Intended for healthcare professionals

Feature The BMJ Appeal Christmas 2019

The BMJ Appeal Christmas 2019: How WaterAid is bringing a sanitation revolution to all

BMJ 2020; 368 doi: (Published 09 January 2020) Cite this as: BMJ 2020;368:l7082
  1. Jane Feinmann, freelance journalist
  1. London, UK
  1. jane{at}

WaterAid brings clean water, sanitation, and better hygiene to the world’s most vulnerable people, which is why we’ve chosen the charity for The BMJ’s Christmas appeal this year, writes Jane Feinmann. Please give generously

In a 2007 poll 11 300 BMJ readers voted on the greatest medical advance since the journal was launched in 1840. They chose the 19th century “sanitary revolution” that brought piped water to people’s homes and sewers rinsed by water.1

However, more than 150 years after the UK’s sanitary revolution, two billion people in low income countries lack toilets, 673 million still defecate in the open, and 2.2 billion do not have safe drinking water.2 This year The BMJ’s 2019 Christmas appeal is offering the journal’s readers the opportunity to support WaterAid, the biggest UK charity working solely to challenge this inequity.

While WASH (clean water, sanitation, and hygiene) services are taken for granted in high income countries, they still fail to be recognised as a health priority in low and middle income countries, says Mala Rao, vice chair of WaterAid UK and professor and senior clinical fellow at Imperial College London. “Yet there is not an aspect or discipline of medicine and healthcare which does not depend on clean water and sanitation for its safe and satisfactory delivery,” she says.

Neonatal health

Babies are especially at risk from inadequate WASH services. Henry Northover, WaterAid’s global director of policy, says, “We all know the links between unsafe water, poor sanitation and hygiene, and child mortality. And still, one in five newborn deaths in the developing world is due to a lack of these basic rights and services.

“Water, sanitation, and hygiene must be in place in order for health systems to be strengthened and deliver safe, effective, and dignified care for all, so that everyone, everywhere has a healthy start in life.”

Women’s lives are adversely affected too. A quarter of women and girls worldwide live without a decent toilet, and an estimated 335 million girls go to school without water and soap available for washing their hands when changing sanitary pads, leading to widespread fear, shame, and embarrassment among girls in sub-Saharan Africa, Asia, and South America.3

Alongside one-off projects, WaterAid’s influence lies in its lobbying role. “At WaterAid we work with a wide range of national and local government partners, civil society, and private sector partners to push for change,” says Rao. “We use evidence from global research and the projects WaterAid implements in its country programmes to influence governments to prioritise effective and affordable WASH services.”

A sustainable development goal

Alongside other groups, WaterAid successfully lobbied to get sanitation added to the United Nations’ millennium development goals. And when the UN’s sustainable development goals were launched in 2015, WaterAid lobbied to ensure that hygiene was also included as a target “in recognition of its vital role in preventing disease,” Rao says.

Among numerous high level political leadership interventions, WaterAid worked with the government of India’s Swachh Bharat (Clean India) mission, a key aim of which is to end open defecation by building toilets for all. “We’re now continuing to work with partners in India to support the government programme to provide all households with piped water,” says Northover.

“But all of this requires funding,” he says. “If we’re to carry on our work and make even faster progress in bringing access to sustainable and safe water and sanitation to everyone, we urgently need donations.

“That’s why we’re so pleased that WaterAid is The BMJ’s Christmas appeal this year.”

How to donate

WaterAid needs your support: please give generously.

  • £60 is enough to buy a clean water tank for a school in a country such as Burkina Faso

  • £144 is enough to install handwashing stations in one school in a country such as Malawi

  • £288 is enough to build two toilets in a country such as Ghana


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