Water, Sanitation and Hygiene: Sustainable Development — [Mrs Pauline Latham in the Chair]

– in Westminster Hall at on 17 October 2023.

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[Relevant documents: Oral evidence taken before the International Development Committee on 28 February 2023, on WASH (Water, Sanitation and Hygiene), HC 1174; Written evidence to the International Development Committee, on WASH (Water, Sanitation and Hygiene), reported to the House on 19 April 2023, HC 1174.]

Photo of Matthew Offord Matthew Offord Conservative, Hendon 9:30, 17 October 2023

I beg to move,

That this House
has considered water, sanitation, hygiene and sustainable development.

It is a great pleasure to serve under your chairmanship, Mrs Latham. This is the first time that I have had the opportunity to do so, and I am particularly pleased that the debate is about an issue that I know is important to you personally. It is also important to those here to speak today, and I thank them for their attendance. I also thank the Backbench Business Committee for granting time for a very important debate.

When the 17 sustainable development goals were set out by the UN in 2015, at the heart of that was one goal—to produce a blueprint for peace and prosperity. The 17 goals range from objectives such as economic growth to affordable energy, but they are all intrinsically interlinked and many of them will be unachievable without the others. Improving access to water, sanitation and hygiene—commonly known as WASH—is vital to many of the goals. Without the correct sanitation facilities, how can we expect women and girls to access education and workplaces? Without prioritising water resources, we reduce the ability to accurately manage and anticipate climate hazards. I will touch on these later in my speech, but I will start by saying that over the last 20 years we have seen that real progress is possible when WASH is prioritised in national development. However, we have also seen that many with the power to accelerate progress do not think that water, sanitation and hygiene are sufficiently important. That has led to progress being unacceptably slow, particularly among the poorest and most vulnerable groups and in the least developed countries and regions.

Now is not the time to slow down. Over the next decade, the populations in the areas of the globe with the worst access to WASH will grow—particularly in sub-Saharan Africa, where the population is expected to double by 2050. An increase in extreme weather events, political instability, conflict, disease outbreaks and the global economic crisis pose huge threats to WASH. This has resulted in a depressing image for the future of WASH. Currently, 1.9 billion of the world’s poorest people live in severely water-scarce areas that risk security for WASH services. It is predicted that by 2050 that will increase by between 42% and 95%, potentially meaning that 3.2 billion people will be affected.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Gentleman for bringing this debate forward. I spoke to him beforehand to highlight an issue that I feel is very important, as I know he does as well. Some 600 million children around the world still lack safe drinking water; 1.1 billion lack safe sanitation; and 690 million lack basic hygiene services. The worst affected are women and children who are internally displaced persons, refugees and from minority communities.

Research by Open Doors, an organisation that the hon. Gentleman and I understand very well, shows that there is a worrying tendency for Christian communities to be deprived of access to development aid, including WASH programmes. That is also highly likely to be the case for other religious minority communities. Does the hon. Gentleman agree that these programmes must be monitored to ensure access for religious minority communities and displaced persons in particular?

Photo of Matthew Offord Matthew Offord Conservative, Hendon

I certainly agree. Any IDPs or people who are removed from their homes or the places where they live will have an immediate problem with access to water in some parts of the world. That is particularly difficult, as we are seeing in Gaza at the moment, for example; we also see it in parts of sub-Saharan Africa as people move as a result of climate change or political instability. It is one of the important issues that link many different communities and religions as well.

Water is vital to many individuals not only on a practical basis but, as Jim Shannon says, on a religious basis. The practice of many religions involves using water—I am thinking, for example, of not only Hindus but Muslims—for their daily rituals, and these are very important. It is a point well worth making, and I thank the hon. Gentleman for making the point, which I had not covered.

The UK has traditionally been a leader in the WASH sector. Given the multitude of challenges facing us, I ask my hon. Friend the Minister today: how will the Foreign, Commonwealth and Development Office project WASH funding increasing? Investing in sustainable and safe WASH is fundamental for countries to have a healthy workforce—the foundation for a thriving economy. The consequences of inaction would be monumental for many people. Left unchecked, diseases will become more frequent, leading to an increased demand for national spending on healthcare and reduced productivity.

WASH is often framed as simply building infrastructure, delivered with little thought to how it will be managed over time to deliver any benefits. But WASH is not about one-time access; it is a group of services and related behaviours that need to be accessed or practised several times a day and sustained over time. That means WASH systems need to be strong enough to deliver services continually to entire populations and to ensure that good hygiene behaviours are reinforced. I saw that on a recent visit to Ghana, where we saw not only water but the idea behind WASH procedures being delivered. Good practice was certainly reinforced.

The FCDO shift towards supporting WASH systems and away from just delivering infrastructure is very welcome, but we need to see more such programmes. The FCDO has a vital role in ensuring that others follow suit so that all interventions lead to a stronger sector. Similarly, it should encourage the integration of WASH within health, as it has done with its ending preventable deaths approach.

At the moment, despite progress on such programmes, we are seeing an international decline in investment in WASH. Since 2018, UK aid for WASH has been cut by two thirds, falling to approximately £70 million in 2021. For comparison, we spent £364 million on education and £548 million on health. The total share of the aid budget going to water supply and sanitation was just 1% in 2021. That is despite polling indicating that 53% of the British public list water, sanitation and hygiene as one of the top three most important ways of spending UK official aid development assistance. There is clearly a mismatch between spend on WASH and the popularity of the issue among the UK public.

With the upcoming international development White Paper due to be published soon, I ask the Minister to carefully consider the evidence provided. As the Foreign Office Minister of State, my right hon. Friend Mr Mitchell, said in his statement on 18 July, the White Paper

“will chart the long-term direction for UK international development up to 2030”— just in time for the review of the sustainable development goals. Can the Minister here today indicate what level of prioritisation WASH will have in the international development White Paper?

I stress to the Minister that Governments and countries as a whole stand to gain hugely if investment in sustainable WASH services is provided. Sanitation alone can have huge economic returns, contributing to the world economy. On top of that, the return on that investment is vast, with basic WASH services providing up to 21 times more value than their cost. Action on this matter overseas will provide direct benefits to people here in the United Kingdom. As covid-19 has shown, infectious diseases do not respect international borders.

