KATHMANDU, 3 December 2007 (IRIN) - Schoolgirl Susmita Chettri is not alone in her embarrassment and disgust at the sight of men urinating in the middle of the Nepalese capital Kathmandu in broad daylight.

"When will this ever stop? These men are shameless and so unhygienic," said 15-year old Chettri walking to a bus stop to get to school. "If this happens in the capital, just imagine how bad it is in the rest of the country," added her classmate Tina Shrestha.

It is an every day occurrence in Kathmandu to see men and women defecating almost everywhere, from the main streets to public parks, near school compounds, government offices and residential areas.

The problem is nation-wide: government statistics indicate that three-quarters of Nepal's 27 million people defecate in the open for lack of toilets.

Children worst affected

Health environment activists have expressed concern over the acutely unhygienic conditions, saying the lack of toilets is responsible for water-borne diseases, which cause large-scale diarrhoea among children.

"Following defecation, the urine stagnates at one spot and is a strong medium for bacteria which often contaminates the ground water and moist soil among others," said medical doctor Sanjay Bhattachan from Kathmandu Hospital. He added that the bacterial parasite reaches underground waters and contaminates the drinking water system and the wells causing diarrhoea and even Hepatitis A.

According to UNICEF, a gram of human feces has 10 million viruses, 1 million bacteria and 12,000 parasites.

In the villages of the Terai, open defecation can fill the fields with hookworms. People walking on the urinated ground can catch the worms, which can enter through their feet and then enter the blood. Besides diarrhea, open defecation also causes anemia and is a huge problem in the Terai, said Bhattachan.

Nearly 13,000 children die every year due to diarrhoea-related diseases and only 45 percent of Nepal's population has access to toilets, according to the UN Children's Fund (UNICEF).

Poor sanitation is responsible for 70 percent of childhood illnesses with nearly 10 million cases of diarrhoea among children under five every year, according to Nepal for Water Health (NEWAH), a local non-governmental organisation (NGO) campaigning for clean drinking water and sanitation.

Sanitation not prioritised

"It's really sad that neither citizens nor the government are giving much attention to this crucial issue," said environmental health activist Prakash Amatya from NEWAH.

Amatya said sanitation had not been prioritised in the government's development programmes. It was high time the government earmarked special funding for hygiene and sanitation measures, he said.

Government officials say the Health Ministry has already allocated around US$5 million this year for improving safe drinking water and sanitation, but activists say the government's track record is not a cause for optimism.

Schoolchildren at risk

In the densely populated southern region of Terai, where most of the houses lack clean toilets or do not have toilets at all, the risks of infection are higher, and schools have been identified as particularly high risk.

According to NEWAH, the state of toilets and washing facilities in schools in both Terai and hills, including lack of soap for all-important hand-washing, is a strong disincentive for students to attend: "The dropout rate especially among girl students is very high and the reason is always sanitation and toilets," said Amatya, who added that children even try not to drink water in order to avoid having to use the school's dirty toilets.

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