More than one billion people drink unsafe
water and 2.4 billion, 40% of the human race are without adequate
sanitation, and 3.4 million people, mostly children, die every year of
water-related diseases (more than one million from malaria alone), the
majority of them unnecessarily.
But the picture is neither gloomy nor hopeless, says
the World Health Organization (WHO) in a report on water and sanitation
released here on the eve of World Water Day, Thursday, 22 March.
"Clearly, a problem of this magnitude cannot be
solved overnight, but simple, inexpensive measures, both individual and
collective, are available that will provide clean water for millions and
millions of people in developing countries – now, not in 10 or 20
years," said Dr. Gro Harlem Brundtland, Director-General of WHO.
"We do not have the luxury of waiting around for large
infrastructure investments to provide water supplies and basic
sanitation services for all who need them. It makes no sense, and it is
not acceptable, to ignore the immediate priorities of the most
Optimistic but realistic, the WHO report, entitled
"Water for Health – Taking Charge", strongly urges several
basic measures, including purifying water (chlorination and sodis), and
improving hygiene, as immediate means of improving people’s water
supply in developing countries.
Chlorination, for example, is "a proven means of
ridding water of disease-causing microorganisms in piped water,"
according to the report.
Moreover, research carried out at the Centers for
Disease Control and Prevention in Atlanta, Georgia, and by the Pan
American Health Organization, supports chlorination in households
without piped water, even though the prevailing wisdom is that
chlorination should follow and not precede the creation of water and
"We looked at how chlorinated water could be
provided to poor households through a simple, low-cost treatment and
secure storage method," says Mark Sobsey, Professor of
Environmental Microbiology at the University of North Carolina in Chapel
Hill. "One of our findings is that
improving water quality alone does work and we can do this without
"What we know now is that even in conditions of
very poor sanitation and hygiene, where people are collecting whatever
water is available to use for their household water supply, if the water
is chlorinated, the water is improved microbiologically, and you can
find statistically significant decreases in diarrhoeal disease."
A good example of successful chlorination is to be
found in the Maldives where a national control programme used it in
wells and in oral rehydration salts against diarrhoea. Rainwater was
also collected for drinking. Twenty years after the programme started,
all of the Maldives islands have their own community rainwater
collection tanks, and deaths from diarrhoea are virtually unknown.
"Another easy, small-scale, cost-effective,
immediate technique for providing safe water, individually or
collectively, is a still little-known but highly effective solar thermal
technique. It is called SODIS and was promoted by the Swiss Federal
Institute for Environmental Science and Technology near Zurich,"
said Dr Jamie Bartram, Coordinator of WHO’s Water, Sanitation and
Health Programme, which issued the report.
"SODIS, or solar water disinfection, is a nearly
cost-free system because sunlight costs nothing, and the only other
elements are throw-away plastic soft-drink bottles and a black
surface," explains Martin Wegelin, a researcher at the Swiss
Institute for Environmental Science & Technology.
Transparent bottles are filled with water and placed
horizontally on a flat surface for about five hours. The illness-causing
microorganisms (pathogens) in the polluted water succumb to the killing
effect of the ultraviolet light in solar radiation. The process is
enhanced when the solar water disinfection is combined with a
"solar thermal water treatment" which makes use of the fact
that the colour black absorbs light. This is accomplished by painting
the bottom half of the bottle black or placing it on black-painted
corrugated iron or plastic sheets.
"Field studies in Bolivia, Burkina Faso, China,
Colombia, Indonesia, Thailand and Togo," the report states,
"show that the process works."
A third recommendation of the report calls for
"Our research shows that washing with hand soap
would probably sharply reduce deaths from diarrhoeal disease,"
asserted Valerie Curtis, a lecturer in hygiene promotion at the London
School of Hygiene and Tropical Medicine. "All it requires is soap
and motivation. But that’s more easily said than done."
A three-year study in India, West Africa, the UK and
The Netherlands proved that the traditional "scolding,
moralistic" approach to changing behaviour doesn’t work. People
turn off if they are warned, "You’ll get sick or die if you don’t
change your filthy ways." Ms. Curtis says that Brazilians refused
to cooperate in a cholera prevention programme because they thought they
were being accused of being "filthy dogs". "We used a
positive motivation approach in a three-year project in
Bobo-Dioulasso, Burkina Faso, and at the end they had tripled their use
of soap." Studies of diarrhoea show that the simple act of washing
one’s hands with soap and water reduces incidence of the disease by
Elsewhere, good water management has almost
eradicated guinea worm, a disfiguring, disabling disease which afflicted
50 million people in Africa and Asia in the mid-1900s. By 1999 that
number had fallen to below 100’000.
But poor irrigation water management, in sharp
contrast, has led to a huge spread of schistosomiasis (snail fever) to
areas of the world where it never existed before. An estimated 200
million people are infected today with schistosomiasis, according to
What should be done differently to prevent
water-related diseases and to ensure that everyone has access to at
least some safe water and sanitation?
For one thing, says the WHO report, the health sector
must get fully involved in water management. It can no longer be left to
water management authorities or to environmental ministries. Just as
major development projects always have environmental impact assessment,
they should also require health impact assessments. Those involved in
water management have to be responsible for its effects on people’s
health. During the past 50 years there has been a strong emphasis on
medical interventions including for example, drug use and this has
tended to reduce the attention and priority given to safe water supply
and adequate sanitation into the back seat. With the growing resistance
to antibiotics, insecticides and standard drugs, health authorities now
understand the limitations of a strictly medical approach. That makes
safe water and sanitation more important than ever.
"Society generally looks at the contribution of
development to health. The contribution of health to development has
been largely ignored. It is time to reverse this way of looking at
things. And it is high time to recognize safe water supply and adequate
sanitation to protect health are among the basic human rights,"
said Dr Brundtland.