Despite the global pandemic, the UN predicts that 3 billion people globally do not practise hand washing with soap, and over 2 billion simply do not have access to basic hand-washing facilities. As a result, diseases spread fast and most easily in places where preventive measures such as WASH do not exist or are inadequate. Most importantly, in some countries this can push health workers, who cannot rely on the availability of soap and clean water, to over-prescribe antibiotics as a preventive measure, contributing to the rising threat of resistance to antibiotics. Yet investing in basic services and healthcare facilities decreases the demand for antibiotics, breaks the chain of infection and removes the opportunities for resistant infections to become dominant.

It is important at this point to say that most resistant infections treated by the NHS originated elsewhere in the world, particularly in low and middle-income countries. Tackling that problem is critical to UK public health and to protect the NHS. Healthcare-acquired infections already cost the NHS at least £2.1 billion a year—costs that will increase as infections become increasingly resistant to antibiotics. As the Minister will be aware, a high-level meeting on antimicrobial resistance will be happening at the UN General Assembly next September, which could provide a significant moment to drive the political prioritisation of WASH and fighting disease abroad and here in the United Kingdom. Will the Minister commit to the UK encouraging political dialogue and drive financial commitments for WASH in the build-up to the conference? Of course, beyond the economic benefits and those for the UK, we are looking at action such as saving the lives of up to 300,000 children each year.

Touching back on achieving sustainable development goal 5—gender equality—women and girls face particular challenges when it comes to WASH. A lack of WASH facilities undermines the specific needs of women when it comes to menstruation, pregnancy, childbirth and menopause. Improving the future prospects of women and girls can be as simple as providing clean water and toilets at home, which would prevent women and girls from wasting 77 million days every year on walking long distances in search of water. That is time they can spend in education or, indeed, working. Beyond that, their direct health outcomes will vastly improve when investment is made in improving access to water and sanitation in workplaces and public spaces.

As the Minister will be aware, the UK will be working towards sustainable development goal 6, which is primarily split between two Departments: the Department for Environment, Food and Rural Affairs, which focuses on improvements here in the United Kingdom, and the FCDO, which is working to improve international results. I am positive that ministerial colleagues will work together to ensure that progress is made to achieve the international targets, but I would be interested to hear what those collaborations will actually mean. However, we understand that this is not always the case in countries struggling with access to WASH. Institutional fragmentation occurs, which undermines the effectiveness of the WASH sector.

Drinking water, sanitation and hygiene typically have their homes within different Ministries, and often the responsible Ministries may vary for rural and urban services. Hygiene, for example, cuts across many sectors, Ministries and Departments, including WASH, health, education, gender and nutrition, meaning that it is everywhere and nowhere. That contributes to problems when it comes to generating political leadership, setting policies and raising finance. It gives rise to co-ordination difficulties, weak regulation and accountability, fragmentation in capacity-building efforts and different—sometimes competing—monitoring systems. Ultimately, this results in a clear lack of ownership and prioritisation by decision makers and budget holders. What assistance are the UK Government providing to other nations to adopt approaches to WASH similar to the UK’s, including the establishment of development banks?

Despite huge progress, WASH is facing significant challenges. The world is changing rapidly. When disease and war hit, water and sanitation are often forgotten first but the consequences are experienced immediately by those displaced. I urge the Minister not to forget the issue. Water is not just the source of all life; it is the source of all future prosperity and peace for billions of people in this world.

Photo of Sarah Champion Sarah Champion Chair, International Development Committee, Chair, International Development Committee 9:43, 17 October 2023

It is a pleasure to serve under your chairship, Mrs Latham. You are the perfect person to be chairing this sitting, as I believe that you have served on the International Development Committee for 12 years now.

Photo of Sarah Champion Sarah Champion Chair, International Development Committee, Chair, International Development Committee

Thirteen years—let me correct myself. You probably know more about this issue than any of us in the Chamber, so I am grateful that you are here today.

I congratulate Dr Offord on securing the debate. I have been reminded of our trip to Uganda together many years ago; I know that his absolute passion for low and middle-income countries has stemmed from that. He has been a true champion of the cause ever since, and I thank him for that.

Access to clean water, sanitation and hygiene is one of the most basic human needs and is fundamental for development. The importance of global action in this area is set out in the UN sustainable development goal 6, which is about working towards clean water and sanitation for all. The International Development Committee, which I chair, held an evidence session on this topic—known by its acronym WASH—in March this year. We heard about the devastating impact of the lack of access to WASH on the world’s poorest people and the most marginalised groups. It is crucial that we continue to shed light on this problem, which can have devastating impacts on those living in lower-income countries across the world.

According to a joint report from the World Health Organisation and UNICEF, in 2022 2.2 billion people lacked access to safely managed drinking water, 2 billion people lacked access to basic hygiene services and 3.5 billion people still lacked access to safely managed sanitation. It is hard to comprehend the scale of those figures or the cost of that inaction. A lack of access to clean water, sanitation and hygiene has serious consequences for health and wellbeing. It increases the risk of diseases such as cholera, dysentery, typhoid and polio.

According to the US Centers for Disease Control and Prevention, a lack of access to WASH contributes globally each year to 3 million cases of cholera, resulting in an estimated 95,000 cholera deaths. In recent days, Zimbabwe has banned large gatherings as the threat of a cholera outbreak grows. The problem will only get worse with water shortages and poor sanitation systems. Those problems also contribute to 11 million cases of typhoid fever, resulting in 129,000 deaths; and 1.7 billion cases of diarrhoea among children younger than five, resulting in an estimated 446,000 deaths.

As the hon. Member for Hendon said, women and girls suffer most acutely from a lack of access to WASH. According to Water Witness, women and girls spend a total of 200 million hours fetching household water each day. My Committee heard that in hilly areas of Nepal, for example, women have to wake up at 3 am to collect water and return home before beginning their daily household tasks as the primary carer. That reduces their ability to attend school and work, and limits their political, social and economic participation.

