10 million child deaths since 2000 due to lack of toilets

19 November 2014

Today 36 prominent international health and development experts including representatives from WaterAid, The World Medical Association, Amref Health Africa, Bangladesh Medical Association, British Medical Association, Commonwealth Medical Association, Global Health Council, Indian Medical Association, Institute of Global Health Innovation, International Confederation of Midwifes, Nigerian Medical Association, and the Royal College of General Practitioners amongst many others, have called for an end to a crisis that has claimed the lives of over 10 million children under the age of five since the year 2000[1].

In an open letter to the Secretary-General of the United Nations, Ban Ki Moon[2], the signatories, representing over 620,000 health professionals globally, highlight the desperate waste of life caused by people not having access to a basic toilet. Without basic sanitation, children have no choice but to live and play in areas contaminated by human waste.

One in three children globally does not have access to a basic toilet[3], which alongside unsafe drinking water and a lack of hygiene services, contributes to the world’s three main killers of children: undernutrition, pneumonia and diarrhoea, the letter states.

The letter, coordinated by the international development organisation WaterAid, has been published to coincide with World Toilet Day. It is also signed by XXXX and highlights that the sanitation ‘crisis touches every moment of every child’s life, from birth to adulthood, if they are lucky enough to make it that far‘.

WaterAid Chief Executive, Barbara Frost, today said:

“10 million children’s lives have been lost since the millennium. This tragic waste of life just cannot continue. The dangers of poor sanitation and dirty water have been known for 150 years, yet still more than one in three children do not have a safe toilet to use which often leads to a lifetime legacy of disease and poverty.

“These children need governments and international agencies to collectively step up and commit that by 2030 no home, hospital or school will be without a toilet and clean water.”

The letter coincides with a new briefing released by WaterAid: ‘Child of Mine’ which states that sanitation ‘remains one of the most neglected issues in developing countries and international development aid’[4]. As the briefing highlights, this is despite a quarter of the 162 million children globally who have had their growth stunted and their physical and cognitive development impaired, because they suffered repeated bouts of diarrhoea when very young.

According to the World Health Organization, 88% of cases of diarrhoea are attributable to a lack of access to basic sanitation, unsafe drinking water and poor hygiene provision[5]. In total, over 12 million children are estimated to have died because of diarrhoeal diseases from 2000 to 2013, with a lack of these services resulting in 10.6 million of these deaths[6].

The release of the letter to the UN Secretary-General and the publication of the briefing come at a crucial time, as governments work to complete the Millennium Development Goals (MDGs) that run from 2000 to 2015, and negotiate the new Sustainable Development Goals which will replace them.

The World Medical Association, an international organisation representing 111 national medical associations internationally and are one of the organisations to have signed the letter.

The World Medical Associations Chair, Dr. Mukesh Haikerwal said:

“It has been estimated that around half the hospital beds in the developing world are being used by patients suffering from diseases brought about because of the unsanitary conditions. Many of the physicians treating these patients are forced to do so in facilities that also lack clean water and sanitation and as such the means to practice good hygiene to reduce infections.

“While cutting edge science and medicine have made a remarkable contribution to our lives, ensuring the basics of an adequate toilet, clean water and could practice good hygiene would save hundreds of thousands of children’s from preventable deaths each year and improve the health and wellbeing of billions of people.”

The open letter includes the call for Ban-Ki Moon ‘to lead the world to a future of better health, dignity and prosperity for all by championing a dedicated goal to deliver water and sanitation to everyone, everywhere by 2030.’

For more information or interview requests, please contact Hratche Koundarjian, News Manager on hratchekoundarjian@wateraid.org, +44 (0) 207 793 4909 / +44 (0) 7905 911 039.

(1) Analysis conducted by WaterAid using data from Supplementary appendix of the Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis, published in the Lancet Journal, 1 October 2014, and assessment by World Health Organisation that ‘88% of diarrhoeal disease is attributed to unsafe water supply, inadequate sanitation and hygiene’ as highlighted in their Water, sanitation and hygiene links to health fact sheet, updated 2004.

(2) Text of open letter -
His Excellency Ban Ki-moon
Secretary-General of the United Nations
United Nations Headquarters
First Avenue at 46th Street
New York, NY 10017
USA

19 November 2014
Dear Secretary-General,

On World Toilet Day, 19 November, we the undersigned are writing to you on behalf of the 2.5 billion people who face a daily health crisis. When they wake each day they are unable to do what we take for granted and relieve themselves in a clean, safe toilet[1].

Over 1,400 children in the developing world will die today of a diarrhoeal disease simply because they and their families do not have access to clean drinking water, a basic toilet or a safe way to deal with human waste – nor do they have sufficient water to wash in and to keep their hands and their bodies clean. We know that this is an issue which you too are very aware of and that you share our grave concern.

This crisis touches every moment of every child’s life, from birth to adulthood, if they are lucky enough to make it that far. Undernutrition, linked to chronic diarrhoeal illness, is estimated to have stunted the development of some 162 million of today’s children aged under-five, often leaving a lifelong legacy of poverty and ill-health. Diarrhoea also significantly contributes to acute malnutrition, a condition which is estimated to kill one million children under-five every year.

