“Pakistan is in fact the third largest country, behind India and Indonesia, where people are forced to defecate in the open”-Arif Mahmood, Dawn March 10, 2015 The United Nations Organization (UNO) has declared November 19 as “World Toilet Day” and has declared that we are facing a global sanitation crisis. This is because as of today 3.6 billion people are living in deplorable and unhygienic conditions with poor quality toilets or no toilets that are detrimental to their health and also pollute their environment as well as those who are abiding by proper sanitation rules. Good public health projects are essential to protect the groundwater but where these are non-existent, human waste can contaminate rivers, lakes, soil and of course, groundwater. They say ‘prevention is better than cure’ so surely for any sensitive government, the mental and physical health of the nation should be among the top priorities for very obvious reasons. Countries that have understood this secret have taken solid actions to ensure the provision of facilities that are necessary for maintaining a high standard of cleanliness and hygiene. Consequently, they have managed to effectively control the environment through strict regulations and making clean toilets in all major places, including parks and gardens, available for public use. Unfortunately, in many countries, especially ones belonging to the Third World spanning the continents of Asia and Africa, issues related to sanitation are plentiful but have not been addressed in a befitting manner. No wonder that when a disease hits these areas it sweeps across within a short time engulfing those whose living conditions are questionable. Betel leaf stains and littering speak volumes about the insensitivity of toilet users. Response to the “call of nature” has varied from ancient civilizations to the present day. Historic chronicles are mostly silent about this aspect of social evolution as evident from travellers’ diaries and other accounts maintained by courtiers and academics. Whatever little we know has reached us as ambiguously as we hesitate to discuss this topic. An integral part of the biological make-up of human beings, interestingly those who are generally shy about talking about it feel no shame in defecating or urinating in public places. This is apparent from the fact that even today 4.5 billion people are deprived of toilets at home that can safely manage human waste. Dr Bindeswar Pathak, Founder of the Sulabh Sanitation Movement in India, writes about the past in his paper: “In the remains of Harappan civilisation in India, at a place called Lothal (62 Kilometers from the city of Ahmedabad in Western India) and in the year 2500 BC, the people had water borne toilets in each house which was linked with drains covered with burnt clay bricks. To facilitate operations and maintenance, it had man-hole covers, chambers etc. It was the finest form of sanitary engineering. But with the decline of Indus Valley civilisation, the science of sanitary engineering disappeared from India. From then on, the toilets in India remained primitive and open defecation became rampant.” Global awareness about a clean environment and the importance of hygiene has caught the attention of people worldwide. Different organizations under the UNO umbrella and independently too are disseminating vital information with regard to the importance of hygiene and the use of proper toilets that help to avert deadly diseases. Reportedly, 750 children under the age of five die every day from diarrhoea caused by unsafe water. Education gets disrupted as the lack of toilets in schools (globally 1 in 3 do not have adequate facilities) fails to attract students, more so in the case of females for whom privacy is all the more necessary. Despite massive propagation, 892 million people worldwide go for open defecation which implies that in order to relieve themselves they go outside, on roadsides, in the fields, in wild bushes or in garbage heaps depending on where they are living, which in the majority instances is in rural areas. In Pakistan, urban dwellings are also not totally free from open toilet habits. Considering the density of the population in the main cities, the number of public toilets is very few, and these too are in highly appalling condition both in terms of hygiene and maintenance. Even the ones in most of our mosques cry out for proper cleanliness. To some extent, people are also to blame. Betel leaf stains and littering speak volumes about the insensitivity of toilet users. While some corporation employees complain that they are not provided ample supplies to ensure proper cleaning, others are too lazy to work diligently. The dearth of this important facility can have serious implications for people’s health. Inability to relieve themselves in time, can cause constipation (which by itself is the mother of many diseases) and even stunted growth, particularly in children who are deprived of private access to toilets. Social disorders can also sprout from these tendencies as some children become prone to encopresis-which envisages the soiling of undergarments. A healthy excretory system is essential for the development of an exuberant populace but this entails good sanitary conditions and hygienic toilets. According to World Health Organization (WHO) toilets, water and sanitation are great investments where every dollar spent on sanitation has a return of US $5.50 in the form of reduced healthcare costs for individuals and society around the world. If only our government too had the same realization. Although Pakistan is a member of UNO and a number of its allied agencies like WHO, UNICEF etc. yet we have not fully complied with different resolutions and conventions to which we are signatories. Still, efforts are being made to introduce hygiene to school-going children, particularly in rural areas. As per Fatima Shahryar’s report, in 2018 UNICEF initiated a programme to support Punjabi authorities to build toilets and install handwashing stations across all public schools in the province. Students were organized into WASH clubs and trained in promoting hygiene. UNICEF with support from United Kingdom’s Department for International Development (DFID) has helped more than 10,000 families so far, to build toilets in their homes. The project has also benefited nearly 500 schools, mobilizing 2,000 teachers and about 100,000 students. These types of measures are promising for the country but we need to expand our efforts to extend these facilities to disadvantaged people. The writer, lawyer and author, is an Adjunct Faculty at Lahore University of Management Sciences (LUMS), a member of the Advisory Board and the Senior Visiting Fellow of the Pakistan Institute of Development Economics.