Poor Sanitation in Developing Countries – The Squalid Truth

slums mumbai india

As a civilization that takes pride in our technological advancements, it is a damning statistic that 2.3 billion people worldwide don’t have a proper toilet at home. It is something many of us take for granted, but across the world, one in three people lack access to proper sanitation. Inconvenience aside, this poses various health and safety risks that make poor sanitation one of the more pressing issues in developing countries.

Proper Sanitation and Why it Matters

According to World Health Organisation (WHO), sanitation refers to the provision of services and facilities for the safe and hygienic management of human excreta, from the toilet to treatment and containment to the eventual end-use or disposal. The availability of clean drinking water and personal hygiene is also absolutely crucial to our overall health.

Poor sanitation or the lack of access to it is the overarching cause of many issues developing countries face. It is often the root of health-related transmissions and life-threatening diseases, such as cholera, diarrhea, typhoid and neglected tropical diseases (NTDs). Aside from serious health impacts, improper sanitation also indirectly causes socio-economical problems such as poor overall well-being, reduced tourism and even an increased risk of sexual assault.

statistics world population access to proper sanitation

Sanitation Saves Lives

Poor sanitation practices help many water-borne diseases spread, such as cholera, typhoid fever and malaria. Despite this, many communities have little awareness of this, and knowledge of their connection is still very low in developing countries. Many people use the same water source that they dump their waste in for cooking, cleaning and drinking. Diarrhea, a very preventable condition, causes a disproportionately high child mortality rate in many countries.

In fact, water-related diseases are responsible for the deaths of more than 5 million people annually, worldwide1. This high mortality rate is largely attributed to how quickly the contamination of water sources can occur and spread throughout communities, especially developing ones. People in these countries tend to rely on natural sources of water for a living, despite the fact that untreated waste (both human and industrial) might be dumped into the same source upstream. Water’s natural ability to dissolve compounds means it is easily polluted by human activities.

Neglected Tropical Diseases (NTDs)

Neglected tropical diseases (NTDs) are a group of diseases that affect more than a billion people residing in 149 countries, mainly in tropical regions. They are considered ‘neglected’ as there is a severe lack of research and development into their cures. Many researchers and pharmaceutical companies have fought for more funding into developing therapeutics for NTDs, with programs in place to incentivize research, as they are not prioritized yet have higher mortality than most major ‘Western’ diseases.

Many of these tropical and subtropical diseases are rampant in developing countries, where clean water and access to proper sanitation are sorely lacking. Developing countries generally have large populations and a lack of funding for sewage infrastructure and teaching good hygiene practices. An estimated 827 000 individuals in low and middle-income countries die due to inadequate clean water, waste disposal, and poor hygiene yearly2.

Case Studies of Poor Sanitation

Nigeria’s cholera epidemic, which has persisted since the 1970s, mainly due to extreme poverty but also their lack of safe drinking water. Like the rest of West Africa, Nigeria undergoes two seasons – the raining ones and the dry spells. The rainy seasons are associated with floods that naturally lead to an increase in water levels, favoring the growth and spread of bacteria. Due to how easy it is for bacteria pathogens to be spread through contaminated water, cholera in Nigeria becomes a seasonal disease. When a country is lacking the necessary resources to ensure basic sanitation, diseases like cholera are much harder to combat.

Yemen is facing arguably the worst humanitarian crisis in the world. Around 80% of Yemen’s population, more than 24 million individuals, mostly children, are in desperate need of humanitarian aid. The severity of this problem is exacerbated by the country’s lack of sewage treatment utilities, safe drinking water, and general poor hygiene. Yemen is a clear example of how sanitation should be an utmost priority in countries. During their cholera outbreak, the disease primarily spread because of contaminated water. And because they did not have proper sewage treatment practices and access to clean drinking water, controlling the outbreak was impossibly slow.

India is similarly facing a sanitation crisis, and problems are still resurfacing in recent years. In 2010, the Telegraph reported that “India has more mobile phones than toilets”, turning heads and providing greater awareness to the lack of sanitation in India. In fact, more than half a billion people there are forced to defecate in public gutters, behind bushes and such due to the lack of proper facilities. These bulk of these issues are concentrated in slums, overcrowded areas on the outskirts of big cities that can be home to millions of people. Not only does public defecation pose a potential risk of assault, but it also increases the risk of the entire population being exposed to waste, dirt and bacteria.

Bearing the Costs of Inaction

Governments and organizations have been looking into the most cost-effective methods of proper sewage treatment. It is often a complex and expensive issue, as solutions must be unique to the infrastructure and population of that specific country. In the case of proper sanitation, many countries choose to bear the costs of inaction over action.

In a table presented by the United Nations Environment Programme (UNEP), it was found that the initial investment costs for a single wastewater treatment plant can go up to USD 646 0003. Taking into account the costs of operation and maintenance, this amount goes north of a million dollars. Faced by such costs, developing countries already plagued by poverty and disease are often forced to deprioritize these projects, choosing to bear the cost of human life instead.

Granted, these projects do not guarantee a significant improvement to overall public health. Even in households and places with functioning toilets, improper handling of excreta still poses a significant health risk. Dense populations and crowded infrastructure mean pathogens can transmit from person to person or surface to person regardless of access to proper sanitation. The lack of knowledge about pathogen transmission coupled with poor hygiene practices also contributes to the spread of disease.

As a civilization, we should be turning out focus on solving issues plaguing these developing countries. Many of us consider access to toilets as essential to human welfare, yet not everyone is provided with the same, clean treatment. Millions of individuals, especially children, are severely impacted by poor sanitation. This, in turn, contributes to a vicious cycle of disease and poverty. Because of high child mortality, families compensate by having more children, causing overpopulation and further aggravating existing problems.

There is a tremendous amount of data that shows us the progress (or lack thereof) when it comes to sanitation in developing countries. As the global population continues to rise, we must continue to innovate to solve one of humanity’s greatest challenges.


  1. Malik, A., Yasar, A., Tabinda, A.B. and Abubakar, M. (2012) ‘Water-Borne Diseases, Cost of Illness and Willingness to Pay for Diseases Interventions in Rural Communities for Developing Countries’, Iran J Public Health, 2012, 41(6): 39-49
  2. Mishra, S.R., Dhimal, M., Bhandari, P.M. and Adhikan, B. (2017) Sanitation for all: the global opportunity to increase transgenerational health gains and better understand the link between NCDs and NTDs, a scoping review’, Trop Dis Travel Med Vaccines, 2017; 3: 8. doi: 10.1186/s40794-017-0051-3
  3. Hernández-Sancho, F., Lamizana-Diallo, B., Mateo-Sagasta, J., & Qadir, M. (2015). Economic valuation of wastewater: the cost of action and the cost of no action. United Nations Environment Programme (UNEP).

You may also like...