Wards without Water

Clean water, decent toilets and good hygiene are fundamental to safe and dignified healthcare.

They help keep people safe from disease and prevent the spread of infections and pandemics.

Still, far too many healthcare facilities around the world don't have these essentials.

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_{Dr Martin Koné washes his hands with soap outside Talo Health Centre, Falo, Circle of Bla, Mali, 2018. (WaterAid/Guilhem Alandry)}

When a hospital or clinic has clean water, decent toilets and handwashing facilities, healthcare is safer.

Doctors, nurses and midwives can wash their hands between patients.

Medical equipment can be sterilised.

Staff, patients and their families have a comfortable and hygienic place to go to the toilet.

Beds, linen, wards and corridors can be cleaned thoroughly and regularly.

Bio-medical waste is collected and disposed of properly.

Infections are kept at bay.

_{Hand hygiene promoter Nasima Khatun washes her hands at Noapara Community Clinic, Gangni, Meherpur, Bangladesh, 2019. (WaterAid/Farzana Hossen)}

_{Nirere Esther cleans the newly renovated labour ward at Nzangwa Health Centre, Rweru, Rwanda, 2018. (WaterAid/James Kiyimba)}

“With both potable water and the best conditions for hygiene and sanitation, we can avoid patients going home with a contagious disease or infection after coming here to be treated,” says Dr Martin Koné (pictured right), health director of Talo Health Centre in Mali’s eastern region of Ségou.

“This means everyone benefits from the water: the village, the school … These things help us believe in the future.”

Dr Koné can be hopeful because, thanks to a project from WaterAid, Talo Health Centre has had running water, toilets and washbasins since 2019.

_{Dr Martin Koné, health director at the Talo Health Centre, Falo, Circle of Bla, Mali, 2018. (WaterAid/Guilhem Alandry)}

_{Community members celebrate the arrival of clean water to Talo Health Centre, Falo, Circle of Bla, Mali, 2019. (WaterAid/Basile Ouedraogo)}

But before that, Talo Health Centre was one of countless other healthcare facilities worldwide that did not have those essentials.

For nine years, the centre served seven villages without any water. There were no taps in the consulting rooms and no handwashing stations outside. The latrines at the back of the health centre were dilapidated, with the roof partially blown away.

It was really tough to work without water. With dirty hands, [giving] injections and medicine to patients was risky for us and for our patients. Without water, we cannot have hygiene.
Madani Coulibaly, pharmacist, Talo Health Centre

To keep themselves and the health centre clean, staff had to rely on patients and their families to bring water with them or collect water from the school's pump 300 metres away – sometimes in the middle of the night.

Around the world, 1 in 4
healthcare facilities don’t have
running water.

1 in 10 don’t have toilets.

The consequences of this
are devastating…

_{Before Talo Health Centre had a water supply, Matron Salimata Dagnogo had to collect water from the nearby school. Falo, Circle of Bla, Mali, 2018. (WaterAid/Guilhem Alandry)}

_{Unsanitary conditions at Talo Health Centre in 2018, before the water supply was installed. Falo, Circle of Bla, Mali. (WaterAid/Guilhem Alandry)}

_{Dirty water being used to wash medical equipment at Mulotana Health Centre, Boane District, Mozambique, 2016. (WaterAid/Sam James)}

_{A broken toilet at Family Clinic Area 2 Primary Health Centre in Abuja, Nigeria, 2016. (WaterAid/Simi Vijay)}

_{Buckets of water collected from a privately-owned shallow well, the closest water source to Nyarugusu Dispensary, Nyarugusu, Tanzania, 2017. (WaterAid/Sam Vox)}

_{A flushing toilet without a water connection at Chikobe Health Centre, Geita District, Tanzania, 2017. (WaterAid/James Kiyimba)}

_{Medical equipment waste left in a bucket at Talo Health Centre in 2018, before a formal waste disposal unit was installed. Falo, Circle of Bla, Mali. (WaterAid/Guilhem Alandry)}

_{A midwife cleans medical utensils with limited water at Etatara Health Center, Cuamba District, Niassa Province, Mozambique, 2018. (WaterAid/Chileshe Chanda)}

_{Click on an image above to open the gallery.}

In the district of Geita, north-western Tanzania, some healthcare facilities that don’t have water ask pregnant women to bring some with them when they give birth.

