The report, entitled Progress on sanitation and drinking-water 2013 update, warns that, at the current rate of progress, the 2015 Millennium Development Goal (MDG) target of halving the proportion of the 1990 population without sanitation will be missed by 8% – or half a billion people.

While UNICEF and WHO announced last year that the MDG drinking water target had been met and surpassed by 2010, the challenge to improve sanitation and reach those in need has led to a consolidated call for action to accelerate progress.

“There is an urgent need to ensure all the necessary pieces are in place – political commitment, funding, leadership – so the world can accelerate progress and reach the Millennium Development Goal sanitation target” said Dr Maria Neira, WHO Director for Public Health and Environment. “The world can turn around and transform the lives of millions that still do not have access to basic sanitation. The rewards would be immense for health, ending poverty at its source, and well-being.”

The report echoes the urgent call to action by United Nations Deputy Secretary-General Jan Eliasson for the world community to combine efforts and end open defecation by 2025. With less than three years to go to reach the MDG deadline WHO and UNICEF call for a final push to meet the sanitation target.

“This is an emergency no less horrifying than a massive earthquake or tsunami,” said Sanjay Wijesekera, global head of UNICEF’s water, sanitation and hygiene (WASH) programme. “Every day hundreds of children are dying; every day thousands of parents mourn their sons and daughters. We can and must act in the face of this colossal daily human tragedy.”

“Communities affected by the crisis are in urgent need of food assistance, protection, healthcare, and water and sanitation support and there are serious concerns about widespread human rights violations across the country,” the UN Office for the Coordination of Humanitarian Affairs (OCHA) said in an update.

“The ongoing humanitarian efforts have been hampered by insecurity and limited access to people in need,” it added, calling on all parties to facilitate access for all aid workers who need to reach affected communities with life-saving relief items such as food, water, shelter and medical supplies.

As of last week, nearly 40,000 people had fled the country, and on Tuesday the head of the UN Integrated Peacebuilding Office in CAR (BINUCA), Margaret Vogt, told the Security Council via video link from Bangui, capital of the impoverished country, that a return to legality is extremely critical.

The UN Children’s Fund (UNICEF) estimates that the country’s entire population of some 4.6 million people, including over 2.3 million children, is directly affected by the conflict due to the collapse of services and law and order. UN agencies and non-governmental organizations (NGOs) operating in the country have also been affected as they had their offices, vehicles and warehouses looted.

The country has been wracked by factional violence for years, especially in the north. Last month a group rebels entered Bangui and forced President François Bozizé to flee.

The call to action, which comes on the eve of World Water Day, aims to focus on improving hygiene, changing social norms, better managing human waste and waste-water, and, by 2025, completely eliminating the practice of open defecation, which perpetuates the vicious cycle of disease and entrenched poverty.

“I am determined to energize action that will lead to results,” said Eliasson. “I am calling on all actors – government, civil society, business and international organizations – to commit to measurable action and to mobilize the resources to rapidly increase access to basic sanitation.

“Let’s face it – this is a problem that people do not like to talk about. But it goes to the heart of ensuring good health, a clean environment and fundamental human dignity for billions of people – and achieving the Millennium Development Goals. With just over a thousand days for action before the 2015 MDG deadline, we have a unique window of opportunity to deliver a generational change.”

The MDG target to halve the proportion of people without access to sanitation has helped to raise the profile of the issue, and 1.8 billion people gained access to improved sanitation since 1990, but there is still far to go, notes a news release on the new initiative. Meanwhile, the MDG target to halve the proportion of people without access to improved sources of water has already been met.

Of the world’s seven billion people, six billion have mobile phones. However, only 4.5 billion have access to toilets or latrines – meaning that 2.5 billion people, mostly in rural areas, do not have proper sanitation. In addition, 1.1 billion people still defecate in the open.

The countries where open defecation is most widely practiced are the same countries with the highest numbers of under-five child deaths, high levels of under-nutrition and poverty, and large wealth disparities.

“We strongly support this effort to increase the focus on sanitation,” said the Deputy Executive Director of the UN Children’s Fund (UNICEF), Martin Mogwanja, who noted that ending open defecation will contribute to a 36 per cent reduction in diarrhoea, which kills three quarters of a million children under five each year.

“We can reduce the cases of diarrhoea in children under five by a third simply by expanding the access of communities to sanitation and eliminating open defecation,” he told reporters at the launch of the call to action at UN Headquarters. “In fact, diarrhoea is the second largest killer of children under five in the developing world and this is caused largely by poor sanitation and inadequate hygiene.”

Mogwanja said he witnessed personally the impact of open defecation in both development and humanitarian contexts when he worked in Pakistan. A total sanitation project was developed there for the flood-affected areas, together with non-governmental and government partners. In less than two years, over six million people gained access to toilets and are now living in open defecation-free communities.

“But the effort succeeded not by building latrines; it succeeded by getting people to recognize and to talk about the problem,” he stated.

