ANTANANARIVO, Madagascar (IRIN)
About a third of Madagascar's 20 million people do not have access to water for washing and most of the rest share unsanitary toilet facilities, according to a July 2011 World Bank Water and Sanitation Programme (WSP) report. The threat of diarrhoea and other diseases is particularly acute in some of the poorer suburbs of the capital Antananarivo.
"There is no formal waste disposal for the moment in Antananarivo," Sylvie Ramanantsoa, a representative from Water and Sanitation for the Urban Poor (WSUP) in Madagascar, told IRIN, and raw sewerage tends to end up downstream in the Ikopa river, the country's second largest.
The problem was exacerbated by the city's water table being about one metre below the surface, which makes waste treatment "a big public health issue", she said.
A network of canals, storm water drains and channels criss-crossing the city are choked with rubbish, causing flooding in low-lying areas during the March to November rainy season.
In April 2011, the UN Children's Fund (UNICEF) reported a worrying rise in pneumonic plague - spread by fleas carried on rodents and linked to poor sanitation - in Antananarivo and in the town of Talatavolonondry, 27km to the north: The Health Ministry reported more than 310 cases of plague and 49 deaths by the end of March. UNICEF responded with a mass disinfection campaign that targeted more than 28,000 families in the most exposed areas of the capital and surrounding towns.
Dadou Andriambolanirina, who works as a toilet attendant in the city for the equivalent of US$27 a month, said a canal in his neighbourhood of Isotry, one of the poorest in the capital, was blocked this year, causing a proliferation of rats, and three people were infected with pneumonic plague. Andriambolanirina shares a pit latrine with 60 other families in the neighbourhood.
Many people cannot afford the equivalent of five US cents Andriambolanirina charges for the use of a public toilet, one of 15 built or repaired by NGO Care International, and nearby Lake Anosy, though picturesque from afar, serves as the capital's largest toilet.
Open defecation occurs everywhere in Antananarivo where there are patches of open land, particularly after sunset, but Lake Anosy's location near the city centre, where there are a shortage of such places, means it is frequently used by those who lack toilets and cannot afford the fee to use a public toilet.
NGOs say almost 70 percent of toilets in the capital are pit latrines, making the city a "timebomb for water borne-diseases", such as cholera.
"An outbreak [of cholera] would be devastating here. As it is now, in the neighbourhoods we've been visiting in the lowlands of this region [around the capital], most people get diarrhoea at least two or three times a month, and that's just a repeated assault by faecal pathogens on people's insides," said Virginia Gardner, designer of Loowatt, a waterless portable toilet which turns waste into fertilizer.
The WSP report said poor water and sanitation was costing the country about US$100 million annually, or 1 percent of its gross domestic product, and that at least 1.5 million toilets were needed to resolve the country's water and sanitation needs.
More than 10,000 people, of whom two thirds are children under five, die prematurely from diarrhoea annually, according to the World Health Organization, which attributes 88 percent of these cases to poor quality water and sanitation.
A cash for work scheme sponsored by UNICEF in 67 Hectares, one of the city's most deprived neighbourhoods, built communal toilets for 67,000 people and installed 375 metres of drains.
Solofo Nirina, head of the local community, said before the clean-up: "People on this side of the canal didn't used to be able to open their doors due to bad smells… The risk of contamination from disease was enormous as all the rubbish and human waste was thrown there."
There are also hopes that with support from the Bill and Melinda Gates Foundation, Gardner's Loowatt concept will be piloted in Madagascar in 2012.
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