I will never forget the day a pregnant woman came here at night ready to deliver but there was no water. I had to run home to collect water. If I did not have water at home, what would I have done?
Nyaganga Juma Samuel, nurse and midwife, Nyamalimbe Dispensary

If the nearest water source to the hospital is unsafe, or patients are unable to bring water with them, they must buy some from commercial vendors at inflated prices. The water is sold in 20 litre buckets and can cost up to 500 Tanzanian shillings (US$0.22) each – a cost which many can't afford.

_{Caregivers leave Nyarugusu Dispensary in search of water, Geita District, Tanzania, 2017. (WaterAid/James Kiyimba)}

_{Water vendor Joseph Enock delivers water collected from a borehole to Nyarugusu Dispensary, Geita District, Tanzania, 2017. (WaterAid/Sam Vox)}

_{Water vendor Francis John comes to the Nyarugusu Dispensary after being called by patients' families, Geita District, Tanzania, 2017. (WaterAid/Sam Vox)}

_{Rose Gabriel, 40, draws water from a privately owned shallow well, the closest water source to Nyarugusu Dispensary, Geita District, Tanzania, 2017. (WaterAid/Sam Vox)}

Kalunde Rashid gave birth to her second child at Chikobe Health Centre in 2017. “Mum is here taking care of me. She is old and could not go to collect water down the valley, so we had to buy two buckets,” says Kalunde.

During delivery I bled so much that all the water was used for cleaning the delivery room and the cloths. There was no water left for bathing in the morning, and I have no money to buy more water. I have to wait until I get home.
Kalunde Rashid

In training, nurses and midwives are told that the minimum amount of water they should use during childbirth is 100 litres. At Chikobe Health Centre, because of the acute shortages of water, healthcare staff can only use 40 litres.

“Bacterial infections and sepsis are common in babies and mothers,” says Dolgan Joseph, a nurse who has worked at Chikobe for six years. “If we can get water and electricity here, my work will be easy ... Once the hospital environment is clean, it minimises the rates of infection.”

_{Kalunde Rashid with her day-old baby at Chikobe Health Centre, Geita, Tanzania, 2017. (WaterAid/James Kiyimba)}

_{Nwjabu Athumani, Kalunde's mother, at Chikobe Health Centre, Geita, Tanzania, 2017. (WaterAid/James Kiyimba)}

1.8 billion

people are at higher risk
of COVID-19 and other
infectious diseases
because they use or work
in a healthcare facility which
does not have water.

_{Head nurse Madhubala Awasti washes her hands after assisting patients, Uttar Pradesh, India, 2021. (WaterAid/Anindito Mukherjee)}

Such infections can lead to prolonged hospital stays, long-term disability and spiralling healthcare costs. Combined, high infection rates and poor water, sanitation and hygiene, can damage trust in health systems and make patients less likely to seek care when they are unwell.

And it’s not only risky for the patients. It’s also dangerous for health workers, weakening their morale and discouraging them from staying in their jobs.

“The working conditions were so bad, I felt like resigning,” says Jacob Busumba, clinical officer in charge at Kakora Dispensary, Nyang'hwale District, Tanzania.

The dispensary had sinks, but no water supply, so the staff had to depend on unprotected sources or buy water from vendors, which then had to be purified with chlorine.

_{Jacob Busumba, clinical officer at Kakora Dispensary, points to a sink without a tap in Geita, Tanzania, 2017. (WaterAid/James Kiyimba)}

_{Jacob Busumba, clinical officer at Kakora Dispensary, points to a sink without a tap in Geita, Tanzania, 2017. (WaterAid/James Kiyimba)}

The centre once also endured three months without a working toilet when their latrine became full, and nobody came to empty it.

