Providing the world with clean water

BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7429.1416 (Published 18 December 2003) Cite this as: BMJ 2003;327:1416
  1. Rhona MacDonald (rmacdonald{at}bmj.com), assistant editor
  1. BMJ

    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 related 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.

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    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 underground) is usually high quality but variable in quantity. Surface water harbours pathogens and the insect vectors of infectious 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 4Treating contaminated water is difficult and costly, so the solution is usually to find another supply, but that may be a distance away, resulting in yet more technical and financial problems. Natural mineral 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 decades 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 groundwater.5 In the United Kingdom, we are fortunate to have an abundance of groundwater,6 but 70 million people in sub-Saharan Africa 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 resources, mismanagement, and poor governance. Groundwater is being 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 between 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 monitoring, enforcement, and conflict resolution.1

    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 international community set the ambitious target of universal access 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 access to safe drinking water (declared a basic human right by the UN) by 2015.9 Financial barriers remain. The international charity 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 because it wants more assurances that the money will be used effectively.11

    It seems obvious that we need to do much more than meet the millennium 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 different directions. We have a collective responsibility to safeguard 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.


    • Competing interests RM financially supports WaterAid and has signed up to its Flush Out Poverty campaign.


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