The dirty truth: 41 million Pakistanis without toilets

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https://www.dawn.com/news/1168630

Recently, a Unicef warning announced that an alarming 41 million people in Pakistan lack access to adequate toilets; forcing them to defecate in public. Pakistan is in fact the third largest country, behind India and Indonesia, where people are forced to defecate in the open.

This troubling practice which has become the norm for 41 million Pakistanis has profound health and nutritional consequences. Open defecation has significant consequences and it is imperative that we explore this topic.

Also read: Finding a phone easier than finding a toilet: UN

The city of Lahore is home to millions of people and has only 21 public bathrooms. Many of these are in dire condition and in a state of chronic decay. It is tragic that in a country that receives millions of dollars of aid annually, we have failed to provide the most fundamental necessities such as clean bathrooms to our people! Forcing individuals to seek out places to defecate leads to stool withholding behavior, constipation, and stunting.

Stool withholding behaviour
When children are confronted with psycho-social stressors such as not being able to defecate in private or adequately; they have a tendency to develop stool withholding behavior – they refuse to defecate in a setting where they are uncomfortable or embarrassed, causing them to reflexively withhold bowel movement.

For a child to defecate in open, it is very embarrassing and anxiety-provoking. This can lead to serious problems known as Encopresis, in which children begin to soil their undergarments.

The colon normally removes water from our faeces, but stool remaining in our gut for too long from conditioned withholding will inevitably lead to constipation. The stool becomes so hard that it is difficult to expel and stretches the colon, impairing the sensations associated with a normal bowel movement. As a result, softer stool often leaks around the blockage, soiling a child’s undergarments.

As anyone can imagine, this has devastating effects on an individual's overall level of hygiene. The faecal contamination of hands, garments, and other clothing will allow infectious diseases to disseminate with ease.

Constipation
The health ramifications of constipation are severe, and unfortunately, frequently overlooked.

Our colon is home to a bacterial flora which is essential for maintaining gut health. Constipation leads to an imbalance in this bacterial flora giving rise to unfriendly strains of bacteria and impaired gut health. The normal helpful bacteria within the colon is disturbed when hard stools associated with constipation persist.

Also read: CDA to upgrade public toilets in Islamabad

Constipation can lead to abdominal pain and a decreased desire to eat as well. In cases where constipation goes unchecked, forceful straining and attempts to evacuate stool can lead to tears and bleeding around the lining of the rectum.

Stunting

A child’s degree of stunting can be evaluated by calculating a child’s height for age as a percentage of the population median. The severity of stunting is determined as a percentage of the expected height for age.

Stunting, along with wasting, is a universal marker of protein energy malnutrition in a child.

Chronic malnutrition is frequently characterised by stunting. Due to open defecation, children are unable to adequately wash themselves and consequently, a bacterial contamination of water ensues. This leads to chronic diarrhoea and malabsorption states in children. Such chronic malnutrition leads to cognitive deficiencies and insufficient brain development.

Sanitation, hygiene, and constructing more public toilets must become a priority in Pakistan.

Failing to provide our children with the basic necessity for living is inhumane, and detrimental to their well-being.

Instructing the masses on adequate hand hygiene, providing ample toileting facilities will help with combating this problem.

Open defecation must be discouraged. And, massive efforts must be implemented to create behavioural change, provide adequate facilities, and increase awareness about overall hygiene.

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https://www.dawn.com/news/727981/pla...public-toilets

June 20, 2012

KARACHI, June 19: As many as 800 public toilets would be built at different locations with the cooperation of the Citizens-Police Liaison Committee (CPLC).

This was stated by Karachi Commissioner Matanat Ali Khan while chairing a meeting here on Tuesday.

The meeting was attended by Senior Director of Health Services Dr Shaukat Zaman, officials of five district municipalities and representatives of the Karachi Water and Sewerage Board and the CPLC.

Mr Khan said that the locations for new toilets had been identified in the various reports submitted to him whereas KMC itself had selected some locations for the purpose. The construction work would start soon, he added.

The commissioner said that at present public toilets existed at 38 locations whereas another 30 would be built in each DMC under the new project.

