Workers often come into direct contact with human waste, working with no equipment or protection which exposes them to a wide variety of health hazards and disease

A labourer cleans an underground sewer at Noida in the northern Indian state of Uttar Pradesh September 2, 2010. REUTERS/Parivartan Sharma

Millions of sanitation workers in many countries around the world are forced to work in conditions that endanger their health and lives.

In Bangladesh, there are an estimated 5 million to 6 million sweepers, who despite providing an essential public service, are often the most marginalised, poor and discriminated against members of society who carry out their jobs with no equipment, protection or legal rights, often violating their dignity and human rights.

This is the most extensive exploration to date on the plight of sanitation workers in the developing world through a report titled "Health, Safety and Dignity of Sanitation Workers" published on Monday.

It is jointly authored by the International Labour Organisation, WaterAid, the World Bank and the World Health Organisation to raise awareness of the de-humanising working conditions and to push for change, said a press release issued by WaterAid Bangladesh.

Sanitation workers are the men and women who work at any part of the long sanitation chain that begins when we go to the toilet and ends when waste is disposed of or reused.

Their jobs can include cleaning toilets, emptying pits and septic tanks, cleaning sewers and manholes and operating pumping stations and treatment plants.

Workers often come into direct contact with human waste, working with no equipment or protection which exposes them to a wide variety of health hazards and disease.

Toxic gases, such as ammonia, carbon monoxide and sulphur dioxide in septic tanks and sewers can cause workers to lose consciousness or die. There are no global statistics available, but in India alone, it is estimated that three sanitation workers die every five days.

Countless more suffer repeated infections and injury, and have their lives cut short by the everyday risks of the job.

The work is often informal with workers subject to no rights or social protections. Pay can be inconsistent or non-existent – some workers report being paid in food rather than money.

In some countries, sanitation work is a socially stigmatising issue, so workers often work at night to hide their job from their communities.

Tim Wainwright, chief executive officer of WaterAid, said, "Everyone goes to the toilet and everyone is put at risk of deadly waterborne disease if the waste is not properly dealt with.

Sanitation workers therefore carry out some of the most important roles in any society."

It is shocking therefore that sanitation workers are forced to work in conditions that endanger their health and lives and must cope with stigma and marginalisation, rather than have adequate equipment, recognition and celebration of the life-saving work they carry out.

"People are dying every day from both poor sanitation and dangerous working conditions - we cannot allow this to continue," he added

Maria Neira, director of Public Health and Environment at WHO, said, "A fundamental principle of health is "first do no harm". Sanitation workers make a key contribution to public health around the world – but in so doing, put their own health at risk. This is unacceptable."

"We must both improve working conditions for these people and strengthen the sanitation workforce, so we can meet global water and sanitation targets."

Alette Van Leur, director of the Sectoral Policies Department at the ILO, said, "There is a lack of policies, laws and regulations surrounding sanitation workers, and where they exist, they tend to be weak, covering only certain types of sanitation workers, or lack the required financing or enforcement mechanism."

Jennifer Sara, global director at the World Bank Water Global Practice, said, "The time is now. We need more concerted efforts by all sector actors to come together and improve the quality of the lives of sanitation workers."

This report represents a first step to better understand the various problems facing sanitation workers and identifies actions that can be taken to reverse the current situation in a more consistent fashion, she added.