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Sanitation workers in developing countries are putting their lives on the line, facing a multitude of hazards and health risks including disease, drowning and suffocation.

These are among the grim findings of a report published today (14 November) by charity WaterAid, which says better regulation and technology is needed to improve the working conditions of these low-grade labourers who are often among the most marginalised in society.

The report, produced jointly with the WHO, the World Bank and the International Labour Organization, warns that the sixth Sustainable Development Goal — providing all people with safe sanitation — is the SDG that is furthest from completion, and will take centuries to achieve at current rates of progress. The report stresses that improving the situation of sanitation workers must go hand in hand with achieving this goal.

“Lots of workers report respiratory problems or eyesight problems that happen because of continuous exposure to toxic waste and gases,”

Andrés Hueso, senior policy analyst for sanitation, WaterAid

Only 45 per cent of the world’s population (3.4 billion people) have access to safely managed sanitation, where faeces are securely removed and treated away from households, the report states.

This means that the majority of global households rely on informal and infrequent waste removal by workers who often lack basic safety equipment and face social stigma due to the unpleasantness of the task.

Andrés Hueso, WaterAid’s senior policy analyst for sanitation, said: “Lots of workers report respiratory problems or eyesight problems that happen because of continuous exposure to toxic waste and gases.”

Other health hazards highlighted in the study include drowning and asphyxiation in poorly maintained latrines, and contracting infections from cuts in the skin caused by sharp objects thrown into pits.

Untreated faeces contain around 9 billion pathogens per gram, putting sanitation workers at risk of diseases such as cholera, typhoid and salmonella.

The report said the dangers of the job, plus the stigma and constant need to overcome disgust, create mental health problems that many sanitation workers try to manage with alcohol and drugs.

Val Curtis, who heads an environmental health research group at the London School of Hygiene and Tropical Medicine, said: “We as the human species are innately repulsed from things that are toxic. Smelling poo all the time is hard emotional labour. It makes you feel sick.”

She said often the job of cleaning latrines is given to foreigners, meaning these workers have even fewer rights and resources than locals.

The WaterAid report proposes a combination of technological tools, provision of safety equipment, and regulatory action to professionalise the jobs of sanitation workers around the globe.

The study highlights the success of the “gulper”, a small pump that helps workers in Tanzania empty latrines without needing to climb into the pits themselves.

These devices are also common in India but, despite this, large numbers of people resort to manual emptying of latrines, says VR Raman, head of policy at WaterAid India.

He said that caste-based discrimination played a part in the exploitation of sanitation workers, because people who are deemed as belonging to an inferior caste carry out the work at a “much cheaper price” than mechanised emptying.

 “The key struggles and life hazards faced by sanitation workers are further increased by urban sanitation infrastructure, wherein manual cleaning or de-clogging the sewer lines has proven fatal for several sanitation workers across India,” he added.

Technology must match the needs of the workers, says Heather Bischel, assistant professor at the department of civil and environmental engineering at the University of California. Bischel has worked with sanitation specialists in the South African township of eThekwini to understand their exposure to dangerous pathogens.

“The most important exposure point was during the emptying of containers — when pathogen concentrations in the waste are the highest,” she said, adding that workers were more likely to wear protective gear if they were able to choose what they found most suitable.

According to the report, creating regulation to protect sanitation workers remains a difficult task, as their services are often performed illegally.

Wali Mwalugongo, who works with the charity Sanergy to improve sanitation services in Kenya, says local workers are regularly forced to bribe officials to be allowed to manually empty pits — a process that is illegal in Kenya — thereby losing the money they have just earned. Mwalugongo’s team managed to achieve better recognition for workers by providing them with a disposal station for the waste. “The biggest issue was they didn’t have a safe dumping site to take the waste, so they would either dump the waste directly into the waterways, the trenches in the community or the environment,” she said.

The treatment site now receives around 38,000 litres of waste every day. The safe disposal of the faeces has reduced stigma and increased the social standing of the workers, who are in the process of unionising, according to Mwalugongo.

“With the official dumping place, the local government recognised them and their service,” she added. “The workers now work normal hours during the day and use branded protective equipment. This professionalises their work and the service they provide to the community.”

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