Oh sh**! Global Sanitation Woes

‘Sanitation is more important than independence’,  Gandhi.

Rasika comes down to the beach each day in Kumara Kanda Sri Lanka to have his morning shit, along with the other fisherman in the village.  Then he washes himself off in the sea, cleans his teeth, and takes back whatever fish he can find, for the morning’s  curry. Of course, there is nothing wrong in any of that, as long as only a few of them do it, leaving the tide to flush the shit away.  It may not be very dignified but at least for him it is convenient.

But the problems are far more serious in some of the large cities in the world today. It is not merely a question of some people not having their own toilet.  Two point six billion people do not have access to a decent toilet.  And many who do, have access only in tandem with a huge number of others. In Kinshasa (Dem Rep of Congo), for example, with a population fast approaching 10 million, there is no waterborne sewage system at all.

In Kenya's Nairobi, the Laini Saba slum in Kiberia in 1998 had just ten working pit latrines for 40,000 people.  Nearby, in Mathare 4a, there were two public toilets for 28,000 people. Mberita Katela lives in the Kiberia slum, and is a vegetable seller. Every morning she walks a quarter of a mile to buy water.  She uses a communal pit latrine just outside her door.  It is shared with 100 of her neighbours and her house reeks of the sewage overflow.  That is the reality for many people in the world in 2008.

Living in dignity:

I use the words shit and crap even though we don’t use those words in polite society to talk about ….evacuating our waste.  The word sanitation is so clinical it has little power to convey the outrage that two fifths of the world population experience every day: having nowhere to shit in private. Middle class people everywhere have toilet(s) and take it for granted that they can attend to their needs privately, with their dignity intact. It can be hard to comprehend what it is like to have to deal with one’s shit in any other way. When I lived in the Gambia, I stayed in a small village where I was given one bucket of clean water each day to ‘attend to my toilet’; that is I had to take a shit (not very privately) and then have a shower with the rest of the water in the bucket.  But that was comparatively civilized compared with what many people have to do.

Now I know writing about this is not very acceptable:  it’s kind of a dirty job.  But, hey, someone has to do it! So here goes.

This is the International Year of Sanitation (IYS) to keep the problems of shit in the public eye!  But hang on…we’ve had International Sanitation events before. The 1980s were the UN’s Decade of International Drinking Water and Sanitation.  But the World Bank researcher Anqing Shi had to admit, at the end of the decade, there was very little improvement.  And WHO conceded “there will still be about 5 million (preventable) deaths in children under five by 2025…mostly caused by infectious diseases within which diarrhea will play a prominent part”.  In 1996 a WHO report added “close to half of the South’s urban population is suffering from one or more of the main diseases associated with inadequate provision for water and sanitation”.

So why are we having another international event in aid of sanitation?  Does anyone believe this will be effective in changing things?  I’ve read the IYS objectives and they are very general:  “increased awareness”, “more government action” …blah, blah, blah!  I hoped it would contain some very specific goals for the year. The campaigning group, WaterAid, points out: “To reach the sanitation target (the Millenium Development Goals) means providing services to an additional 450,000 people a day until 2015. This calls for almost a doubling of the current efforts. On current trends, the world will miss the sanitation targets by more than half a billion people.”

It does not look good.

Living healthily:

Over half the population of developing countries has no access to any form of toilet.  That amounts to over two-fifths of the world’s population, including 980 million children.  The results of this are serious.  Across the world, 160,000 people migrate from the countryside to cities every day.  In Dhaka, Bangladesh, a senior city official said recently (quoted in Water Aid’s 2008 Report on Sanitation):"The entire city is a cesspool, a septic tank... the urban poor have no sanitation facilities whatsoever. The situation is getting worse by the minute." According to Eileen Stillwaggon (Stunted Lives, Stagnant Economies), “every day around the world illnesses related to water supply, water disposal and garbage kill 30,000 people and constitute 75 percent of the illnesses that afflict humanity”.  In fact, digestive-tract diseases arising from poor sanitation and the pollution of drinking water – including diarrhea, enteritis, colitis, typhoid, and paratyphoid fevers – are the leading cause of death in the world. Children are most likely to suffer from diarrhea, typhoid, skin diseases or malaria.  It is hard for people to clean themselves, their clothes and their cooking equipment.  Every day 5,000 children across the world die as a result of diarrheal diseases.  Yet these deaths never get announced in the media.  It is the equivalent of seven jumbo jets crashing every day.

