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Water, Sanitation and Dignity

Compiled by:
Risch Tratschin (seecon international gmbh)

Executive Summary

The lack of access to sanitation and the means of good hygiene is an assault against human dignity. Lack of a toilet in the home means millions of people have to spend time walking to unhealthy and sometimes unsafe locations to defecate. Household, school, and community sanitation not only impact on educational access and economic productivity, they are essential tools to enable communities to live in dignity and to realise their full potential. Human rights of equity and justice demand this issue to be addressed with highest priority.

What Does Dignity in Relation to Water and Sanitation Mean?

The term dignity signifies that a being has an innate right to respect and ethical treatment. Subject of historic philosophical debate, today dignity is often used to critique the situation of vulnerable groups (WIKIPEDIA 2011).

As the access to water and sanitation facilities is essential for human life, its improvement is also related to respect and dignity for those in need. For example, every human being deserves to be protected from the many health problems posed by poor disposal of excreta (GNANAKAN et al. 2004). But in 2010, still 2.6 billion people lack improved sanitation facilities, and 884 million people still do not use improved sources of drinking-water (WHO UNICEF 2010) (see also access to water and sanitation).

Direct contact to excreta is more or less unacceptable in different cultures all over the world (see also water sanitation and culture). The poor often must be content with polluted water and unhealthy and unsafe sanitation facilities. Not only do they face the pollution of their own defecation, but often have to live beside water bodies that have been released from urban sewers. While the rich can be identified with their bottles of mineral water, the poor must be content with polluted water from any source, mostly contaminated by the rich. Regarding sanitation, unsheltered or far away defecation options leave especially women exposed with a sense of shame (GNANAKAN et al. 2004).

This situation highlights the inequalities caused by the different access to water and sanitation. To fight these inequalities is a precondition to ensure a life in dignity for everybody.

Expanding access to water and sanitation is a moral and ethical imperative rooted in the cultural and religious traditions of societies around the world and enshrined in international human rights instruments (UNMP-TWS 2005). Both the right to water and sanitation are contained in important international legal documents. Particularly the right to sanitation entitles every person to access to, and use of, excreta and wastewater facilities and services that ensure privacy and dignity (see also right to water and sanitation).

Groups Vulnerable to Indignity

Especially in developing countries, various societal groups are facing everyday life circumstances in relation to their access to water and sanitation which do not correspond to the concept of a life in dignity:

The Poor

(Adapted from GNANAKAN et al. 2004 & UNICEF 2006)


Due to absence of waste management, these community members in a semi-formal settlement in Kaolack, Senegal, are cleaning their water stream from solid waste. As access to clean water also has to do with dignity, this can also be seen as an act to restore their own dignity. Source: TRATSCHIN (2007)

Conventional toilets have been guilty of converting massive quantities of clean water into blackwater (see also water pollution). In developing countries, 90 % of this sewage is flushed into surface waters, polluting rivers, lakes and coastal areas. This has contributed to the spread of diseases mainly amongst the poor.

Women and Girls

Heeb 2004 Girl Dirty Water

A still too common picture in the absence of proper sanitation: a girl defecating openly and unsheltered. Source: HEEB (2007)

The impact of poor water supply and sanitation services on poor women’s physical security, opportunities for adult education, overall productivity, income-generating capacity, nutritional status, time, and overall health and well-being is severe (UNMP-TWS 2005).

In many cultures, girls and women wait until after dark to defecate if they have no latrine in the household, walk to a place distant from their home for excreta disposal, particularly at night, they are vulnerable to harassment and assault. Women often refrain from drinking so that they do not have to go to toilet. This practice leads to severe health consequences i.e. bladder infections, constipation, or kidney problems (GNANAKAN et al. 2004).

Girls also commonly miss out on an education if school sanitation facilities provoke sexual harassment or hamper girls going to school during menstruation. If adequate sanitation is provided in schools, attendance of girls will rise, thus enabling them to get school education (BRUECHER et al. 2005). Studies show that girls’ attendance at school is increased through improved sanitation (UNMP-TWS 2005).


Inadequate access to safe water and sanitation services, coupled with poor hygiene practices, kills about 4’500 children and sickens thousands more every day. Countless others suffer from poor health, diminished productivity and missed opportunities for education (UNICEF 2006).

