Exploring the link between climate change and WASH: insights from World Water Week 2023

The relationship between water, sanitation, hygiene (WASH), and climate change is an emerging concern with significant implications for global public health. As temperatures rise and weather patterns become more unpredictable, sustained access to clean water sources and safe sanitation is increasingly sporadic.

This critical issue was the topic of the Coalition against Typhoid’s World Water Week (WWW) session, “Bridge over troubled waters: Improving water systems to combat typhoid.” Each year, WWW is dedicated to addressing global water-related issues on a transformative scale.

The Coalition’s session included four presentations and a moderated panel discussion by leading WASH and infectious disease experts focusing on climate change’s impact on waterborne disease transmission. Among the distinguished speakers was Dr. Eunice Ubomba-Jaswa, the Research Manager: Water Resources Quality & Management at the Water Research Commission in South Africa. Dr. Ubomba-Jaswa’s presentation, “WASH Infrastructure and Access: Integrating Climate Resilience,” shed light on the existing WASH conditions in Hammanskraal, South Africa, along with the impact of extreme weather events on WASH infrastructure.

We spoke with Dr. Ubomba-Jaswa to further discuss the repercussions of climate change on WASH infrastructure and accessibility.

What are some examples of how climate change is impacting WASH? How do you see this unfolding in South Africa?

South Africa has been plagued by both droughts and floods in recent years. Several provinces, mainly the Eastern Cape, Northern Cape, Limpopo and notably the Western Cape, have experienced severe drought. In these provinces and several others, dam levels were extremely low, and as a result, water taps were empty, reducing the amount of water available for personal daily use and for business. In some cases, boreholes had to be sighted and drilled to provide water. Some communities increased spending on bottled water, while others had to travel longer distances to find water and reuse grey water for flushing and gardening.

Cyclones and intense flooding events have also affected the Southern African region within the last five years. Cyclone Idai made landfall in March 2019, resulting in intense flooding in Mozambique and affected Zimbabwe and Malawi. In April 2022, Storm Issa brought long periods of heavy rains to KwaZulu-Natal Province in South Africa. WASH infrastructure damaged by Cyclone Idai, including overflowing sanitation facilities, led to a confirmed increase of infections from waterborne and vector-borne diseases such as malaria, measles, and cholera. An oral cholera vaccination programme launched in combination with other WASH activities led to a significant reduction of the number of reported cases within a two-week period.

On the African continent, Mozambique and Malawi have some of the highest proportions of community-acquired bloodstream infections caused by non-typhoidal Salmonella (NTS). Flooding exacerbates this risk because of possible contaminated water and food; there is also a higher risk of typhoid and paratyphoid fever caused by Salmonella Typhi and Salmonella paratyphi, respectively.

How can policymakers mitigate the existing challenges of climate change as it relates to waterborne diseases?

Policymakers must use national data that is currently being collected around climate change and its effects to make better decisions about how to mitigate it. For example, the data could help national programs develop meaningful proxy indicators to track diarrhea occurrence during various seasons and extreme weather events. Another possibility is to analyze 20–30-year-old weather and clinical data sets to gain a solid understanding of the effect of climate change on health and disease and to identify vulnerable population groups.

In terms of waterborne disease, having access to clean potable water is key to preventing the spread of the disease; in this regard, access to source water is necessary. Policies that drive innovation in identifying new sources of water and building climate change infrastructure are key, e.g., desalination and reuse of effluent and groundwater.

Policies must be harmonized across different sectors to ensure a coordinated, coherent, efficient, and effective response to climate change, locally, nationally, and globally. In the case of WASH, policy development in the health, environment, education, water, and sanitation sectors must be cross-cutting because impacts of and responses to climate change are inherently cross-cutting in nature. Educational policies that prioritize public access to climate change information and promote both technical and managerial skills are important.

Do you currently see local climate change advocates working collaboratively with WASH advocates?

There is a move towards more collaborative efforts between the two sectors now that there is research available on how best that should be done. The Water Research Commission (WRC) in South Africa has funded a lot of water-related research and capacity development work in various aspects of climate change that centers local community insights. One example is the development of a health vulnerability index for extreme weather events for various communities that had experienced drought in South Africa and in Zimbabwe. Communities were involved in co-creating the frameworks used to define vulnerability and assess vulnerability to drought.

What are the key actions leaders should take to prevent and control waterborne diseases in the context of climate change?

Each country needs a committed governance structure that is held accountable, continually engages across sectors to respond in real-time to outbreaks, makes concerted efforts to treat wastewater, and ensures climate-resilient infrastructure.

Robust climate change models at national, regional, and continental levels is essential for storing data guiding policy. Hotspot mapping (overlays of climate change, WASH vulnerability, real-time and sentinel surveillance data) is one strong example. Additionally, thinking beyond national borders, early warning systems should take into consideration transboundary changes in water quantity and quality.

It is also crucial to improve fragile healthcare systems and ensure that effective vaccination programmes are run and maintained not only during the time of outbreaks but in general for any vaccine-preventable waterborne disease.

As the global community continues to grapple with the impact of climate change on WASH and disease transmission, the insights from this World Water Week session highlighted the need for urgent, coordinated action. A full recording of the Coalition against Typhoid’s session can be viewed here.

Cover photo: A mother helps her daughter wash her hands in Dhaka, Bangladesh. Credit: Sabin Vaccine Institute/Suvra Kanti Das.