Now wash your hands

Every day, 5,000 children die because of poor sanitation. Villagers in Madagascar tell Barbara Gunne

"What did we tell you last time we were here?" shouts the man with the microphone.

"Wash Your Hands!" yell back 200 children aged around 5-11. They are seated on the grass verges of the crossroads at Amparatanana, a village on Madagascar's east coast, the audience for a travelling marionette show spreading the word about hygienic use of latrines, keeping water uncontaminated and, above all, hand-washing.

As Mr Clean upbraids Mr Dirty for his bad habits, the children scold along; as Mr Dirty goes home to his wife clutching his stomach with diarrhoea pains, they giggle uncontrollably.

The puppets are part of this region's response to the international rural water, sanitation and hygiene (WASH) project that got under way in Madagascar soon after the country suffered a severe cholera outbreak early in 2000. Water Aid, the key international NGO in this field in the country, is working here with local partners, the Frères Saint-Gabriel.

Yvon, one of the FSG hygiene educators, regularly updates the puppet-show scripts to keep the children hooked on the message. His aim, he told me, is to use storylines as close to the children's home lives as possible, so that hand-washing becomes second nature. This sounds easy until you consider that, in the middle of our own culture of abundant soap and hot water, medical staff still manage to spread MRSA because they fail to wash their hands between patients.

In fact, educators like Yvon have to work miracles. The wood and thatch huts of these east-coast villages are tightly packed in to small compounds without running water. Soap is a luxury and such latrines as exist are poorly designed, badly sited and almost always a health hazard.

Yet the children do absorb the hand-washing message and the impact of the singing, dancing, 12-foot-high marionettes has been rapid in the schools. Albertine-Rosalie Clode, a teacher for 37 years, whom we met fetching water at the new water kiosk, told us that her school of 1,686 pupils aged 6-17 was already seeing improvements.

"Awareness has changed in just one year [since WaterAid and FSG came to this village], particularly among the children. When the ice-cream seller comes by, they ask him, 'What water did you use to make it?' The puppets show families as they know them. In the past we could have 20 children off sick out of a class of 44-60, particularly in the rainy season," says Mme Clode, who lives alongside the families of her pupils, and whose many grandchildren are as vulnerable to the debilitating water-borne diseases of the area as the children of poorer neighbours.

The hand-washing message - enormously effective in its own right - also underscores the urgent need to speed up provision of clean water and appropriate sanitation. The poorest villagers here still depend on river collection for some water and still manage without toilets. The few existing wells, some provided only in the past few years, are uncovered and vulnerable to impurities from the buckets of different users. And, as the area has an unusually high water table, there is considerable risk of groundwater contamination from badly designed and sited latrines.

The proportion of people with safe water and adequate sanitation in the villages of the Analanjirofo district (to which New Statesman subscri bers' contributions are directed) is estimated to be as low as 9 per cent, inflicting a heavy penalty on the local economy in hours lost to education and productive work.

Persuading officialdom of the economic good sense of developing a national sanitation strategy has been an important part of WaterAid's work in Madagascar. In 2003, its research showed that the country was losing five million working days and 3.5 million schooldays each year as a result of ill-health caused by dirty water and inadequate sanitation. To this must be added the human cost. Every day around the globe, 5,000 children die from the diarrhoeal diseases associated with contaminated water; it is the second-biggest childhood killer after tuberculosis and respiratory disease.

"Sanitation is the invisible sector," says Lucky Lowe, WaterAid's representative in Madagascar. She confirms that it is far easier to get politicians to talk about water and to promise pumps and new mains supplies than it is to get a constructive debate going about pit latrines. Clean water is a good election promise. Talking about building latrines that help make that possible isn't.

On top of the hard statistics must be added less tangible human costs: the drudgery of walking miles each day to collect contaminated water for the family, or the sheer unpleasantness and indignity of using a foul-smelling, poorly draining communal latrine day in and day out. Or, for those who have nowhere else, a patch of land that has become accepted as the local open-air toilet. We should not suppose that force of habit appreciably lessens the disgust.