Speed of growth:

Since the middle of the last century, the speed of growth of slums in the megacities has been phenomenal.  In Sudan's Khartoum, for instance, in 1988, the city was 48 times bigger than it was in 1955. In Lusaka (in Zambia), the shantytowns now house two thirds of the city’s population.  In Dhaka, the shantytowns far outweigh the proportion of ordinary housing in the city.  And with this growth comes a rise in the tonnage of shit deposited each day. In Mumbai (India), about five million people have no toilet to shit in.  Like Rasika in Kumara Kanda, they have to shit outside each day.  If they shit half a kilo each, that amounts to two and a half million kilos of shit each morning.

In Kabul, Afghanistan, the city is turning into one big reservoir of solid waste...every 24 hours, 2 million people produce 800 million meters of solid waste.  “If all 40 of our trucks made three trips a day, they can still transport only 200 to 300 cubic meters out of the city”, complains the city planning director.

In India, one estimate says that 700 million people are forced to defecate in the open, while only 17 out of 3700 cities/large towns in India have any kind of sewage treatment system. And a study of 22 slums in India in 2002 found 9 with no latrines at all, and in a further 10, there were just 19 latrines for 102,000 people.  Compared to what we in the West experience, this is outrageous.  “This never ending contamination of drinking water and food by sewage and waste defeats the most desperate efforts of slum residents to practice protective hygiene” (Mike Davis).

Housing is a verb:

So why don’t shantytown residents insist on better conditions for themselves? 

John Turner always says that ’housing is a verb’. In other words, the urban poor have to make a hard calculus of confusing trade-offs.  They have to try to optimize housing costs, tenure security, quality of the shelter, with the journey to work, and maybe personal safety.  And their work choices (with the money they are likely to make from it) will probably be paramount.  Somewhere in all this calculation will be sanitation. Many people don’t understand the narrow room for maneuvre that poor people arriving in cities have over their housing conditions.  They often assume that lack of good sanitation is a choice poor people make.  It isn’t.  Poor people would like the luxury of privacy, since with privacy comes dignity.  But for many, dignity is simply too costly. For everyone, the worst situation is a bad, expensive location without services or security of tenure. That, sadly, is all that some people can find. Poor people go where others (even those with just a little more money) choose not to - swamps, dangerous volatile land, tombs; whatever they can find.

Shitting is a place:

Finding the most dignified place to attend to one’s personal toilet needs, having found a place to inhabit, means making the best of bad options.  Or having no options except to copy what everyone else does. People don’t shit in the open as a matter of choice. Everyone has concerns about maintaining their own sense of dignity.  I learnt that through watching the fishermen of Kumara Kanda:  there is an un expressed rule that people who are about to shit get left in peace to do it as privately as possible even though everyone can see what is occurring.  People choose the best possible, in terms of privacy, that they can find.  For some, the ultimate may be not very private but it is reasonably clean.  There are tradeoffs. One trade-off, for some people, is living near stagnant water and untreated sewage, but being near work.  David Keating writes about one place he visits:  a place that ‘created an overpowering stench, and the entire area was overrun with rats, mosquitoes, flies and other insects’.

In many places in Africa, slum residents (especially in the huge slum outside DR of Congo's Kinshasa), have to rely on ‘flying toilets’ or ‘scud missiles’ as they are called.

