The Plumbing Paradox: Unraveling Afghanistan's Hidden Infrastructure

Afghanistan is a country with one of the worst morbidity and mortality rates in the world. The country is extremely poor, with a sparse network of medical facilities and low-quality healthcare. The availability of healthcare depends on access to transportation, which is challenging due to the high risk of attacks by anti-government forces.

The country's water supply is managed by the National Water Affairs Regulation Authority (NWARA), which is based in Kabul. However, only about 67% of the population has access to drinking water, and even this water is often contaminated with bacteria. The lack of access to clean water and proper sanitation facilities has led to high rates of infectious diseases, with preventable diseases such as diarrhoea, cholera, dysentery, and pneumonia killing about 600 children under five every day.

Indoor plumbing is not common in most of Afghanistan, and even in places like government offices, toilets are often hole-in-the-ground types without proper sanitation facilities. The traditional dry vault toilet system, commonly used in Afghanistan, is considered a major health and sanitation problem.

The situation is slowly improving, with projects like the Afghan-India Friendship Dam (Salma Dam) built in Herat Province in 2016, and the Pashdan Dam, which is expected to be completed in 2021.

Poor sanitation and bad toilets

Afghanistan has been experiencing a crisis regarding clean water and sanitation. The country's water supply is managed by the National Water Affairs Regulation Authority (NWARA), which is based in Kabul. However, there are several challenges to accessing clean water, including a lack of infrastructure, dilapidated infrastructure due to decades of war and neglect, high levels of non-revenue water, inappropriate pipe materials, a lack of qualified personnel, and widespread poverty. As a result, an estimated 92% of Afghanistan's population did not have access to proper sanitation in 2007, and even though this number decreased to 61% by 2017, the situation remains dire.

One of the main issues is the prevalence of open defecation, which has caused social, health, environmental, and development problems. The lack of proper sanitation facilities has led to an increase in waterborne diseases such as diarrhoea, cholera, dysentery, and pneumonia, which kill about 600 Afghan children under five every day. The traditional dry vault toilet system, commonly used in Afghanistan, is also considered a major health and sanitation problem as it does not safely dispose of waste.

The lack of access to clean water and proper sanitation facilities disproportionately affects women and girls, who are often responsible for fetching water for their households. This chore takes up precious time that could be spent on education or pursuing livelihoods. Additionally, girls' education is impacted by the lack of access to clean and private toilets at schools, especially during menstruation when they may need to miss school due to a lack of proper sanitation facilities.

To address these issues, organizations such as UNICEF have partnered with the Afghan government and local communities to improve access to clean water and sanitation facilities. UNICEF has been working to increase the water supply to impoverished communities, promote proper hygiene practices, and construct separate bathroom facilities for males and females in schools. They have also been providing hygiene kits to displaced families, which include soap, detergent, towels, sanitary pads, and a plastic bucket for water collection.

Despite these efforts, there is still a long way to go to ensure that all Afghans have access to proper sanitation facilities and clean water. The improvement of sanitation and hygiene practices often requires behavioural changes, which can take a significant amount of time. However, with continued aid and support, Afghanistan can continue to make progress towards providing clean water and sanitation for all its citizens.

Water supply

The water supply in Afghanistan is characterised by a number of achievements and challenges. Some of the achievements include the expansion of rural water supply infrastructure, the successful expansion of water supply in the city of Herat and towns such as Kunduz, and a reform of the institutional framework for urban water supply.

However, there are also several challenges that need to be addressed. These include a tense security situation that limits the mobility of personnel, dilapidated infrastructure due to decades of war and neglect, a high level of non-revenue water, inappropriate pipe materials, a lack of qualified personnel, widespread poverty, and traditional social norms regarding the role of women.

In urban areas, additional challenges include delays in the procurement of large works due to the absence of contractors, pollution of shallow groundwater due to a lack of sanitation, and poor service quality of piped water supply, including interruptions caused by an unreliable electricity supply.

To address these issues, the Afghan government, with support from international organisations and aid agencies, has implemented various projects and initiatives to improve water supply and sanitation in the country. These efforts have resulted in significant improvements in access to water supply in recent years.

Lack of access to drinking water

Afghanistan's water crisis is a result of various factors, including geographical constraints, climate change, lack of education on clean water and sanitation, and decades of war that have decimated the country's infrastructure. The effects of climate change are felt first through water, with record droughts forcing families to flee their homes in search of clean water for drinking, cooking, and bathing. This has led to malnutrition, cholera, and poverty as families abandon their villages.

Access to safe drinking water is a significant issue in Afghanistan, with only about 67% of the country's population having access as of 2019. This number is even lower in rural areas, with only 20% of the population having access to improved water sources. The lack of access to safe drinking water has severe health consequences, especially for children. Diarrhea, caused by contaminated water, is the leading cause of illness in children under five years old and contributes to malnourishment, which leads to further health problems. Other health issues caused by contaminated water include dehydration, typhus fever, and kidney disease, which have claimed thousands of lives nationwide.