He said that some of the locations proposed for the new public toilets were Jail Chowrangi, Baloch Colony flyover, Karimabad flyover, Banaras flyover, Old Golimar, Nehr-i-Khayyam, Glass Tower, Clifton Centre, Quaidabad flyover, Tariq Road and Bahadurabad.—PPI

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* WaterAid report says Pakistan is now the seventh worst country in world in terms of access to basic sanitation facilities * 21.8m people in Pakistan still defecate in the open

https://dailytimes.com.pk/145728/79m...toilet-report/

NOVEMBER 23, 2017

LAHORE: WaterAid report revealed at a ceremony in connection with World Toilet Day (WTD) on Wednesday stated that Pakistan is now the seventh worst country in the world in terms of access to basic sanitation facilities, while 42 percent of the total population in Pakistan remains without access to at least basic sanitation at this time.

A staggering 79 million in Pakistan still lack a decent toilet, while 37 percent people have no system for wastewater disposal, which leads to spread of diseases due to contamination of water and contact with human waste. While calling for immediate attention to the situation, the Public Health Engineering Department in collaboration with Saaf Sehatmand Pakistan Campaign marked the World Toiled Day under the them “Wastewater” at a local hotel.


This year’s theme for World Toilet Day “Wastewater” holistically leads to bridge the gap between basic and safe sanitation. The participants stressed the need for containing, transporting, treating and disposing of human waste in a safe and sustainable way.

Those in attendance included UNICEF Country Representative Kitka Goyol, Public Health Engineering Department (PHED) Punjab Secretary Captain Retired Mohammed Khurram Agha, WaterAid Country Director Siddiq Ahmed Khan and Member Health Planning and Development Dr Shabana Haider. A large number of civil society representatives, students and people from different walks of life attended the ceremony.

On the occasion, AGAHE and STEP College students jointly presented a skit and emphasised to wash hands before eating. They gave a message of behavior change by saying that “cleanliness is half of the faith”. As well, a painting competition was also held on the WTD theme “Wastewater”.

PHED Punjab Secretary Khurram Agha, talking with Daily Times, said that there was a global sanitation crisis affecting more than 4.5 billion people around the world, creating diseases and putting economic burden on societies. “In Punjab, 17 percent of the people are defecating in open. According to the UNICEF report, 94,000 persons die each year due to waterborne and sanitation-related diseases, while 80 percent of all diseases may be attributed to water and sanitation, like polio, diarrhea, jaundice, typhoid and cholera.”

79m-Pakistanis-still-lack-a-decent-toilet-021LAHORE: WaterAid report revealed at a ceremony in connection with World Toilet Day (WTD) on Wednesday stated that Pakistan is now the seventh worst country in the world in terms of access to basic sanitation facilities, while 42 percent of the total population in Pakistan remains without access to at least basic sanitation at this time.


A staggering 79 million in Pakistan still lack a decent toilet, while 37 percent people have no system for wastewater disposal, which leads to spread of diseases due to contamination of water and contact with human waste. While calling for immediate attention to the situation, the Public Health Engineering Department in collaboration with Saaf Sehatmand Pakistan Campaign marked the World Toiled Day under the them “Wastewater” at a local hotel.


This year’s theme for World Toilet Day “Wastewater” holistically leads to bridge the gap between basic and safe sanitation. The participants stressed the need for containing, transporting, treating and disposing of human waste in a safe and sustainable way.

Those in attendance included UNICEF Country Representative Kitka Goyol, Public Health Engineering Department (PHED) Punjab Secretary Captain Retired Mohammed Khurram Agha, WaterAid Country Director Siddiq Ahmed Khan and Member Health Planning and Development Dr Shabana Haider. A large number of civil society representatives, students and people from different walks of life attended the ceremony.



On the occasion, AGAHE and STEP College students jointly presented a skit and emphasised to wash hands before eating. They gave a message of behavior change by saying that “cleanliness is half of the faith”. As well, a painting competition was also held on the WTD theme “Wastewater”.

PHED Punjab Secretary Khurram Agha, talking with Daily Times, said that there was a global sanitation crisis affecting more than 4.5 billion people around the world, creating diseases and putting economic burden on societies. “In Punjab, 17 percent of the people are defecating in open. According to the UNICEF report, 94,000 persons die each year due to waterborne and sanitation-related diseases, while 80 percent of all diseases may be attributed to water and sanitation, like polio, diarrhea, jaundice, typhoid and cholera.”



