State of Africa’s Environment: Death rate due to unsafe water sources 1,000-fold of that in developed countries

Water and sanitation are intertwined: lack of safe sanitation practices and behaviours lead to water pollution and diseases, besides other reasons. But safe sanitation is critical to ensuring safe water and also to bring down the disease burden arising out of this.

Unsafe water and sanitation have been major killers in Africa. Going by an analysis by data-centric portal Our World in Data, deaths attributable to unsafe water sources are much higher in the Africa continent, found the annual State of Africa’s Environment 2024 report published by the Delhi-based think tank Centre for Science and Environment and the Down To Earth magazine.

“Death rates (due to unsafe water sources) are high in lower-income countries, particularly across Sub-Saharan Africa and Asia. Rates here are often greater than 50 deaths per 100,000 people,” said an analysis of the Our World in Data portal. In comparison to death rates in developed block of countries, like in Europe, this rate in Africa is over 1,000-fold.

In a report Triple Threat, released in March 2023, United Nations Children’s Fund UNICEF said nearly two of five deaths due to lack of sufficient access to water, sanitation and hygiene (WASH) were from 10 countries in sub-Saharan Africa. Some 190 million children residing in the 10 African countries faced the triple threat of a combination of water-related risks, water-borne illnesses among children under five and climate-related hazards.

Download the State of Africa’s Environment 2024 report free here.

The threats were most acute in Benin, Burkina Faso, Cameroon, Chad, Ivory Coast, Guinea, Mali, Niger, Nigeria and Somalia, making West and Central Africa one of the world’s most water-insecure and climate-impacted regions. The 10 African countries were classified as either “fragile” or “extremely fragile” by the Organisation for Economic Co-operation and Development (OECD) and according to the UNICEF report, they had less than 50 per cent access to basic drinking water or sanitation services.

The lack of safe drinking water, sanitation and hygiene is destructive to all aspects of a child’s life. It puts fundamental needs — good nutrition, health, education and safety — at stake. African countries carry the heaviest burden of child deaths from diseases caused by inadequate wash services, the report said.

Globally, a total of 394,802 children under five years died of inadequate wash services and 254,976 of those were in sub-Saharan Africa alone.

The World Bank’s water security diagnostics showed that “the economic and human development costs associated to these gaps (inequality in access to water and sanitation) are too high.”

By 2050, “water scarcity could reduce gross domestic product (GDP) by 6 per cent (in sub-Saharan Africa). Half of global maternal deaths occur in sub-Saharan Africa. Poor water, sanitation, and hygiene (wash) also lead to increased diarrhoeal diseases, which are still the leading cause of death in the region, causing more than 8 per cent of child deaths. Nearly 35 per cent of all children are stunted, which is in part attributable to unsafe water, inadequate sanitation, and insufficient hygiene,” according to the World Bank analysis.

The Global Burden of Disease 2021 report, led by the Institute for Health Metrics and Evaluation (IHME), gives the latest estimate on the water-sanitation-related mortality and morbidity in Africa. According to this report, globally, unsafe water, sanitation, and handwashing contributed to 62.84 million disability-adjusted life years (DALY) in 2021. DALYs are the sum of the years of life lost due to premature mortality and the years lived with a disability.

Africa, with 36.6 million DALYs, accounted for about 58 per cent of the global total, followed by Asia (39 per cent). At least 1.21 million people died worldwide as a result of unsafe water, sanitation, and lack of handwashing. Africa accounted for about 44 per cent of these deaths, followed by Asia (53 per cent) according to the Global Burden of Disease 2021 report.

However, when the death rate is considered, the burden in Africa is far greater, with at least 38 people (per 100,000 population) dying from inadequate access to clean water and sanitary facilities, as compared to 12 people in Asia. Around 5 per cent of all deaths in Africa were attributed to poor hand-washing, poor sanitation, and hazardous water, compared to 1.79 per cent worldwide.

Africa has the largest percentage of deaths attributable to this “risk”. Unsafe water and sanitation contributed 1.75 per cent of all deaths in Asia lower than the global average. America and Europe followed with 0.32 per cent and 0.06 per cent, respectively. The economic loss due to the lack of access to safe drinking water and sanitation is estimated to be 5 per cent of the region’s gross domestic product.

According to World Health Organization (WHO), every dollar invested in sanitation could yield over six-fold return. This was recognised in 2008 when 52 countries on the continent signed the Libreville Declaration on Health and the Environment for Africa.

But the Strategic Action Plan to Scale Up Health and Environment Interventions in Africa 2019-2029, adopted at the closing of the Third Inter-ministerial Conference on Health and Environment held in Gabon in November 2018, showed that financial resources for these are limited.

In the sanitation sector, the real challenge is eradicating open defecation practices in Africa. Around 196 million of the 494 million people practicing open defecation in the world are from sub-Saharan Africa, according to the Joint Monitoring Programme (JMP) report on WASH by WHO and UNICEF released July 1, 2021.

The JMP report stated that sub-Saharan Africa lacked access to safe sanitation. About a billion people in the region lacked safely-managed sanitation. The majority of the population in sub-Saharan Africa lacks access to basic sanitation. According to UNICEF, the use of improved facilities that are not shared with other households is “basic sanitation”.

There has been a reduction in open defecation to 18 per cent from 32 per cent in the countries of sub-Saharan Africa. But this has been replaced majorly by unimproved and limited sanitation, which increased to 50 per cent from 45 per cent.

According to the definition of the JMP report, the use of improved facilities that are shared with other households is ‘limited sanitation’. These are again not safe sanitation practices, according to UNICEF. Communities usually tend to go back to open defecation if they adopt such unsafe sanitation practices.

The rural areas of these countries, where the most number of people reside, show the same pattern. Usage of improved sanitation facilities that are not shared with other households and where excreta are safely managed and treated offsite is “safely managed sanitation”.

Open defecation in rural areas of sub-Saharan Africa decreased from 47 to 27 per cent. But unimproved and limited sanitation increased to replace it. Disposal of human faeces in fields, forests, etc or with solid waste is “open defecation”, according to the JMP 2021. Poor faecal sludge management and sanitation caused 115 deaths per hour from excreta-related diseases in Africa, according to a joint study by the UN Environment Programme and the International Water Management Institute, an international research organisation.

(This article is excerpted from the State of Africa’s Environment 2024 report. To read the full article, download the report free here)