[....] "So central are flush toilets to our lives that we easily forget how many people do without them, or any other kind of effective sanitation either. Nobody seems to keep toilet statistics per se, but the World Health Organization and UNICEF monitor access to what is called "improved sanitation" -- which they reckon 2.5 billion people live without.
Contrary to what the term appears to imply, "it doesn't mean anything indoors and it doesn't mean water. It certainly doesn't mean flushable toilets," says Patricia Dandonoli, the president of WaterAID America, an organization that works to provide sanitation in developing countries. It does mean a private, covered pit latrine -- which Dandonoli stresses is "several steps up the sanitation ladder" from open defecation.
In cities like Nairobi, many residents have no option but to use what is known as the "flying toilet." They defecate in a plastic bag that they throw onto the roadside. Others may only have access to the woods or open fields. In slums and shantytowns in South Asia and South America, millions of people rely on "hanging latrines," an open platform with a hole in the middle built precariously on poles over a river or stream.
Women are especially vulnerable when there are no sanitation facilities. Modesty may keep them from going until night, when they are vulnerable to attack. In developing countries, 11% more girls go to school when sanitation is available.
Diseases such as diarrhea and dysentery -- caused by food and water contaminated with excrement -- are the second-biggest killer of children worldwide, causing 5,000 deaths a day, five times the number dying from HIV/AIDS. (The No. 1 killer is pneumonia and upper-respiratory infections.) The costs of not having sanitation are enormous. According to the U.N. Development Program, countries in sub-Saharan Africa lose 5% of their total GDP because of illness and death caused by poor sanitation and water. The United Nations estimates that every $1 spent on sanitation saves at least $9 in accumulated health costs, lost productivity and delayed economic development.
One of the U.N.'s Millennium Development Goals, set in 2000, was to halve the proportion of people living without "basic sanitation" by 2015. We are nowhere near to making good on that promise, Dandonoli says. It would require spending about $10 billion a year for a decade to get covered pit latrines to just 50% of those who need them. That's less than what Americans spend on bottled drinking water, which, according to the Beverage Marketing Assn., is running at more than $12 billion annually." [....]