Sick and Elderly People

Sick and elderly people face special difficulty and a loss of dignity when sanitation facilities are not available nearby. This loss of dignity is especially acute for elders, for whom honour and respect are important (GNANAKAN et al. 2004).

People with Disabilities

Attempts to increase coverage of basic services such as water and sanitation have too often marginalised or excluded the needs of disabled people. This neglect can have negative impacts on health, dignity and economic and social exclusion, especially on women. For dignity reasons, people with disabilities should not rely on anyone – not even their family – for their intimate needs (HANDICAP INTERNATIONAL 2008).

Forced Manual Excreta Scavengers

 SuSanA on Flickr (2007)

A toilet emptier passes the bucket full of faecal sludge to his assistant. The man works without gloves, boots and mask, because these are too expensive. This is an extremely undignified task that poses severe health risks. Source: SuSanA on Flickr (2007)

Inadequate sanitation solutions also maintain inequalities within societies. Mainly in India, but as well other parts of South Asia, several hundred thousands of people are forced to do the extremely degrading and inhumane practice of manual excreta scavenging – the practice of manually cleaning and removing human excreta from dry (non-flush) toilets. (Watch the short movie “Lesser Humans” on this topic here).

The work is done with the most archaic equipment, sometimes with nothing else but bare hands. This inhumane and degrading practice continues to exist due to the absence of adequate sanitation systems. Nearly all of the estimated 800’000 scavengers (the so called “Dalit” or “Untouchables”) in India are women (GNANAKAN et al. 2004).

Under some circumstances also municipal workers charged with manually emptying and/or transporting faeces, excreta and sludge are subject to indignity – especially when working unprotected or in dangerous situations or when they are forced to do the work because of their social status or economic need (see also human-powered emptying and transport).

Sustainable Sanitation as Contribution to Restoring Human Dignity

(Adapted from GNANAKAN et al. 2004; BRUECHER et al. 2005)

By promoting sustainable sanitation, human dignity can be restored in many aspects of human life:

Health & Safety: Provision of safe toilets increases health and safety especially for women and girls and cuts back on time spent walking to sanitary installations. More and more safely constructed toilets can enable people to leave the vicious cycle of diseases and poverty.

Economy: If waste can be turned into useful resources such as compost or fertiliser, it increases the value of human excreta and the dignity of those dealing with it will be restored. Hence, ecological and healthy sanitation systems can foster economic development.

Exploitation: Sustainable sanitation technologies can help to eliminate the degrading practice of manual scavenging by proposing sanitation options which foreclose the direct handling of human faeces. The saying “Water is life. Sanitation is dignity” reflects the aim that decent sanitation can promote a life in dignity.

Education: Evidence from Alwar District, India, showed that school sanitation increased girls’ enrolment by one-third, and improved academic performance for boys and girls by 25%. Similar results from Bangladesh showed that the provision of girls’ bathrooms increased girls’ enrolment by 11% (WSSCC 2011).

References Library

HANDICAP INTERNATIONAL (Editor) (2008): How To Build an Accessible Environment in Developing Countries. Manual No. 2 – Access to Water and Sanitation Facilities. Part 1 – Toilets and Closed Showers. Phnom Pemh: Handicap International France Cambodia Program. URL [Accessed: 06.04.2011]. PDF

JENSSEN, P.D.; HEEB, J.; HUBA-MANG, E.; GNANAKAN, K.; WARNER, W.; REFSGAARD, K.; STENSTROEM, T.A.; GUTERSTRAM, B.; ALSEN, K.W. (2004): Ecological Sanitation and Reuse of Wastewater. Ecosan. A Thinkpiece on ecological sanitation. Norway: The Agricultural University of Norway. URL [Accessed: 19.04.2010]. PDF

UNICEF (Editor) (2006): Children and Water: Global Statistics. New York: UNICEF. URL [Accessed: 29.04.2011].

UN MILLENNIUM PROJECT TASK FORCE ON WATER AND SANITATION (UNMP-TWS) (Editor) (2005): Health, Dignity and Development: What Will it Take?. London: United Nations Development Programme. URL [Accessed: 28.03.2011]. PDF

WIKIPEDIA (Editor) (2011): Dignity. Wikipedia. URL [Accessed: 28.04.2011].

