South Sudan, where 93% of the population lacks access to an adequate toilet, has fewer safe and hygienic latrines per person than any other country in the world, according to a study highlighting the world’s failure to address the global sanitation crisis.

In a report released on world toilet day, WaterAid ranked countries according to how difficult it was to find toilets meeting basic hygiene standards. Among developed countries, Russia had the worst sanitation record, with more than a quarter of its population lacking access to safe, private toilets.



The UN defines an improved toilet or latrine as a facility that hygienically separates human waste from human contact; this could be through a mechanical or manual flush that sends the waste matter to a piped sewer system, septic tank or pit latrine. Composting toilets also qualify as improved toilets.



South Sudan ranked last on WaterAid’s list, ahead of Niger, Togo and Madagascar.



Poor access to safe toilets can lead to faecal matter contaminating water and food, raising the risk that diseases such as diarrhoea – the second leading cause of death in children under five – could spread through vulnerable populations.



WaterAid’s senior policy analyst on sanitation, Andrés Hueso, said countries in conflict, such as South Sudan and Niger, often had the poorest access to adequate toilets. “When countries go through conflict or major instability, often the priorities shift to basic survival aspects, which ignore proper sanitation,” he explained. “Also institutions at this time are very weak, and donors tend not to fund these countries because they see an increased risk.”



Hueso said data showed that economic growth did not automatically lead to greater spending on sanitation. “Stories from Nepal and Ethiopia are promising because they have improved more than many expected, and they didn’t necessarily wait for their economic indicators to improve first.”

Hueso said Nepal was a particularly interesting case because, despite slow economic growth, it had shown “incredible progress” in bringing sanitation to its people through prioritising the issue politically and investing in public campaigns against open defecation.

“On the other hand you have countries like Nigeria where, despite economic progress, the coverage of adequate sanitation has actually reduced,” Hueso said. “We don’t see the level of political priority in Nigeria that other countries have shown in sanitation. And I think that’s the biggest reason why it is showing some regression.”



The report also listed the developed countries with the lowest proportion of hygienic toilets to population. Russia came out worst, with Moldova, Romania, Bulgaria and Latvia rounding out the top five.

The report noted that wealthier countries also had a responsibility to improve sanitation standards. “Although the proportions are small compared with those in developing countries, all of these nations have measurable numbers of people who live without private access to toilets in their households,” it said. “This includes student dormitories, bedsits and homeless shelters, as well as the apartment blocks once common in eastern Europe, where more than one household might share a toilet.”

Activists hope progress in clean water access could pave the way for similar advances in sanitation. In 2012, the world met the millennium development goal target to halve the proportion of the population without access to safe drinking water, five years ahead of schedule. But progress on access to toilets was much slower, and 2.3 billion people still lack access to a safe, private toilet.

Looking ahead to the sustainable development goals, which will replace the millennium development goals on 1 January next year, Barbara Frost, the WaterAid chief executive, said leaders must show their political will to fix the problem.

“Just two months ago, we saw all the member states of the United Nations promise to deliver access to safe, private toilets to everyone everywhere by 2030,” she said.

“Our analysis shows just how many nations in the world are failing to give sanitation the political prioritisation and financing required. We also know that swift progress is possible, from the impressive advances in sanitation achieved in nations like Nepal and Vietnam. No matter where you are in the world, everyone has a right to a safe, private place to relieve themselves, and to live healthy and productive lives without the threat of illness from poor sanitation and hygiene.”