WASH Central and Eastern Europe, West and Central Asia

At CSD 12, the Report of UN Secretary-General put emphasis on the concerns of not meeting the sanitation target even in the most developed areas of the world, e.g. Europe1. A comparison between the state of art in 1990 and 2000 shows that Europe is the only continent where the sanitation coverage is dropping down - from 100% in 1990 to 95% in 2000, with only 84% coverage for rural areas2. It is also well known that only 14% of wastewater in Europe is treated treated by effective treatment plants3. As a total an estimated 41 million people in Europe do not have access to safe drinking water, and 85 million people lack access to basic sanitation4.

The WHO-United Economic Commission for Europe (UNECE) Protocol for Water and Health5, adopted in 1999, requires all countries to provide sanitation to a standard which sufficiently protects human health and the environment through the establishment, improvement and maintenance of collective systems and wastewater treatment installations, and to establish a programme for monitoring situations likely to result in outbreaks or incidents of water-related disease. Progress made is to be assessed in terms of suitable indicators, of which this indicator is one.

Awarness Campaign

The size of the burden of disease attributable to poor sanitation and hygiene, and the availability of means to reduce it, led to the inclusion of “access to improved sanitation” in the United Nations Millennium Development Goals indicators.

In 2004, the Fourth Ministerial Conference on Environment and Health adopted the Children’s Health and Environment Action Plan for Europe (CEHAPE), which includes four regional priority goals to reduce the burden of environment-related diseases in children. One of the goals (RPG I) aims at preventing and significantly reducing morbidity and mortality arising from gastrointestinal disorders and other health effects, by ensuring that adequate measures are taken to improve access to safe and affordable water and adequate sanitation for all children.

Council Directive of 21 May 1991 (91/271/EEC) concerning urban wastewater treatment prescribes the level of treatment required before discharge. It requires member states to provide all agglomerations of more than 2000 population equivalents (p.e.) with collecting systems. Secondary (biological) treatment must be provided for all agglomerations of more than 2000 p.e. discharging into fresh waters and estuaries and for all agglomerations of more than 10 000 p.e. discharging into coastal waters. EU member states must identify water bodies as sensitive areas (vulnerable to eutrophication) in accordance with the criteria of the Directive. In sensitive areas, they must provide more advanced treatment of wastewater with nutrient removal, placing more stringent criteria with specific monitoring requirements. The Directive is designed to protect the ecological status of receiving waters and does not require microbiological analysis of effluents discharged from wastewater treatment facilities. Member states are required to submit biennial reports to the EU of their progress towards the implementation of the Directive.

The cohesion policy of the EU will continue to support sewage treatment plants from its €336 billion budget for 2007–2013 for all new member states. Support is greatly needed as current investments in some of the eastern European countries are at the level of €5–10 per capita and will need to be increased to €40–50 per capita to comply with the deadlines.

There are wide differences between countries in EU. In the Nordic and some northern European countries, which have the longest tradition of water purification, more than 85% of the population were connected to wastewater treatment facilities. In southern European countries coverage ranged between 40% and 60%, while in some of the new EU member states it was less than 40%.

Lack of safe drinking-water and poor sanitation threaten the health of millions of people in the WHO European Region. While most of the Region's 877 million people take clean water for granted, too many still lack a regular supply:

almost 140 million (16%) do not have a household connection to a drinking-water supply;
85 million (10%) do not have improved sanitation; and over 41 million (5%) lack access to a safe drinking-water supply.

Water-related diseases of microbiological origin that are identified for priority action include cholera, bacillary dysentery, enterohaemorrhagic Escherichia coli, typhoid (and paratyphoid) and viral hepatitis A. The countries that are Parties to the Protocol will review their systems for disease surveillance and outbreak detection, and implement the most appropriate measures to reduce disease, including vaccination or water treatment and distribution measures. Chemical contaminants of drinking-water and related diseases are also under review.

This aspect of implementing the Protocol contributes to achieving the two Millennium Development Goals that include improving water supply and sanitation and reducing child mortality. The incidence of infectious diseases caused by poor-quality drinking-water is often highest in children aged 6-11 months. In the WHO European Region, this risk factor causes over 13 000 deaths from diarrhoea among children aged 0-14 years (5.3% of all deaths in this age group) each year, with the countries of central and Eastern Europe and central Asia bearing the largest share of the burden.

