Key facts
- In 2024, 58% of the global population (4.8 billion people) used a safely managed sanitation service.
- Since 2015, 1.2 billion people have gained access to safely managed sanitation services.
- 1.5 billion people still do not have basic sanitation services, such as private toilets or latrines.
- Of these, 354 million still defecate in the open, for example in street gutters, behind bushes or into open bodies of water.
- In 2024, approximately 44% of household wastewater generated globally was not safely treated before discharge (1).
- Approximately 15–20% of irrigated cropland is located in catchments highly dependent on
- Poor sanitation reduces human well-being, social and economic development due to impacts such as anxiety, risk of sexual assault, and lost opportunities for education and work.
- Poor sanitation is linked to transmission of diarrhoeal diseases such as cholera and dysentery, as well as typhoid, intestinal worm infections and polio. It exacerbates stunting and contributes to the spread of antimicrobial resistance.
Overview
According to the latest WASH-related burden of disease estimates, 1.4 million people die each year as a result of inadequate drinking-water, sanitation and hygiene. The vast majority of these deaths are in low- and middle-income countries. Unsafe sanitation accounts for 564 000 of these deaths, largely from diarrhoeal disease, and it is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis and trachoma. Poor sanitation also contributes to malnutrition.
In 2024, 58% of the global population (4.8 billion people) used safely managed sanitation services. Since 2015, 1.2 billion people have gained access to safely managed sanitation, with coverage increasing from 48% to 58%. In 2024, 82% of the global population used at least a basic sanitation service. However, 3.4 billion people still lacked safely managed sanitatio1n, including 1.9 billion using basic services, 560 million using limited services, 555 million using unimproved facilities and 354 million practising open defecation (2).
Diarrhoea remains a major cause of illness and death but is largely preventable. Better water, sanitation and hygiene could have prevented an estimated 395 000 deaths among children under 5 years of age in 2019.
Open defecation perpetuates a vicious cycle of disease and poverty. The countries where open defecation is most widespread have the highest number of deaths of children aged under 5 years as well as the highest levels of malnutrition and poverty, and big disparities of wealth.
Benefits of improving sanitation
Benefits of improved sanitation extend well beyond reducing the risk of diarrhoea. These include:
- reducing the spread of intestinal worms, schistosomiasis and trachoma, which are neglected tropical diseases that cause suffering for millions;
- reducing the severity and impact of malnutrition;
- promoting dignity and boosting safety, particularly among women and girls;
- promoting school attendance: girls’ school attendance is particularly boosted by the provision of separate sanitary facilities;
- reducing the spread of antimicrobial resistance;
- potential safe recovery of water, nutrients and renewable energy from wastewater and sludge;
- increasing resilience to climate-related shocks and water scarcity, including through the safe use and reuse of treated wastewater where appropriate; and
- enabling safe recreational water use for pleasure, sports and tourism.
A WHO study in 2012 calculated that for every US$ 1.00 invested in sanitation, there was a return of US$ 5.50 in lower health costs, more productivity and fewer premature deaths.
Challenges
Progress has been substantial, but the world remains off track to achieve universal sanitation by 2030. Since 2015, the population practising open defecation has fallen by 429 million, but 354 million people still practised open defecation in 2024. Current rates of progress would need to increase threefold to achieve universal basic sanitation and sixfold to achieve universal safely managed sanitation by 2030.
The situation in urban areas, particularly in dense, low-income and informal areas, is a growing challenge. Sewerage is precarious or non-existent, space for toilets is at a premium, poorly designed and managed pits and septic tanks contaminate open drains and groundwater, and services for faecal sludge removal are unavailable or unaffordable. Inequalities are compounded when sewage discharged into drains and waterways pollutes poorer, low-lying areas. Climate-related floods, water scarcity, drought and sea-level rise threaten both progress towards universal safely managed sanitation and the resilience of existing services.
Wastewater and sludge are increasingly seen as a valuable resource in the circular economy that can provide reliable water and nutrients for food production and recovered energy in various forms. Wastewater and sludge are already widely used in many settings, but unsafe use without adequate treatment, risk management or regulatory oversight can create significant health risks. Safe use that prevents transmission of excreta-related disease is vital to reduce harms and maximize beneficial use of wastewater and sludge.
Achieving universal safely managed sanitation requires moving beyond isolated projects towards government-led, at-scale sanitation systems, supported by effective policies and regulation, sustainable financing, strong public data systems, capable institutions and workforces, and regular monitoring and review.
WHO response
In 2010, the UN General Assembly recognized access to safe and clean drinking water and sanitation as a human right and called for international efforts to help countries to provide safe, clean, accessible and affordable drinking-water and sanitation. Sustainable Development Goal target 6.2 calls for adequate and equitable sanitation for all and target 6.3 calls for halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse.
As the international authority on public health, WHO provides health-based guidance, standards and tools and supports governments to strengthen sanitation policy, regulation, surveillance and service delivery. WHO monitors sanitation access through the WHO/UNICEF Joint Monitoring Programme (JMP), wastewater treatment under SDG 6.3.1, and the policies, institutions, financing, regulation, workforce and other enabling conditions for progress through GLAAS. WHO also estimates the health burden attributable to unsafe WASH. Recent GLAAS findings show important implementation gaps: only 19% of reporting countries had at least 75% of the human resources needed for sanitation regulation, and surveillance of wastewater and faecal sludge remains limited. Such monitoring gives Member States and donors global data to help decide how to invest in providing toilets and ensuring safe management of wastewater and excreta.
WHO supports countries to implement risk-based approaches across the sanitation service chain through the Guidelines on sanitation and health, sanitation safety planning, sanitary inspections and guidance on the safe use of wastewater, excreta and greywater and safe recreational water. Recent implementation resources include the WHO/UNICEF Steps to achieve universal access to safely managed sanitation and WHO’s Roadmap for advancing sanitation regulation, which support countries to strengthen policies, institutions, regulation, financing, data systems, workforce capacity and service delivery for both sewered and non-sewered sanitation.
WHO also works with health programmes where sanitation and wastewater are critical to disease prevention and public health, including cholera, neglected tropical diseases, antimicrobial resistance and wastewater and environmental surveillance. Climate resilience is increasingly integrated across WHO sanitation guidance, risk management and country support.
References
- WHO (2025). Progress on the safe treatment of domestic wastewater: 2024 update (briefing note). https://www.unwater.org/sites/default/files/2025-12/progress_on_the_safe_treatment_of_domestic_wastewater_-_2025_briefing_note.pdf
- WHO/UNICEF JMP (2025). Progress on household drinking water, sanitation and hygiene 2000–2024: special focus on inequalities. https://washdata.org/reports/jmp-2025-wash-households