Close to 50,000 residents live crammed within the Nima neighborhood in greater Accra, Ghana, a community of homes made of wood, concrete and rusted iron roofing sheets.
Indeed, living in Nima is a squeeze.
Here, Rose Alhassan is frying fish with her 8-year-old granddaughter, who fans the pan atop the coal pot resting on red-hot charcoal.
Alhassan’s house has nine single rooms that accommodate 32 people. Yet, this household — like many across this community — has no toilet.
“The lack of toilets in this house really worries me a lot because the closest public toilet is about 10 minutes’ walk from here. … And I have rheumatism, which gets really unbearable when I walk for that long.”
“The lack of toilets in this house really worries me a lot because the closest public toilet is about [a] 10 minutes’ walk from here,” Alhassan said. “And I have rheumatism, which gets really unbearable when I walk for that long.”
She ends up having to use a plastic bag to defecate, which she then discards into an open drain.
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About 4.2 billion people lack access to safely managed sanitation worldwide, according to the United Nations. Of those, 3 billion lack basic handwashing facilities and 673 million still practice open defecation, the UN said.
At least 2 billion people use drinking water contaminated with feces globally, according to the World Health Organization.
In Ghana, 1 in 5 people defecates openly, while only 1 in 7 households in the West African country have toilet facilities.
The bags not only choke gutters, but open drains also pollute the air with putrid odors.
Alhassan said this practice is widespread.
“All the houses around here don’t have toilets and so usually, when you wake up early in the morning, you will see people throwing toilets [bags] in the drain,” she said.
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Ghanaian law requires landlords to provide toilets for their tenants, with associated penalties for defaulters. But over the years, authorities have been lax about effective enforcement of this law.
In Nima, public toilet conditions have deteriorated. The building has huge cracks with perforated, rusted roofing. Inside, 12 open cubicles choke with heat and the stench of a heady mix of urine, cigarette smoke and piles of feces.
Health authorities say scenes like these are often hotbeds of infections and diseases like cholera, diarrhea or typhoid.
Outside, desperate patrons in a long queue hold pieces of tissue paper and used newspapers, waiting to take their turn. They pay $0.16 for tissue paper or $0.08 for a used newspaper to access this public toilet.
Mariatu Mohammed said coming here at night is a risky affair.
“There is no toilet in my house and so, I meander through so many corners before I get here. And for a girl or woman like me, it is dangerous especially at night,” she said.
Gender activist Lilipearl Baaba Otoo is concerned about the disproportionate impact of the problem on women and girls in Ghana.
“My work has taken me to so many communities where women have to step out at night to use the bushes because there are no toilets and they are pounced on by either kidnappers, rapists and other unscrupulous people.”
“My work has taken me to so many communities where women have to step out at night to use the bushes because there are no toilets and they are pounced on by either kidnappers, rapists and other unscrupulous people, she said.
Otoo said a lack of toilets can also force girls and women to neglect their menstrual health needs.
Diseases linked to dirty water and a lack of safe toilets cause more deaths among women than diabetes, HIV/AIDS or breast cancer, according to the international development organization WaterAid.
In Ghana, nearly 20,000 people including more than 5,000 children under the age of 5, die each year from diarrhea, with nearly 90% of cases directly attributed to poor water, sanitation and hygiene.
The World Bank estimates that poor sanitation and hygiene results in $290 million in economic losses for the West African nation each year.
But the situation is not all doom and gloom.
Community-led initiatives throughout Ghana aim to reverse these worrying trends.
In the sprawling community of Fadama, near the capital Accra, a constructor clad in a black apron used his shovel to dig into a mixture of sand, cement and gravel. He repurposes the cement bag into a helmet.
After many years without a toilet, 16 tenants living in a single house plan to construct one.
Resident Ernest Fullah led the private fundraising effort.
“We face a lot of problems concerning our sanitation situation in this household. So, as a household, we decided to come together, contribute little by little to start this toilet project …”
“We face a lot of problems concerning our sanitation situation in this household. So, as a household, we decided to come together, contribute little by little to start this toilet project that you are seeing right now, Fullah said.
He says seeing the construction near completion gives him joy.
“Personally, I am very, very happy that at long last, we are going to have a toilet in our house and when you speak to the people in the house too, I can see everybody is happy,” he said.
In 2013, the World Bank financed the $150-million project aimed at providing water and sanitation to deprived communities in Ghana’s capital. Beneficiary households and institutions pay 30% of the cost. The project has constructed about 30,000 household toilet facilities. The next phase of the program is expected to extend to other parts of the country when funding is made available.
But the need is still great.
To complement these efforts, the UN children’s agency, UNICEF, together with its partners, has begun a hackathon for young people to showcase their innovative solutions toward ending open defecation in their communities.
Nana Kwaku Amoako Oduro-Mensah, 14, is one participant proffering digital solutions: a mobile app concept called T-toilet, to help people locate toilet facilities in their communities.
“Because people who pass by in towns and other places, do not have any knowledge about the location of toilet facilities and therefore engage in open defecation. With this app, they can easily find a toilet to go and ease themselves comfortably,” he said.
Barbara Parker, 13, has a different idea — to promote continuous public health education.
“Building toilet facilities is not really the thing. Many people have the toilet facilities all right but they don’t really have the ways to use it,” she said.
UNICEF’s deputy country representative, Fiachra McAsey, said the hackathon reinforces the urgency to mobilize young people to play a more critical role in the movement for safer, cleaner sanitation.
“…We are going to take some of these ideas and we are going to invest in them.”
“I think it is an accelerator and a way to see change happen very fast. We are going to take some of these ideas and we are going to invest in them,” McAsey said.
Access to sanitation is a human right and part of the UN’s sustainable development goals.
The aim is to end the practice of open defecation by 2030 and ensure that everyone has access to toilets for improved living conditions — and dignity.
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