The water crisis in Afghanistan is also closely linked to the issue of sanitation. Improper disposal of sewage and a lack of wastewater management contribute to water contamination. Open defecation is prevalent and causes social, health, environmental, and development problems. Traditional latrines, though better than open defecation, do not effectively isolate excrement from human contact or dispose of waste properly, leading to disease and infection.

The lack of access to drinking water and proper sanitation facilities disproportionately affects women and girls, who are often responsible for fetching water for their households. This chore takes up precious time that could be spent on education or income-generating activities. Additionally, women and girls in rural areas walk long distances to collect water, which can be exhausting and detrimental to their health, especially if they are pregnant or breastfeeding.

The consequences of the water crisis in Afghanistan are dire, and it is crucial that efforts are made to improve access to safe drinking water and proper sanitation facilities to protect the health and well-being of Afghans, especially children and women.

Poor personal hygiene practices

Afghanistan is a poor, mountainous country with a low standard of medical support and hygiene. The country's water supply is managed by the National Water Affairs Regulation Authority (NWARA), which is based in Kabul. However, despite these management efforts, there are still many challenges to accessing clean water in Afghanistan.

As of 2019, only about 67% of the country's population has access to drinking water, and this water is not always safe to drink. This is due to a variety of factors, including dilapidated infrastructure, a high level of non-revenue water, inappropriate pipe materials, a lack of qualified personnel, and widespread poverty.

The lack of access to clean water and sanitation facilities has severe consequences for the health and well-being of Afghans, particularly women and children. Here are some examples of poor personal hygiene practices in Afghanistan:

• Open Defecation: Open defecation is a prevalent issue in Afghanistan, with human waste spreading disease quickly and causing social, health, environmental, and development problems. This practice is particularly dangerous for individuals and families living near waterways.
• Lack of Handwashing: In rural areas, Afghans typically wash their hands and feet regularly before praying and before eating, but soap is not usually a part of this practice. The lack of soap and running water contributes to the spread of diseases.
• Inadequate Toilets: Even in places like government offices with indoor plumbing, toilets are often hole-in-the-ground squat toilets. These toilets can be uncomfortable and difficult to use for the elderly or those with physical disabilities.
• Menstrual Hygiene: Women and girls in Afghanistan face challenges due to a lack of access to clean and private sanitation facilities, particularly during their menstrual, pregnancy, and postnatal periods. This creates an unsafe environment and puts them at risk of physical and psychological harm.
• Water Collection: Women and girls are often responsible for fetching water for their households, a time-consuming chore that takes away from their education and livelihood opportunities. It also means they are more likely to come into contact with contaminated water sources.
• Lack of Basic Hygiene Knowledge: In some rural communities, there is a lack of awareness about basic hygiene practices, such as brushing teeth and washing hands after touching animals. This lack of knowledge contributes to the spread of diseases.

To address these issues, organizations like UNICEF and local governments have implemented various programs and initiatives. These include providing funding and resources for clean water and sanitation infrastructure, promoting handwashing and safe faecal disposal practices, installing separate bathrooms for males and females in schools and workplaces, and distributing hygiene kits to displaced families.

Water-borne diseases

Afghanistan has a high risk of infectious diseases, including water-borne illnesses. In 2004, half of the recorded deaths of children under five were caused by water-borne diseases.

The country's water supply is managed by the National Water Affairs Regulation Authority (NWARA), which is based in the capital city of Kabul. However, only about 67% of the country's population has access to drinking water. This number is expected to increase in the future, especially in Kabul, with the completion of several dam projects.

Access to an improved water source does not guarantee safe drinking water. For example, protected shallow wells in urban areas and piped water supplies can be contaminated with bacteria. Many households without access to an improved source obtain water from streams, rivers, open wells, and unprotected springs, which are often polluted.

To address the issue of water-borne diseases, health workers in flood-affected areas of Afghanistan have been chlorinating drinking water and providing prompt healthcare services. The World Health Organization (WHO) has also dispatched medical relief supplies to cover the basic health needs of affected individuals.

• Diarrhea: Preventable diarrhea kills about 600 Afghan children under five every day, according to UNICEF.
• Cholera: Cholera is often caused by bacteria found in water and food contaminated with feces. It spreads quickly in areas with low-quality water treatment, unsanitary conditions, and poor hygiene.
• Dysentery: Dysentery is another water-borne disease that affects Afghan children, leading to severe diarrhea and requiring hospitalization.
• Leptospirosis: Leptospirosis is a bacterial disease transmitted through contact with water or food contaminated by animal urine. It can cause fever, headache, muscle pain, and, in severe cases, organ failure.
• Typhoid Fever: Typhoid fever is caused by contaminated water and is commonly spread in unsanitary areas.
• Hepatitis A: Hepatitis A is typically contracted during childhood and spreads through the consumption of contaminated food and water. It can cause fever, jaundice, and diarrhea, with symptoms lasting up to nine months in some cases.

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