The role of water in tackling a global health emergency

SI Advocacy Advisor, Linda Witong, explains the importance of access to clean water in the context of a global health emergency.

“It has been acknowledged that pandemics, which are large disease outbreaks that affect several countries, pose major health, social, and economic risks. A quick-moving pathogen spreading across the globe has the potential to kill tens of millions of people, disrupt economies, and destabilise national security. A severe pandemic can result in millions of deaths, and even the most conservative estimates suggest that pandemics destroy up to 1% of global GDP, which is comparable to other top-priority threats, such as climate change.

To make matters worse, in the past, global policies have also failed to consider how women and girls experience such outbreaks and responses differently from men or boys. For example, existing global policies or public health efforts which have failed to adopt a gender lens when responding to a disease outbreak or its response have resulted in women and girls continuing to be more likely to be infected or even die as a result of being infected by a virus, given their predominant roles as caregivers within families which often occurs with little external support, or as front-line health-care workers. [1] Existing global policies or public health without a gender lens have also resulted in providing women or girls with inadequate access to health care during such outbreaks as well as insufficient financial resources to travel to hospitals for check-ups, purchase necessary medicines or even support their family.  Existing global policies or public health efforts without a gender lens have also increased the threat of violence including when women or girls searched for water or food for their families, contributed to women or girls suffering from the stigma or psychological trauma arising from taking care of the sick or dying, the threat of eviction and the loss of employment and educational opportunities.[i]


Officially, COVID-19 is now a pandemic, spreading so quickly that any tally of infections and deaths will rapidly become outdated before this can even be published. Cases outside of China have already increased 13-fold in the last two weeks, with the global number of infections surpassing 126,000 on March 12, 2020. As countries from Italy to Iran, from Sweden to South Africa, struggle to contain the virus, it is more important than ever to turn to expert advice from institutions such as the World Health Organization. We already have learned that data from the State Council Information Office in China suggest that women or girls are still suffering effects which men or boys do not as a result of this outbreak. For example, more than 90% of health-care workers in Hubei province are women, again emphasising the gendered nature of the health workforce and the risk that predominantly female health workers incur.[i] Moreover, as in past cases, the closure of schools to control COVID-19 transmission in China, Hong Kong, Italy, and South Korea e.g. have also been viewed to potentially have a differential effect on women, who again provided most of the informal care within families, with the consequence of limiting their work and economic opportunities. Travel restrictions were also projected to cause financial challenges and uncertainty for mostly female foreign domestic workers, many of whom travel in southeast Asia between the Philippines, Indonesia, Hong Kong, and Singapore.[ii]

COVID-19 and Water, Sanitation and Hygiene 

Strong health systems that reach all people—especially the most vulnerable—with effective services are the only way to ensure protection from major disease outbreaks. That is why ensuring and investing in preparedness before a crisis strikes saves lives and ultimately saves money. Yet, the world is not prepared for a fast-moving, virulent respiratory pathogen due to the poor integration between preparedness and day to day health needs as, in too many places, the lack of even the most rudimentary health-care infrastructure including equal access to safe and clean water and sanitation only contributes to potentially fast-spreading and lethal outbreaks. In reviewing the experts’ advice as to how one should deal with this pandemic, one message comes through loud and clear: regular hand-washing with soap and water is a crucial step in order to protect ourselves as well as halt the transmission of this virus rather than magnify or expand its reach.

But there is a problem with reaching that goal: while hand washing with soap, when done correctly, is critical in the fight against the novel coronavirus disease (COVID-19), millions of people have no ready access to a place to wash their hands according to UNICEF. In total, only 3 out of 5 people worldwide have basic hand washing facilities, according to the latest data. It was observed that: “Hand washing with soap is one of the cheapest, most effective things you can do to protect yourself and others against coronavirus, as well as many other infectious diseases. Yet for billions, even this most basic of steps is simply out of reach.” observed Sanjay Wijesekera, UNICEF Director of Programmes. “It is far from a magic bullet. But it is important to make sure people know what steps they should take to keep themselves and their families safe, even as we continue our longstanding efforts to make basic hygiene and sanitation available to everyone.”

In many parts of the world, children, parents, teachers, healthcare workers and other members of the community do not have access to basic hand washing facilities at home, in healthcare facilities, schools or elsewhere. For many communities, water sources are usually far from their homes, and it typically falls to women and girls to spend much of their time and energy fetching water, a task which often exposes them to attack from men and even wild animals. Beyond the community, the lack of effective waste disposal or sewerage systems can also contaminate ecosystems and contribute to disease pandemics.