WHO (Editor); UNICEF (Editor) (2010): Progress on Sanitation and Drinking-Water. 2010 Update. Geneva: World Health Organisation (WHO) / New York: UNICEF. URL [Accessed: 14.04.2011]. PDF

WSSCC (Editor) (2011): The cold, hard facts. URL [Accessed: 25.04.2011].

Further Readings Library

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JENSSEN, P.D.; HEEB, J.; HUBA-MANG, E.; GNANAKAN, K.; WARNER, W.; REFSGAARD, K.; STENSTROEM, T.A.; GUTERSTRAM, B.; ALSEN, K.W. (2004): Ecological Sanitation and Reuse of Wastewater. Ecosan. A Thinkpiece on ecological sanitation. Norway: The Agricultural University of Norway. URL [Accessed: 19.04.2010]. PDF

This paper shows that there are comprehensive experiences and available technologies that meet new and sustainable sanitation requirements. Ecological sanitation constitutes a diversity of options for both rich and poor countries, from household level up to wastewater systems for mega-cities and needs to become recognised by decision-makers at all levels.

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UNICEF (Editor) (2000): Sanitation for All. Promoting Dignity and Human Rights. New York: UNICEF. URL [Accessed: 05.04.2011]. PDF

The 20-page UNICEF sanitation brochure was developed as a tool for generating new sanitation and hygiene policy and programme actions at country, regional and international levels. It explains how promotion of sanitation can contribute to more dignity especially among the poor and other neglected groups. The document contains good illustrations.

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UN MILLENNIUM PROJECT TASK FORCE ON WATER AND SANITATION (UNMP-TWS) (Editor) (2005): Health, Dignity and Development: What Will it Take?. London: United Nations Development Programme. URL [Accessed: 28.03.2011]. PDF

The UN Millennium Project Task Force on Water and Sanitation published this extensive report in 2005 with two main aims: First, it highlights which specific policies and resources are needed to meet the MDGs and who needs to take reasonability for ensuring they are in place. And secondly, it identifies the specific policies and resources required to meet the MDGs as part of a larger UN Millennium Project. It also pinpoints actions required in other sectors, emphasising that advances in a number of other areas strongly affect the ability of countries to meet the MDG water and sanitation target (7c) and to optimise water use.

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UN WATER (Editor) (n.y.): Sanitation for All: Making the Right a Reality. (= Factsheet, 1). United Nations Water (UN WATER). URL [Accessed: 17.10.2011]. PDF

This short factsheet is a good overview on the right to water and sanitation, including latest achievements as well as ideas for taking action.

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UN WATER (Editor) (n.y.): Sanitation Brings Dignity, Equality and Safety. (= Factsheet, 3). United Nations Water (UN WATER). URL [Accessed: 17.10.2011]. PDF

This short factsheet informs about how sanitation is connected with questions of dignity, equality and safety, including questions of gender, disabilities, etc.

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UNICEF (2013): Equity of Access to WASH in Schools: A Comparative Study of Policy and Service Delivery. New York: UNICEF. URL [Accessed: 17.04.2013]. PDF

This study presents findings from a six-country study conducted by UNICEF and the Center for Global Safe Water at Emory University in collaboration with UNICEF country offices in Kyrgyzstan, Malawi, the Philippines, Timor-Leste, Uganda and Uzbekistan and their partners. The six case studies presented together contribute to the broader understanding of inequities in WASH in Schools access by describing various dimensions that contribute to equitable or inequitable access across regions, cultures, gender and communities.

Language: Spanish

Case Studies Library

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LIBERIA WASH CONSORTIUM (Editor) (2010): Life and Dignity at Risk. Liberia: The Water, Sanitation and Hygiene Sector in Liberia. URL [Accessed: 17.04.2011]. PDF

Liberia’s water and sanitation policy states that “water is life” and “sanitation is dignity”. These powerful statements signal a welcome commitment in a country where safe water and decent sanitation have long been absent for the vast majority of the population, with catastrophic impacts on life and social welfare.This report details the current situation before focusing on the questions that will be crucial in the success of improving access to water and sanitation in the West-African country.

