Over the past decades, substantial progress has been made towards improving access to safe drinking-water and adequate sanitation and hygiene across the WHO European Region. However, gaps persist in providing safe and equitable water, sanitation and hygiene (WASH) services for all in all settings. Consequently, the Region continues to experience water-related disease outbreaks impairing health, well-being and livelihoods.
Climate change is expected to impact the availability and quality of freshwater resources and challenge access to safe WASH services. Other emerging concerns include, for example, the environmental dispersal and transmission of antimicrobial resistance and the role that WASH and wastewater factors play in this, the hazards posed to freshwater resources by persistent anthropogenic chemicals, and the proliferation of legionella in building water systems.
The COVID-19 pandemic highlighted the critical role of WASH services as the first line of defence in preventing and controlling the spread of infectious diseases. Investment in such services is a central policy prescription for a healthy and green recovery from the pandemic. Such “no-regrets” investments pay a rich dividend in health, human rights and inclusive economic growth. Continued and strengthened efforts are required to close existing gaps sustainably while accelerating efforts towards providing safely managed water and sanitation services, including the safe disposal or reuse of wastewater.
The Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes is a key legal instrument for the Region in helping countries to advance their national WASH agenda and fulfill regional and global commitments at the national level, such as those set out in the 2030 Agenda for Sustainable Development, the Ostrava Declaration on Environment and Health and relevant World Health Assembly resolutions.
Key facts
- Water-related infectious diseases, such as diarrhoeal diseases and respiratory infections associated with unsafe drinking-water, poorly managed sanitation and inadequate hygiene practices, still represent a considerable burden in the Region and inflict significant economic costs: an estimated 33 500 deaths can be attributed to inadequate WASH conditions and services annually (92 deaths per day) of which 13% can be attributed to diarrhoeal disease and 87% to acute respiratory infections. Shigellosis, E. coli diarrhoea, hepatitis A and cryptosporidiosis had the highest number of outbreaks in countries in the Region in 2010–2021.
- Most people living in the Region can rely on basic or safely managed drinking-water services. However, while more than 80 million people gained access to such services between 2000 and 2020, almost 16 million still do not enjoy such access. More than 2.5 million people still use surface water as their drinking-water source.
- Over 271 million people lack access to safely managed sanitation services, of whom 29 million still do not enjoy access to basic sanitation, and more than 300 000 still have to practice open defecation, which is unacceptable.
- Over 5 billion cubic metres of untreated wastewater is discharged annually into the environment. Around 85% of the Region’s domestic wastewater is collected, but only two thirds is safely treated.
- Equitable access to essential WASH services is not a reality for many people in the Region, as geographical, economic and social inequalities persist. For instance, around 17% of rural dwellers across the Region do not have access to safely managed drinking-water services, compared to only 5% of urban residents.
- Most pupils in the Region have access to basic WASH services during the school day. However, over 4 million still visit schools with no water available. Around 10 million children attend schools lacking basic sanitation services and over 10 million go to schools with handwashing facilities without water or soap.
- Adequate WASH services play a fundamental role in health-care facilities. Yet, there is a significant data gap in the Region, with fewer than 20% of countries reporting data, which does not allow a representative analysis.
Our role
WHO ECEH provides leadership in tackling the prevailing challenges on WASH and health in the European Region and supports Member States in strengthening their capacities in developing and implementing practical and health-protective strategies, policies and regulations, including by providing valuable tools to improve and manage WASH services. Specifically, WHO ECEH:
- provides core secretariat functions to the Protocol on Water and Health, together with the United Nations Economic Commission for Europe (UNECE), and supports its implementation;
- establishes the evidence base for informed policy-making at regional and country levels, and supports the national uptake of WHO guidelines in policy and practice;
- develops technical guidance and tools, and provides assistance and capacity-building; including in, for example:
- assessing and improving WASH provisions in health-care facilities and schools;
- adopting risk-based management approaches to achieve safe and climate-resilient water and sanitation services;
- promoting environmental surveillance of SARS-CoV-2 and other disease agents of concern in wastewater;
- establishing adequate water quality and water-related disease surveillance systems;
- promoting hand hygiene in public places;
- facilitates regional rollout of global monitoring programmes, such as the WHO/United Nations Children’s Fund (UNICEF) Joint Monitoring Programme for Water Supply, Sanitation and Hygiene and the UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) as the official United Nations mechanisms to measure progress towards achieving Sustainable Development Goal (SDG) 6 targets on safe WASH;
- provides technical advice to countries in their preparedness planning and response to water, sanitation and hygiene emergencies.