Health professionals are often expected to deliver quality healthcare in unhygienic facilities that lack basic sanitation and clean water, putting patients’ lives at risk. Furthermore, around half the hospital beds in Sub-Saharan Africa are taken up by illnesses which could be prevented with safe water, basic sanitation and good hygiene.

As you know, one in three women and girls around the world do not have access to basic toilets and risk their health and their safety each time they must find a place to relieve themselves. Girls who attend schools without safe, private, separate toilets are more likely to drop out at puberty, depriving themselves of the education that can help break the cycle of poverty.

What’s more, the British Medical Journal has identified sanitation as the most important invention in 150 years, more critical than antibiotics and immunisations.

Yet of the UN’s existing Millennium Development Goals, the target for sanitation remains one of the most off-track. An estimated ten million children have died from diarrhoeal diseases in the years since the goals were launched.

We have a moment now to change this. You can change this.

As the UN shapes new Sustainable Development Goals, this needless tragedy can be ended by ensuring the delivering of safe water and sanitation and improved hygiene.

We call on you to lead the world to a future of better health, dignity and prosperity for all by championing a dedicated goal to deliver water and sanitation to everyone, everywhere by 2030.

Yours sincerely,

Dr. Madhumita Dobe, Director-Professor (Public Health) & Head of the Department of Health Promotion & Education, All India Institute of Hygiene & Public Health (India)
Dr. Teguest Guerma, Director General, Amref Health Africa
Dr. Anne Trimmer, Secretary General, Australian Medical Association
Dr. Mahmud Hasan and M. lqbal Arslan, President and Secretary General, Bangladesh Medical Association
Dr. Roland Lemye, President, Belgium Medical Association
Dr. Kaosar Afsana MD MPH PhD, Director of Health Nutrition & Population, BRAC University (Bangladesh)
Dr. Florentino Cardoso, President, Brazilian Medical Association
Baroness Illora Finlay, President, British Medical Association
Dr. Solaiman Juman FRCS, President, Commonwealth Medical Association
Dr. Abiy Hiruye, President, Executive Director, Ethiopia Medical Association
Ben Hobbs, Coaltion Secretariat, Generation Nutrition
Dr. Zulfiqar A. Bhutta, Director, Global Child Health - Canada
Dr. Christine Sow, Executive Director, Global Health Council
Dr. Muhammed M. Lecky, Executive Secretary, Health Reform Foundation of Nigeria
Dr. Istvan Éger, President, Hungarian Medical Chamber
Dr. Narendra Saini, Honorary Secretary General, Indian Medical Association
Lord Ara Darzi, Director, Institute of Global Health Innovation
Frances Ganges, Chief Executive, International Confederation of Midwifes
Dr. Moojin Choo, President, Korean Medical Association
Atty. John Y. Jukon, National Chairman, Liberia NGOs Network
Dr. Amedeo Bianco, President, National Federation of the Orders of Doctors and Dentists (Italy)
Dr. J G Ado Mohammed, Executive Director, National Primary Health Care Development Agency (Nigeria)
Dr. Anjani Kumar Jha, President, Nepal Medical Association
Bhogendra Raj Dotel, President, Nepal Public Health Association
Dr. Lawrence Kayode Obembe, President, Nigerian Medical Association
Eche Ugochukwu C. President, Nigerian Medical Students Association
Pramila Dewan, President, Nursing Association of Nepal
Dr. Javed Iqbal, Chairman, Pakistan Medical Association
(Signed as organisation) People′s Health Movement - Pakistan Chapter
Simon Ross, Chief Executive, Population Matters
Professor Mike Pringle, President, Royal College of General Practitioners
Bello Hamman Diram, Secretary General, Nigerian Red Cross Society
Barbara Frost, Chief Executive, WaterAid International
Katja Iveresen and Jill Sheffield, CEO and President, Women Deliver
Dr. Mukesh Haikerwal, Chairman, World Medical Association
Dr. Elizabeth Mason, (Former Director of Maternal, Newborn, Child and Adolescent Health, World Health Organisation)

(3) UNICEF and World Health Organisation Joint Monitoring Programme data tables.

(4) Child of mine - How putting toilets at the centre of the Sustainable Development Goals can transform the health of children everywhere by 2030. WaterAid November 2014.

(5) Assessment by World Health Organisation ‘88% of diarrhoeal disease is attributed to unsafe water supply, inadequate sanitation and hygiene’ as highlighted in their Water, sanitation and hygiene links to health fact sheet, updated 2004.

(6) Analysis conducted by WaterAid using data from Supplementary appendix of the Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis, published in the Lancet Journal, 1 October 2014, and assessment by World Health Organisation that ‘88% of diarrhoeal disease is attributed to unsafe water supply, inadequate sanitation and hygiene’ as highlighted in their Water, sanitation and hygiene links to health fact sheet, updated 2004.

WaterAid’s vision is of a world where everyone has access to safe water and sanitation. The international organisation works in 26 countries across Africa, Asia, Central America and the Pacific Region to transform lives by improving access to safe water, hygiene and sanitation in some of the world’s poorest communities. Since 1981, WaterAid has reached 19.2 million people with safe water and, since 2004, 15.1 million people with sanitation. For more information, visit www.wateraid.org, follow @WaterAid on Twitter or visit us on Facebook at www.facebook.com/wateraid.

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