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PRADHAN, A.; JONES, O. (2008): Creating User-friendly Water and Sanitation Services for the Disabled: The Experience of WaterAid Nepal and its Partners. In: WICKEN, J. (Editor); VERHAGEN, J. (Editor); SIJBESMA, C. (Editor); SILVA, C. da (Editor); RYAN, P. (Editor) (2008): Beyond Construction: Use by All. A Collection of Case Studies from Sanitation and Hygiene Promotion Practitioners in South Asia. London / Delft. URL [Accessed: 05.04.2011]. PDF

This case study from Nepal explores what implications the phrase “services for all” can have and elaborates on needs related to water and sanitation services of people with disabilities. Within rural Nepal, disability is a significant issue with many people experiencing impairments of all natures and traditional water and sanitation project approaches have inadvertently excluded disabled people.

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AHMED, S. (2013): Reaching the Marginalised and Socially Isolated Sex Worker and Sweeper Communities of Tangail, Bangladesh. (= WEDC International Conference, Nakuru, Kenya, 36). Leicestershire: Water, Engineering and Development Centre (WEDC). URL [Accessed: 11.01.2014]. PDF

Sex workers and sweepers are socially isolated in Bangladesh. WaterAid in ist Inclusion Programme included both these communities and provided special support to ensure their WASH rights in the respective communities.

Awareness Raising Material Library

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HANDICAP INTERNATIONAL (Editor) (2008): How To Build an Accessible Environment in Developing Countries. Manual No. 2 – Access to Water and Sanitation Facilities. Part 1 – Toilets and Closed Showers. Phnom Pemh: Handicap International France Cambodia Program. URL [Accessed: 06.04.2011]. PDF

This booklet is the first technical manual of a three-part set called “How to build an accessible environment in developing countries” for people with disabilities. It can be used for learning more about standards and general principles; drawings and pictures will enhance the general understanding. This part of the manual focuses on how to build accessible water and sanitation facilities, which comprise toilets, closed showers, washing areas and access to clean water.

Training Material Library

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GNANAKAN, K.; CONRADIN, K.; HEEB, J.; JENSSEN, P. (2008): M2: Ecosan – an Approach to Human Dignity, Community Health and Food Security. M2-3: Ecosan and Human Dignity. PDF presentation (tutorial). In: HEEB, J.; JENSSEN, P.; GNANAKAN; CONRADIN, K. (2008): Ecosan Curriculum 2.3. Switzerland, India and Norway. PDF

This presentation is adapted from the Ecosan Curriculum 2.3. The ecosan curriculum was created in order to compile the large amount of information in a structured and comprehensive way. This is the tutorial on ecological sanitation and human dignity.

Important Weblinks [Accessed: 17.04.2011]

This is the story of how the youth in Kibera slum (Nairobi, Kenya) confront daily challenges on sanitation and hygiene. The young Kibera residents, who filmed and edited the film, range in age from 9 to 19 years. Kibera slum, Kenya and Africa's largest slum is home to about one million people living in abject poverty without clean water, toilets, electricity and sewerage. Time: 7”47. Language: English subtitles. [Accessed: 05.04.2011]

The page not only describes the work of this Indian human rights organisation, but also provides valuable information on the inhumane practice of manual scavengers (Dalit / Untouchables) in India in general. [Accessed: 05.04.2011]

This site gives some cold, hard and shocking facts on sanitation, hygiene and water supply around the world. One section provides information on the relation between the access to sanitation and human dignity. [Accessed: 05.04.2011]

This article from “The Independent” elaborates on the impacts on dignity of insufficient sanitation facilities in an urban slum of Dhaka, Bangladesh, and describes the role of the WaterAid programme to overcome these huge challenges. [Accessed: 29.04.2011]

A short movie by the Ford Foundation about the live of human scavengers in India. The film was prepared around the year 2002 and shows quite stark images. It starts with an interview with the former director of Navsarjan, Martin Macwan, an India-based human rights organization, which works to "eliminate discrimination based on caste and untouchability practices, to assure equality of status and opportunities for all, and ensure the rule of law".