Jamie Bartram, Kristen Lewis, Roberto Lenton, Albert Wright

A silent humanitarian crisis kills some 3900 children every day and thwarts progress towards all the Millennium Development Goals (MDGs), especially in Africa and Asia. The root of this unrelenting catastrophe lies in these plain, grim facts: four of every ten people in the world do not have access to even a simple pit latrine; and nearly two in ten have no source of safe drinking water.1 To help end this appalling state of affairs, the MDGs include a specific target (number 10) to cut in half, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.


Far more people endure the largely preventable effects of poor sanitation and water supply than are affected by war, terrorism, and weapons of mass destruction combined. Yet those other issues capture the public and political imagination—and public resources—in a way that water and sanitation issues do not. Why? Perhaps in part because most people who read articles such as this find it hard to imagine defecating daily in plastic bags, buckets, open pits, agricultural fields, and public areas for want of a private hygienic alternative (as do some 2·6 billion people). Or perhaps they cannot relate to the everyday life of the 1·1 billion people without access to even a protected well or spring within reasonable walking distance of their homes. 
There should be an outcry, from the health community above all, for immediate, concerted efforts to
confront the reality that sanitation coverage rates in the developing world barely keep pace with population growth. Sufficient progress has been made with regard to drinking water to place within reach the target of halving the proportion of the population without access to safe drinking water between 1990 and 2015. Even meeting this target, however, will leave hundreds of millions of people without safe drinking water, particularly in east Asia and sub-Saharan Africa.
Diseases related to unsafe water, poor sanitation, and lack of hygiene are some of the most common causes of illness and death among the poor of developing countries (panel 1). According to WHO, 1·6 million deaths every year can be attributed specifically to these health determinants.3 For every person who dies, many more become ill.

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