The private sector also played an important part in this transformation, he said, by engaging in sanitation marketing activities, and developing a supply chain which ensured that people had access to the right products in the right place at the right time.

“And it worked,” Mogwanja stated, noting that with the direct support of UNICEF and its partners, over 25 million people in over 44,000 communities now live in open defecation-free environments.

“This can also improve the safety of women and girls, who are often targeted when they are alone outdoors. And providing safe and private toilets may also help girls to stay in school which we know can increase their future earnings and help break the cycle of poverty.”

The call to action will not set up any new structures or funding mechanisms, but focus on generating action at the community level – one community at a time.

According to the UN Office for the Coordination of Humanitarian Affairs (OCHA), more than 30,000 people fled their homes over the weekend, coinciding with the declaration of a state of emergency by the Government and the beginning of a French air operation in support of the Malian army, bringing the number of internally displaced persons (IDPs) to over 200,000.

“The degradation of the sanitation, shelter, health and food security conditions which has been observed over the last nine months in the North is likely to be aggravated as the number of IDPs increases,” OCHA spokesperson Jens Laerke told reporters in Geneva.

Northern Mali was occupied by radical Islamists after fighting broke out in January 2012 between Government forces and Tuareg rebels, after which the country underwent a military coup d’état, in March.

The renewed fighting comes at a time when OCHA estimates that 4.2 million Malians will need humanitarian assistance this year. These include some 2 million food insecure people and hundreds of thousands of malnourished children.

The Office of the UN High Commissioner for Refugees (UNHCR) stressed that it is becoming increasingly difficult to access areas in the North as fighting continues. In Bamako, the capital, many families are struggling to make ends meet as the security situation deteriorates.

“Many families live in small rooms in bad conditions with no electricity or direct access to water. They generally lack space to accommodate all family members. The needs for money, food and shelter are huge,” said UNHCR spokesperson Adrian Edwards, adding that the agency is in the process of working with partners on income-generating activities to ameliorate the situation.

UNCHR is also assisting Malians who have left their country for neighbouring Niger, Burkina Faso and Mauritania by providing clean water, sanitation and hygiene structures, healthcare and education.

“Refugees are telling us they fled the ongoing military intervention, the absence of subsistence opportunities and basic services, and the imposition of Sharia Law,” Mr. Edwards said. He added that UNHCR remains short of funds for the Mali crisis with only $77.4 million received of the $123 million sought to help refugees and IDPs in 2012. For 2013, the agency anticipates needs at a further $195.6 million.

Meanwhile, the World Food Programme (WFP) warned that chronic problems of food insecurity and malnutrition in the country will only be worsened by the conflict. The agency has so far managed to move emergency food to 270,000 conflict-affected people in the North, including 70,000 IDPs. However, it states that persistent insecurity is severely limiting its work.

WFP spokesperson Elisabeth Byrs added that the agency would continue to monitor the situation and work closely with its partners to reach more than 400,000 crisis-affected people in the cities of Timbuktu, Gao and Kidal, which have been some of the most affected areas.

As the number of displaced people increased, there is also a growing concern for children as they are at high risk of being separated from their families and are more vulnerable to many forms of abuse, including military recruitment and sexual violence, noted the UN Children’s Fund (UNICEF).

“A major concern is of children being used in the fighting,” said UNICEF spokesperson Marixie Mercado. “Children were often used in the first wave of fighting, which significantly raised the risk of injury and death.”

In addition to humanitarian concerns, there is also a need to protect the country’s cultural sites, which have previously been attacked during the fighting. The Director-General of the UN Educational, Scientific and Cultural Organization (UNESCO), Irina Bokova, today launched an appeal to all military forces in Mali “to make every effort to protect the cultural heritage of the country, which has already been severely damaged.”

In anticipation of military operations, Ms. Bokova mobilized the agency’s Emergency Fund to protect the four sites in Mali that are inscribed on UNESCO’s World Heritage List. Efforts include developing preventive measures and the training of armed forces on the prevention of illicit trafficking.

UNESCO has already provided the topographic features relative to the location of sites to the concerned military staff, as well as information for soldiers to prevent damage to cultural heritage. The information has been shared with police and aid workers.

“Mali’s cultural heritage is a jewel whose protection is important for the whole of humanity. This is our common heritage, nothing can justify damaging it. It carries the identity and values of a people,” Ms. Bokova said.

“The destruction of World Heritage sites in Mali in 2012, especially the mausoleums in Timbuktu, sparked a wave of indignation across the world, helping to raise awareness of the critical situation facing the Malian people. The current military intervention must protect people and secure the cultural heritage of Mali,” she added.

According to the initial results of the Haiti Demographic and Health Survey (DHS), which covered 13,350 households, 77 per cent of children aged 6-11 years attended primary school in 2012, compared to just below 50 per cent in 2005-2006 when the last survey was conducted.

Acute malnutrition among children aged 6-59 months has been reduced by half from 10 per cent to five per cent, and chronic malnutrition has been cut from 29 per cent to 22 per cent between 2005-2006 and 2012.