People visiting the hospital used to look for latrines in neighbouring homes, or wait until they got back to their home.
Jacob Busumba

When the staff couldn’t wait any longer, they decided to take matters into their own hands. With the help of community members, and without any money, they built a new pit latrine using an old rainwater harvesting tank.

Since then, WaterAid has worked with a local partner NGO to build toilets and medical waste disposal facilities at the dispensary and construct a solar-powered water system. The system not only supplies water to the health centre but also serves the primary and secondary schools, and the rest of Kakuro village – reaching more than 3,000 people.

_{Jacob Busumba washes his hands in a newly installed sink in Kakora Dispensary's labour room, Geita, Tanzania, 2018. (WaterAid/James Kiyimba)}

_{Jacob Busumba washes his hands in a newly installed sink in Kakora Dispensary's labour room, Geita, Tanzania, 2018. (WaterAid/James Kiyimba)}

The changes have come as a great relief to Jacob.

“I am very happy today,” he says. “My work is more enjoyable.”

_{Sunita Kharel, senior auxiliary nurse midwife, washes her hands outside Bhumlutaar Health Post, Kavre, Nepal, 2020. (WaterAid/Mani Karmacharya)}

_{Public health officer Basanta Shrestha washes his hands during the inauguration of the handwashing station at Bhumlutaar Health Post, Kavre, Nepal, 2020. (WaterAid/Mani Karmacharya)}

After the World Health Organization identified Nepal as a high-risk country for COVID-19, WaterAid Nepal worked with the government to make sure that critical water, sanitation and hygiene facilities were available in healthcare facilities and clinics in the most vulnerable communities.

“Health centres are the first place people visit when they have a health-related issue, so it is important that we, as health professionals, make sure to avoid infections and contamination,” says Sunita Kharel, senior auxiliary nurse midwife of Bhumlutaar Health Post where WaterAid Nepal installed a contactless handwashing facility.

“We used to keep a bucket and a soap to wash hands, but they were not very practical … People were hesitant to wash their hands when they visited the health post,” says Sunita. “But when the handwashing station is installed right at the entrance, everybody can easily wash their hands without touching the taps … Not only me, but all the health post staff feel much safer.”

In May 2019, all 194 member states of the World Health Organization adopted a resolution on water, sanitation and hygiene in healthcare facilities.

They pledged to make sure that every healthcare facility has a safe and reliable supply of water, safe and accessible toilets or latrines, good handwashing facilities, and routine and effective cleaning procedures.

Despite this, half of all health centres in the poorest countries still don't have clean water.

One in three health centres worldwide don’t have somewhere for healthcare staff to wash their hands between patients.

And 800 million people use a healthcare facility without a toilet.

If the World Health Organization’s resolution was to be fully realised and hand hygiene made a priority, conditions in so many healthcare facilities around the world would improve drastically.

_{Image 1: Hospital cleaner Sor Socheat cleans the delivery room at Battambang Referral Hospital, Cambodia. (WaterAid/Laura Summerton)}

_{Image 2: Nahida Aktar measures the blood pressure of a patient at the Saharbati Community Clinic, Gangni, Meherpur, Bangladesh. (WaterAid/Farzana Hossen)}

_{Image 3: Maternity nurse, Ernesta Culpa, stands in a ward at the Matibane Health Centre, Chicoma Village, Mozambique. (WaterAid/Eliza Powell)}

Nahida Aktar measures the blood pressure of a patient at the Saharbati Community Clinic, Bangladesh.

Maternity nurse, Ernesta Culpa, stands in a ward at the Matibane Health Centre, Mozambique.

_{Mary Wezani and Maliya Bendikito collect water at Kamsonga Health Centre, Ntchisi, Malawi, Malawi, 2019. (WaterAid/Dennis Lupenga)}