Disgust was certainly written on the face of eight-year-old Sidonie when we talked to her mother before the puppet show about the field "toilet" in her village. We had gone there with Claudia Lemalade, FSG's hygiene educator for Amparatanana, to talk to a family due to receive one of the project's new latrines. We stood on a pathway that led down to a small river with the typical wooden huts on one side and lush vegetation - banana plants, coconut palms and vivid, flowering shrubs - on the other.

The path, even before the rainy season, was wet in patches and drained into the small river below, as, inevitably, would the open-air defecation site a few yards from the path.

Claudia chatted with three generations of one family: Toto Suzanne, her daughter Marceline and Sidonie, Marceline's daughter. Finally the family was to get a latrine - paying around 10 per cent of the cost price (approximately £30). They had been able to pay their £3 contribution as and when they liked, in whatever instalments suited them, but the contribution had to be paid upfront before work could begin on the structure. The family had been targeted because of financial need; FSG has set families' contributions low enough to put latrines within reach of most of the poorest.

It is not hard to understand why Marceline wanted to divert her family's limited budget to pay for a latrine. "Down there is where we have to go. After dark it is really horrible for the children." Sidonie refused to discuss the matter though she had been lively enough before. As we talked, a young woman came up the hill from the river carrying a bucket. "This is to wash my baby's feet," she told us, as if to assure us that the murky water would not be used for drinking or cooking. For household use, she explained, she had limited access to a neighbour's well (itself also contaminated, according to Claudia). She understood clearly the WASH message that the puppets would later be blasting out across the village, but what, she asked us, could she do?

There is a standard image of hopeless poverty that we see on television and in poster campaigns, images usually connected with appeals for emergency aid. Yet life in these villages is far from miserable or hopeless. Men and women are visibly industrious - most have family members in work as fishermen or farmers; good-quality food is available and at this time of year the trees are laden with coconuts, lychees and jackfruit. The literacy rate of 71 per cent is reasonably high and, despite a high poverty rate of 70 per cent, when news spreads of a visit from the WaterAid people, the women come out to meet us in well-kept best clothes.

Quite small investments in sanitation could turn around that high poverty rate. But at the moment, for the vast majority of Madagascar's people, energy that could be put into education and wealth creation is being dissipated by avoidable ill-health. The Madagascan economy loses to illness around 300 times the amount the government has allocated to sanitation in its national budget, according to WaterAid.

WaterAid estimates that if Madagascar is to achieve its Millennium Development Goals (MDGs), the country has to increase the number of rural households being newly supplied with adequate sanitation, from roughly 485 households per month now to more than 12,000.

More and carefully focused international aid is, as always, one solution. Determined local politicians unafraid to champion an unpopular cause is another. Mme Clode said she intends to run as a local councillor next year and wants politicians to speak up for the Cinderella sector of sanitation.

Of Madagascar's local MDG targets, she said: "I expected things to move faster. Many things need doing. For example, there is no water in the market in Fenerive Est [the nearby town]. And we need more latrines." Against current orthodoxy, Mme Clode believes in communal latrines as a way of speeding things up, while government and international policy very much favours and directs finance towards family-based facilities, on the grounds that only families will keep them clean enough to prevent water-borne disease.

But her concern about the slippage in local millennium targets exactly mirrors WaterAid's concern about the big picture. The millennium goals included halving the proportion of those living without water and sanitation by 2015. Of all the targets (including poverty, education, health and environmental concerns), sanitation is most off-track. At the present rate of progress, the goal would be reached 61 years late. Yet hopes of eradicating extreme poverty and hunger depend more on sorting out safe sanitation than on any other intervention.

A report commissioned by WaterAid and released in October spelled out that, for every dollar spent on sanitation, the return on investment is roughly $9. Worldwide, the need is enormous, but tiny interventions and local ingenuity can still have a big impact. In Madagascar, a puppet show costing just £31 can make 200 children laugh. And possibly save their lives.

