Life-threatening illnesses such as cholera and diarrhoea are preventable with clean water, decent toilets and good hygiene. That they are still costing lives today is unacceptable.

When clean water, decent toilets and good hygiene are not a normal part of daily life, the impacts on health and wellbeing are devastating. Never was this more clear than during the COVID-19 pandemic. Handwashing is vital to help prevent the spread of coronavirus, but for people across the world without access to soap and water, following this public health advice has been impossible. And, with half of all healthcare facilities worldwide operating without a basic hygiene service, millions of health workers and patients were left on the frontline without defence. To guard against this and future pandemics and provide quality care, every health centre must have clean water, decent toilets and good hygiene facilities.

Without access to these essential services, people are at high risk of potentially fatal diseases such as cholera and serious conditions such as blinding trachoma. Diseases transmitted through water, hands, soil and food contaminated by human faeces spread because properly protected water sources, toilets and good hygiene habits are absent or inadequate.

The effects go beyond the illnesses themselves. It is estimated that half of undernutrition is associated with inadequate water, sanitation and hygiene (WASH), because diarrhoeal diseases and parasites prevent people from absorbing nutrients from food. Undernutrition in the first two years of life causes stunting, which permanently damages children’s long-term physical and mental development.

Frequent illnesses and undernutrition keep children from attending school and adults from going to work, limiting students’ potential and reducing adults’ income. All of this contributes to a vicious cycle of poverty, and impacts on a country’s economic growth and development.

And without clean water and soap in healthcare facilities, staff and patients cannot deliver quality, safe healthcare, putting the lives of patients – especially vulnerable mothers and babies – in danger.

Reducing child undernutrition with improved WASH

Water, sanitation and hygiene are essential to good nutrition, especially in early life. Our research in Cambodia, Ethiopia and Madagascar, with Action Against Hunger, points to ways governments can improve integration between sectors to improve child nutrition.

Image: WaterAid/ Mani Karmacharya


Cholera is a disease entirely preventable by clean water, decent sanitation and good hygiene. It is spread by faecal contamination of water or food, including through poor hand hygiene around food preparation. It causes acute watery diarrhoea and can kill in hours.

Since summer 2022 there has been a growing global cholera crisis, reversing years of declining infections, including new outbreaks appearing in countries that had reported no cholera for many years. The outbreaks are not only occurring in more countries – they are also larger and deadlier. The situation has continued to worsen in 2023, with many African countries significantly affected.

Climate change is greatly increasing the vulnerability of many countries to cholera, including countries where cholera is endemic and cases occur seasonally as well as in fragile settings where the disease is not endemic. This is on top of the global worsening in recent years of longstanding drivers like conflict, poverty, humanitarian crises and population displacement.

Provision of water and sanitation services as well as hygiene behaviours represent the only long-term solution for ending this crisis and ultimately eliminating cholera for everyone, everywhere. Cholera therefore forms an important focus within WaterAid’s health work. We are a key partner of the Global Task Force for Cholera Control (GTFCC) on advocacy and have served as chair of the GTFCC WASH working group. Prior to this, we were official partners at the launch of the Global Roadmap to End Cholera in 2017 and helped push through a 2018 World Health Assembly resolution on cholera.

Our approach

When more developed nations came to understand the importance of clean water, decent toilets and good hygiene for health, it triggered massive investment in public infrastructure and legislation. People in the countries where we work deserve exactly the same.

We participate at global events such as the World Health Assembly to influence governments to increase prioritisation of WASH in international and national health policies and strategies. We also advocate for decision-makers to embed WASH in relevant areas, such as healthcare facilities. Click on the icons in the image below to explore our WASH interventions in a healthcare centre in Mali:


We focus on health in our research, programmes, policy and advocacy, boosting our efforts to improve access to clean water, toilets and hygiene as a key health intervention. And we foster integration between sectors and ministries, helping those working in WASH, health, education, nutrition, and more, to work together to make a bigger difference.

Through our innovative programmes and research, we influence changes from the national level to individual behaviours, to ensure improvements last. For example, in Tanzania, together with the SHARE consortium and the Soapbox Collaborative, we have partnered with the Ministry of Health to improve water and sanitation provision in maternity units, as part of Government efforts on maternal and newborn health. In Malawi, we are working with the Government and non-governmental partners to promote hygiene and sanitation to communities to eliminate blinding trachoma.

Only by making clean water, decent toilets and good hygiene normal for everyone, everywhere, can we prevent disease, tackle undernutrition, and deliver quality health services that keep people well and unlock their potential.


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