open defecation (defecation in fields, ditches and buckets, flying toilets)

outbreaks (outbreaks of water-borne diseases, spread of disease, water borne epidemics)

disease (infectious diseases, easily preventable diseases, cholera, diarrhoea, typhoid, cholera, malaria, hepatitis, deadly acute respiratory infections, waterborne diseases, parasitic diseases, kidney failure, dysentery)

death

• child death (newborn deaths, children die before their fifth birthday

negative impact on livelihoods

negative impact on quality of people's lives: health, food availability and education opportunities.

economic loss

high absenteeism among young girls and female teachers (girls staying at home during menstruation, girls can miss up to five days from school a month or drop out entirely)

malnutrition (high malnutrition rates, chronic malnutrition)

forces people to drink unsafe water

breeding sites for mosquitoes

improved health

• reduces risk of diseases and infections

• reduces overall child mortality by about a third

increased education opportunities, safety and dignity

reduces burden of unpaid care work on women

reduces flood risk by removing waste that would otherwise block drainage systems

reduces water pollution after flooding, mitigating negative impacts on health

leads to growing population (dramatic demographic shift as lifespans increase).

increases dignity and safety: no need to trek into the woods or bathe in front of strangers

billions of people

refugees

poor individuals

women and girls, who are traditionally responsible for fetching water for the family

neonatal mortality, post-neonatal morality

community health

community socioeconomic development

nutrition

nutritional outcomes

Concrete steps must be taken to accelerate access disadvantaged groups to sanitation. The first step is to track better when and how and which people access improved sanitation and drinking water. (Activity_Report, Africa, 2014, NGO_Fed, MO, AR-845)

People living in low-income, informal or illegal settlements, and on the outskirts of cities or in small towns, are less likely to have access to improved water supply or better sanitation. (Activity_Report, Africa, 2014, NGO_Fed, MO, AR-845)

The water and sanitation crisis facing poor households in the developing world has parallels with an earlier period in the history of today's rich countries. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Without safe water or sanitation, people are trapped in a cycle of poverty and disease. (Activity_Report, North_America, 2018, NGO_Fed, MO, AR-376)

Underlying each of these problems is the fact that the people suffering the most from the water and sanitation crisis–poor people in general and poor women in particular–often lack the political voice needed to assert their claims to water. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

One plausible explanation is that, unlike HIV/AIDS and avian flu, the water and sanitation crisis poses the most immediate and most direct threat to poor people in poor countries–a constituency that lacks a voice in shaping national and international perceptions of human security. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

The crisis in water and sanitation is–above all–a crisis for the poor. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Those suffering the sanitation crisis the most–poor people in general and poor women in particular–often lack the political voice needed to assert their claims to water. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Tackling the crisis requires awareness of the cost generated by deficient sanitation. Key sanitation policy challenges include:

• Developing national and local political institutions that reflect the importance of sanitation to social and economic progress.

• Building on community-level initiatives through government interventions aimed at scaling up best practice.

• Investing in demand-led approaches through which service providers respond to the needs of communities, with women having a voice in shaping priorities.

• Extending financial support to the poorest households to ensure that sanitation is an affordable option. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

The obligation that water and sanitation are available, accessible, affordable, acceptable and safe for all without discrimination at all times, must be progressively realised by states within available resources. (General_Document, Europe, 2011, RC, IFRC, GD-100)

Economic models of sanitation must be redesigned to cover the entire value chain, managing waste, protecting the environment and living conditions, while generating business and jobs for private operators. (General_Document, Europe, 2012, IGO, IGO_Other, GD-152)

All governments should prepare national plans for accelerating progress in water and sanitation, with ambitious targets backed by financing and clear strategies for overcoming inequalities. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Governments should aim at a minimum of 1% of GDP for water and sanitation spending. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Developing countries should be judged on their ability to use aid resources efficiently and transparently to reach the poorest with clean water and sanitation. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Improving sanitation may require radical behavioural change as well as funding and reforming public policies. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Working with people those who are struggling to survive was very challenging to motivate them on behaviour changes related to sanitation and hygiene without offering any tangible incentives. (Activity_Report, Asia, 2016, Found, 0, AR-332)