Despite significant progress, there are still 2.2 billion people around the world today who do not have safely managed drinking water services. Over half of the global population, or 4.2 billion people, lack safely managed sanitation services. Three billion people lack basic hand washing facilities with soap and water available at home. Overall, there are also vast inequalities in the accessibility, availability and quality of water, sanitation, and hygiene services, over one-third of schools worldwide and half of schools in the least developed countries have no place for children to wash their hands at all. 26% of health-care facilities globally do not have basic water services and without these basic needs being met, new mothers and babies are at a significantly increased risk of disease, infection or death. 16 percent of healthcare facilities, or around 1 in 6, had no functional toilets or hand washing facilities at either points of care where patients are treated.

It has also been observed that targets 1 and 2 of Sustainable Development Goal (SDG) 6 (clean water and sanitation), concerning drinking water, sanitation and hygiene, cannot be achieved without attention to the whole of SDG6, which also takes into account issues of water scarcity, water quality, and climate resilience. Improving equitable access to water and sanitation, therefore, underpins the success of all SDGs as well as aids in successfully combating the COVID 19 virus.

As evidenced by the present outbreak of the COVID-19 virus, all economies including those of developing countries are vulnerable to pandemics as pandemics can threaten basic primary health care, public health services, health infrastructure, and effective infection control mechanisms resulting in greater losses, including death, displacement and economic devastation. But developing countries also have another challenge. Water is sometimes taken for granted until it isn’t there. Imagine what could happen (or not happen) to your community if water stops running, pumps shut down, or purification cannot be guaranteed during an influenza pandemic.  If power is lost, it can threaten the supply of water as power and water often have a reciprocal relationship as many of them rely on water or can’t run without water while water cannot run without power. In addition, water utilities may also require disinfectants such as chlorine to make water drinkable and because water utilities can store only about 3 weeks’ worth of chlorine, they rely heavily on suppliers. Any disruption involving any link in the supply chain of chlorine or other necessary ingredients could also thwart any efforts to deal with a pandemic such as COVID-19.

If the response to disease outbreaks such as COVID-19 is to be effective and not reproduce or perpetuate gender and health inequities, it is important that gender norms, roles, and relations that influence women’s and men’s differential vulnerability to infection, exposure to pathogens, and treatment received, as well as how these may differ among different groups of women and men, are considered and addressed strengthening health systems to provide health- care options and providing opportunities for women in all aspects of the response, whether it be through formalised work in the health sector, decision-making, or security. Local, regional, national or global governments must also acknowledge the critical role played by water and sanitation in responding to health emergencies and create the necessary capacity and financial funding to provide infrastructures which address all of the targets of SDG 6 as improving equitable access to clean, affordable and quality water and sanitation will not only prevent pandemics from progressing globally but will also support the achievement of all of the other SDG goals”.

[i] COVID-19: the gendered impacts of the outbreak published online 3-6-2020  March 6, 2020  S0140-6736(20)30526-2 Volume 395 March 14,2020 pages 846-847

Boniol M, McIsaac M, Xu L, Wuliji T, Diallo K, Campbell J. Gender equity in the health workforce: analysis of 104 countries: Working Paper 1. Geneva: World Health Organization, 2019.

[ii] COVID-19: the gendered impacts of the outbreak published online 3-6-2020  March 6, 2020  S0140-6736(20)30526-2 Volume 395 March 14,2020 pages 846-847

citing The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus disease (COVD-19). China CDC Weekly 2020; 2: 113–22.

Also citing  Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395: 507–13. And citing Carvalho R, Cheung E, Siu P. Coronavirus: Hong Kong families await return of thousands of stranded domestic helpers as the Philippines lifts travel ban. South China Morning Post, Feb 18, 2020.

[i] COVID-19: the gendered impacts of the outbreak published online 3-6-2020  March 6, 2020  S0140-6736(20)30526-2 Volume 395 March 14,2020 pages 846-847

citing Davies SE, Bennett B. A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies. Int Aff 2016; 92: 1041–60.   Citing Smith J. Overcoming the “tyranny of the urgent”: integrating gender into disease outbreak preparedness and response. Gender Develop 2019; 27: 355–69. Citing Boniol M, McIsaac M, Xu L, Wuliji T, Diallo K, Campbell J. Gender equity in the health workforce: analysis of 104 countries: Working Paper 1. Geneva: World Health Organization, 2019. Citing Davies SE, Bennett B. A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies. Int Aff 2016; 92: 1041–60. Citing Harman S. Ebola, gender and conspicuously invisible women in global health governance. Third World Quart 2016; 37: 524–41. Citing Sochas L, Channon AA, Nam S. Counting indirect crisis-related deaths in the context of a low-resilience health system: the case of maternal and neonatal health during the Ebola epidemic in Sierra Leone. Health Policy Plan 2017; 32 (suppl 3): iii32–39. Citing Wenham C, Arevalo A, Coast E, et al. Zika, abortion and health emergencies: a review of contemporary debates. Global Health 2019; 15: 49.

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