From the perspective of the economically developed world, it is hard to imagine children attending school without access to safe drinking water. However, some 288 million children under 15 still lack this service in their schools: they cannot drink between classes and during meals unless someone, often themselves, fetches water from a nearby source, which does not always comply with health standards.

It is perhaps harder to imagine the lack of toilets. However, 240 million students worldwide still have to leave school to defecate in the open or use unsafe latrines without privacy or security. This stressful experience for millions of girls compromises their safety and dignity, and they drop out of school.

In the economically prosperous world, it is unthinkable that schoolchildren do not wash their hands before and after eating or using the toilets. This is a fundamental principle in any educational system, and its practice is instilled in children as soon as they can reach the faucet in the washroom. However, there are 480 million students who do not have any facilities in their schools to do so, and not all of those that do have them can provide adequate hygienic service: clean water, soap, and towels are not within reach of 321 million students. This means that four out of every ten school-age children worldwide cannot practice an essential personal hygiene routine: washing their hands.

The WHO/UNICEF Joint Monitoring Program (JMP) has recently included 2021 data in its monitoring of the evolution of access to water, sanitation, and hygiene since the start of the 2030 Agenda. Since 2015, there has been progress despite the alarming stagnation of the last three years.

The worst figures are in pockets of extreme poverty, which has prompted urgent calls from UN agencies and NGOs. The slowdown has come in the wake of the coronavirus pandemic, which is paradoxical given that this was when the vast majority of us became aware of the importance of hand washing to prevent the transmission of infections.

According to WHO experts, proper hand washing with soap and water would prevent about 44% of deaths caused by diarrheal diseases and 25% of acute respiratory infections, the leading cause of death among children under five years of age worldwide.

Trachoma, a little-known eye disease spread when washing the face with water contaminated by the bacterium chlamydia trachomatis, is also the cause of blindness in 1.9 million people and is transmitted at an early stage in schools in the world’s poorest areas.

Childhood illnesses disrupt families, and the cost of school dropout they cause is a burden that, in many cases, hinders progress toward poverty eradication. This situation has been endemic for years in many sub-Saharan African countries and parts of South Asia and Latin America. Achieving SDG 4 (quality education) is also the subsequent link in the chain to SDG 1 (end poverty).

In two new projects in India, we again focus on the most vulnerable schools. In the states of Uttarakhand and Rajasthan, we are collaborating with Habitat for Humanity to build complete sanitation and hygiene facilities and improve access to water in three schools in the most neglected communities.

WHO estimates that the total number of diarrhea deaths in India among children under six was 158,209, and the proportional mortality in this age group was 9.1%. In both project areas, diarrhea is endemic. In Rajasthan, India’s most water-stressed state, nearly 25% of the state’s villages also suffer from high fluoride levels in groundwater.