Safe sanitation for all: the least glamorous part of the battle against poverty

There is no point in installing any kind of infrastructure if you do not invest in or train enough people to maintain it. Similarly, there is no point in defending the benefits of a safe toilet if there is no education and hygiene campaign to change old habits. (María José Carmona)

If the face is the mirror of the soul – as Cicero would have it – the toilet is the mirror of society as a whole. Our toilets say as much if not more about us than a sociological treatise. Our values, our customs, our prejudices are exhibited with discretion in an act that equates us all, and at the same, time sets us apart.

“Toilets give you an insight into how people view life, what they think is important and what is not, what standards of living they have, and their perceptions of what is public and private,” says photographer Siqui Sánchez, who decided some years ago to explore and portray the world’s most intimate corners. The result – Toilet Planet – is a catalogue of stark contrasts ranging from holes in the ground to bathrooms with piped music. Toilets also reflect our world, and its terrible inequalities.

Talking about them is taboo in some cultures, whilst in others it is a topic associated with humour or frivolity. But we should all, in truth, be talking more about what is perhaps the least glamorous – and yet crucial – battle against poverty.

In 2010, the United Nations explicitly recognised the human right to water and sanitationfor the first time, having realised that guaranteeing any other right was impossible without safe drinking water and safe sanitation. The world’s leaders pledged to achieve universal access to sanitation by 2030, but the fact is that, today, only 39 per cent of the world has access to a toilet that can be considered decent.

The rest, 4.2 billion people – more than half of the global population – is still deprived of that right. There are those who have latrines but no sanitation system – meaning that they dump their waste into the river or near wells from which they or their animals drink; there are those who have latrines but they are broken, and there are those who have latrines but have to share them with several other families.

Then there are those who have nothing at all: 673 million people who have to go in the open, and that’s not just an inconvenience, it is an extremely serious public health issue. According to the World Health Organization (WHO), over 280,000 people, mainly children under five, die every year from diarrheal diseases caused by inadequate sanitation.

We all need to be talking more about toilets because it is unacceptable that people are still dying for want of decent sanitation, because it is outrageous that, in today’s world, there are more mobile phones than safe toilets.

Bill Gates’ obsession

Between the years 2000 and 2017, the number of people having to defecate in the open was halved, with 23 countries managing to bring the rate to below one per cent. The latest wasIndia, one of the countries with the world’s worst sanitation problems. After its intense ‘Clean India’ campaign, lasting five years, during which 100 million toilets were built, the country was recently able to declare itself ‘open defecation free’.

Progress has been made in the fight for universal sanitation, but much remains to be done. “We are not on track to meet the goal. There are studies showing that at the current rate universal access will not be achieved until after 2100, never mind 2030,” warns Alberto Guijarro, a specialist in water and sanitation at the Spanish NGO Engineering for Human Development (ONGAWA).

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There is concern about the scant progress in the large urban areas where 55.3 per cent of the world’s population is currently concentrated, but especially in rural areas, traditionally the most neglected, where administrations are often unstable, resources and skilled technicians are lacking, and where most houses have no running water or sewage systems, never mind toilets. This is where Bill Gates claims to have come up with the solution.

Through his foundation, the philanthropist and Microsoft business tycoon launched a competition in 2011 calling for technological alternatives to the lack of toilets around the world. The premise was that the new toilets should be able to operate without water or electricity, without being connected to a sewage system, that the waste should be recyclable, and that they should cost no more than five cents per user per day. One such alternative is what is known as the waterless or ‘dry toilet’.

“The dry toilet system is based on separating the urine from the faeces. Urine is rich in nitrogen and can be recovered for use as a fertiliser. The faeces are the most problematic part, if they are not treated properly, they can lead to contamination and insalubrity,” explains Ernesto Cidad, chemical engineer and publisher of the website Agua Ecosocial.

To avoid any risk and to inactivate any pathogenic compounds, the faeces are stored in a safe, watertight compartment, where they undergo a long composting process. “If the system is well designed, with good ventilation and the right conditions in terms of temperature and humidity, the material can be used as a natural fertilizer after a year,” says Cidad. The engineer says it is an effective solution, even for societies where sanitation is not a problem. It is already, in fact, being used in some parts of Europe, especially in remote rural homes, as a more ecological alternative to flushing potable water down the drain.

Gates is not the only businessperson to have detected the hole in the market. The‘sanitation industry’ is already seen as a niche business with a bright future. “It’s good that companies are looking at the issue and proposing solutions. The more innovation the better. But poor sanitation is more than just a technological problem,” warns María del Mar Rivero, an industrial engineer and a member of ONGAWA.

“When you come up with individual solutions you have to make sure that they are comprehensive solutions. Not only does there have to be safe toilets, but they also have to be managed safely. There has to be control over the whole process, up to the point when the waste is no longer a health hazard,” says Rivero. It would be naive to think that the problem can be solved by simply taking modern toilets to remote places, not least in light of the countless examples of how such initiatives have failed.

Lessons to be learned

There is no point in installing any kind of infrastructure if you do not invest in or train enough people to maintain it. Similarly, there is no point in defending the benefits of a safe toilet if there is no education and hygiene campaign to change old habits. Yet mistakes like these are still being made in some projects.

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Another critical mistake behind the fact that some of the latrines installed are never used or end up being used as storage space is the failure to take into account the cultural, religious and social context of each community, and to listen to the people the project is supposed to help before implementing solutions.

“A project that fails to consider all the cultural variables will lack sustainability. If the so-called beneficiaries are not given ownership of a project, then it will amount to no more than a band-aid solution,” says Andrés Narros, a social anthropologist and programme coordinator at the Allegro Foundation.

Knowledge of a space’s social distribution, its power structures, is essential, as Narros explains, “the map of a village’s piping system perfectly represents the map of power dynamics”, for example. But even more important is an awareness of the religious and gender taboos surrounding such an intimate matter as this one. Problems have to be taken on board such as the harassment or assault women are exposed to when they do not have access to a safe and private toilet, or the stigma attached to menstruation.

“I remember having worked in Iran installing public latrines for women – a country like Iran, where latrines have to be in a private area. They didn’t last two days,” the anthropologist recalls.

Hygiene is not the only issue

The countries with the least access to basic domestic sanitation – Ethiopia, Chad, Madagascar, South Sudan, Eritrea, Niger – have much more in common than toilets. Poor sanitation is not only a health hazard, it is also a poverty trap. According to the World Bank, it results in annual losses of US$260 billion (about €234 billion) in developing countries, that is, 1.5 per cent of their GDP.

The absence of safe toilets has a high educational cost – one in three schools worldwide does not have decent toilets and many children, especially girls, miss school because of it. The labour cost is also high, mainly due to the time wasted queuing in public toilets and the high level of absenteeism due to sanitation-related illness.

This is why the focus of World Toilet Day 2019 is on ‘Leaving No One Behind’. Private support is not enough to achieve this, and public investment must be increased. At least US$100 billion more a year (€90 billion) is needed to achieve the 2030 target, according to the World Bank. And the need is all the greater in view of the climate emergency, with access to water becoming increasingly less predictable.

“If you ask people what they think the big global issues are, sanitation isn’t likely to come up, and yet there are few global problems of such magnitude,” insists Guijarro. This is why public awareness needs to be raised in the West (where two per cent of the population has to defecate in the open, most often in slums), to place the issue firmly on the agenda and to make the lack of toilets stir as much indignation as hunger or poverty.

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