Handwashing without WASH and lockdowns without toilets: critical contradictions amid COVID-19

When COVID-19 became a global pandemic, frequent handwashing, lockdowns, and social distancing were quickly prescribed to control spread and limit new infections. Among these measures, frequent handwashing with soap is the most cost-effective defense against new infections. Yet despite the importance of handwashing and other preventive measures, they are nearly impossible to attain for billions of poor and underprivileged people around the world for whom inadequate water, sanitation, and hygiene (WASH) is a daily challenge.

How can one wash hands and maintain hygienic conditions without clean water? How can one abide by lockdowns without household taps and toilets? How can one socially distance while waiting for hours in line for water? How can one follow recommended health regulations with barely enough clean water to drink, let alone wash? These are a few of the many contradictions those without access to safe WASH are grappling with as the pandemic rages on. After decades of global policy initiatives and attempts, progress in the WASH sector is still moving at a snail’s pace: universal provision of water and sanitation to all people remains a distant reality.

The physical availability of a water point does not guarantee access.

Even before COVID-19, poor WASH was threatening the health, well-being, and dignity of billions around the world. The World Health Organization estimates that a staggering 2.2 billion people are without access to safe water; nearly 4.2 billion people lack basic sanitation facilities; and 3 billion people do not have basic handwashing facilities at home. Almost 700 million people currently practice open defecation due to lack of toilets.

Those of us who study WASH dynamics in poor communities know that these numbers are conservative. In many communities in low-income countries, the physical availability of a water point does not guarantee access. A landlord can decide to exclude a tenant from using a shared tap; a traditional leader may have the power to determine who gets priority to fetch water; and a husband could decide that the last bucket of water at home is his. Access to water, therefore, is not solely about water availability but also is intricately tied to social norms, culture, community dynamics, and social relations.

Pandemic worsens poor water access

The COVID-19 pandemic has accentuated the plight of billions around the world for whom access to safe WASH remains more a luxury than a right. This lack of access has serious implications for human flourishing, with cascading impacts for food security, economic status, mental and emotional well-being, infant health, and reproductive health.

COVID-19 is exacerbating an already dire WASH situation for the women and girls who bear the daily brunt of water collection, cooking, and cleaning. In a recent publication, my co-authors and I detail extensively how COVID-19 will amplify the toll of poor water access on women and girls in low-income countries. Expectations on women and girls to meet household WASH needs are enormous and often rooted in longstanding socio-cultural norms. Handwashing, sanitation, and hygiene needs will increase water demand at home, and the responsibility to meet those demands will fall disproportionately on the women and girls who already invest countless hours collecting water for their families.

Women and girls risk contracting the virus when they wait in long queues for water.

Women and girls in low-income countries must provide clean water and sanitation for their families’ fight against COVID-19 infections. At the same time, they risk contracting the virus when they wait in long queues for water. Social distancing is difficult while standing in long lines. In many parts of the world, more trips and longer distances in search of water expose women and girls to injuries and sexual assaults and rape. Poor WASH is a recognized trigger for gender-based violence, and some recent research shows that COVID-19 has resulted in an alarming increase in violence at home. Traditionally, women and girls in low-income countries are often expected to clean family toilets and other shared sanitation spaces, areas that are major sources of airborne exposure to COVID-19.

The WHO and UNICEF have warned that COVID-19 could also severely undermine women’s and girls’ ability to manage menstrual health and hygiene. Discriminatory cultural norms, taboos, and stigma associated with menstruation will put girls under severe pressure as they struggle to maintain hygiene amid growing competition over water due to COVID-19. In cultures where menstruating women and girls are viewed as impure and thus prohibited from or ridiculed in shared spaces, the impact of lockdowns on them will be enormous. During lockdowns in low-income countries, sanitary pads may be expensive or difficult to come by, and menstruating women and girls could be forced to remain in shared family spaces and endure stigmatization.

Poor water, sanitation, and hygiene (WASH) is a recognized trigger for gender-based violence.

Indeed, these challenges are not confined to low-income countries. In the United States, COVID-19 has shone a long overdue spotlight on weak public water systems plagued with the very challenges found in low-income countries. In a recent paper, my collaborators and I highlight the many myths of water access in high-income countries—including that water access is universal, clean, affordable, trustworthy, and equitably governed. The Flint water crisis that garnered global attention remains a reminder that the United States faces worrying WASH issues that are undergirded by decades-old regulatory failures, institutional weaknesses, and systemic racism.