In certain regions, water collection can increase the risk of women contracting diseases. As part of our inquiry into the FCDO’s approach to sexual and reproductive health, my Committee heard that women risk getting infected with the neglected tropical disease, female genital schistosomiasis—I am very happy for you to correct my pronunciation of that, Mrs Latham—through snails carrying parasites in bodies of water. It is a serious and painful condition, which also increases the risk of contracting HIV.

UNICEF and the WHO have found that half of the world’s healthcare facilities do not have basic hygiene services, rising to two thirds across the least developed countries. That meant that in 2021, 3.85 billion people lacked basic hygiene services at their healthcare facilities, 1.7 billion lacked basic water services and 780 million had facilities with no sanitation services.

Practising hygiene during antenatal care, labour and birth reduces the risk of infection, sepsis and death for children and their mothers. Right now, there are pregnant women receiving care and giving birth in places without basic access to clean water, soap and sanitation. WaterAid told my Committee that babies born in hospitals in low and middle-income countries are up to 20 times more likely to develop neonatal sepsis than hospital-born babies in high-income countries such as the UK. Those are shocking statistics, which emphasise starkly the global inequality of the issue.

Efforts across the world to achieve access to clean water and sanitation for all are being set back by climate change. Natural disasters such as floods and earthquakes destroy and damage water and sanitation infrastructure, and pollute water sources. My Committee heard that in coastal regions, due to sea level rises, saline contamination of water is increasing in countries such as Bangladesh. Saline water is a breeding ground for cholera. The UN also recognises that water shortages undercut food security and the income of rural farmers. Farmers often use waste water because it is the only reliable supply of water, which then increases the risk of infection for both farm workers and those who consume their crops. This is an act of desperation: 34 million people are facing acute levels of food insecurity in 2023.

On top of that, there is a vicious cycle of conflict and water scarcity that we must work to break. Scarcity of access to water is increasingly recognised as the likely multiplier of conflict, and it contributes to the creation of refugees. That conflict then increases the likelihood of destruction of water supply systems, and so the cycle continues. As we speak, we know that the people of Gaza have limited access to water, and nearby Jordan is now the second most water-scarce country in the world. Jordan’s resources are stretched by instability in the region, and it needs a sustainable strategy for long-term refugees, which my Committee has also published on. Two million Palestinian refugees are in Jordan and, given what is happening, that is likely to only increase.

The UN’s high-level panel on water predicts that 700 million people are at risk of being displaced by 2050 because of intense water stress. It is clear that access to water, sanitation and hygiene impacts on all aspects of a country’s development. I welcome the UK’s involvement in the declaration for fair water footprints at COP26, which brings together the needs of communities, businesses and ecosystems to stop water pollution and maintain the sustainable and equitable withdrawal and use of water.

Making water usage more equitable and sustainable will be key to achieving SDG 6 by 2030. However, since 2018 the UK aid budget for WASH has been slashed by nearly 80%, falling from £206.5 million to £45.6 million in 2022. The percentage of bilateral ODA spent on WASH has more than halved between 2021 and 2022. My Committee heard that

“The scale and the speed of the cuts have been shocking to those working in the sector.”

That is despite the FCDO approach paper on ending preventable deaths of mothers, babies and children by 2030, which included commitments to work with countries, partners and the private sector to strengthen WASH delivery systems.

As I have highlighted, WASH is crucial to the empowerment of women and girls, which again is a stated aim of this Government. To achieve SDG 6 in low and middle-income countries, WaterAid has stated that investment in WASH needs to triple by 2030, with at least $200 billion a year needing to be invested into WASH systems. That is where the UK Government could play a significant role in catalysing investment and bringing stakeholders together. I urge the Minister to reconsider the Government’s ODA spending on WASH so that it aligns with their own goals and priorities. Without action, the most vulnerable will continue to be at risk of dehydration, disease and death.

Photo of Maggie Throup Maggie Throup Conservative, Erewash 9:52, 17 October 2023

It is a pleasure to serve under your chairmanship, Mrs Latham. I thank my hon. Friend Dr Offord for securing this extremely important and timely debate. Access to safe, clean sources of water, alongside basic levels of sanitation and personal hygiene, is essential within the realms of public health, for both prevention of, and protection from, infectious diseases.

Although hon. Members may be somewhat reluctant to do so, if we cast our minds back to the beginning of the pandemic in 2020, before the vaccine, masks, lockdown and social distancing, the first thing we asked the public to do was to wash their hands regularly for the amount of time it took to sing “Happy Birthday” twice. I am sure that we will never forget that, and we probably still sing “Happy Birthday” when we wash our hands even today. That may seem simplistic, yet in a country where clean water is in abundance and a bar of soap costs merely pence, it is the public health measure that is often the most overlooked. It is largely taken for granted, even by those of us who are washers not walkers after using the loo.

Although handwashing was commonplace in most medical settings involving doctors and surgeons by the mid-19th century, it was Florence Nightingale with her strong Derbyshire roots who truly brought it to the masses. While the true potential of regular handwashing was still to be fully understood, it was her intuitive approach towards promoting the importance of cleanliness and personal hygiene that led to a rapid improvement in public health in the years that followed the Crimean war.

In a similar vein, our understanding of how infectious diseases spread and the vital importance of providing good sanitation facilities have their roots in the Broad Street cholera outbreak of 1854, less than a few miles from this Chamber. It claimed the lives of 616 people and was eventually tracked back to a single contaminated water pump. Here in the UK we may have come a long way since that time, but shockingly even now, in 2023, the UN estimates that 2.2 billion people across the world do not have access to safe, clean drinking water or basic handwashing facilities, while 3.5 billion people lack safely managed sanitation facilities.

Earlier this year, I was privileged to take part in a parliamentary delegation to Kenya hosted by World Vision, during which I saw first hand how climate change is increasingly affecting people’s access to water. I had a discussion with a group of schoolchildren, who shared their experience of how extended periods of drought are causing crops to fail and boreholes to dry up. I hope in responding to the debate that my hon. Friend the Minister will look closely at not only how we can further prioritise water, sanitation and hygiene through the remit of international development, but how the Government can build on the UK’s track record of action to help to tackle climate change on the global stage.

