Source: India Sanitation Portal
"Before my house had a toilet, I would have to ask my grandsons to help me out into a field, hold me up, and stay with me until I was done,” Krishna Devi, a 59-year-old woman with a physical disability in Nepal’s southern Kapilbastu District along the border with India, told IRIN.
“It was humiliating,” she said, “but now with a toilet I have independence and control over my own life.”
Devi’s village is in one of the poorest in Nepal. She lives in a small cluster of houses that has in recent months begun to end open defecation, which can contribute to water contamination and the spread of infectious diarrhoeal diseases, including cholera, says the World Health Organization.
According to local research organizations, a 2009 diarrhoea outbreak in Nepal’s Far West region killed hundreds of people.
A 2011 Nepal population and housing census indicated that nearly 40 percent of homes do not have toilets, leading millions of people to defecate outside.
Although the public health benefits of ending open defecation are widely touted, knowledge of the effects of such campaigns on the lives of people with disabilities remain only anecdotal, say experts.
“While we don’t have exact data on ODF [open defecation free] and disability, we are confident the programmes are benefiting people with disabilities,” said Andreas Knapp, chief of water, sanitation and hygiene (WASH) for the UN Children’s Fund (UNICEF) in Nepal.
Disability rights activists also see sanitation as a crucial part of inclusion.
The UN special rapporteur on the right to sanitation has noted that technical provisions - including the construction of toilets - can contribute to the erosion of stigma against people with disabilities.
In 2011 Nepal launched an extensive campaign to end open defecation across the country by 2017.
Seven of the country’s 75 districts have been declared ODF, and six are on track to complete the process by the end of 2013, according to UNICEF. In order for a village to be declared ODF, each household and public facility must have a functioning toilet.
Focus on Schools
Previous programmes in Nepal have focused on school-based sanitation, targeting children, as studies have shown children suffer high rates of diarrhoea and stunting as a result of contamination that takes place in areas where people defecate in the open.
Lack of accessible sanitation can also limit participation in society.
A 2011 Human Rights Watch (HRW) report highlighted cases of children who are unable to access toilets at schools, one of the many barriers to education they face.
"Girls with disabilities often have no choice but to drop out of school once they reach puberty because there are no support services in school - for example, to help them during menstruation - and sometimes not even toilets in the school," Shantha Rau Barriga, HRW’s disability rights director and author of the report, told IRIN.
But, Barriga said, toilets at schools are not enough - they must be accessible and safe as well.
"When schools are building toilets to improve sanitation for everyone, they should consult with students with disabilities and their parents about how to make the facilities accessible," she said, echoing the findings of studies on sanitation and disability which have shown that establishing sanitation infrastructure does not necessarily mean access for people with disabilities.
“People with disabilities face many problems related to infrastructure, including inaccessible sanitation facilities,” said Shudarson Subedi, chair of the National Federation of the Disabled - Nepal.
The Nepal government’s guidelines stipulate that all toilets must be disability-friendly, with ramps, sufficient space, and hand rails.
According to UNICEF’s Knapp, the programme, by virtue of being holistic and community-driven, will benefit people with disabilities. “The model in Nepal for ODF goes community-by-community so we see everyone benefiting because for a village to get credit for `going ODF’ they have to help each other - including people with disabilities,” he said.
“It’s amazing what a difference an inexpensive handrail can make,” he added.
Toilets provide dignity for Nepal’s disabled | India Sanitation Portal