls leave their homes to “answer a call of nature”.

Around the world there are more than 2.5bn people who lack any form of sanitation and have to go outdoors to openly defecate. This is more than an affront to human dignity; it’s a health hazard that has deadly consequences far beyond the rapacious behavior of sexually inadequate men.

One in 10 of the world’s illnesses can be traced to fecal-contaminated water, according to Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters.

For children the consequences are horrendous. Diarrhea kills more of them than AIDS, TB or malaria – one every 15 seconds. In the decade leading up to 2008, diarrhea deaths exceeded the total number of people killed by armed conflict since the Second World War. Simply put:

Food and water tainted with fecal matter results in 1.5 million child deaths every year. Most of these deaths could be prevented with the introduction of proper sanitation, along with safe drinking water and improved hygiene – Bill and Melinda Gates Foundation

Since George’s book was published in 2008, the Gates Foundation has put considerable financial weight behind reinvention of the toilet, challenging researchers and scientists to come up with ways of managing human waste and it’s a much harder challenge than you might think.

The requirements stipulated that the toilet had to:

  • Remove germs and recover valuable resources such as energy, clean water, and nutrients.
  • Operate “off the grid” without connections to water, sewer, or electrical lines.
  • Cost less than US$.05 cents per user per day.
  • Promote sustainable and financially profitable sanitation services and businesses that operate in poor, urban settings.
  • Be a next-generation product everyone would want to use – in developed as well as developing nations.

The winners were chosen last year and their efforts remain work in progress. While the initiative is welcome and promising, previous well-intentioned attempts to deliver decent sanitation in places like India and Africa have been abject failures.

George points out that just because latrines are provided it doesn’t mean that people will use them and when they do it can be in ways that are not expected or not appropriate. Changing a culture has to come from within, not be imposed and it requires long-term commitment and intensive on-the-ground effort to succeed.

Filthy conditions endured by people in slums may seem remote to those in the developed world, but there are good financial as well as humanitarian reasons why decent sanitation should concern us all.

According to the World Health Organization, improved sanitation delivers up to $9 in social and economic benefits for every $1 invested because it increases productivity, reduces healthcare costs, and prevents illness, disability, and early death.

More than that, there is the persistent fear of pandemic; slums with their poor hygiene and people living in close proximity to animals create an ideal pool for diseases to develop. But, according to  WHO, no country is safe where sanitation infrastructure is neglected.

In 2003, an outbreak of SARS (Severe acute respiratory syndrome) in Hong Kong rapidly spread to 37 countries, infecting more than 8,000 people and killing 775. There have also been major alerts around bird flu and swine flu and currently, health officials in several countries – including the UK and US – are tackling Middle East Respiratory Syndrome, a virus transmitted to humans from camels, which has infected more than 800 people, and killed over 300 of them.

Each year more than 2bn people fly between the world’s countries and along the way an estimated 10m will contract what is commonly known as the trots, the runs, Delhi Belly or Montezuma’s Revenge. On those same flights there will be people unwittingly aiding the rapid international spread of infectious agents and their vectors – and it’ll take more than Pepto-Bismol tablets to tackle the contagions.


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