1. WHO and the IYS 2008 Roger Aertgeerts Regional Adviser, Water and Sanitation watsan@ecr.euro.who.int

2. Brussels 29 jan 2008WECF IYS 20082 Questions 1.What IS sanitation? 2.Why is it important to health? 3.How fares Europe? 4.Barriers to be overcome? 5.WHO actions 6.Conclusions

3. Brussels 29 jan 2008WECF IYS 20083 What IS sanitation ? XIXth century: the promotion of hygiene and prevention of disease by maintenance of sanitary conditions XXth century: the collection, transport, treatment, and disposal or reuse of human excreta or domestic wastewater, whether through collective systems or by installations serving a single household or undertaking. XXIth century: arrangements to protect public health, especially the provision of clean drinking water and the disposal of sewage.

4. Brussels 29 jan 2008WECF IYS 20084 Why is sanitation important? Human dignity Health risk Diarrhoeal diseases Non-diarrhoeal diseases Emerging diseases. Environmental risk Intestinal helminth infections Skin and eye infections

5. Brussels 29 jan 2008WECF IYS 20085 Preaching to the choir BUT is the choir reading the same hymn sheet ? UN Water Conference in Mar del Plata 1977 Water and Sanitation for All Decade 80s UN Millennium Development 7/10 International Year of Sanitation 2008 Water for Life Decade DID IT WORK?

6. Brussels 29 jan 2008WECF IYS 20086 Sanitation in European Union (2004) Total pop: 487 m Urban pop: 364 m House connection: 276 m (75.59%) No house connection: 88 m (24.41%) Rural pop:122 m House connection: 64 m (53%) No house connection: 58 m (47%)

7. Brussels 29 jan 2008WECF IYS 20087 Sanitation in Europe Appr 85 million people do not have access. Coverage stable or regressing – little or no progress towards MDG 7/10 Rural areas particularly disadvantaged Operation and maintenance problems of water systems favour cross contamination Ecologically unsafe disposal of waste Contamination by sanitary waste compounds the modern health threats

8. Brussels 29 jan 2008WECF IYS 20088 Health impact Mortality: estimated 13,000 children Morbidity: results in around 736,000 DALYs or the loss of 1.8 million years of life Standards: In many EECCA countries, more than one third of the population drinks water that does not meet hygiene standards

9. Brussels 29 jan 2008WECF IYS 20089 Sub-regional programmes Barcelona Convention Protocol on protection of the marine environment from land-based sources of pollution Protocol on Water and Health Article 6 on Targets and Target Setting Childrens Environment and Health Action Plan for Europe - CEHAPE Regional Priority Goal 1

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12. Brussels 29 jan 2008WECF IYS 200812 Looking forward to 2050 Climate change: Function of sanitation end products in climate change adaptation strategy and integrated water management. Tourism: Over 300 m arrivals each year.

13. Brussels 29 jan 2008WECF IYS 200813 Climate change Water demand has doubled in the second half of the XXth century and is likely to increase by 25%. Renewable water exploitation index rapidly increasing expected to be 75% in Spain Temperature increase exceeding 5 C in summer at the end of the 21st century. Net decrease in precipitation in excess of 20 C on year basis with subsequent decrease in river flow and aquifer recharge.. Treated wastewater is a substantial and reliable source of water, with controllable health risks Wastewater to be reused should be judged by its quality, not its history Indirect potable reuse will be enforced by future circumstances, rather than being an option. Reuse of sanitation end products will need to be factored in as a normal component of IWM Sanitation is not stand-alone. Reuse of its end products, with due management of health and environmental risks; will need to be factored in as a component of any future WMP.

14. Brussels 29 jan 2008WECF IYS 200814 Health risks Contaminated sea food: transboundary movement of GI Contaminated coastal recreational water: GI, skin and eye infections, VHA Mucoses from contaminated sand HARD solutions (plants) SOFT solutions (laws, institutions, capacity building)

15. Brussels 29 jan 2008WECF IYS 200815 Protocol on water and health

16. Brussels 29 jan 2008WECF IYS 200816 Combined objectives DRINKING WATER QUALITY HEALTH OUTCOME ENVIRONMENTAL QUALITY LEGAL FRAMEWORK

17. Brussels 29 jan 2008WECF IYS 200817 Arguments for ratification General: flexible soft law instrument Bridging environment and health National Interdepartmental and intersectoral Improved regulatory environment Public participation Regional Long term European integration Novel approaches prior to codification Holistic approach vs. piecemeal legal approach Global ?

18. Brussels 29 jan 2008WECF IYS 200818 Health activities under the Protocol Surveillance and outbreak detection: ITA, ALB, ARM, BEL, BiH, CZE, GER, HUN, NOR, ROM, SRB Equity in access: FRA, BEL, CHE, ALB, ARM, BiH, CRO, FIN, ISR, MKD Progress targets and indicators: CHE, FIN, HUN, MDV, NET, NOR Wastewater, system performance, sludge Project facilitation: NOR

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21. Brussels 29 jan 2008WECF IYS 200821 Problem areas in the WHO EURO region EUR-C: about 9 million people do not have access to water (3.7%) About 32 million people to not have access to sanitation EUR-B: About 13 million people do not have access to water (12.2%) about 18 million people do not have access to sanitation

22. Brussels 29 jan 2008WECF IYS 200822 CEHAPE Childrens specific needs Country 1 16% of schools lacks locking or separate toilets 21% has only intermittent water supply 38% cannot afford soap 96% cannot afford paper Country 2 School rely on wells that are not maintained and require sanitation programs.

23. Brussels 29 jan 2008WECF IYS 200823 MDG and IYS Slow progress or regression Active commitment and action by all states needed Civil societys role explicitly recognized INTERNATIONAL YEAR OF SANITATION 2008

24. Brussels 29 jan 2008WECF IYS 200824 Barriers to action National policy Human behaviour Perception and factual understanding Poverty and economic barriers Gender issues Supply

25. Brussels 29 jan 2008WECF IYS 200825 Arguments for policy-makers Reduction of the global disease burden National stability Integrated water resource management Economic arguments Local action Empowerment of women and minority groups

26. Brussels 29 jan 2008WECF IYS 200826 Conclusions Universal access remains a dream in the IYS In rural areas in the European Union More generally in the new countries Sanitation is still often removal, but … there is no away to take waste to! The scientific evidence base needs to be strengthened, notably by developing indicators and monitoring the impact of sewerage on health and environment. More funding is needed for sanitation, especially in rural areas

27. Brussels 29 jan 2008WECF IYS 200827 Conclusions As peri-urban areas are likely to absorb most of city growth, special attention to sanitation in these areas is needed. Funding should include O&M Principle of subsidiarity in governance of water resources. Promote use of available tools for cost benefit analysis of sanitation options at national and subsequently at lower levels of government. Sanitation needs to be recognized as an integral part of WRM, and as an adaptation strategy to combat the effects of climate change.

28. Brussels 29 jan 2008WECF IYS 200828 THANK YOU For more information please visit our website at: www.euro.who.int/wat san or via email at watsan@ecr.euro.who.int