“They put the waste in a polythene bag and throw it on to the nearest roof or pathway”.  Andrew Harding, Guardian 2002.  Two in every three people in the slum said that was how they disposed of their shit! Just imagine what happens when a million people do that everyday of the year! 

Mumbai’s achievements:

In Mumbai, campaigners living in the shantytowns have been campaigning  for years, trying to get the municipal authority to take on this enormously complex problem of supplying decent toilets for the 6.7 million slum dwellers (60% of the population) in the city.  That demand was ignored for a long time, but in the late Nineties Mumbai began to take the problem seriously. Greg O”Hare Dina Abbott & Michael Barke for example describe how in 1998, Mumbai city promised a massive slum clearance programme (affecting 3 million people), in order to provide proper sanitation.

But at the time, the results were poor. Its aims had been to provide one toilet for every 20 residents but the ratio achieved was only one per a hundred and sporadic maintenance nullified the public health advantage .Of course, providing proper sanitation in a very large shantytown is exceedingly difficult since the housing units are typically so close together that it entails quite substantial disruption of households.  Then again, in 2002, the city, supported this time by a World Bank loan spent 40 million dollars covering a quarter of all Mumbai’s slum areas.  This was indeed a huge step forward since it was trying to eradicate sewage problems for a huge number of people.

This time, the city planned to erect blocks of toilets with accomodation above them for the cleaners and their families, and supported by money raised by each community before the blocks were built, to pay for the maintenance of the toilets.  Each household would be charged an amount each month to be collected by the users committees.So far, this has worked, although the numbers using each toilet are far higher (80 instead of 50 to each toilet) than planned and this creates its own maintenance problems. But there is a problem.  Not everyone can afford the very low maintenance charges. Rupa Chinai, writing in the Bullietin of the WHO 2002, points out that about 60 percent of the slum population live on less than 2 dollars a day and cannot afford to pay for these privately built toilets.

The Economist (Dec 18 2007) describes life in the famous Dharavi slum in downtown Mumbai.

“All along the street, water is gushing into blue plastic tanks and aluminium tubs, washing sticky breakfast dishes clean. It flows down the street in a rippling sheet. Bisecting it is an open drain, which gushes torrentially, flushing away the detritus of the previous day.

From the stink of this, it includes a lot of human excrement—which tiny naked children, squatting with their backsides jutting over the torrent, are busy adding to. In fact, it is not supposed to be used for this purpose. The locals are instead supposed to take their turn at a block of 16 public latrines, serving 300 hutments (or 3,000 people). It costs a rupee a visit--or 30 rupees (75 cents) for a monthly family ticket”.

How are we doing?

My interest in writing this is to pinpoint a problem that is not really being tackled.  We literate Internet users usually live in those parts of the world where most things are getting better.  Poverty worldwide is decreasing; child health and education is improving.  There are fewer wars now than ever before. And sanitation is being brought to areas where it was lacking before.  But!  And it’s a big but!

In those areas of the world where megacities exist – Lagos (23 million), Cairo (15 million), Mexico City (22 million), Lima (8 million), Kolkata (15 million), Jakarta (24.9 million), Dhaka (25 million), Karachi (26.5 million), Shanghai (27 million), Mumbai (33 million), Rio/Sao Paulo (37 million).  These are all growing so rapidly that sewage disposal is out of control.  UN_Habitat 2005 reports that slum populations are increasing each year at the rate of 25,000,000. (sorry I got this figure wrong previously!) That is staggering!

More shit is being dumped each year than is being collected 

It is fairly easy to improve small, more manageable urban shantytowns to provide adequate sanitation.  It makes sense of course to concentrate on the achievable.  There’s little wrong in that; except that the critical problems are being avoided.

In Nairobi, commuters now confront “ten year olds with plastic solvent bottles wedged between their teeth brandishing balls of human excrement – ready to thrust them into an open car window – to force the driver to pay up”.  What has the world come to when people use their shit as a source of making money?