Around 2.6 billion people worldwide live without a toilet. They relieve themselves in latrines, rivers, buckets or behind the next bush - and risk their health. Diarrheal diseases and Cholera can quickly cause death.
In his career as a physician, Dieter Häussinger has traveled extensively. One of his recent lecture tours led the professor of medicine at the University Hospital in Dusseldorf to the Indian metropolis of Calcutta.
As he drove through the city one early morning, he noticed several children squatting on the roadside with their pants pulled down relieving themselves.
"This is clearly a way to transmit diseases," said Häussinger, who heads the gastroenterology, hepatology and infectious diseases clinic at the Dusseldorf hospital.
Personal hygiene is crucial
Access to a toilet and clean, controlled water is provided nearly everywhere in Germany. The situation is quite different in many African countries, especially the sub-Saharan ones, and in many parts of Asia, particularly India. In addition to toilets, personal hygiene plays an equally important role for protection against infectious diseases. And that begins with washing hands.
Human excrement contains numerous germs that can cause sickness and can survive for a long period of time, "especially in liquids," Häussinger said. The expert sees a particular problem in countries that don't separate between waste water and recycled water. "Sewage is discharged into water that is also used to clean containers and rinse plates," he said.
But excrement that doesn't come into contact with water can also pose a risk. Flies transfer the virus with their legs and can pass it on to humans.
The "fecal-oral route," or hand-to-mouth, is the most common transmission path for infectious diseases caused by a lack of toilets. Once a germ enters a person's body, the body begins to fight back. "Every germ produces a particular toxin," Häussinger said. "The toxin causes the intestine to secrete and produce fluids to flush the germs." And this leads do diarrhea.
For Sebastian Dietrich with Doctors without Borders, diarrhea is one of the main diseases that he and his colleagues have to treat on their missions abroad. Between 3,000 and 6,000 children die every year from the consequences of a diarrheal disease because their bodies lose too much fluid.
"Diarrhoeal diseases are a huge problem," Dietrich said. "But these will become an even bigger problem with some groups of people and children that are already weak - for instance, people who are already suffering from malaria or hunger."
What adults are often able to compensate with their body volume is something that children lack and it can quickly cause death. "A loss of one to two liters of fluid can often be enough," Dietrich said. A simple dehydration solution consisting of water, sugar and salt could help the body regain its strength. But the water needs to be clean and free of germs.
"It is also challenging with people who are already dehydrated and unable to drink as they are already apathetic," Dietrich said, adding that only an infusion can help. But the distance to the next treatment center is often too far for many.
The most feared of all diseases is cholera. It occurs especially when many people live together in a confined area without access to toilets and to clean drinking water. Then it's only a matter of time for the germs to penetrate the drinking water cycle and cause an epidemic. "Haiti is a prime example," Häussinger said.
With cholera, people suffer from a "watery diarrhea," said Dietrich who together with his colleagues from the medical relief organization has treated numerous people abroad. Infected people can lose between 10 and 20 liters of fluid per day.
"Everything flows through them," he said. What eventually causes death to those suffering from cholera is dehydration. People simply dry out.
One of the first tasks that Dietrich and his colleagues pursue when they arrive at a refugee camp is to build toilets to prevent infectious diseases from emerging.
"A simple hole in the ground with a simple shelter over it, a screen to keep flies out and ventilation to release the odor is enough to prevent the worst," he said.
Author: Andreas Sten-Ziemons / jrb
Editor: Sarah Steffen