By Ms. Therese Dooley, Senior Advisor, Hygiene & Sanitation, UNICEF

By now we all know the grim reality — that over 40 percent of the global population or 2.5 billion people live without access to improved sanitation. And we know that sanitation is important for health, dignity, environmental protection, social and economic development. But perhaps what is not as tangible in this dialogue is that, underlying the statistics and facts, are real people, real lives — and more specifically those of young children — that bear the brunt of this global crisis.

Children under five are most vulnerable to the effects of poor sanitation and hygiene. Every year, diarrhea resulting from inadequate sanitation and unsafe hygiene practices kills more than 1.5 million children under the age of fi ve. This means that every 20 seconds a child dies as a direct result &8212; that's three unnecessary child deaths per minute, almost 5,000 young lives wasted every day. Diarrhea is also closely linked to under-nutrition, a condition that is associated with more than half of all under-five deaths. Undernourished children, in turn, have compromised immune systems and are at a higher risk for developing pneumonia — which kills more children than any other disease. This chain reaction illustrates how fundamental hygiene and sanitation are for child survival. This is of grave concern when you consider that 980 million children under-18 years old and 280 million children under-5 years of age don't have access to basic sanitation, and of the approximately 120 million children born in developing countries each year, half will live in households without access to improved sanitation facilities.

In addition to saving young lives, improved sanitation can reduce illness due to diarrhea by 35 percent. It is estimated that up to 190 million cases of diarrhea could be averted each year if sanitation access was improved. Hand washing with soap, another key issue linked to sanitation, can decrease diarrhea by over 43 percent. Improved sanitation and hand washing can also have signifi cant impact on cholera, dysentery, trachoma and worms. Infestation with parasitic worms is another major health problem, and children in countries which have low sanitation coverage commonly carry up to 1,000 hookworms, roundworms and whipworms at a time, which can cause anaemia and other debilitating conditions. Improvements in sanitation and hygiene can thus have a tremendous impact on children's health, growth and development.

Behind the Statistics

Consider children like 3 year old Fatima* who has had 19 bouts of diarrhea in the past two years. She has lost much of the valuable nutrients her parents work so hard to provide her with, and is undernourished, weighing just eight kilograms — less than she weighed two years ago. She has also had 16 episodes of respiratory infections since her birth, so during her short life of three years has had at least one debilitating illness every month. It is not surprising she is failing to thrive and she is lucky to have managed to survive.

Imagine being three years old and constantly sick, with little energy or hope. Instead of running around and playing you spend your days feeling tired and listless and you do not even understand what hope or the future is! Or imagine being Fatima's parents; much of their time, energy and income is devoted to caring for her and getting her treatment. They work so hard to provide for her and daily watch her wasting away before their eyes.

It's because of the children like Fatima and her parents that improvements in sanitation and hygiene are so important, and she is one of millions of children around the world who are behind the statistics we quote each day.

Agents of Change

However, children are not just the victims they also are part of the solution to any hygiene and sanitation revolution. Children can be effective advocates of change in their communities. Several studies have shown that children can be an important factor in a family deciding to build a toilet. In many countries school-related sanitation activities are taking place and gaining momentum. We need to ensure that every school has adequate sanitation facilities and children are being taught the importance of hand washing and hygiene. The absence of separate facilities for girls is an important inhibitor to their attendance at school. When they are provided, many girls who would otherwise have been withdrawn at puberty stay on to complete their education. These children can then be effective advocates back into their homes and communities. Students who take part in regular hygiene and sanitation promotion take forward their new knowledge and habits into their future lives. On their shoulders rest the best hope for hygiene and sanitation transformation world-wide.

Hassina, a 10 year old girl at Gewane Primary School, illustrates the importance of sanitation and hygiene to children. "Toilets in our school and at home have made a big difference to my life. Before I hated using the old toilet at school or going to the fi eld and I preferred to wait until evening time even if I had to go badly." Hassina told us that "At first people did not want to talk about toilets and hygiene, they said it was embarrassing and that I shouldn't be talking about it. But for me it is very important as it will protect my family — so I kept talking and my parents listened to me and now we have a toilet at home." A key member of the sanitation and hygiene club Hassina is an agent of change in her community. "I want to be a doctor when I grow up, but through what I have learned at the club I can start healing people from today, not only other students but also those people who are not in school."

Unlike Hassina, almost a billion children throughout the globe still lack access to clean and safe toilets, so the International Year of Sanitation (IYS) is especially significant for UNICEF and the work it supports for children. We all know that improvements in sanitation and hygiene are achievable, and many good examples exist throughout the globe. By working together in partnership with governments, civil society, faith based organisations, communities and children we can make a difference. Like Hassina, we must be prepared to take action about sanitation and spread the message of its importance to everyone, so that children like Fatima can survive, thrive and grow to become the advocates and change agents of the future.

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Originally published in Water Front / Stockholm International Water Institute