The Multiple Indicator Cluster Survey (MICS) statistics show that the rate of diarrhea in Punjab is 17 percent, he said, adding that sustainable sanitation was a human right and a matter of dignity, equity and safety.

He said that in order to achieve the objectives, the government of Punjab had conceived WASH sector policies including WASH Sector Development plans. Government of Punjab is implementing large-scale programmes related to liquid waste management, water quality and safety, creation of open defecation free environment, promotion of hygiene behaviors and malnutrition reeducation, he said.

Speaking on the occasion, the secretary further said that despite the severity of the issue, sanitation remains a low priority area in the county. “There is an immediate need to shift focus. The Sustainable Development Goals launched in 2015 include a target to ensure everyone has access to a safely managed household toilet by 2030. This makes sanitation central to eradicating extreme poverty.”

The SDG target 6.2 calls for achieving by 2030 “access to adequate and equitable sanitation and hygiene for all and end open defection, paying special attention to the needs of women and girls and those in vulnerable situations”. According to WaterAid’s report, Pakistan is the fifth best country in the world for reducing open defecation. Though Pakistan has made some progress towards achieving this SGD, a lot more still needs to be done as 21.8 million people in Pakistan still defecate in the open. Special attention also needs to be paid to the treatment and disposal of wastewater, which undermines progress in child health and survival by spreading killer diseases.

UNICEF Country Representative Kitka Goyol said that the lack of access to toilet and sanitation and unavailability of systems for wastewater disposal also have direct implications on the future and education of children. He said, “One in three schools in Pakistan is missing a toilet which contributes to dropouts, especially that of girls. Untreated human waste and lack of sanitation facilities also cause diseases, which keep children from attending school and disrupt their education. Sanitation and wastewater management are essential to safeguard the future of our children.” Kitka also briefed on the topics of “SDGs are Pakistan Development Goals”, “SDG are progression of MDGs”, “SDGs are universal – leave no one behind” and “SDGs Build upon unfinished business of MDGs”.

WaterAid Country Director Siddiq Khan said, “Improving funding and allocation of resources is at the heart of solving the sanitation and wastewater problems in Pakistan. It is encouraging to see the government’s willingness and promise in this regard but more needs to be done to ensure we are able to achieve the SDG for sanitation and wastewater management. Unless appropriate funding is diverted to these areas, long-term, sustainable gains cannot be made.”

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https://medicalxpress.com/news/2015-...stan-tied.html

More than 40 million people in Pakistan do not have access to a toilet, forcing them to defecate in the open, which in turn is a major contributor to stunting in the country, a top UNICEF official said.

"There are 41 million people who do not have access to a toilet in Pakistan and as a result they are defecating in the open. And open defecation has significant health and nutritional consequences," said Geeta Rao Gupta, deputy executive director at UNICEF. She recently spoke to The Associated Press during a trip to Pakistan to draw attention to the problem.

"Open defecation is a major contributor to stunting and that's why we've got to do all we can to stop it," she said.

Pakistan is the third-largest country when it comes to people going to the bathroom in the open, behind India and Indonesia. The problem can spread disease and lead to intestinal infections, which can contribute to stunting in young children, she said.

Stunting means children don't grow as tall as they would otherwise, and it can also affect a child's brain development. Stunted children are more at risk of disease, don't do as well in school and stunted mothers can also give birth to stunted children.

UNICEF is working with the Pakistani government to improve sanitation by doing things like encouraging people to wash their hands more often. They're also working with communities to help them build toilets so they don't have to use the bathroom in a field or elsewhere.

Building more toilets is also vital for empowering women and girls and keeping them in school, Gupta said. If women have to walk long distances to find a private place to relieve themselves, they are more vulnerable and exposed to attack. They're also less likely to go to school if there are no toilets.

"Having toilets is a big advantage to girls," she said.

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40m Pakistanis without toilets, 27m without clean water: report

BY WEB DESK , (LAST UPDATED MARCH 27, 2017)

https://www.pakistantoday.com.pk/201...-water-report/

LAHORE: More than 27 million Pakistanis do not have access to clean water whereas 40 million are defecating openly due to lack of proper toilets.

According to a report issued by World Resources Institute, Pakistan is on 36th number in the list of 180 countries who is facing severe pressures over providing basic necessities of life including clean water.

Ministry of Climate Change spokesman Saleem Sheikh said that the report has stated that Pakistan is facing scarcity of water which can be turned into famine in near future. He said the only way to avert drought is timely preservation and right use of water.