Sustaining water and sanitation services and good hygiene behaviour is a significant challenge in many developing countries. Governments and other service providers should pay more attention to skilled management and maintenance of facilities that are appropriate, affordable and accessible. Key drivers behind sustained hygiene behaviour change are often overlooked, resulting in poor hygiene practices. (Strategy, Europe, 2015, NGO, NGO_Int, 2305)

With the increased number of pupils in primary schools, a major challenge for the water and sanitation sector is to ensure a healthy and hygienic learning environment for children. (General_Document, North_America, 2006, IGO, UN_OPA, GD-284)

A lack of sanitation facilities in schools results in high absenteeism among young girls and female teachers. (Activity_Report, Oceania, 2011, NGO_Fed, NGO_Fed_NA, AR-3751)

Inappropriate sanitation facilities in schools affect the children's performance at school, personal hygiene and well being and even jeopardise their access to education. (Activity_Report, MENA, 2011, NGO, NGO_Reg, AR-1761)

Teenage girls will tend to be absent from school during their menstrual period if hygiene facilities are not appropriate. (Activity_Report, MENA, 2011, NGO, NGO_Reg, AR-1761)

Cultural restrictions on sharing of sanitation facilities between adults and children, men and women and in-laws have caused slow scale-up of sanitation coverage. (Activity_Report, Africa, 2012, NGO_Fed, MO, AR-843)

Building of sanitation facilities is considered a waste of resources by nomadic households, particularly if they expect to move when drought strikes. (Activity_Report, Africa, 2012, NGO_Fed, MO, AR-843)

Failed reliance on standard and hardware subsidies and a top-down approach has provided inadequate costly toilets, delivered them to people who are not the most poor, achieved only partial coverage and use, and engendered dependence. (General_Document, North_America, 2011, IGO, UN_OPA, GD-195)

There can be particular collective action problems for water and sanitation provision, where the costs, for example of maintaining boreholes or latrines, may be seen as too high for communities to be able to meet these needs themselves. (General_Document, Europe, 2013, C/B, 0, GD-64)

The Millennium Development Goal requires an investment of $10 billion, which represents less than five days' worth of global military spending and less than half what rich countries spend each year on mineral water. This investment can save millions of young lives, unlock wasted education potential, free people from diseases that rob them of their health and generate an economic return that will boost prosperity. (Activity_Report, Africa, 2014, NGO_Fed, MO, AR-845)

Global efforts to provide improved water and sanitation for all are gaining momentum, but serious gaps in funding continue to hamper progress. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Sanitation facilities are often public and therefore prone to social dynamics and even conflicts at community level. (Activity_Report, Europe, 2017, NGO, NGO_Int, AR-380)

When it comes to development aid projects, the issue of access to water and sanitation is complex, because the solutions considered must take into account a large number of local parameters, and it is critical that the beneficiaries and all the stakeholders fully appropriate the project and thus foster its technical and social sustainability. (Activity_Report, Europe, 2017, NGO, NGO_Nat, AR-876)

Ideally, there should be closer coordination with actors providing water, sanitation and shelter. (General_Document, Europe, 2010, C/B, 0, GD-55)

Local planning and coordination play a major role in sanitation projects, involving all stakeholders. Partnerships should not only address project implementation but also governance of the life cycle of the sanitation project. Monitoring, maintenance, financing, regulation, as well as its financial accountability, should be addressed within a framework of agreement and partnership with all stakeholders involved. (Activity_Report, Europe, 2011, State, AA, AR-743)

Product innovations such as sanitation kits can offer improvement but fail to reach full adoption because humanitarian agencies prefer to create their own version of an innovation rather than adopting one built by another organisation. (General_Document, Europe, 2016, C/B, GD-73)

