PHA-Exchange> Providing the world with clean water

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From: Dr Rana Jawad Asghar <jawad at alumni.washington.edu>

Providing the world with clean water
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BMJ 2003;327:1416-1418 (20 December),
doi:10.1136/bmj.327.7429.1416

Providing the world with clean water remains a complex problem,
but time is running out

Some 150 years after John Snow discovered that a contaminated
water pump was responsible for a localised cholera outbreak, two
million people world wide still die every year from water re-
lated diarrhoeal illnesses.1 2 In 1854 John Snow did not know
that an organism was responsible, but meticulous epidemiological
studies and common sense led him to close the Broad Street pump,
saving hundreds of lives. At the beginning of the 21st century,
despite our extensive knowledge of the causes and prevention of
water associated illnesses, 1.1 billion people around the world
have no access to clean water and 2.4 billion have inadequate
sanitation.1

Ideally, everyone would have the same high quality, abundant
quantity water supply that people in the developed world take
for granted: we flush drinking water down our toilets and wash
ourselves, our clothes, and our cars in it. But usually it is a
trade off between quality and quantity.

The quantity of surface water (rivers, lakes, ponds, etc) is
variable, depending on rainfall, and is poor quality, whereas
groundwater (found in permeable rocks more than 100 metres un-
derground) is usually high quality but variable in quantity.
Surface water harbours pathogens and the insect vectors of in-
fectious diseases. Although groundwater is usually the safer
choice, accessing it entails obvious difficulties, and in some
areas it is naturally contaminated by minerals such as arsenic
and fluoride, which are harmful to health.3 4 Treating contami-
nated water is difficult and costly, so the solution is usually
to find another supply, but that may be a distance away, result-
ing in yet more technical and financial problems. Natural min-
eral contamination of groundwater accessed from boreholes has
resulted in the very damage to health that they were meant to
avoid-just one of the many lessons learnt over the past few dec-
ades of water and sanitation initiatives.

By far the biggest threat to providing the world with safe water
is water quantity. Fresh water is a finite source, making up
less than 1% of the earth's total water; 95% of this is ground-
water.5 In the United Kingdom, we are fortunate to have an abun-
dance of groundwater,6 but 70 million people in sub-Saharan Af-
rica live in areas where groundwater is very difficult to find.7

Getting worse

Water quantity and its sustainability has always been a problem
but is predicted to get much worse as a result of depleted re-
sources, mismanagement, and poor governance. Groundwater is be-
ing depleted globally by the demands of increased population and
the growth of major cities, and increased chemical pollution
(mostly from fertilisers) is threatening its quality. By 2025,
two thirds of the world's population will live in water stressed
countries.5 Compounding these problems are political, social,
and technical barriers.

Upstream-downstream water conflicts are difficult to solve. The
river Nile, for example, has long been a source of conflict be-
tween Egypt, Ethiopia, and Sudan. A total of 145 countries have
territory in shared river basins, and in the past 50 years 200
treaties have been signed about international water courses.
Most of these remain weak because of poor mechanisms for moni-
toring, enforcement, and conflict resolution.1

Further information
http://www.world.water-forum3.com/
http://www.who.int/health_topics/water/en/
http://www.wateraid.org
http://www.thewaterpage.com
http://europa.eu.int/comm/research/water-initiative/index_en.html
http://www.unesco.org/water/wwap/wwdr/index.shtml
http://www.bamwsp.org/
http://www.wsp.org

One of the key findings from past initiatives is that the
sustainability of water supplies depends on the community's
sense of ownership, so women (who are often the main water
collectors) need to be involved in decisions about siting
sources and maintenance.8 This can presents challenges. For
example, if groundwater analysis shows that the best place to
drill a borehole is 4 km away from the village that will rely on
it, the villagers are not likely to switch to using it rather
than a pond a few metres from their homes. Hygiene education
also plays a part, as some communities have been reluctant to
use latrines. Initiatives promoting having a latrine as a status
symbol are the most likely to succeed. Throwing money at the
problem or arbitrarily placing boreholes without any
communication with users is always doomed to failure.

Moving the goalposts

So what is the global community doing to solve these problems?
If setting targets and holding summits (such as the third World
Water Forum earlier this year) were the answer, we would be
there by now. Instead there has been an embarrassing resetting
of targets and moving of goal posts.

In the 1980s, the "water supply and sanitation decade," the in-
ternational community set the ambitious target of universal ac-
cess to safe water and sanitation by 1990. Then it slipped to
2000, and now one of the United Nations' millennium development
goals is to halve the proportion of people who do not have ac-
cess to safe drinking water (declared a basic human right by the
UN) by 2015.9 Financial barriers remain. The international char-
ity WaterAid is campaigning for the rich countries of the G8
group to double all forms of funding for improved water and
sanitation if this goal is to be met.10 But at the moment the
European Union (which is leading "Water for Life" initiatives;
http://europa.eu.int/comm/research/water-initiative/index_en.html)
is blocking a bid for 1bn ($1.2bn; £700m) for this purpose be-
cause it wants more assurances that the money will be used ef-
fectively.11

It seems obvious that we need to do much more than meet the mil-
lennium development goals to avoid disaster for the majority of
the world's population. To avoid repeating the mistakes of the
past decades, governments, donors, non-government organisations,
and communities need to work together rather than pull in dif-
ferent directions. We have a collective responsibility to safe-
guard our water resources through sustainable water practices.
The outlook, however, if the model of the agreements on carbon
dioxide emissions is anything to go by, is grim.12 But time is
running out: even the rich can't buy their way out of everything
forever.

Rhona MacDonald, assistant editor, BMJ
mailto:rmacdonald at bmj.com