1. Ch 1. Sustainable sanitation - a review Management & organisation Residents´ views & actions Physical arrangements including technology The challenge is to protect our health and the environment This challenge can be addressed, if management, residents, policies, technology and engagement are in place Jan-Olof Drangert, Linköping University, Sweden

2. 1.1 Sanitary Conditions in the world How do we perceive sanitary conditions? What functions must a sustainable system fulfil? Learning objective: To become familiar with various sanitary conditions in the world, and to foster a critical understanding of data and functions Jan-Olof Drangert, Linköping University, Sweden

3. Sanitation – the silent crises 2.4 billion people (40% of the world's population) lack so called adequate sanitation 18% of the world's population lack safe water supply 10% of all wastewater in developing countries is treated Malnutrition is a major factor making us more vulnerable to disease and death, thus food security is important The combined effects of poor personal and domestic hygiene and lack of safe water and good environmental sanitation is considered the most important risk factor for disease and death Jan-Olof Drangert, Linköping University, Sweden

4. Diseases related to excreta and wastewater Disease:Mortality (death/year) Burden of disease* Comments Diarrhoea 1 798 000 61 966 000 99.8% of deaths occur in dev. countries; 90% in children Typhoid 600 000 N/A Estimate: 16 M cases/year Ascariasis 3 000 1 817 000 Estimate: 1.45 billion infections, of which 350 M suffer adverse health effects Hookworm disease 3 000 59 000 Estimate 1.3 billion infections of which 150 M suffer adverse health effects Schisto- somiasis 15 000 1 702 000 Found in 74 countries, 200 M estimated infected, 20 M with severe consequences Hepatitis A N/A Estimate: 1.4 M cases/yr Source: WHO 2006 * DALYs/year estimates the time lost due to disability or death from a disease compared with long life free of that disease (See Ch 3).

5. Stormwater, solid and organic waste Animals scavenging organic material and clogged storm water drains Stormwater drainage as a conduit for solid waste Copyright: Jan-Olof Drangert Jan-Olof Drangert, Linköping University, Sweden

6. Upgrading environmental sanitation in dense settlements Thor-Axel Stenström, SMI, Sweden beforeafter Thor-Axel Stenström, SMI, Sweden

7. Sanitation ladder....... upgrading Outside house: Private dry urine- diverting toilet Communal flush Open defecation Indoors: Local reuse Jan-Olof Drangert, Linköping University, Sweden

8. What sanitation is about Personal and household hygiene Clean environment incl. water Solid waste management Greywater disposal and treatment Safe excreta disposal Stormwater handling Traditional interpretation: Acceptance, affordable, convenience and pride Environmentally sustainable arrangements Additional perspectives : Jan-Olof Drangert, Linköping University, Sweden

9. 1 2 3 4 5 6 7 Pathogen & hazardous waste reduction – indicators depend on flow stream Nutrient reuse – (i) X% of excreted N, P, K is reused for crop production, (ii) Y% of used water is reused Nutrient & hazardous waste containment – indicators depend on flow-stream Integrated resource management – indicators depend on flow-stream Access – (i) 24-hr access to facility year-round, (ii) privacy, personal security and shelter, (iii) preferrable indoors and accessible to men, women, children, elderly Greywater management – (i) no stagnant water in compound or in streets, (ii) no vectors (iii) no pollution A sanitation ladder for improved functions Adapted from Kvarnström et al., 2010 Excreta containment – (i) in use, (ii) no vectors, (iii) no faecal matter, (iv) hand-washing facility in use (v) can withstand stormwater events

10. Sustainable - more than a catch word The Bruntland Commission (1987) expressed sustainability as: …development that meets the needs of the present without compromising the ability of future generations to meet their own needs" … Sustainability comprises a variety of perspectives: Ecology, Economy, Social, Resource conservation, Reuse, etc. Sustainability criteria for sanitation arrangements may read (EcoSanRes): - protecting and promoting human health, - not contributing to environmental degradation or depletion of the resource base, - being technically and institutionally appropriate, economically viable and socially acceptable

11. Reuse or disposal in the history of sanitation Land area making use of organic waste from the city of Stockholm 1910 Karl Tingsten, 1911 Stock- holm 60km The silent highway man rowing on river Thames Illustration: www.CartoonStock.com.