The burden continues to fall disproportionately on females—WaterAid estimates that around 60% of all household water is collected by women and girls. At the same time, over 266 million are thought to be without access to proper WASH or sanitary materials to manage their periods, which can lead to deadly infection and disease. Similarly, waterborne diseases caused by poor WASH and leading to complications including diarrhoea and malnutrition are responsible for around 13% of all deaths among children under five, the majority of which are preventable.

While WASH facilities at home are thankfully of a good, modern standard, the lack of WASH in low and middle-income countries still presents a significant threat to the UK, with most resistant infections treated by the NHS originating from elsewhere in the world, at a cost of some £2 billion per year. The lack of hygiene in low and middle-income countries leads to the overuse of antibiotics, which in turn leads to the threat of antimicrobial resistance becoming even more real. When she was chief medical officer, Dame Sally Davies stated that, after terrorism, AMR poses the greatest threat to the world.

I would like to pay tribute to a young scientist, Kirsty Smitten, who, at the age of 29, lost her life to a rare cancer just a few days ago. Kirsty, while still a student at Sheffield University, and working in a spin-off company, worked on developing a new class of antibiotics, which I am sure will make a huge difference. Kirsty had a great future ahead, but I know that she has left a great legacy and that her work will help to tackle antimicrobial resistance for many generations to come.

With the global cost of AMR set to grow exponentially over the next decade, the Government must prioritise aid spending for WASH to allow more time for new antibiotics to come online, and in the meantime help to defend the NHS from being overwhelmed. We cannot just sit back and let this situation continue to play out. As we all know, having lived through the pandemic, access to WASH is the very foundation on which good public health is built. We must do everything we can, through the vehicle of the UK international development strategy, to ensure that it is properly prioritised and funded accordingly.

Photo of Fleur Anderson Fleur Anderson Shadow Minister (Northern Ireland) 9:58, 17 October 2023

It is a pleasure to serve under your chairship in this very important debate, Mrs Latham. I congratulate Dr Offord, my co-chair in the all-party parliamentary group for water, sanitation and hygiene, on securing this debate.

I declare an interest as co-chair of the all-party parliamentary group. I also spent seven years working for WaterAid before I became a Member of Parliament. That was not because it was the only job available to me at the time. I wanted to work for WaterAid, campaigning with people around the world for clean water, sanitation and hygiene, and deliberately did so because I had worked in development for many years before that and seen that WASH is fundamental to tackling poverty and achieving equality—to achieving what the British public want to see achieved from the support they give to international development. WASH and conflict are the two biggest issues that undermine progress in development.

As co-chair of the all-party parliamentary group, I am glad of this opportunity to talk about the global crisis, the rise of antimicrobial resistance, the impact on women and WASH at home and in the UK, and how investing in that will tackle poverty and inequality, and yield results far into the future. As previous contributors to the debate have said, 1.9 billion people live in severely water-scarce areas, and that number is growing all the time. It is a climate crisis. Also, 2.2 billion people do not have access to clean water and sanitation. That undermines our progress on so many of the sustainable development goals, and not only No. 6, which is dedicated to that issue, but those on climate, health, gender equality, food security, conflict and economic growth, so it is vital that we get this right.

The World Health Organisation has reported that two thirds of healthcare facilities in the world’s 46 least developed countries do not have access to hygiene facilities. Let us just pause to think about that. If my local hospital, St George’s, did not have water, it would be closed. It would not be open and would just not be seen as an acceptable place to offer healthcare. However, healthcare facilities around the world do not have water. That leads to a new-born baby dying every minute from infection caused directly by a lack of safe water and a clean environment.

Last week, I had the pleasure of becoming a grandmother. My granddaughter is in an incubator at the moment in a special care baby unit and it breaks my heart to think that she would not have access to hygiene. It is so important. We are terrified of that baby getting infected. Yet there are mothers around the world giving birth in places that are not hygienic and they do not have the healthcare facilities they need. It is not a matter of living in a hot country or one where it is difficult to access water. This is about political choice. Water can be provided to all those healthcare facilities and communities with the right amount of political will, support and focus.

In recent years, we have been on a steep decline in both investment and leadership on WASH. That is having a detrimental impact on the delivery of lifesaving basic services. Since 2018, UK aid for water and sanitation has been cut by two thirds and, shockingly, the total share of the aid budget going to water supply and sanitation was barely 1% in 2021. That does not tally, and as the hon. Member for Hendon said, there is a mismatch with what the UK public would like to see done with UK aid. They can understand that if a water supply is cut off, within hours and days people are absolutely desperate. They do not know what to do; their lives are turned upside down. The UK public understand how vital water is, but Government aid funding just does not seem to be in step with that.

Like others, I want to highlight the vital issue of antimicrobial resistance, which will be the leading cause of death in the UK by 2050, according to the Government’s own statistics. The current lack of water, sanitation and hygiene services in healthcare facilities increases infection, disease and death rates. The level of contamination means that antibiotics need to be used more often as a regular form of prenatal care in many countries and over longer periods of time, causing their effectiveness to be reduced in the long run. The World Bank has reported that if the current trend continues, antimicrobial resistance could push up to 28 million people into poverty by 2050, with global increases in healthcare costs predicted to range from $300 billion to more than $1 trillion by the same year.

The all-party parliamentary groups for water, sanitation and hygiene and the all-party parliamentary groups on antibiotics have produced a report on that subject called “Prevention first”. We took evidence from the World Health Organisation and from experts around the world about the need to curb the spread of antibiotic resistance. We found that a lack of hygiene means

“that doctors and nurses are unable to wash their hands before and after touching patients, new mothers are unable to clean themselves or their babies,” and health workers are unable to clean as much as they would want to. Also, patients do not have a safe and hygienic toilet in their healthcare facilities. That causes repeated disease outbreaks that need to be treated with antibiotics, which contributes to the ever-increasing resistance.

Despite our inaction so far, there is a way to avoid this catastrophe—this ticking time bomb. Investing in WASH now, especially in low-resource nations, can go a long way towards containing the spread of antimicrobial resistance and save countless lives in the decades to come. It is such a good value-for-money investment and could be the huge step change that we need.

