Sanitation: basic need, matter of dignity, and fundamental human right

UNICEF-Eritrea staff with Her Excellency Amina Nurhussein, Minister of Health & Dr Andat Tefatsion, DG Health

Sanitation: basic need, matter of dignity, and fundamental human right

Dr. Fikrejesus Amahazion

15 December 2018

Earlier this week, a two-day conference on sanitation, jointly organized by Eritrea’s Ministry of Health and UNICEF, the world’s leading organization for the rights of children and young people, was conducted at the Asmara Palace Hotel. The conference featured a number of different events, including a pair of important addresses delivered by Ms. Amina Nurhussein, Eritrea’s Minister of Health, and Dr. Pierre Ngom, UNICEF’s Country Representative in Eritrea. Eritrea, like many countries in Asia and Sub-Saharan Africa (SSA), is working to improve access to basic and safe sanitation. This article presents a general overview of sanitation and provides a brief discussion about sanitation in Eritrea.

According to the World Health Organization (WHO), sanitation refers to “the provision of facilities and services for the safe management of human excreta from the toilet to containment and storage and treatment onsite or conveyance, treatment and eventual safe end use or disposal” (WHO 2018). Sanitation is a basic need, a matter of dignity, and a fundamental human right. In July 2010, the United Nations General Assembly (UNGA) adopted a resolution (A/RES/64/292) which explicitly recognized “the right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights.” Sanitation was also explicitly recognized as a distinct right in a UNGA resolution adopted by consensus by Member States on 17 December 2015. However, according to the United Nations (UN), at present, billions of people worldwide – mostly residing in Asia and SSA – are confronted by significant challenges to safe and basic sanitation. For example, about 60 percent of people around the world lack access to safely managed sanitation facilities, at least 892 million people continue to practice open defecation, and approximately 4 billion people lack access to basic sanitation services, such as toilets or latrines.

Unsafe sanitation is a massive global problem that is becoming more urgent as the world’s population increases and trends like water scarcity and urbanization intensify. Importantly, lacking access to sanitation is associated with a number of significant health risks and other issues. For instance, preventable water and sanitation-related diarrheal diseases kill more than 2 million people every year. Most of those are children under the age of 5. In fact, the number of children under the age of 5 annually dying from water and sanitation-related diseases is greater than the number dying from AIDS, measles, and tuberculosis combined (WHO 2016). Sanitation is also a gender equality issue; women and girls suffer disproportionately from lack of privacy and the health and personal safety risks associated with not having access to household sanitation.

Increasingly, access to safe and basic sanitation has become a priority for governments and the international development community. There is a considerable amount of research illustrating how illnesses and diseases arising from a lack of water and sanitation lead to considerable losses in productivity, burden individuals, families, communities, and healthcare systems with massive costs, and ultimately stunt national economies. According to several estimates, the lack of proper sanitation costs the world an estimated $US 223 billion every year. Additionally, worldwide, it is estimated that every dollar spent on sanitation on average provides at least five dollars in economic return (UN n.d.). Through addressing sanitation, countries can promote development and growth. For example, health gains from sanitation reduce individual health care costs and lost earnings related to poor health, as well as enhance attendance and achievement in schools. Moreover, sanitation can reduce the two main causes of death for children, acute respiratory infections and diarrhea, while sanitation within schools increases and sustains enrolment, of adolescent girls in particular (Hunt 2006).

As a part of the UN’s Millennium Development Goals (MDG), the international community aimed to halve the proportion of those unserved by improved sanitation by 2015. Despite some progress, however, the sanitation target was missed by one of the widest margins of all the 18 targets under the MDGs. Subsequently, access to basic and safe sanitation has become an important part of the UN’s Sustainable Development Goals. Specifically, goal 6.2 calls for ending open defecation and providing adequate, equitable, and safely managed sanitation for all people by the year 2030.

Eritrea, a low-income, developing country located in the Horn of Africa, is one of the world’s youngest countries. It achieved independence in 1991, after waging a 30 year war for liberation. Over a relatively short period of time, it has made considerable progress in relation to sanitation. For example, at independence, basic public services, such as sanitation, “were almost non-existent,” while utilities, such as clean and safe water, “were in short supply.” In fact, only approximately 15% of the national population had access to clean and safe water (Kidane 2016). However, the proportion of households without flush toilets or ventilated improved pit latrines declined from 87.2% (figures for the period 1993 to 2005) to 68% in 2015. Moreover, in recent years, access to clean drinking water in rural and urban communities has risen to 85%, dramatically higher than the meager figure at the onset of independence.

Notably, community-led total sanitation (CLTS) was adopted by the Government of Eritrea in late 2007. CLTS is an innovative, low-cost approach to rural sanitation where communities are facilitated to assess their own sanitation situation, analyze and take action to stop open defecation and build their own latrines without any subsidy and using locally available materials. The adoption of the CLTS approach helped create a significant shift in hygiene and sanitation promotion in many parts of the country. Over the years, numerous villages and areas of Eritrea have been declared “open defecation free.”

Despite these notable improvements, a substantial amount of work still needs to be done. For example, in many parts of the country, rural and urban, young and old people lack access to basic sanitation facilities and many practice open defecation. As with many countries in SSA and Asia, Eritrea’s poorest citizens have the least access to improved sanitation and they suffer the greatest burdens. Moreover, although there are some public toilets, these are few and inadequate to serve the numbers who use them, generally inaccessible for the elderly and infirm, and often have limited access, particularly at night when they are frequently locked.

Safe sanitation is a basic need, a matter of dignity, and a fundamental human right. Moreover, it is essential to a healthy and sustainable future for developing economies. Although sanitation is often taken for granted by many within the developed world, billions of people living in developing countries, such as Eritrea, still face significant challenges. Moving forward, it is imperative that sanitation remain a priority issue for the country’s policymakers and public authorities. Ultimately, through enabling widespread use of safely managed and sustainable sanitation services, Eritrea can help protect the fundamental rights and dignity of its people – particularly the most marginalized and disadvantaged – and contribute to positive health, economic, and gender equality outcomes across the country.

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