With the revelation last week that Cambodia is facing a cholera outbreak for the first time in more than a decade, issues of drinking water and sanitation have been brought to the forefront of public discourse.
If cholera has reminded people how dangerous diarrhea can be, it may also help the public understand how pervasive the problem is, how treacherous the effects and how far the country has to go to eradicate it.
“I do hope [cholera] is going to be a motivation for the government to strengthen hygiene promotion,” said Hilda Winarta, a water and sanitation specialist at Unicef.
Highly treatable, diarrheal diseases nevertheless remain one of the country’s top causes of death. In 2004, the date of the latest mortality estimates released by the World Health Organization, diarrhea ranked as the number three cause of death. Only HIV/AIDS and tuberculosis killed more Cambodians each year. 10,900 died from diarrhea, most were children.
“Diarrhea has continued to be the second major killer among children under 5,” said Ms Winarta.
The financial implications are no less staggering. In 2005, the World Bank conducted a study on the economic impact of Cambodia’s lack of sanitation coverage. It stated $448 million, or about 7 percent of the country’s GDP, is lost each year to health problems resulting from poor sanitation.
With an eye toward lessening the human and fiscal blow, the government has been working to increase access to clean water and toilet facilities, but it can be slow going.
“Sixty percent still need to have safe drinking water,” said Mao Saray, director of rural water supply at the Ministry of Rural Development.
While diarrhea is a danger year round, the problem escalates in the dry season. According to figures from the Ministry of Health, there were approximately 8,500 cases of acute watery diarrhea in September. Flash-forward to January and there’s well over 10,000.
“Every year, we have this problem when people’s water source runs dry,” explained Mr Saray.
Those accustomed to using rain or well water suddenly have to turn to a more contaminable source, such as a pond or a stream. Someone unused to treating his water is less likely to begin boiling or filtering it and, as the dry season progresses and the water supply grows increasingly contaminated, diarrhea runs rampant.
“This is still a problem and we would like people to pay heightened attention,” admitted Dr Ly Sovann, deputy director of communicable disease control at the Health Ministry. “They should drink boiled water and have good sanitation every time” they use the toilet, he said.
Drinking water is just part of the problem.
“If you talk about diarrhea, it’s important to talk about sanitation and hygiene–not just clean water,” said Jan Willem Rosenboom, country team leader of the World Bank’s water and snitation program. “If we had sanitation to start with, we wouldn’t have this problem in the dry season.”
(Additional reporting by Chhorn Chansy)