As no piped water was available on the sites, sanitation had to be waterless. General_Document, Europe, 2010, C/B, GD-55)

Several factors underline that we should be looking at alternatives to conventional sanitation Firstly, there is a very high incidence of diarrhoeal illnesses, which are themselves sometimes made worse by sanitation systems which are not adapted to the hydro geological context, like for example, in places where the water table is high. (General_Document, Europe, 2012, NGO, NGO_Nat, GD-251)

Pilot sanitation projects should be encouraged, in order to test new solutions on a small scale before they are diffused more widely, make adjustments if necessary and learn lessons. (General_Document, Europe, 2012, NGO, NGO_Nat, GD-251)

Due to the lack of sanitation facilities women were compelled to relieve themselves in the open and often did so at night leaving them vulnerable. (Activity_Report, Asia, 2018, NGO, NGO_Nat, AR-3798)

The biggest problem is the lack of indoor water and sanitation facilities, causing pregnant or menstruating women to shy away from shelters often at the cost of their lives. (General_Document, Europe, 2014, RC, IFRC, GD-102)

Overcoming the crisis in water and sanitation is one of the great human development challenges of the early 21st century. Success in addressing that challenge through a concerted national and international response would act as a catalyst for progress in public health, education and poverty reduction and as a source of economic dynamism. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Sanitation has received far less attention, partly because of the huge scale of underprovision and a legacy of underinvestment. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

The benefits of progress in water may be eroded by a failure to achieve advances in sanitation. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

No act of terrorism generates economic devastation on the scale of the crisis in water and sanitation. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

The sanitation sector is affected by the "classic" problems as other sectors in post-crisis situations: the need for high quality initial assessments, positioning in relation to the state, funding for the intermediary phase between emergency relief and development, coordination and planning ahead for the transition from assistance to cost recovery. Humanitarian and development agencies have interconnected know-how, but there is a lack of understanding between them. (General_Document, Europe, 2009, NGO, NGO_Nat, GD-246)

Reluctance to talk about sanitation contributes to its neglect. (Activity_Report, Europe, 2008, Net, AR-3194)

Stigma and taboos around women and sanitation must be challenged to overcome harmful practices. (Activity_Report, Asia, 2018, NGO, NGO_Nat, AR-3798)

Rapid progress is possible. Perhaps the biggest obstacle can be the stigma associated with sanitation, which is similar to HIV/AIDS. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

As the "dirty" counterpart to the clean topic water, the serious problem of the worldwide insufficient sanitation supply, is still a cultural taboo. (Activity_Report, Europe, 2013, NGO, NGO_Int, AR-878)

One of the reasons that the stigma has been so slow to dissolve is that the crisis in sanitation , unlike the crisis in HIV/AIDS, is more discriminating: it is overwhelmingly a crisis for the poor, not the wealthy. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

It is absolutely essential that sanitation, which aims to allow everyone to live in a healthy environment, should be taken into account in order to manage water resources in a sustainable and integrated manner. (General_Document, Europe, 2012, NGO, NGO_Nat, GD-251)

In ecological sanitation, the "re-use" of human waste should automatically be taken into consideration from the beginning of projects, and at the very least, the final destination of the waste should be established in advance when sanitation projects are being designed. (General_Document, Europe, 2012, NGO, NGO_Nat, GD-251)

The absence of a consensus on an acceptable basic level of sanitation, allied to problems in generating demand, has contributed to the failure. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Should it not be shocking that a displacement camp in Darfur has better sanitation, nutritional support, shelter, health care and protection programmes than the places where refugees are staying in Greece or France? (General_Document, Europe, 2016, C/B, GD-74)

"Not having access" to water and sanitation is a polite euphemism for a form of deprivation that threatens life, destroys opportunity and undermines human dignity. (General_Document, North_America, 2006, IGO, UN_OPA, GD-191)

Humanitarian organisations are being forced to become default providers of essential services like sanitation. (General_Document, North_America, 2016, IGO, UN_OPA, GD-32)