“You have come from Mumbai to teach us about handwashing?”
The villagers couldn’t stop laughing at Yusuf Kabir. He works at UNICEF’s Mumbai office, in a division with an apt acronym—WASH, for water, sanitation, and hygiene—and he was on a tour of the Latur district, some 250 miles east of Mumbai, to advocate hand hygiene as a safeguard of health. In Latur, as elsewhere in the state of Maharashtra, Kabir was learning that handwashing just wasn’t a priority for many villagers. “They couldn’t see any tangible impact,” he recalls.
That was long before the COVID-19 pandemic.
On March 24, the same day Prime Minister Narendra Modi ordered India’s more than 1.3 billion citizens to stay inside their homes for at least three weeks—a period he later extended—researchers at the University of Birmingham in the United Kingdom released a study documenting a strong correlation between the size of a country’s COVID-19 outbreak and the weakness of its handwashing culture. China, where the pandemic began in late 2019, had the weakest result: Seventy-seven percent of those surveyed reported that they didn’t automatically wash their hands after using the toilet. India did better—but 40 percent of Indians still said they didn’t wash their hands, with or without soap, at that crucial moment.
That survey too was done before COVID-19.
This year, Indians have been getting the message as never before: Frequent handwashing with soap prevents disease. They’ve been getting it from their national and state governments. They’ve been getting it on social media, from Bollywood stars and from cricket champions and, most entertainingly, from a squad of uniformed, face mask–wearing policemen in the southern state of Kerala, who danced in synchronous formation to a popular tune while demonstrating proper handwashing technique.
As the coronavirus has torn through the world, not sparing the rich and the powerful, India’s rural poor have felt their own acute vulnerability, Kabir says, and that has made them more open to the message. Soap, he says, is now one of the top items sold in village shops, right behind rice and wheat flour.
Even before COVID-19, Kabir had a long list of arguments for soap buying and handwashing. Worldwide in 2018, pneumonia killed more than 800,000 children under the age of five, including 127,000 in India. Diarrhea, usually caused by rotavirus infection, killed more than 500,000 children, including more than 100,000 Indians. Handwashing with soap is a first defense against both diseases, as it is against cholera, dysentery, hepatitis A, and typhoid. It can cut the risk of diarrhea by 40 percent, UNICEF says.
The great hope of WASH activists like Kabir is that the fear of COVID-19 will inspire a surge in handwashing that, in a post-pandemic world, will lead to a lasting reduction in the disease burden of many developing countries.
This is “probably the only silver lining of the disease,” says VK Madhavan, CEO of WaterAid India. “The change and awareness about it now, as compared to a few weeks back, is phenomenal.”
But there’s a daunting obstacle to realizing that hopeful vision: In places like India, there’s just not enough clean water.
If you add up all the situations in which international authorities such as UNICEF recommend washing hands during this pandemic—after visiting a public space or touching a surface outside the home, after coughing, sneezing, or blowing your nose, and of course after using the toilet or taking out garbage and before and after eating—it easily amounts to at least 10 times a day.
That’s a lot of handwashing. A single 20-second wash plus wetting and rinsing uses at least two liters of water, more than half a gallon. A family of four washing 10 times a day each would use 80 liters just for handwashing. In the United States, where the average person consumes up to 100 gallons daily (around 379 liters), that’s no big deal. In much of India and other parts of the developing world, it’s an unimaginable luxury.
Last year, after Chennai, India’s sixth largest city, ran out of water during a prolonged drought, NITI Aayog, an Indian governmental think tank, released a report on the country’s ongoing water crisis. It found that nearly 60 percent of India’s urban households don’t have piped running water. In the countryside, the figure rises to 82 percent, or 146 million rural homes without an adequate water supply.
Here’s just one example of what that life looks like. In the village of Kaithi, in the Bundelkhand region in north-central India, there is one shared tap for every five households. Bundelkhand has suffered 13 droughts in the past two decades. Water shortage is a way of life here.
This spring, as COVID-19 began spreading, people in Kaithi, as in so many other Indian villages, faced a disconcerting choice: They could wash their hands or they could keep their social distance, but it was hard to practice both methods of warding off the disease at the same time. “We are not allowing too many people to crowd around the taps and trying to wash our hands as much as possible,” Kaithi resident Mangal Singh told me by phone after the lockdown began.
Like many Indian villages, Kaithi has a colony at one end inhabited only by lower-caste Dalits. There, some 400 people share a single tap. And many people in the region don’t have access to any nearby water source, says Kesar Singh, convener of the Bundelkhand Water Forum, a local nonprofit. Women in such villages often travel more than a mile and stand in a long line to fetch water.
“To expect that people in this poverty-stricken, water-deficient region will prioritize handwashing over daily living is nothing short of a cruel joke,” Singh says.
Worldwide, some three billion people—40 percent of the global population—lack basic facilities to wash their hands with soap and water at home, according to a report released last year by the World Health Organization and UNICEF. Most are in either South Asia or sub-Saharan Africa.
“It’s not that people do not like the idea of handwashing,” says Kenya-based indigenous rights activist Ikal Ang’elei, echoing what Singh told me. “It’s like this: Do you make your child wash his hands after he comes back from school, or do you save the water for cooking?”
In India, the Modi government announced plans last year to provide every household with 55 liters of water a day by 2024. The goal is hugely ambitious—and still far from equal to both the need and the opportunity that will exist in a post-COVID-19 world.
“The awareness about sanitation and handwashing will be at its peak now,” says Kelly Ann Naylor, global WASH chief at UNICEF. “But it will have to be taken forward by governments.”