Back to Basics!

About 2.3 billion people (40 pc of the world) do not have proper toilets. Hence, lack of sanitation is a global issue and Pakistan also suffers from it. It has a human and environmental cost that most of us are unaware of.

The first modern sanitation system was implemented in the Indus Valley in 2800 to 2000 BC Mohenjodaro. Toilets were made with bricks and contained wooden seats. In 2500 BC Harrapa, near Ahmedabad, modern water flushed toilets and brick covered drain pipes were discovered that eventually connected to a main pipe. It is ironic that today, South Asia is doing worst in terms of sanitation, health and waste management.

According to the government, though the water supply coverage is 90pc, merely 58pc of Pakistan's population gets sanitation coverage. According to a recent WHO report, sanitation in Pakistan is improving due to the open pits in rural areas. The report said that from 58pc in 1990, open defecation had decreased to 27pc in 2008.

"The situation is unaesthetic. Human waste is full of disease-causing bacteria contaminating the air, food and water," said Nazeer Watto, an environmental expert who works for the Anjuman Samaji Behbud (Organisation for Social Welfare) in Faisalabad.

"When waste is generated in the open and remains untreated, it interacts with the food chain through the soil, water and crops. The disease causing bacteria are incorporated in the food we consume, persisting longer and having worst effects by the time they reach humans," says Mustafa Talpur of WaterAid. "Sanitation is for human dignity; otherwise it enhances class isolation since only the lowest classes endure it."

According to WHO, Pakistan loses 52000 children annually, due to diarrhea. The World Bank Strategic Environmental Assessment for Pakistan estimates the total healthcare cost of diarrhea and typhoid, both water and sanitation related diseases, to be Rs112 billion (US$1.33 billion), or 1.8 percent of the country's gross domestic product (GDP).

Although the urban sanitation has improved, it is still not up to the safe standard. Inadequate sanitary conditions are prevalent the sidelined and oppressed communities -- the more remote and poorer the village, the worst the sanitary conditions there. Pakistan's entire water system is running from north to south. This means that when waterways get polluted, the water goes downstream. People downstream utilise the polluted water for daily use.

"In hilly areas, water channels get polluted and the water travels downstream. This is not the case in planes," said Faheem Riaz Khan, director at the Pakistan Environmental Protection Agency. "In urban areas, the excretion takes place near water pipes. Usually, the sewage and the water pipes are close to each other, with the former contaminating the latter."

Even if a handful of families perform unsanitary practice, the entire community is at risk. Most urban centers in Pakistan include several slums. Lahore alone has 155 registered slums and these do not include the unregistered, illegal settlements. How many tons of biological/ human waste they produce and where does it all go? Is there a data available? Can anyone estimate the invisible cost it has in terms of human health?

Lack of sanitation persists in underprivileged communities. These communities (slums, remote villages ) are not hot spots of political activities. Therefore, politicians are not propelled to improve sanitation and create influence. We see protests on food or power shortage, unemployment and inflation. The government prioritises its budget and policy plans accordingly. Due to the invisible health cost, lack of NGOs and pressure groups and political socialisation, the lack of sanitation is never seen as a national level crisis. Hence, in the provincial and federal budget, there is never any finance reserved to improve the public sanitation.

Mustafa Talpur is an expert working with the Water-Aid, an NGO for social welfare. "We work in coordination with other groups like MUAWIN, PURC, Orangi Pilot Project, and some 12 other organizations," said Talpur. "We give covered sewage lines in urban dwellings, connecting these communities with the existing central sewage system. We sometimes start sanitation from scratch in rural areas."

The biggest brunt is faced by women, another greatly oppressed faction of our society that lacks political representation. The illness of children, their consequent death takes a financial and emotional toll on these women. They lack awareness about the basics of hygiene and how these illnesses can be prevented. Million of women in Pakistani slums and villages persistently forced to bare their privates due to lack of proper lavatories are never discussed in the media.

Since millions of people are in need of proper sanitation, we need a national level policy in order to tackle this problem. Water scarcity worsens this dilemma. Where people do not have water to drink and cook, ablution and sanitation is not given precedence, especially when the awareness regarding its significance is missing. The floods have worsened the sanitation crisis, because the water that infiltrated the dwellings, lands and water table was unclean. Furthermore, people escaping the affected areas are cramped together under unhygienic conditions. Keeping themselves and their abode unsoiled is not one of their priorities. "We need awareness, better and effective ways, community mobilization and government effort," said the director PEPA.

In Kenema (Siera Leon's third largest city) the city council, district council, and NGOs have launched the sanitation campaign to prevent rural community from relieving themselves in the bushes, any water body and house. Indian government gives special awards to communities that stop open discharge and in Nepal children blow whistles, put up shame flags on those who violate the sanitation code. Nepalese NGOs assist communities in converting their waste into "humanure" for crops; and a women's group "calculated" how much waste spoiled the food supply.

An international NGO called the World Toilet Organisation is also working in 58 countries to improve the international sanitation. It has declared 19th November of each year, the world toilet day. WTO now has 235 NGOs as members and is trying to form a network of global support to influence governments. Hopefully, Pakistan will seek WTO's services.

In India, an innovative methodology called the Community Led Total Sanitation (CLTS) has been initiated to mobilise communities against open defecation. Building a toilet is easier than creating an open defecation free community, therefore, CLTS focuses on behavioral reform to make the change permanent. CLTS instead encourages the community to innovate, support and seek local solutions.

There are a few Pakistani NGOs now that are working to improve sanitation. Pakistan lacks a nationwide NGO that is dedicated to resolving this problem. Every village has a different water table, topography, soil order, etc. Dumping standard washroom equipment in each village might not help. However, the fact remains that in a third world country like Pakistan, the community awareness and action like CLTS will be the most successful in bringing change.