Water and sanitation: the silent emergency.

• Author: Frost, Barbara

In December 2006, the UN General Assembly declared 2008 as the International Year of Sanitation. The intention was to raise awareness of the importance of sanitation and encourage Governments, partners and communities to embrace the need for urgent action to reduce the number of people living without this basic service.

The declaration could not have been timelier or more welcome. At the midpoint in the time frame to achieve the internationally agreed Millennium Development Goals (MDGs), which include targets to halve the proportion of people living without sanitation and water by 2015, it is clear that investment to reach these targets is seriously insufficient. However, with seven years to go, there is still time to reverse the situation and reap the substantial potential rewards of taking action to meet the MDGs.

Current investment would need to be increased by $10 billion a year for the sanitation and water targets to be met. (1) But sanitation, perhaps the most off-track of all the Goals, is suffering acutely from under-investment. There are 2.6 billion people, or 42 per cent of the world's population, without improved sanitation. (2) If the present trend continues, the MDG target will be missed by half a billion people. (3) These people, who should have access to toilets, will continue to face the indignity of defecating in the open, with the risk of diseases, and even the abuse that it brings.

There is compelling evidence that sanitation brings the greatest public health returns of any policy intervention, but despite its importance it is rarely included in the development agenda. Simply put, no one wants to talk about toilets. The challenge is to raise awareness and prioritize the issue, so that sanitation stops being seen as an international taboo.

Globally, the water target is faring better and as a whole is currently on track to be met. However, the World Health Organization/United Nations Children's Fund Joint Monitoring Project (JMP) has warned that the trend appears to be deteriorating. The distribution of investment is far from equitable, with the world's poorest communities being disproportionately excluded from water services. Water coverage rates in sub-Saharan Africa are lowest. The JMP estimates 56 per cent coverage in 2004, but this figure masks large national differences; in Ethiopia, the official coverage is just 22 per cent. The poorest and most marginalized--women, children, people living with HIV/AIDS and those...