Millions of people in the United States struggle with high and unaffordable water bills or live with plumbing poverty, that is, they live in households with incomplete or no plumbing, and no in-house showers, toilets, or piped water. An estimated 1,121,100 people in the United States had no household piped water connection between 2013 and 2017. Plumbing poverty is particularly widespread in Black and other minority neighborhoods, and indigenous communities. Is it therefore any surprise that in the United States, Black and Hispanic/Latinx people are the hardest hit by the pandemic and have much higher death rates? The highest water shutoff and disconnection rates due to nonpayment have been concentrated in low-income communities of color most vulnerable to COVID-19.

COVID-19 should teach us that more ambition is needed to advance global WASH goals and targets. The ultimate WASH goal should be safe water at home regardless of one’s status, race, ethnicity, income, tribe, and background. When infectious outbreaks strike, we are only as good as our global WASH infrastructure can take us. We are inherently relational beings and are bound to each other. Our common dignity reflects our individual dignity, and each person’s life is not just of value but is also integral to our common development.

Water as human right

In 2010, the United Nations took an unprecedented action to recognize water and sanitation as fundamental human rights. Never in the organization’s sixty-five-year history had water and sanitation been recognized as human rights, rendering the declaration a momentous step forward. Despite this commendable recognition, respective national commitments towards a human rights approach to water and sanitation have been lukewarm. COVID-19 must push the global community to recognize that no public health and development agenda will succeed without a WASH ambition far greater than a human rights declaration.

Many global WASH initiatives have sadly not been ambitious enough. In 2000, the United Nations subsumed WASH targets under Millennium Development Goal 7 to ensure environmental sustainability by 2015. In 2015, recognizing that WASH was sufficiently critical to stand alone as a goal, it set Sustainable Development Goal 6 to “ensure availability and sustainable management of water and sanitation for all” by 2030. In 2030—by then the world may have experienced several new pandemics—the United Nations and the global WASH community will revisit these goals and targets and chart a new course of action.

Where do we go from here? First, we must recognize that when we neglect the global WASH crisis, such neglect will result in dire consequences when infectious pandemics strike. We all are in the same global boat. We must anchor the global WASH and development discourse around the notion of dignity. Lack of WASH is a violation of human dignity at the very fundamental level. In Fratelli Tutti, Pope Francis’s encyclical on social friendship, the pope urges concern for the common good of humanity and respect for the fundamental human dignity of every person. He writes: When the dignity of the human person is respected, and his or her rights recognized and guaranteed, creativity and interdependence thrive, and the creativity of the human personality is released through actions that further the common good.

Institutions at all levels must recognize that WASH is indispensable for human flourishing and development. Bold steps are needed to prioritize global WASH needs and create safety nets to help the poor and vulnerable. In the United States, some cities have imposed moratoria on water shutoffs due to COVID-19, a commendable step to take care of poor households. There is a nationwide call on President Joe Biden to impose a national moratorium on all water shutoffs even as some water utilities refuse to suspend shut-offs or reconnect households. In Michigan, a new bill has been introduced to permanently ban water shutoffs for vulnerable residents. The moral question in all this is: must it take a global pandemic to lift water shutoffs?

Some countries in Sub-Saharan Africa have instituted temporary measures to provide free water to poor households during the pandemic. But as our research has shown, such interventions may not benefit the very poor and vulnerable households they are intended to help, because they secure water mostly from middlemen and vendors. Free water initiatives, such as water shutoff moratoria, cannot simply be a stopgap solution during the pandemic; they must be formalized as strategies to help those who simply cannot afford water.

As the world endures the pandemic, WASH decision-makers must recognize the true cost of inadequate action on behalf of the poor and marginalized groups. Analyses of the damages and disruptions COVID-19 has wreaked on the global community should take seriously how a fragile WASH situation undermines the fight against pandemics.

Ellis Adjei Adams is assistant professor of geography and environmental policy in the Keough School of Global Affairs at the University of Notre Dame.

This article is part of a series of blog posts published by the Keough School of Global Affairs. Dignity and Development provides in-depth analysis of global challenges through the lens of integral human development. 

Photo by Ellis Adjei Adams.


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