According to the World Health Organization, “over half of the world’s population or 4.2 billion people use sanitation services that leave human waste untreated, threatening human and environmental health”. 2 billion people lack a basic toilet.  673 million have no toilets at all. This means they practise open defecation.

In 2017 UNICEF found that 6 million Filipinos defecated openly and some 29 million lacked access to basic sanitation facilities. Many countries have communal latrines. UNICEF 2019 says that for women and girls to go to the toilet outside, often having to wait until the cover of darkness, can leave them vulnerable to abuse and sexual assault.


Poor sanitation in India is potentially responsible for the stunting of over 65 million children. Unhygienic practices transmit cholera, dysentery, diarrhoea, hepatitis, polio, and a host of other diseases. Fecal matter attracts flies. They deposit microbes on food. The Indian government launched Swachh Bharat, a campaign to provide toilets in urban and rural areas so as to keep the environment clean. It has yielded satisfactory results though much remains to be done to address the problem of open defecation.

Human excreta can lead to water pollution; wells, from which water is drawn for use and consumption, become unclean. Children playing in the proximity of land infested with faeces are easy targets. They may pick up things from the ground to eat without prior washing. Thousands of children die yearly due to severe intestinal worm infections.  Defecating in fields or along railway tracks puts workers and pedestrians at risk of coming into direct contact with the excreta. They may bring it home in their shoes. This is how entire families can get exposed to microbes and germs. Apart from flies, other mechanical vectors like cockroaches, beetles and dogs may carry the microbes.

Bad sanitation is generally associated with rural areas but Dele Akindoya in an article “Tackling open defecation in Nigeria” says, “The phenomenon does not just occur in rural areas of Nigeria but also in the cities and among the educated class in public tertiary institutions, business and residential areas. Over 47 million Nigerians defecate openly in and on bushes, gutters, sidewalks, motor parks, rivers and streets among others.” Efforts are ongoing to address the issue but he regrets that these efforts remain mainly efforts.

According to Pan American Health Organization, nearly 16 million people still practise open defecation in Latin America and the Caribbean. WaterAid is an international Organization that works to make clean water, decent toilets and good hygiene available to the poor. It finds that “A staggering 93% of Ethiopia’s population still have no access to a basic toilet.” The organization reports that in Madagascar more than 8,000 children die from diarrhoea annually due to unsafe water; 1.8 million Malagasy children face stunted growth as a result of a lack of necessary nutrients in the drinking water.  World Health Organization and UNICEF’s Joint Monitoring Programme reports that 10.6 million people in Madagascar defecate in the open.

Angus Ingham, writing for (7.3.2016) in “5 Facts about Poop in India” observes, “Every day, around 100,000 tons of poop end up in the open    an amount that would fill London’s Wembley Stadium”.

Water shortages

It has been found that diarrhoea-related diseases in children under five are twice higher in communities where open defecation exists compared to communities where there is no open defecation. Children under age five living in countries with protracted conflict are 20 times more likely to die from causes linked to unsafe water and bad sanitation than from violence. One million deaths each year are associated with unclean births. 663 million people live without access to drinking water. 2.4 billion do not have access to basic sanitation. Globally, at least 2 billion people use a drinking water source contaminated with faeces. 40% of world population is affected by water shortages. This implies that they are compelled to live without a bath over days. Both adults and children are thus exposed to diseases.

2 million tons of sewage are dumped into waterways every day. Pesticides and chemicals contribute to water pollution.

Street foods around the world are convenient but they may cause non-communicable diseases because of high quantities of carbohydrates and fats or sugar. Besides, there is no guarantee that they are handled, prepared, stored and sold in ideal conditions. No one knows how often they are controlled by the officials. In Mauritius it is common to see flies hovering over baskets into which papers are thrown after eating dholpuri and roti. We have all of us seen stray dogs roaming around in markets.


UNICEF and WHO 2019 report that open defecation and the widespread use of squat toilets pose additional risks concerning the transmission of COVID-19 and other fecal pathogens in developing communities. Since squatting toilets are typically without lids or built-in U traps, users are exposed to virus-laden splashes. The semi-enclosed space of squat toilets and the lower breathing zone of users could exacerbate the risks. In short, open defecation poses elevated risks of fecal transmission of COVID-19.

Two out of five households practise safe disposal of child faeces in Bangladesh. Out of four latrines, one is unhygienic and without lids. Inadequate sanitation carries a high economic cost in this country: US$4.2 billion.

A C/Net report by Ben Fox and Rubin S Kepur Gomes (Sept 11, 2020) says, “Studies have found that coronavirus can be spread through faeces, so stopping wastewater from contaminating water supplies should help prevent the virus from spreading.”


The extent of poor sanitation in the world is mind-boggling. The real challenge for governments is to provide access to proper sanitation and hygiene to their citizens. Tackling poverty must be a priority. Sensitization programmes must continue. Defecating in the open is a matter of habit and mindset. Criminalizing open defecation or overuse of water-polluting pesticides might be effective. It is also necessary to have better waste disposal systems.

Flooding causes a stunning overflow of toilets in flood-prone regions. This contaminates water sources. It takes weeks for the water to evacuate. In the meantime, people are directly exposed to diseases. More efforts must go into constructing toilets capable of surviving floods.

We must be having thousands of garbage dumps around the world. Residents living near landfills are at a disadvantage as they are vulnerable to air pollutants and toxins that may cause cancer, respiratory problems, birth defects and infectious diseases.

Countries that aim to attract tourists must bear in mind that it is a clean environment that tourists are basically looking for. Educating people about cleanliness and giving them financial assistance to build basic toilets in their homes would be one way of changing things.

Slums are crowded places where you have stagnant water, garbage, improper drainage, a lack of sanitation facilities and a lack of proper ventilation. People can easily fall ill. Studies show that childhood illnesses and malnutrition are higher among children living in slums than those living elsewhere.

The world is a dirty place. We need to make it livable. If we want to fight the spread of diseases, we must begin with eliminating the causes.