Sanitation by numbers

£15 Cost per head of hygiene education and good sanitation
£31 Cost of puppet show promoting hand-washing
£31.25 Cost of effective latrine with simple concrete pit lining
$23.4m Most expensive toilet in the world (for space shuttle)
$10bn Annual cost of achieving Millennium Goals
$20bn Global annual spending on bottled mineral water
1.1bn People worldwide without access to clean water
2.6bn People worldwide without an adequate toilet

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This article first appeared in the 03 December 2007 issue of the New Statesman, Russia’s fragile future

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When it comes to responding to Islamic State, there is no middle ground

If Britain has a declared interest in curtailing Islamic State and stabilising Syria, it is neither honourable nor viable to let others intervene on our behalf.

Even before the brutal terrorist attacks in Paris, British foreign policy was approaching a crossroads. Now it is time, in the words of Barack Obama, addressing his fellow leaders at the G20 Summit in Turkey on 16 November, “to step up with the resources that this fight demands”, or stand down.

The jihadist threat metastasises, and international order continues to unravel at an alarming rate. A Russian civilian charter plane is blown out of the sky over the Sinai Peninsula in Egypt, killing 224 people, most of them returning from holiday, and the various offshoots of Islamic State bare their teeth in a succession of brutal attacks in France, Lebanon, Tunisia, Turkey and further afield. Our enemies are emboldened and our friends want to know to what extent we stand with them. The UK can no longer afford to postpone decisions that it has evaded since the Commons vote of August 2013, in which the government was defeated over the question of joining US-led air strikes against President Bashar al-Assad’s regime following a chemical weapons attack on Syrian civilians. MPs’ continued introspection is on the verge of becoming both irresponsible and morally questionable. There is no fence left to sit on.

On Sunday night, two days after the Paris attacks, the French – with US support – launched a series of bombing raids against Islamic State targets in Raqqa. With much more to come, the choice facing this country may not be easier but it is certainly clearer. Britain must determine whether it wants to be a viable and genuine partner in the fight against Islamic State, and in the long-term efforts to bring an end to the assorted evils of the Syrian civil war; or whether we are content to sit on the sidelines and cheer on former team-mates without getting our knees dirty. We can join our two most important allies – France and the United States, at the head of a coalition involving a number of Arab and other European states – in confronting a threat that potentially is as grave to us as it is to France, and certainly more dangerous than it is to the US. Alternatively, we can gamble that others will do the work for us, keep our borders tighter than ever, double down on surveillance (because that will certainly be one of the prices to pay) and hope that the Channel and the security services keep us comparatively safe. There is no fantasy middle ground, where we can shirk our share of the burden on the security front while leading the rest of the world in some sort of diplomatic breakthrough in Syria; or win a reprieve from the jihadists for staying out of Syria (yet hit them in Iraq), through our benevolence in opening the door to tens of thousands of refugees, or by distancing ourselves from the ills of Western foreign policy.

That the international community – or what is left of it – has not got its act together on Syria over the past three years has afforded Britain some space to indulge its scruples. Nonetheless, even before the Paris attacks, the matter was coming to the boil again. A vote on the expansion of air operations against Islamic State has been mooted since the start of this year, but was put on the back burner because of the May general election. The government has treated parliament with caution since its much-discussed defeat in the House in summer 2013. The existing policy – of supporting coalition air strikes against Islamic State in Iraq but not Syria – is itself an outgrowth of an awkward compromise between David Cameron and Ed Miliband, an attempt to reverse some of the damage done by the 2013 vote in parliament.

The Conservatives have waited to see where the ground lies in a Jeremy Corbyn-led Labour Party before attempting to take the issue back before the Commons. Labour pleaded for more time when Corbyn was elected, but there is no sign that the Labour leader is willing to shift in his hostility to any form of intervention. More significantly, he has now ruled out Labour holding a free vote on the matter.

If anything, the coalition of Little Englanders, anti-interventionists and anti-Americans in the House of Commons seems to have dug its trenches deeper. This leaves the Prime Minister with few options. One is to use the Royal Prerogative to announce that an ally has been attacked, and that we will stand with her in joining attacks against Islamic State in Syria. The moment for this has probably already passed, though the prerogative might still be invoked if Isis scores a direct hit against the UK. Yet even then, there would be problems with this line. A striking aspect of the killing of 30 Britons in the June attacks in Sousse, Tunisia, is just how little domestic political impact it seems to have made.

