In the flat, arid plains surrounding the Nuba mountains, Sudan, a woman scoops drinking water from muddy puddles on the ground into a jerry can, loads the can onto a camel, and returns to her village. Scenes like this are repeated throughout sub-Saharan Africa and make it hard to understand why water and sanitation are not getting more global attention.

Diseases related to the lack of clean water are the second biggest killer of children under 5 years, two million dying every year from diarrhoea; 1.1 billion people do not have access to water and 2.6 billion are without sanitation. The United Nations' 2006 Human Development Report asserts that a global action plan under G8 leadership is desperately needed to resolve the growing crisis, but water and sanitation—which earlier this year topped a BMJ poll of the most important medical advances (BMJ 2007;334:111)—remain absent from this year's G8 agenda.1 In an attempt to change this, the charity WaterAid is launching its End Water Poverty campaign on 26 March.

World governments committed to halving the proportion of people without safe drinking water and sanitation by 2015 as part of the millennium development goals, but progress has been slow. Sanitation is one of the worst performing goals, and although water supply has improved in many regions, there is still a long way to go in sub-Saharan Africa. The other goals—achieving universal primary education and reducing child and maternal mortality—are also unlikely to be reached because they are all closely linked with the basic needs of water and sanitation.