How toilets are saving lives and money in Afghanistan

A village celebrates as it declares itself ‘open defecation free’

Mercia checks that her two children, Alisina and Sohaila, are washing their hands properly at their home in Chaw village. “The toilet was there but it wasn’t always used. This initiative helped us to realize that we should use it and to keep some soap nearby,” says Mercia. © UNICEF/UN0142769/Didari

Each year thousands of child deaths in Afghanistan could be avoided by using toilets and washing hands. Nili district in central Afghanistan recently celebrated being declared ‘open defecation free’ — a first in the country. Fatima, 23, is one of the people behind this change, helping to create a healthier environment for children and the entire community.

By Toby Fricker

NILI, Afghanistan, 18 November 2017 — For 23-year-old Fatima, it took the death of one child to spark a simple but transformational change, to convince the whole village to start using toilets and improve the health of many young lives.

“People didn’t think about using toilets here because of all the ground available,” says Fatima at celebrations in Chaw village, Nili district, to mark it being declared ‘open defecation free’, the first district in the country to achieve such a status.

“We needed to take a stand and to reduce the amount of illness and problems as a result of people not using toilets and because people were not washing their hands,” she says.

Diarrhoea-related deaths among children under the age of 5 total over 9,500 a year in Afghanistan. This means some 26 children die each day as a result of an infection that leads to diarrhoea, many of which are avoidable.

Confronting open defecation

When health workers visited Chaw, a remote village in the central highlands, Fatima realised she could do something to bring about change.

Mercia and her two children Alisina and Sohaila. Their village and district were declared ‘open defecation free’ at a ceremony on 01 November.
© UNICEF/UN0142773/Didari

She volunteered with the village health committee, which took part in the district wide ‘Community-led Total Sanitation’ approach, where families identify areas around their homes that are used as toilets.

Using a combination of shock, shame, pride and disgust, families are encouraged through peer pressure to build a latrine and commit to using it. The process usually lasts three to six months until an entire community has given up defecating in the open, contributing to a healthier environment for everyone.

“There were faeces everywhere but it’s cleaner now, people realised they needed to use their toilets,” says Mercia, 20, who lives on the edge of the village.

The impact has not only been positive for the health of her son Alicina, 3, and daughter Sohaila, 5, but also her bank balance. “We’ve cut down on the numerous trips to the health clinics and hospitals to treat the children. The transport and treatment costs would add up to 2,000 Afghanis (US$30) a month,” she explains.

Stopping diarrhoea to prevent malnutrition and stunting

Toilet use and improving hygiene is also at the frontline of efforts to reduce malnutrition and stunting in Afghanistan. Regular bouts of diarrhoea contribute to malnutrition, while a malnourished child is more susceptible to infections that can cause diarrhoea.

With 1.3 million children malnourished and 41 per cent of all children in Afghanistan stunted, the country is missing out on one of its most valuable resources — its children.

Villagers gather for a ceremony to mark their certification as ‘open defecation free’ in Chaw Village, Nili District, Daikundi province, Afghanistan. ©UNICEF/UN0142771/Fricker

Fatima is playing a key role, as part of broader nationwide efforts, to build momentum for change. “I wasn’t told about the impact of this [not using toilets] when I was young but as a mother I want change for my son,” she says. “As a woman, it was very encouraging that I changed the views of people in the community, even men listened to me,” Fatima adds with a smile.

If nutrition issues are not tackled, children in the country will grow up with poorer health, be a greater burden on health systems, and ultimately lead to cycles of disadvantage that affect families, communities and the development of the country as a whole.

While insecurity affects much of the country and many children are regularly exposed to the direct impact of violence, using a toilet and washing your hands is one simple and cost effective way to save and improve lives.

In 2017, UNICEF supported more than 500 communities in Afghanistan to be declared ‘open defecation free’. ‘Community-led Total Sanitation’

are supported in part by generous donations from the people and the Government of the Republic of Finland.

Read more: 9 fast facts about toilets