“Results of the survey show that the efforts of partners in Haiti in these three years contributed to progress in many sectors and mitigated the impact on children of the 2010 earthquake, the outbreak of cholera and other disasters.” said the representative of the UN Children’s Fund (UNICEF) in Haiti, Edouard Beigbeder.

“These findings call for a continued commitment to support the country in sustaining this success while addressing existing challenges and where progress has lagged,” he continued.

The Caribbean nation has been re-building since the earthquake struck in early January 2010, killing some 220,000 people and making 1.5 million others homeless, in addition to causing widespread destruction – particularly in the capital, Port-au-Prince – and a major humanitarian crisis.

The DHS 2012 was conducted by the Institut Haitien de l’Enfance, under the overall direction of the country’s Ministry of Population and Public Health, and was supported by UNICEF and the UN Population Fund (UNFPA), amongst others.

The survey also notes that the under-five mortality rate, at 88 child deaths per 1,000 live births, has shown a declining trend in the last 15 years, according to new estimates, down from 112 in 1997-2001 and 96 in 2002-2006.

Access to improved sources of water remained unchanged at 65 per cent, while 82 per cent of residents of internally displaced camps had access to improved sources of water. Access to improved sanitation almost doubled from 14 per cent in 2005-2006 to 26 per cent in 2012.

The 2012 Haiti DHS estimates socio-economic, demographic and health indicators for the entire Haitian population, including women of child-bearing age, children under five years of age, men aged between 15 and 59 years old. The last survey took place between October 2005 and June 2006.

Inhabitants of urban and peri-urban areas relied on contaminated water from shallow wells, water providers who charge high unit prices, or standpipes which required mostly women or children to queue for hours. Most households used cesspits or poorly designed septic tanks, risking further groundwater contamination, while the poorest people often had no form of sanitation at all. These deficiencies had serious and direct impacts on people’s health, their ability to engage in economic activities, and children’s school attendance. These problems also harmed the finances of water utilities, which generally attain very low cost recovery from public standpipes.

In 2005, the Government of Morocco and water utility operators in three cities requested a grant from the Global Partnership on Output-Based Aid (GPOBA) to pilot the introduction of performance-based subsidies to encourage service expansion using an innovative output-based aid (OBA) approach.

The outputs for which subsidies were disbursed were simultaneous network connections to water supply and sewerage services for individual households, or in the case of Meknes, connection to either service. The subsidy was operator- and service-specific and paid in local currency in two steps: 60 percent upon certification by an Independent Technical Reviewer (ITR) of a working water and sewerage connection to an eligible household; and 40 percent upon verification by the ITR of at least six months of sustained service.

The OBA approach helped refocus attention on household demand, which led to increased accountability, strengthened partnerships between local authorities and operators, and made monitoring of service delivery a priority.

The pilot provided subsidized access to water supply to 10,504 households and sanitation services to 9,036 households, hence benefitting more than 52,500 people. The programme contributed to improve women and children’s living conditions as they were/are the major water provider/manager in the family.

Households that were simultaneously connected to water supply and sanitation services through the pilot totaled 5,593 in Casablanca and 2,909 in Tangiers. In Meknes, 2,002 households acquired access to water supply services and 534 to sanitation service.

The pilot programme was funded through a US$7 million grant from the GPOBA – a multi-donor trust fund administered by the World Bank. The total project cost was assessed at about US$24 million during preparation.

The built-in incentives of the OBA approach were specifically designed to overcome traditional obstacles to expanding services in informal neighborhoods, namely: inability to afford connection costs; complex technical and administrative obstacles to infrastructure development in poor unzoned areas; and reluctance of national and local governments to fund subsidy programs with no accountability or guarantee of results.

The Gaza Power Plant produced electricity at less than 30 per cent of capacity in April, causing severe disruption to basic services, including water, health and sanitation, Al Jazeera reported.

Coastal Municipal Water Utility (CMWU) noted that the situation is critical, with up to 40 per cent of the 1.6 million population under blockade getting water in their houses only once every four days, PNN reported.

Spokesman for the health ministry Ashraf Al-Qudra earlier warned that medical work in Gaza hospitals is still endangered by the power crisis and there is not sufficient fuel even to operate their emergency generators in the coming days.

The fuel crisis has also affected the fishing industry, already crippled by restricted access to Gaza’s fishing waters imposed by Israel’s siege.

The Palestinian enclave usually depends on fuel smuggled in from Egypt, but the power facility has run out. Gaza is under a sea and land blockade imposed by Israel, which prevents regular shipments of power to the area, Al Jazeera reported.

Although the Qatari Government sent 30 million litres of fuel to ease the crisis months ago, Israel and Egypt have prevented its entry into Gaza, and it still sits in reservoirs in the Port of Suez, although Israel last week approved Egypt to transport it to Gaza, according to Haaretz.

Apart from the significant impact on daily life such as incapability to use computers, the spoiling of food, the power cuts have also resulted in several deaths and many injuries, explosion of  generators, and the failure of life-saving medical and surgical equipment which depend on electricity.