Worldwide, just fewer than 900 million people play the water lottery everyday, not knowing whether the water they drink will nourish their bodies or infect them with potentially deadly diseases. Cholera, dengue fever, giardia, Hepatitis A virus, river blindness, besides the danger of heavy metal toxicity as a result of mercury, lead, and arsenic poisoning, swirls in the cups, cooking pots, and sinks of one in six people worldwide.

Approximately forty percent of the world population (about 2.5 billion people) lack access to adequate sanitation. One result is that human stool in open sewers sometimes cross open water lines or empty into water sources such as rivers, lakes, and streams that people depend on for drinking water. Industrial pollution and agricultural runoff exacerbate the problem, dumping dangerous chemicals into the water supply leading to the contamination of fresh water and coastal ecosystems.

In many developing nations, the existing under-dimensioned and aged wastewater infrastructure is already overwhelmed, and with predicted population increases and changes in the climate the situation is only going to get worse. Without better infrastructure and management, many millions of people will continue to die each year and there will be further losses in biodiversity and ecosystem resilience undermining prosperity and efforts towards a more sustainable future.

According to a UNEP-HABITAT interagency report up to 90 per cent of wastewater flows untreated into the densely populated coastal zone contributing to growing marine dead zones, which already cover an area of 245 000 km2, approximately the same area as all the world's coral reefs. This situation poses a threat to food security, access to clean drinking water and providing major health and environmental management challenges.

The toll exacted on human health is staggering. Up to 4,500 people die everyday due to waterborne illness--more than deaths from HIV-AIDS, malaria, and tuberculosis combined. Not surprisingly, diarrhoea is the second leading contributor to the global burden of disease with two and a half billion cases occurring in children under five years of age every year and an estimated 1.5 million of them dying from it annually.

Throughout Africa, the World Health Organization estimates that 40 billion working hours are lost annually in the search for water. People spend hours daily walking to fetch clean water, taking time away from more productive work and education. In regions where collecting water is time-consuming and dangerous, women and children bear the burden of the daily search for water. Often walking miles per day, they expose themselves to robbery, rape, and physical harm from carrying jerry cans on their backs or heads.

In Ethiopia for example, fetching water is both a daily ritual and a daily danger for women. In the countryside, only 24% of the people have access to clean water, and women walk an average of four miles for water everyday. Often contaminated with disease, the water they fetch causes sickness and death. The government has promised help, but it never arrives. The consequences are serious. Spending their hours in a day fetching water, women and children miss out on school and more productive work.

Water is also a constant struggle in Kenya, both in the cities and in the countryside. In Kakuma, the location of a refugee camp and the homeland of the Turkana people, residents not only have to walk for miles looking for water, but also dig for it despite there being a mechanical pump nearby. The Turkana people simply cannot afford the prices charged by its owner.

In the slums of Nairobi, the setting is different, but the challenges are the same. Government water lines do not penetrate the slums due to concerns about acknowledging the right of squatters to the land. As a result, private contractors deliver water at prices about 100 times its cost. Left without a choice, the poor drink water from pipes that leak and cross open sewers. Sanitation is non-existent-people prefer the flying toilet, also known as a plastic bag. To address the water quality problem, residents are adopting sunlight purification techniques using ordinary plastic bottles. It has reduced diarrhoea cases by 20% since the project started in March 2004. Still, water remains their greatest challenge.

The irony is that unlike many systemic crises around the world, clean water and sanitation are achievable goals. Water purification and sanitation technology exist at affordable prices, and returns on investment are impressive: A $1 investment in sanitation leads to up to $34 in return. The only thing in short supply is the political will for change. Governments in Africa should formulate and implement people centred policies in different sectors including the water sector.

Written by: Kenneth Sinei, Intern, Environmental Security Programme, ISS Nairobi Office