Another area is clearly gender equality. Women and girls have been said to be the priority for UK aid for many years now, under successive Ministers. Women make up 70% of the world’s healthcare workers and 90% of the world’s nurses, so the lack of WASH in healthcare facilities disproportionately impacts women, who are working in those facilities. Women face unique needs at times of pregnancy and childbirth; they need that clean and safe environment. Having access to WASH facilities prevents up to 1.4 million maternal and neonatal sepsis-related deaths each year—such preventable deaths, and such heartbreaking stories.

Equally distressing is the impact that the lack of WASH is having on women’s trust in healthcare. A White Ribbon Alliance survey of 1.2 million people from 114 countries found that women’s second highest priority was access to water, sanitation and hygiene. We have heard from previous contributors about the effect that this has on education. Walking to fetch water often takes away from time spent in schools. Having to care for sick relatives and family members takes time away from education, and I have met girls around the world who have to spend one week a month missing school when they are having their periods because they do not have toilets in their schools. That impacts on their education.

However, there are also good stories about WASH. I am constantly thinking about the women I have met in many towns and villages around the world whose lives were changed when they got access to water and sanitation. Their lives were changed; they became leaders in their communities; they were able to go out to work; their families were well and healthy. WASH can enable an enormous amount of women’s empowerment.

I want to be direct and tell anyone who may believe that this is an issue for other countries to worry about, and that it remains a problem of little consequence to the UK, that they are wrong. Unless we invest in WASH abroad, we will see a significant, prolonged and costly impact here at home. The most resistant infections treated by the NHS originated elsewhere in the world. Healthcare-acquired infections already cost the NHS at least £2.1 billion a year, and that will go up as infections become increasingly resistant to antibiotics. So while I am delighted to have the Minister here, we really need a Health Minister here, to accept the impact that this will on the NHS here.

To conclude, I was pleased to learn from the Minister for development, Mr Mitchell, that FCDO officials worked hard to lobby for the inclusion of water, sanitation and hygiene language in the political declarations at the recent UN high-level meetings on universal health coverage and pandemic preparedness and response. We also had several meetings with the Minister in advance of those meetings. But it was disappointing not to see the vital importance of WASH reach the messaging in UK Ministers’ speeches and press releases. They are constantly saying that WASH is a priority, but that does not come out at the highest level at the moment it is needed.

Can the Minister ensure support for WASH at the most senior level and ensure that these undervalued issues are given the political priority they deserve at future international events? Given that WASH is a top priority for MPs and the public, and is so clearly in Britain’s own best interests, will he commit to prioritising investment in water, sanitation and hygiene services across the developing world, and to say, “What about WASH?” in all development projects?

How do the Government plan to increase the prominence of antimicrobial prevention measures in any future WASH investments? Will the Foreign, Commonwealth and Development Office be restoring UK official development assistance funding for WASH—which has fallen by two thirds between 2018 and 2021—as part of its women and girls strategy? I thank hon. Members very much for this debate, and I look forward to the Minister’s responses.

Photo of Patrick Grady Patrick Grady Scottish National Party, Glasgow North 10:09, 17 October 2023

It is a pleasure to serve under your chairship, Mrs Latham; as others have said, it is very appropriate that you are in the Chair. I congratulate Dr Offord on securing the debate, and I am proud to serve as a vice chair of the all-party parliamentary group for WASH, which he and Fleur Anderson so ably co-chair. I also refer to my entry in the Register of Members’ Financial Interests regarding a visit to Malawi earlier this year with the APPG on malaria and neglected tropical diseases.

Malawi is a country very close to my heart. There is a popular saying in that country, “madzi ndi moyo”: water is life. That probably encapsulates everything we have heard in this debate. As the hon. Member for Putney said, lots of interventions and policy areas are often cited as key to sustainable development and ending poverty, but access to clean, safe water is inarguably right at the very top. A human being can survive several weeks without food but only days without water. Access to water is a basic human right, and yet 2.2 billion people go without ready access to safe drinking water, and more than half the world’s population do not have access to safe sanitation. We take access to clean water so much for granted here in the west—particularly in this country, where it falls out of the sky with such frequency—that is can be hard to comprehend just how difficult life can be without access to safe water.

If water is life, the inverse must be true. Lack of access to water deprives people of life—sometimes quite literally, with 13% of all deaths among children under five attributed to inadequate water, sanitation and hygiene. If unsafe water does not kill, it certainly makes life much more difficult. Water-borne diseases cause terrible sickness, particularly diarrhoea and fluid loss, as the Chair of the International Development Committee said. That can make recovery from illness and the ability to retain nutrition from food even more difficult. Experiencing such illnesses in childhood can have long-term consequences for mental and physical development, which reduces life expectancy and life chances.

Lack of access certainly impacts quality of life: as we have heard, 29% of schools globally do not have access to clean water. I have taught in some of them. About 443 million school days are lost every year because of water-related diseases. As others have said, that disproportionately affects women and girls. Girls are more likely to miss school because of a lack of sanitary facilities—frankly, that is as true here in the United Kingdom as anywhere else in the world—and it is women in developing countries who bear the largest burden of water collection needs, as the hon. Member for Hendon said.

Water Aid estimates that more than 77 million working days could be freed up for women if there were universal access to water and sanitation. The hon. Member for Putney spoke passionately about the difference that that can make. Again, I have been in exactly the same situation; I have travelled to villages and communities in Malawi and other parts of Africa, where water has transformed the lives of the whole community, particularly empowering women and allowing them to assume leadership roles.

The climate crisis is also increasingly experienced as a water crisis. In many places there is either too much or too little or it is too contaminated. That is not just in developing countries. In the United Kingdom, we are experiencing both floods and droughts, and the situation puts massive pressure on our sewerage system. Where efforts are made, benefits can be seen by all, and the potential for benefits can be predicted.

Earlier this year, I and other members of the APPG on malaria and neglected tropical diseases had the privilege of visiting Malawi. We met people in communities where trachoma had been eliminated, thanks to the adoption of WHO’s SAFE strategy: surgery to treat blindness; antibiotics to clear infection; facial cleanliness and hand hygiene to reduce transmission; and environmental protection to stop the infection spreading. Malawi has now been declared a trachoma-free country—something that many other countries in that part of the world aspire to.

