Lack of access to water and sanitation will worsen antibiotic crisis in India, WaterAid warns

19 May 2017
Antibiotic crisis
Ronny Sen

The race to prevent the ‘catastrophic threat’ of antimicrobial resistance, expected to kill up to 10 million people a year globally by 2050, is being hampered by the lack of access to clean water and good sanitation in developing nations, the international development organisation, WaterAid warned today.

The warning comes as health ministers of UN Member States meet in Geneva for the annual World Health Assembly, where discussions on tackling antimicrobial resistance are expected to figure prominently.

India is one of the world’s largest consumers of antibiotics. It also has the highest number of people globally without access to clean water — 76 million — and the most without safe toilets – 774 million. Almost one quarter of India’s health care centres do not have a water supply and 41% do not provide adequate sanitation.

A recent study by the London School of Economics and Political Science found almost half a billion cases of diarrhoea are treated annually with antibiotics in India, Nigeria, Indonesia and Brazil; it found this could be cut by 60% by improving people’s access to clean water and safe sanitation.

Progress on bringing clean water, sanitation and hygiene to developing nations is too slow and is not being sufficiently linked to efforts to tackle the crisis of antimicrobial resistance. Analysis by the UN revealed aid commitments to water and sanitation have fallen sharply since 2012 despite an international target to reach everyone, everywhere with access to clean drinking water and toilets by 2030.

India’s successes in maternal and newborn health are among those most threatened by the growing threat of antimicrobial resistance, WaterAid also warned, as more women decide to give birth in health facilities, which may lack water, sanitation and hygiene facilities. A recent study published in Lancet estimated almost 58,000 babies die in India each year from antibiotic resistance bacteria or superbugs.

Arundati Muralidharan, WaterAid India’s Policy Manager on WASH in Health & Nutrition said:

Antimicrobial resistance can seriously undermine the significant progress India has made in reducing deaths among mothers and their newborns. Along with medical and pharmaceutical interventions, improvements in water, sanitation and hygiene (WASH) services have the potential to contribute towards India’s efforts to combat antimicrobial resistance. To further catalyze action, we must invest in research to better understand the links between WASH and AMR in the Indian context.

The scale of the Global AMR crisis:

  • According to the World Bank drug-resistant infections could cause global economic damage on par with the 2008 financial crisis
  • The World Health Organization estimates 480,000 people develop multi-drug resistant TB each year, and drug resistance is starting to complicate the fight against HIV and malaria.
  • Diarrhoea, pneumonia and cholera are often preventable through basic improvements in water, sanitation and hygiene (WASH); these infections are commonly treated with antibiotics and are increasingly resistant to available drugs
  • Around 68,025 children aged under 5 years die each year in India from diarrhoeal diseases caused by dirty water and poor sanitation. That’s almost 8 children every hour
  • An estimated 494 million cases of diarrhoea are treated annually with antibiotics in India, Nigeria, Indonesia and Brazil
  • Antibiotic use to prevent diarrhoea could be cut by 60% in India, Nigeria, Indonesia and Brazil by improving people’s access to water and sanitation
  • According to a recent Lancet paper, hospital-acquired infections are the third-biggest contributor to AMR globally


For more information, please contact

Pragya Gupta, Media & Communications Coordinator, WaterAid India, [email protected]