KABUL - The United Nations General Assembly’s designation of 19 November as World Toilet Day shines a spotlight on a sometimes overlooked but urgent public health issue in Afghanistan – the lack of access to hygienic sanitation facilities.

World Toilet Day has previously been marked by international and civil society organizations all over the world. However, it was not formally recognized as an official UN day until yesterday with a resolution passed by the Assembly at UN Headquarters in New York.

The purpose behind the Assembly’s decision was to spur changes in behaviour and policy on issues relating to sanitation, such as water management and environmental planning. Worldwide about 2.5 billion people, mostly in rural areas, do not have proper sanitation. In addition, 1.1 billion people still defecate in the open.

“This new annual observance will go a long way towards raising awareness about the need for all human beings to have access to sanitation,” said UN Deputy Secretary-General Jan Eliasson in a statement that followed the Assembly’s decision. “It is also unacceptable that many girls are pushed out of school for lack of (sanitation) facilities. I urge every country to accelerate progress towards a world in which everyone enjoys this most basic right.”

Improving access to sanitation among the world’s poor is seen as an important link in global efforts to attain Millennium Develop Goals (MDGs) like decreasing child mortality rates. The eight MDGs, agreed on by world leaders at a UN summit in 2000, set specific targets on global issues such as poverty alleviation and education, in addition to child and maternal health.

The scale of the problem of sanitation in Afghanistan is stark.

“On a typical day, half of the hospital beds in Afghanistan are occupied by patients who have fecal-related diseases,” said the UN Environment Programme’s (UNEP) Country Representative for Afghanistan, Andrew Scanlon, who also serves as a board member of the non-profit body known as the World Toilet Organization. “Improving sanitation is an urgent issue.”

According to the UN Children’s Fund (UNICEF), preventable diseases like diarrhea and dysentery kill about 600 Afghan children every day, or about 85,000 per year. About 25 per cent of children under five are affected each year by diseases stemming from poor or bad sanitation.

Among health practitioners, Afghanistan’s lack of adequate sanitary facilities is seen as a silent killer. Because so few schools and municipalities have properly-functioning toilets, it is common in some parts of the country for residents to defecate outdoors or in river and lakes that are used by other residents for washing or drinking.

Such everyday occurrences help explain the relatively high rate of sicknesses like diarrhea, dysentery and other water-bourne diseases. Tainted water is also a leading cause of cholera.

In large cities, like the Afghan capital of Kabul, the press of so many people living together without sanitary facilities is leading to growing health risks. Kabul municipal officials estimate that the city’s approximately three million residents produce about 1,500 cubic metres of solid waste each day. But owing to a lack of resources and low capacity, the municipality collects less than half of this waste. All of this waste becomes particularly dangerous when it rains because the rain mixes with the waste and can enter drinking water sources.

UN agencies are at the forefront of moves to improve this situation and the last few years have seen measurable improvements.

UNICEF statistics show that by the end of 2011, 37 per cent of Afghans had access to adequate sanitation facilities, up from 34 per cent in 2007. The change has been pronounced throughout the country. Whereas in 2007 only 49 per cent of city dwellers had access to safe sanitation facilities, four years later that number was 60 per cent. During the same time period in rural areas the number inched upwards from 29 to 30 per cent.

UN agencies believe that more gains could be achieved but the country’s volatile security situation often impedes access to many communities.

UNICEF has wide-ranging programmes to improve access to water for students and to teach residents about safe sanitation practices. UNEP and UN Habitat are also deeply engaged with government partners, including the Ministry of Urban Development, in designing projects which aim is to create more hygienic facilities in urban areas. This has included establishing standards for an initiative to create decentralized water treatment facilities in urban areas.

In addition, various UN entities have also contributed to the Afghan Government’s national emergency preparedness plan by supporting a surveillance system for cholera and other water borne diseases and strategically placing water basins.