Another option for Cameron is to try to make one final effort to win a parliamentary majority, but this is something that Tory whips are not confident of achieving. The most likely scenario is that he will be forced to accept a further loss of the UK’s leverage and its standing among allies. Co-operation will certainly come on the intelligence front but this is nothing new. Meanwhile, the government will be forced to dress up its position in as much grand diplomatic verbiage as possible, to obfuscate the reality of the UK’s diminishing influence.

Already, speaking at the G20 Summit, the Prime Minister emphasised the need to show MPs a “whole plan for the future of Syria, the future of the region, because it is perfectly right to say that a few extra bombs and missiles won’t transform the situation”. In principle, it is hard to argue with this. But no such plan will emerge in the short term. The insistence that Assad must go may be right but it is the equivalent of ordering the bill at a restaurant before you have taken your seat. In practice, it means subcontracting out British national security to allies (such as the US, France and Australia) who are growing tired of our inability to pull our weight, and false friends or enemies (such as Russia and Iran), who have their own interests in Syria which do not necessarily converge with our own.

One feature of the 2013 Syria vote was the government’s failure to do the required groundwork in building a parliamentary consensus. Whips have spent the summer scouting the ground but to no avail. “The Labour Party is a different organisation to that which we faced before the summer,” Philip Hammond, the Foreign Secretary, has said. It is ironic, then, that the Prime Minister has faced strongest criticism from the Labour benches. “Everyone wants to see nations planning for increased stability in the region beyond the military defeat of the extremists,” says John Woodcock, the chairman of the Parliamentary Labour Party defence committee, “but after two years of pussy-footing around, this just smacks of David Cameron playing for time when he should be showing leadership.”

The real story is not the distance between the two front benches but the divisions within both parties. There are as many as 30 Conservative MPs said to be willing to rebel if parliament is asked to vote for joining the coalition against Islamic State in Syria. It seems that the scale of the Paris attacks has not changed their position. A larger split in the Labour ranks also seems likely. Even before Paris, there were rumoured to be roughly 50 MPs ready to defy their leader on this question.


At first, in the wake of last week’s attacks, it seemed as if the Prime Minister might force the issue. To this end, he began the G20 in Turkey with a bilateral meeting with President Putin. His carefully chosen words before and after that discussion, in which he was much more emollient about Moscow’s role, showed the extent to which he was prepared to adapt to the changing situation. Cameron hoped that if he could show progress in building an international coalition on the diplomatic front, that might just give him enough to get over the line in a parliamentary vote.

This new approach has not had the desired effect. At the time of writing, the government believes it is too risky to call another vote in the short term. It calculates another defeat would hugely diminish Britain’s standing in the world. In truth, the government was already swimming upstream. On 29 October, the Conservative-
dominated Commons foreign affairs select committee, chaired by Crispin Blunt, released a report on the extension of British military operations into Syria, in anticipation of government bringing forward a parliamentary vote on the question. The report recommended that Britain should avoid further involvement unless a series of questions could be answered about exit strategy and long-term goals. The bar was set deliberately high, to guard against any further involvement (even the limited option of joining the existing coalition undertaking air strikes against IS in Syria).

The most flimsy of the five objections to further intervention in the report was that it will somehow diminish the UK’s leverage as an impartial arbiter and potential peacemaker. This is based on an absurd overestimation of the UK as some sort of soft-power saviour, valued by all parties for its impartiality in Middle Eastern affairs. Britain cannot hope to have any influence on policy if it is always last to sign up while others put their lives on the line. As so often in the past, what masquerades as tough-minded “realpolitik” is nothing of the sort. It is just another post-facto rationale for inaction.

Although it is sometimes said that Britain has yet to recover from the consequences of the invasion of Iraq, the committee report had a retro, 1990s feel. Many of the objections raised to burden-sharing in Syria were the same as those raised against humanitarian intervention in the Balkans two decades ago, when Blunt was working as special adviser to Michael Rifkind as defence and foreign secretary, and the UK was at the forefront of non-intervention. Likewise, two of the committee’s Labour members, Ann Clwyd and Mike Gapes, were veterans of the other side of that debate, and strong supporters of the Nato intervention in Kosovo in 1999. They expressed their dissent from the report’s conclusions but were voted down by their Conservative and SNP fellow committee members. “Non-intervention also has consequences,” said Gapes when he broke rank. “We should not be washing our hands and saying, ‘It’s too difficult.’”