The burden of disease is estimated to be 5.3% of all deaths and 3.5% of all DALYs in children 0?14 years of age in the European Region. The largest contribution to the burden of disease comes from EUR B, with over 11 000 deaths and almost 500 000 DALYs. Our results also point out the number of deaths and DALYs that could be avoided by simple interventions in personal hygiene.

Although over 90% of the European population is estimated to be covered by an improved water supply, in many of the countries of the former USSR, the infrastructures of water and sanitation systems need to be developed or have been disrupted owing to poor maintenance for the last two decades:

An estimated 2 million people or more in the European Region do not have access to clean water, thus exposing children to a high risk of diarrhoeal diseases.

The burden of diarrhoeal disease attributable to poor water, sanitation and hygiene is estimated at 5.3% of all deaths and 3.5% of all DALYs, in children aged 0–14 years in the European Region. The largest contribution to the burden of disease comes from EURO B countries with over 11 000 deaths and almost 500 000 DALYs.

This suggests that high potential savings in deaths and DALYs could be made by the development of infrastructures and better personal hygiene. For instance, in EURO B, giving the entire child population access to a regulated water supply and full sanitation coverage, with partial treatment for sewage, would save about 3700 lives and 140 000 DALYs.

Water has a role, direct or indirect, in reaching two of the eight MDGs. In the European Region, WHO addresses the water-related MDGs under the umbrella of two major regional instruments: the Protocol on Water and Health and the Children's Environment and Health Action Plan for Europe (CEHAPE). The MDGs are currently the priority in the Protocol implementation. WHO/Europe also participates in the scientific work of the Secretariat as required by the Parties to the Barcelona Convention on the Protection of the Mediterranean Sea against Pollution by contributing to the Mediterranean Action Plan, the operational programme of the Barcelona Convention.

Village Committee Meeting

Goal 4: Reduce child mortality
Target 5: Reduce by two thirds the under-five mortality rate between 1990 and 2015.

European perspective: In the Region, lack of safe water and adequate sanitation has been recognized as a major cause of child mortality, especially in eastern countries. CEHAPE focuses on four main pillars for improving children's health, one of which specifically concerns ensuring safe water and adequate sanitation to prevent and reduce child morbidity and mortality. CEHAPE was adopted by European health and environment ministers in June 2004.

Goal 7: Ensure environmental sustainability
Target 10: Halve the proportion of people without sustainable access to safe drinking-water and basic sanitation by 2015.
Target 11: Achieve a significant improvement in the lives of at least 100 million slum dwellers by 2020.

European perspective: In the Region, access to drinking-water is nearly 100% achieved, however in many countries this water is still not safe (target 10). Managing water supply to ensure fair water pricing to all in Europe is a key challenge that would significantly improve the lives of slum dwellers (Target 11). The Protocol on Water and Health is the first instrument in Europe to prevent, control and reduce water-related disease through improved and harmonized water supply and management. In accordance with Article 6 of the Protocol, Parties pursue the aim of providing access to drinking-water and sanitation to everyone, and are obliged to set targets and report on progress towards these targets at each meeting of the Parties. The Protocol is therefore in important supportive instrument of the MDG process.

To assist countries in this effort, in the context of integrated water resource management plans, water supply and water quality, as well as of collection and treatment of wastewater, WHO/Europe is developing jointly with UNECE a guidance document on setting targets and monitoring progress in water supply and sanitation.

The Mediterranean Action Plan covers fourteen countries of the WHO European Region. It contributes to the achievement of target 10 by monitoring methods and performance of sewage collection, treatment and discharge in cities over 10,000 population in all countries of the Mediterranean since 2000 (expected to be extended to cities of populations over 2,000), and by providing training on environmental health impact of wastewater treatment plants, wastewater usage practices, natural treatment systems and safe wastewater use in irrigation.

Author: Diana Iskreva-Idigo

1 Commission on Sustainable Development, Twelfth session, 14-30 April 2004; Thematic cluster for the implementation cycle 2004-2005 Sanitation; Progress in meeting the goals, targets and commitments of Agenda 21, the Programme for the Further Implementation of Agenda 21 and the Johannesburg Plan of Implementation, Report of the Secretary-General

2 www.wssinfo.org/en, 15.06.06.

3 Global Water Supply and Sanitation Assessment 2000 Report, WHO/UNICEF, 2000

4 Local Actions for a Global Challenge; Europe, Regional Document; 4th WWF, Mexico, 2006

5 WHO-United Economic Commission for Europe (UNECE) Protocol for Water and Health, 1999.