As we have heard, the WASH APPG published an important report earlier this year—I took part in some of the evidence hearings—that demonstrated how WASH interventions as simple as cleaning hands and hospitals with soap and clean water can decrease demand for antibiotics, break that chain of infection and remove the opportunity for resistant diseases to become dominant. Maggie Throup spoke of the importance of cleanliness in hospitals in particular.

A few months ago, Lord Boateng hosted a really inspiring event, appropriately enough in the River Room, celebrating the work of Water and Sanitation for the Urban Poor, a charity that he is very closely involved with. It works to improve the delivery of clean water to increasingly densely populated areas of towns and cities in developing countries in Asia and Africa. Many stories were featured of lives transformed as a result of putting in sometimes quite complicated and sometimes very simple infrastructure. Again, that has a transformative effect on people’s lives.

The Scottish Government are investing, again, in Malawi in its Water Futures programme, supporting Malawi’s National Water Resources Authority and the Malawi Environmental Protection Authority to map, monitor and enhance that country’s water infrastructure.

I can see that the Minister shares the enthusiasm and inspiration that many of us do on this matter, and it is clear from this debate that water, sanitation and hygiene flow through the development agenda. Making sure that people have access to clean, safe water and a water infrastructure that protects them against floods and droughts helps to unlock so many other aspects of the sustainable development goals. We know that there will be a wider debate on progress towards those goals later in the week. I do not know whether the Minister for Europe will respond to that debate with the same enthusiasm with which he is gearing up to respond to this one.

Questions arise for the Government about how they can support the kind of positive interventions that we have heard about today and what action they will take to overcome the many challenges that remain to ensure that everyone around the world has access to water, sanitation and hygiene. We have heard about the level of public support for these kinds of interventions that exist here in the UK. That needs to be reflected in the White Paper when it is published and it needs to be heard more clearly, as the hon. Member for Putney said, at the highest possible level when the Government make representations on these matters on an international level.

The Government’s own statistics show the dramatic reductions to WASH funding since the ODA cuts were announced. Many of us said at the time that effective aid cannot be turned on and off like the taps that we all take for granted. Government cuts have a long-term impact, so even if funding is slowly being increased and bilateral aid is being increased in some countries, that does not change the fact that there has been a loss of capacity and a loss of progress resulting from the previous cuts. That will not be easily undone.

I do not think we can allow the debate to conclude without addressing the question of access to water in Israel and Palestine—as the Chair of the International Development Committee did—and particularly at this moment in Gaza. Denying people access to water is a fundamental breach of their human rights. Cutting off water supplies to hospitals in Gaza will condemn to death innocent people who have nothing to do with the terrorist atrocities perpetrated by Hamas. The Government of Israel must not use the denial of civilian access to water as part of siege or any other military tactics. I hope that the Minister will echo that statement.

Water is life and, in this part of the world, all too often we take it for granted. The Government have to do more—much more—to make sure that everyone has the access they need to water and to the life that it brings.

Photo of Lyn Brown Lyn Brown Shadow Minister (Foreign, Commonwealth and Development Affairs) 10:18, 17 October 2023

It is a genuine pleasure to serve under your chairship, Mrs Latham, and I am well aware of your expertise in this issue. I also thank Dr Offord for securing this debate. He is clearly a dedicated and knowledgeable member of the all-party group for water, sanitation and hygiene. He is right: we know that when communities have comprehensive access to clean water and sanitation, it mitigates the spread of diseases, reduces maternal and infant mortality, slows the rise of antimicrobial resistance, reduces poverty and so much more. It is part of a prevention-first approach, not just in international development, but, as my hon. Friend Fleur Anderson said, for our health security here in the UK. It is a real shame that the Government’s cuts saw aid for WASH fall by more than three quarters between 2018 and 2022.

In most households without running water, women and girls are responsible for fetching it. Every hour a girl spends fetching water is an hour not spent in education; and, for the reasons stated by the hon. Member for Hendon, when a school does not have clean water, that is a massive barrier to girls’ inclusion in education. Every hour a woman spends fetching water is an hour not spent earning a livelihood.

Why am I focusing on women and girls? It is because, as hon. Members have stated and repeated, women and girls globally spend 200 million hours each day collecting water. When the journeys are too lengthy or dangerous to risk, families can be left reliant on unsafe water or none at all, which we know leads to terrible illness and needless death. Preventable diseases caused by inadequate water, hygiene and sanitation are sadly all too common, with 1.4 million lives lost each year. Almost half a million children under the age of five die of diarrhoea every year, and many of those deaths are caused by unsafe water or a lack of sanitation. Imagine being a mum who has successfully delivered a healthy baby, only to have that life snatched away because the clinic lacks clean running water. It is the cruellest outcome, but sadly one that is all too common around the world.

In December 2021, the Government published a very welcome approach paper on ending the preventable deaths of mothers, babies and children by 2030. I ask the Minister a very simple question: does he think that goal will be met? How much progress does he think has been made over the two years since the publication of that paper? Perhaps he could also say a little about the work his Department is doing to ensure that the particular needs of women and girls are reflected in both the design and the implementation of WASH programmes.

I am sure that the Minister and I agree that WASH systems can have so many positive impacts when done right. They can underpin global health security, which impacts positively on our citizens too: if we cannot ensure that health clinics around the world have water and sanitation, we cannot minimise the risk of superbugs and infectious diseases coming to the UK; if half the world are not able to wash their hands, we cannot slow the rise of antimicrobial resistance. Right now, one in four people cannot wash their hands at home, and half the world’s healthcare facilities do not have even basic hand hygiene services. This impacts on the health of the entire world—not just on the health of impoverished communities, but on the health of the UK too—so we need a solution for those mums whose children cannot survive, and for us.

The solution goes beyond installing water pumps. Whole-system approaches are needed, where WASH is incorporated into health facilities and accompanied by information campaigns. System building will require significant long-term investment in institutions and infrastructure, and working with communities: in a word—partnership. Is the Minister confident that the FCDO has retained enough country-level technical expertise in WASH to enable genuine, respectful partnerships, and does he feel that the information about FCDO plans and budgets is being given to our in-country partners early enough so that they can make the most effective use of funds?

