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Open defecation: How are 22 million Pakistanis living without basic sanitation?

Nearly 10 per cent of the population of Pakistan lacks access to sanitary toilets, enabling diseases like typhoid, polio, diarrhea, jaundice, and cholera to flourish. How is the problem being addressed as Covid-19 cases spike in the country of 200 million?

32 year-old Rehmat Bibi, who’s wearing a black shawl in the picture above, woke up in the middle of the night. She shook her younger sister who lay beside her to wake her up. The two women ventured outside the house in pitch darkness with a gas lamp. After walking a few metres they came across a large bush, which both women took turns using to relieve themselves behind.

Rehmat Bibi and her sister are two among millions of other women who are forced to defecate out in the open due to a serious dearth of toilets in rural Pakistan.

According to a study conducted by children’s charity Unicef, 22.2 million Pakistanis lack proper toilets and sanitation in the country of 200 million people. Water borne and sanitation-related diseases like typhoid, polio, diarrhea, jaundice, and cholera are some of the leading causes of death in Pakistan; 94,000 people in the country die due to the consumption of contaminated water, and 53,000 Pakistani children under the age of five die a year from diarrhoea due to poor water and sanitation. 

Rehmat Bibi’s house is situated on a mountain top by a natural border between the provinces of Sindh and Balochistan. Her village, named Mitho Goth (which means sweet village in Urdu), consists of about 100 other households, all of which are deprived of basic sanitation. The village, which is so remote it cannot be found on a map, has just one washroom adjacent to a mosque built by the locals. It is constantly used by the village men, the women have to hold in the urge and wait until nighttime to defecate out in the open.

In 2007, when Cyclone Yemyin wreaked havoc and flooded the village, killing 24 people, a team of non-government organisations (NGOs) and government officials came to help with the relief effort. A toilet was built in the area, but it was kept off limits for the locals. Only the visiting dignitaries were allowed to use it.

During the time of the rescue operation, two women died as a result of stomach problems owing to poor sanitation and hygiene. One of the NGOs, Caritas Pakistan, which is run by the Catholic Church, took note of the gravity of the issue and built new public washrooms for the villagers the following year

Mansha Noor, executive secretary of Caritas Pakistan, said that the purpose of building toilets for the village locals was not only to provide better hygiene, but to give vulnerable women venturing out in the dark somewhere safe to relieve themselves away from the attentions of men.

Noor said the village women had previously been oblivious to the notion that open defecation could be a health risk, and were keen to use the new toilets and adopt better hygiene and sanitation standards. They were trained how to use the toilets and taught basic hygiene, such as hand-washing before and after using the toilet.

Just over half (59.6 per cent) of the population of Pakistan has access to basic handwashing facilities, and the proportion is lower (46.1 per cent) in the countryside; worrying statistics, particularly in the time of the coronavirus. As of 17 April, Pakistan had recorded just under 4,000 cases of the virus, and 54 deaths.

Before the coronavirus had first emerged in Pakistan, Naseem Salahuddin, an infectious disease specialist at Aga Khan University Hospitall in Karachi, said that if coronavirus entered the country it would “spread like wildfire.” There will be many more deaths as our “general population is fairly unhealthy,” she said.

Class divide

Water Aid, another NGO operating in Pakistan, has done extensive research on sanitation in Pakistan and attributes poverty to the lack of sanitary toilets.

Head of programmes for Water Aid, Asim Saleem, said that most villages in Pakistan have one toilet at most, which is designated for visitors and special guests. 

Saleem said that most people in rural parts of Pakistan are used to defecating in open fields, and have no qualms about doing it. Indeed, many don’t want to change their ways. Proper sewerage systems rely on underground water sources, and it’s a commonly held belief that building a sanitation system would interfere with the water table and pollute it, Saleem said.

Water Aid is working on changing that belief, and is raising awareness through door-to-door campaigns to teach proper sanitation and hygiene using informational videos and public talks on how proper sewerage systems work and why essential hygiene and sanitation contribute to a healthier society.  

Changing behaviour

Speaking to Eco-Business about Pakistan’s toilet habits, a spokesperson for the health ministry of Sindh said that a sanitation policy set in 2017 aims to end the practice of open defecation in the province by 2025. 

However, he admitted that persuading the people to change long-held habits is a big task, since many don’t believe that their behaviour needs to change.

In numerous villages where new toilets had been installed they were used as storage rooms and kitchens rather than the purpose for which they were built, said the spokesperson, who preferred to remain anonymous.

However, one silver lining to the spread of the coronavirus, could be a hastening shift in attitudes towards hygiene, as the need for handwashing and sanitation becomes critical, said Saleem of Water Aid. However, he pointed out that attitudes are changing faster in urban areas than in the countryside, but even in cities access to soap and handwashing facilities remain limited.

“Though attitudes are changing [in light of Covid-19], they are not changing to the level required. People still don’t give sufficient priority to washing,” he said.

Meanwhile in Mitho Goth, Rehmat Bibi insists that the introduction of toilets has had a profound impact on her life and the lives of others, and this change needs to be embraced to bring about a healthier, safer community, and a cleaner environment. 

“[The introduction of toilets was] a sign to us all, assuring us that we are cared for and not forgotten out here, away from mainstream society,” she said.

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