Polling figures have shown majority public support for air strikes against IS since the spate of gruesome public executions that began last year, but nothing seems to change the calculus of the rump of anti-interventionist MPs.

All this promises an uncertain future for British foreign policy. On 6 November, the Defence Secretary, Michael Fallon, suggested that the UK’s existing position, of joining the coalition in Iraq but stopping at the borders of Syria, is “morally indefensible”. The killing of Mohammed Emwazi, aka “Jihadi John”, by a US predator drone on 12 November demonstrates what he meant. Emwazi was a Briton who was responsible for the beheading of British and American citizens, as well as countless Syrians. While the UK government was closely involved in that operation – and has previously used the justification of “self-defence” to “take out” targets in Syria – such are the restrictions placed upon it that we are forced to ask our allies to conduct potentially lethal operations (which are in our core national interests) on our behalf. The very act of “self-defence” is subcontracted out once again.

How long can this last when Islamic State poses a much greater threat to the UK than it does to the US? There is an issue of responsibility, too, with hundreds of British citizens fighting for and with Islamic State who clearly pose a grave danger to other states.


The very notion that Britain should play an expansive international role is under attack from a pincer movement from both the left and the right. There are two forms of “Little Englanderism” that have made a resurgence in recent years. On the left, this is apparent in the outgrowth of a world-view that sees no role for the military, and holds that the UK is more often than not on the wrong side in matters of international security, whether its opponent is Russia, Iran, the IRA or Islamic State. The second, and arguably just as influential, is the Little Englanderism of the right, which encompasses a rump of Tory backbenchers and Ukip. This is a form of neo-mercantilism, a foreign policy based on trade deals and the free movement of goods that regards multilateralism, international institutions and any foreign military intervention with great suspicion, as a costly distraction from the business of filling our pockets.

The time is ripe for long-term, hard-headed and unsentimental thinking about Britain’s global role. The country is not served well by the impression of British “decline” and “retreat” that has gained ground in recent times; and it is no safer for it, either. Given how quickly the security and foreign policy environment is changing, the publication of the Strategic Defence and Security Review in the coming week, alongside an update of the National Security Strategy, is likely to raise more questions than it answers. The officials responsible for its drafting do not have an easy brief, and news forecasting is a thankless task. Strategic vision and leadership must come from our elected politicians.

For all the talk of British decline, we are still one of the five wealthiest nations in the world. What we do matters, particularly at moments when our friends are under attack. However, until a new broad consensus emerges between the mainstream Labour and Conservative positions on foreign policy, the Little England coalition will continue to have the casting vote.

Syria continues to bleed profusely and the blood seeps deeper into different countries. There will be no political solution to the civil war there for the foreseeable future; to pretend that there is a hidden diplomatic solution is to wish to turn the clock back to 2011, when that might have been possible. Nor is the security situation any easier to deal with. A few hours before the attacks in Paris began, President Obama gave an interview in which he argued that he had successfully “contained” Islamic State. For the wider Middle East and Europe, that is simply not the case. Now, France will escalate its campaign, and the US will do more. Russia already has troops on the ground and will most likely send reinforcements.

The war in Syria is becoming more complicated and even more dangerous. The best that can be hoped for is that the Syrian ulcer can be cauterised. This will be achieved through the blunting of Islamic State, simultaneous pressure on Assad, and the creation of more safe places for Syrians. All roads are littered with difficulties and dangers. Yet, in the face of this ugly reality, is Britain to signal its intention to do less as every other major actor – friend and foe alike – does more? If we have a declared national interest in curtailing Islamic State and stabilising Syria – both because of the growing terrorist threat and because of the huge flow of refugees – then it is neither honourable nor viable to let others take care of it on our behalf.

John Bew is an NS contributing writer. His new book, “Realpolitik: a History”, is newly published by Oxford University Press

This article first appeared in the 19 November 2015 issue of the New Statesman, The age of terror