There are, of course, challenges in many places most in need of better WASH, including poor infrastructure and weak governance. I would be grateful if the Minister could say a little about his approach to managing those challenges because—let’s face it—many of those countries in need have fast growing urban populations who put pressure on water systems, often including large numbers of people displaced by violence and hunger.

In February, we heard that earthquake victims in some shelters in Aleppo were without clean water, and up to 150 people were having to share a single toilet. Syria has the highest population of internally displaced people in the world, so it can hardly be a surprise that today 7.6 million people in Syria are in acute need of WASH services.

In Cameroon—where 1.1 million people are internally displaced, and there are almost half a million refugees and asylum seekers—over 1 million people badly need support with clean water and sanitation. In shelters and camps that do not have WASH facilities, disease can spread quickly. Both Cameroon and Syria have had serious cholera outbreaks.

Clearly, if more displaced people and refugees have clean water, the spread of diseases across borders will lessen. Ultimately, this is about supporting the conditions that enable people to live with security and dignity. To me, that is what international development is all about—actually, I think that is what politics is all about.

This issue is about looking ahead, and thinking about what we can do now to head off the rise in resistance to antibiotics and even the next pandemic. As we have heard, antimicrobial resistance already impacts patients in the UK, and will affect us more and more over the coming decade. The challenges will not go away, so I say gently that I was a bit disappointed that the Deputy Prime Minister did not mention water, sanitation and hygiene even once in his speech to the United Nations General Assembly last month.

How can we tackle health threats that affect us in the UK unless we work in partnership across the world to improve access to clean water and sanitation? We are some way off meeting our sustainable development goal of universal access to safely managed drinking water, sanitation and basic hygiene services by 2030. To achieve that goal, we would need a fourfold increase in current rates of progress. I also add my words to the concerns expressed by colleagues today about depriving the people of Gaza of their basic human right to water.

We in this Chamber and in this Parliament need to get real. In no way will we see universal access to WASH without meeting the threat of climate change. The Minister knows that UK leadership on climate change is expected at COP28. I therefore finally ask him— I know he has been taking copious notes of all my questions—what he will do to secure strong global action, and recognition that WASH and climate vulnerability are strongly linked. That is a building block in cutting poverty, improving global health security, securing our own population’s health and building gender equality. Our own communities and those around the world need to see action on this agenda now.

Photo of Leo Docherty Leo Docherty Parliamentary Under-Secretary (Foreign, Commonwealth and Development Office) 10:28, 17 October 2023

I am pleased to serve under your chairship, Mrs Latham. I am grateful to my hon. Friend Dr Offord for securing this important debate, and all Members present appreciate his ongoing work as vice-chair of the APPG for water, sanitation and hygiene. He spoke with knowledge and passion.

The Minister with responsibility for development and Africa, my right hon. Friend Mr Mitchell, would like to have been here, but he is attending to his duties in Cabinet this morning. It is therefore my pleasure to respond on behalf of the Government. I am grateful for the contributions of all hon. Members this morning and will seek to cover the various points raised. It has been an extremely knowledgeable and passionate debate, for which I am grateful.

Let me start by addressing the comments made about the situation in Gaza. Some colleagues will have seen the Prime Minister’s statement to the House yesterday, including the announcement of £10 million in additional funding for humanitarian use in Gaza. That is on top of the £27 million that already goes to the UN Relief and Works Agency and the UN Office for the Co-ordination of Humanitarian Affairs. It is right that I put that on the record at the start.

As has been discussed, water and sanitation are basic human needs and a central part of our effort to improve global health and end preventable deaths. All people should be able to enjoy what are fundamental aspects of their health and dignity without discrimination or barriers. As has been described this morning, billions worldwide are unable to do so, lacking access to safely managed water, sanitation and hygiene services. It has been interesting to hear reflections on the dire and far-reaching consequences that that has not just for individuals, but for the goals that we are all striving towards.

Without equitable access to WASH worldwide, we will fail to achieve our sustainable development goal on clean water and sanitation. We will also miss other important global health goals, including our commitment to end the preventable deaths of mothers, babies and children, which has been raised this morning. Our fight against antimicrobial resistance will be compromised, as will global efforts to educate all girls, build climate resilience and protect natural resources. For all those reasons, the UK Government continue to drive progress on the WASH agenda.

Let me share some of the details of what we are doing, as well as reflecting on the scale of the challenges that we face. I should say that we invested last year in excess of £100 million of ODA spend into WASH. There has been a shift in focus from direct delivery to helping Governments establish sustainable WASH facilities. Despite the overall shape of the ODA package, we remain committed to that extremely important agenda.

Hand hygiene, as has been described, is one of the simplest and most cost-effective methods of protecting our health, as we witnessed during the pandemic. That is why we joined forces with Unilever on our innovative Hygiene and Behaviour Change Coalition, which helped to limit the spread of the virus in lower-income countries. The coalition supported nearly 15,000 healthcare facilities with critical supplies and services and trained close to half a million health workers on hygiene.

However, two thirds of healthcare facilities in the least developed countries lack basic hygiene services. Millions of patients and staff are unable to keep their hands clean, meaning that infections spread and antibiotics must be used, which of course increases antimicrobial resistance. Mothers and babies are at risk of dying from infections caught in hospitals, where they ought to be safe. Women and girls often bear the brunt of poor access to water, sanitation and hygiene and suffer higher rates of diarrhoea from the lack of clean facilities. They are most often the person responsible for fetching water, as has been said—a task that can often expose them to physical violence and injury.

Meanwhile, schoolgirls deserve to focus on their education without the burden of worrying about menstrual hygiene. That is why the Foreign Office supports training on menstrual health and helps to construct suitable toilets in schools in Mozambique and Ethiopia.

We cannot forget the links between WASH and climate change. Natural disasters are wreaking havoc on water, sanitation and hygiene systems just when they are needed most. That is why the UK backs UNICEF’s efforts to support climate-resilient WASH services by developing national adaptation plans in countries across Asia and Africa, identifying climate risk and providing technical support to Governments.

