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Global Health
May 21, 2019

Water and Sanitation Deficits Take a Toll in Armed Conflict Regions

JAMA. 2019;321(19):1861. doi:10.1001/jama.2019.6186

Diarrheal diseases resulting from scarce clean water and sanitation in countries with protracted armed conflicts take more children’s lives than the violence itself, according to a recent United Nations Children’s Fund (UNICEF) report.

In 16 countries where conflicts rage, including Afghanistan, Myanmar, Somalia, Sudan, Syria, and Yemen, nearly 3 times more children younger than 15 years and about 20 times more children younger than 5 years die from inadequate water, sanitation, and hygiene (WASH) facilities than violence.

Often these countries have underdeveloped WASH systems at the outset. As conflicts grind on, the systems deteriorate as attacks destroy infrastructure, cut off power, and restrict the transport of supplies such as chlorine to treat water or fuel to run water pumps. Attacks on WASH facilities can force children to collect water in extreme temperatures or as fighting ensues.

The report outlines a 3-pronged call to action to uphold the right to safe drinking water and sanitation in conflict-prone areas. It includes stopping attacks on water and sanitation infrastructure and personnel, which can be a violation of international humanitarian law. In addition, UNICEF has called for building a resilient WASH system to provide high-quality water and sanitation during emergencies as well as involving humanitarian organizations in developing and supporting sustainable water and sanitation systems.

A related report from the World Health Organization and UNICEF found that in many countries, particularly those in Africa, an estimated 1 in 5 health care facilities has no sanitation services and many also lack sufficient quantities of toilets, soap, and waste disposal units.

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