12. Proportion of households in major cities connected to piped water and sewers House or yard Connected to connection for water (%) a sewer (%) Africa 4318 Asia7745 Latin America &7735 Caribbean Oceania7315 Europe9682 North America 10096 Source: Stockholm Water Front, No. 4 December 2007

13. new Wastewater - collected and treated by effective treatment plants (median percentage) Source: UNDP& UNICEF 2003 (Fig. 3.13 )

14. World-wide statistics on backlogs (SEI 2005:40) UN Region: Urban sanitation Target population Rural sanitation Target population Urban water Target population Rural water Target population East Asia 247.9 147.8 254.2 14.2 Eurasia 7.5 16.2 4.7 9.7 Latin America & Caribbean 114.8 25.2 97.4 7.9 North Africa 27.6 17.8 27.8 13.8 Oceania 0.8 2.7 0.8 2.9 South East Asia 89.7 60.8 105.2 31.9 Southern Asia 189.5 380.9 171.2 132.3 Sub-Saharan Africa 158.4 199.4 146.9 147.9 West Africa 44.5 22.8 43.6 16.8 TOTAL (Millions) 880.8 873.5 851.9 377.4

15. Hurry up in the toilet: 2.6 billion are waiting

16. Microbes multiply on substrates Sanitation viewed as less important People assumed to be uninterested Is less of a public concern, and attracts little public investment in poor urban areas up to now Residents do not perceive that they pay for sanitation Lessons to consider: The Millennium Development Goals deal more with water than sanitation issues, but sanitation is picking up with the new emphasis. Separate planning for sanitation and water leads to installation of piped supply long before proper disposal and wastewater treatment Jan-Olof Drangert, Linköping University, Sweden Microbes perish in water Water will do the trick Everyone wants water Water supply is a public concern, and attracts public and private investments Easy to charge for water if the supply is regular Sanitation versus Water

17. Requirements on sanitation arrangements In the bathroom and kitchen (old requirements): - hygienic and protecting human health - comfortable (indoors, no smell, easy to clean, security) Outside of the home requirements (new! ): - save resources (little/no water, reuse nutrients, little energy) - protect the environment (ground & surface water, soil, air) Lessons to consider: Requirements change over time, sometimes quickly Energy use is high for conveyance over long distances and for advanced treatment technology Jan-Olof Drangert, Linköping University, Sweden

18. Epidemics rather than endemics have shaped our views After John Snow discovered (1854) that cholera can be trans- mitted by contaminated well water, sanitary engineers focussed their interest on organic matter in water as an indicator of faecal contamination. Many rivers with high organic loads were wrongly labelled as hazardous since the origin of the organic was not from faeces but from humus! (Hamlin 1990) Example 2 Sanitary inspectors in Linköping (small city in Sweden) described the sanitary conditions in the workers´ living quarters with stagnant storm water and awful smell as deplorable and causing ill health (1870s). However, infant mortality in such areas did not differ from that in richer areas with piped water and sewers. Lack of sanitary precaution by all classes was the reason, and not until the general hygiene improved did the death toll figures come down! (Nilsson 1994, Esrey 1990) Example 1

19. Continued Example 3 Water issues have been in focus to the detriment of appreciating good sanitation. Cairncross (1989) and others have reached the conclusion that water quantity is more important to good health than water quality for many diseases. Enough water to clean the hands and body, wash clothes, clean the house, etc. is more important than improved drinking water quality at the margin. This supports and explains the results from Linköping in the 1870s. Lesson to consider: We need to measure the right parameters to be able to draw correct conclusions. Jan-Olof Drangert, Linköping University, Sweden