The UK will continue to play a leading role, prioritising system-wide approaches, supporting political leadership and strengthening data and evidence. We had previously focused on providing first-time access to basic services. Our programmes supported more than 120 million people with sanitation or water services between 2010 and 2020. We now have greater reach and impact by supporting Governments to make enduring changes themselves. This includes building systems to provide long-term, safe and climate-resilient services to communities.

Our WASH Systems for Health programme is leading that approach. Working closely with Governments and non-governmental organisations, the UK will support the long-term provision of services, benefiting people far beyond the lifespan of the programme. That work must be founded on the bedrock of political accountability and leadership, so we are working with Sanitation and Water for All to raise the profile of WASH and build commitment through high-level presidential compacts. Alongside that, the UK will continue to lead the way in pushing this agenda at the highest levels.

At the UN General Assembly, we made sure that the new declarations on pandemic prevention, preparedness and response, and on universal health coverage, explicitly noted the WASH crisis. At the recent landmark UN Water Conference, we led the conversation on WASH and health, and amplified the voices of representatives from the global south. Since the conference, we have worked to ensure that political momentum is kept up and that the hundreds of commitments made as part of the water action agenda are actioned, and we will continue to do that.

An important part of this effort is bolstering vital evidence and data to underpin our actions. We support the joint monitoring programme hosted by UNICEF and the World Health Organisation, which provides reliable data to which the whole sector can be held. Our work with the private sector includes TRANSFORM, a partnership with Unilever and EY that is generating evidence on behaviour change, including on sanitation. I am pleased to reconfirm to colleagues that WASH will also feature in the forthcoming international development White Paper, which will outline our plans for the next seven years and will be a fundamentally important strategy paper for future development until 2030. Meanwhile, our programmes are bringing people from finance, water resources, health and gender ministries together around the same table to tackle the challenges head on.

We are conscious of the obstacles we face in achieving our shared WASH goals, including poor healthcare facilities and the impacts of climate change, but I can give colleagues an absolute assurance that we will continue to forge and promote partnerships—the key word mentioned today, and we endorse that—with NGOs, Governments and the private sector, while advocating at the highest levels for increased financing and political leadership. We will continue to lead by example by supporting stronger systems, driving progress on WASH worldwide, in order to build a fairer, healthier and safer future for billions of people.

Photo of Matthew Offord Matthew Offord Conservative, Hendon 10:37, 17 October 2023

I am very grateful for the contributions from the Members who have come along today. What has struck me is that so many people have not only developed a passion for this subject, but have seen the situation on the ground when they have visited countries where WASH projects have been undertaken.

Sarah Champion mentioned the Ugandan visit that she and I made several years ago, and we certainly saw benefits occurring in that country. She also raised the issue of diarrhoea, which is very important: according to the US Department of Health and Human Services, 2,195 children die from diarrhoea each day—more than the number of children who die from AIDS, malaria and measles. Some 1.6 million people die each year from diarrhoeal diseases globally, and that is more than the number who die from suicide, homicide, conflict and terrorism in a single year. We often laugh about things such as diarrhoea in this country, but the statistics emphasise that this is a mass killer that we could easily overcome.

My hon. Friend Maggie Throup spoke about her visit to Kenya through World Vision, as well as the issue of eye health—that is also very important to me—and sanitation. She mentioned that antimicrobial resistance kills more people than terrorism, and that fits in with the statistics I have mentioned.

Fleur Anderson says that she did not fall into her role with WaterAid, and she certainly did not; she has had a long and illustrious career in the international development sector. I was particularly interested to see that she worked in Serbia during the time of the war. As global head of campaigns at WaterAid, she will know, without any doubt, the importance of this subject, but I want to add to one of her points. She spoke about the unique experience of women and girls with access to water. One thing that I did not mention in my earlier speech is my understanding that the number of sexual offences against women and girls has a direct link with access to toilet facilities. Many girls do not use toilets at night or simply do not have the opportunity to, and those who do run the risk of sexual exploitation. So the issue of WASH is about not just health and sanitation, but sexual offences against women.

Patrick Grady mentioned his visit to Malawi, the issue of access to water and the three-day survival rule. The Minister may be a military man; I am not, but I am certainly someone who is interested in the outdoors. He knows the three-day survival rule, which is that human beings cannot survive for more than three days without access to water. They cannot survive for more than three minutes in extremely cold temperatures. They cannot survive for more than three weeks without food. But they cannot survive for more than three days without access to water.

The hon. Member makes a very good point about Gaza. It is certainly something that I will take on board. I think the Israelis should allow access to water. I defend them for not allowing access to other things, but I think that they should allow access to water. But I gently remind him that the EU did spend €100 million on putting 30 miles of water pipes into Gaza, and Hamas decided to remove those water pipes because they felt that they could make rockets out of those. I would certainly condemn that action.

Ms Brown emphasised the issue of hand washing and how it affects the entire world. I would point to the issue of bedbugs, which have spread across the channel very easily, so we can recognise that microbial diseases will spread even more easily than something as large as bedbugs. She mentioned her visit to Cameroon. Again, that emphasises the number of people who have visited and seen WASH projects.

Jim Shannon reminded us of the religious importance of water. I am aware that he had another important meeting to go to and was not able to stay for the rest of this debate.

I am grateful to the Minister, who outlined the Government’s actions, the additional funding, which is very important, and the importance of health programmes overall. I have, with others, met the Minister with responsibility for overseas development—my right hon. Friend Mr Mitchell—and he unofficially reminded us that the issue of WASH would be included as part of the international development White Paper. I am grateful that today this Minister has publicly announced that it will be included in the international development White Paper in the coming months. I am also grateful that he has reinforced the fact that political accountability and leadership are a priority for the Department and that these issues will be raised at the forthcoming UN conferences.

I am grateful for what the United Kingdom has done in this area. Although the issue of overseas development funding can be contested, the issue of overseas development funding being spent on WASH facilities is not. The people of the United Kingdom feel very strongly about that, and I certainly feel very strongly about it. Water scarcity is a problem across the world, but I hope that we can play our part, reduce the inequalities and improve the life chances of those around the world.

Question put and agreed to.


That this House
has considered water, sanitation, hygiene and sustainable development.

Sitting suspended.