The report further mentioned that 60 years ago, 50lac litre per person water was available in Pakistan but now the quantity has decreased by five times.

More than 39,000 children below age five fall prey to Cholera every year due to dirty water and inadequate cleanliness situation in Pakistan.

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https://www.arabnews.com/node/1410116/world

BASTI AMEERWALA, Pakistan: For as long as she can remember, Ayeesha Siddiqua has fought her male relatives for access to toilets — but a sanitation drive by new premier Imran Khan could make life easier for women in patriarchal Pakistan.
“I told them: ‘You can go where you want, but me, my movements are restricted!’,” said Siddiqua, who is in her 60s, in Basti Ameerwala, a small agricultural village in central Punjab province where residents have been relieving themselves in the open for generations.
Women in the village have long been forced to hide their bodily functions from the conservative, deeply patriarchal society, Siddiqua and other female residents told AFP.
Restraining themselves over long days working in the fields, they wait for night and the cover of darkness — braving snakes, dogs, or even unpleasant encounters with strange men, Siddiqua’s daughter-in-law Tahira Bibi said, her face hidden by a brown veil.

“I would limit my consumption of water and eat less just to avoid going to the bathroom in the daytime,” the 35-year-old said, describing a ploy used by all the women interviewed by AFP in the region.
For the last month and a half, however, Tahira Bibi has not had to wait. A small red-brick cottage housing a pastel green squat toilet has been erected in front of her house.
The initiative has come from a Pakistani non-profit, the Lodhran Pilot Project (LPP), whose team has ventured into the remote hamlet to preach hygiene — mainly, they say, to men.
Tahira Bibi says one of her four children died after “stomach problems,” while another was at one point in critical condition.
“We thought it was God’s will,” she said soberly.


Providing toilets is the responsibility of men in the region, according to Altaf Hussain, a program officer for LPP.
“When we ask them, they are ashamed that their women have to defecate outside,” he said.
“So they tell us they have never thought about toilets. They are surely lying. They can spend money on TV, smoking, other things, but latrines are not a priority.”

Added to this, he says, is a cultural issue: “People see open defecation as routine, and as fertilizers for their soil. They are not aware of the consequences.”
The United Nations children’s agency says 22 million Pakistanis relieve themselves in the open. In rural areas just 48 percent of the population has access to toilets, compared with 72 percent in the cities.
Some 53,000 children die each year from diarrhea in Pakistan after consuming polluted water, according to UN data.
Typhoid, cholera, dysentery and hepatitis are common. Those who do not die “tend to see reduced capacity of their body to absorb nutrients,” says Kitka Goyol, a UNICEF expert on water and hygiene.
That can be a factor in stunting, which afflicts 44 percent of Pakistani children.

Tahira Bibi says one of her four children died after “stomach problems,” while another was at one point in critical condition.
“We thought it was God’s will,” she said soberly.

The UN, which marked World Toilet Day this week, says the lack of toilets costs Pakistan up to $2.5 billion per year.
Khan, who came to power in August, vowed last month to “eradicate the deficit of toilets in the country by 2023.”
His counterpart in neighboring rival India, Narendra Modi, launched his own aggressive sanitation drive in 2014.
New Delhi claims it has slashed the number of people forced to defecate in the open from 550 million that year to less than 150 million today.
Khan’s government, meanwhile, has launched “Clean Green Pakistan,” a massive social and environmental initiative seeking to shift behavior in areas including sanitation, minister of climate change Malik Amin Aslam said. He did not offer details, however.
Non-profits such as LPP, which is not part of Clean Green Pakistan, are already paving the way in places like Basti Ameerwala, where 15 out of 60 households now have latrines.
In the neighboring hamlet of Chah Jamalianwala, where LPP also works, 35 out of 60 houses have one, six of which have been built in recent weeks.
Mohammad Nasir, a frail man of 45, is one of the last to have taken the step.
Like many other men in the area, he did not consider a toilet a priority — having relieved himself in neighboring fields for 28 years, and spending his money instead on a satellite dish, television and solar panel.
Finally, after his doctor warned him about his wife’s health, his small field is equipped with roofless latrines.
The construction cost him 15,000 rupees ($110), a month’s salary — but, he says, he feels “pride” at finally having a toilet.