October 8, 2014
Dear Vice President Jorge Familiar,
We write to you in advance of the donor conference on “Haiti: Clean Water, Improved Sanitation, Better Health,” co-hosted by the World Bank in Washington D.C. on October 9, 2014. Human Rights Watch welcomes that the international community will come together to make commitments to combat water-borne disease such as cholera and to provide water, sanitation, and health services in cholera hotspots throughout Haiti. These commitments should be carried out in a way that promotes related human rights, including the rights to health and education.
In furtherance of this, Human Rights Watch calls for the World Bank to show leadership and bring the need for water and sanitation in schools, in particular, to the forefront of these discussions. We highlight areas of attention and recommendations below for urgent consideration at the forthcoming conference.
Contrary to what is called for in the government of Haiti’s guidelines for the promotion of hygiene in schools, safe, clean latrines and water for drinking and hand washing are extremely scarce in Haitian schools. Most students and teachers have nowhere to relieve themselves, wash their hands with soap, obtain clean water, or, for women and girls, maintain menstruation hygiene. Where facilities do exist, they may not be sufficient in number, may not function, or may not be clean or safe. Nearly 60 percent of schools lack toilets and more than three-fourths of schools lack water access. The Inter-American Development Bank has stated that “[i]nstead of promoting children’s health, many schools in Haiti expose children to health hazards such as diarrhea and intestinal worm infections. These conditions, mainly due to inappropriate sanitation and unsafe water sources, have been shown to hinder both the physical and intellectual development of children.”
In September, Human Rights Watch visited a number of schools in the Central Plateau of Haiti to assess water and sanitation conditions of educational facilities. These schools, including recently constructed ones funded with money from the international donor community, lacked adequate water and sanitation facilities. None of the schools we visited were consistent with the government’s guidelines for the promotion of hygiene in schools. Teachers, students, and government officials all told us that the situation was dire and has a negative impact on students’ education.
Donors, including the World Bank, have invested heavily in tuition waiver and school nutrition programs in Haiti, often disregarding the inter-dependence with water and sanitation services. This investment has been successful in supporting more Haitian children to register, attend, and stay in school. However, attention must also be given to the conditions in which these children learn. Cooking and eating at school canteens often occurs in the vicinity of students who have no choice but to defecate in the open and where there is nowhere to wash their hands with soap. This makes schools a locus for the spread of disease. A demographic and health survey conducted in 2012 found that school-aged children (age 5-19) represented the highest percentage of cholera victims, and the second highest percentage of cholera deaths (age 5-14), compared to all other age groups.
Lack of potable water and sanitation at home or at school can increase the risk for water-borne illnesses and diarrheal disease, and lessen the amount of time children are in school. Teachers in Haiti told Human Rights Watch that diarrheal disease is disruptive to children’s education. Some of their students stay home for more than a week to recover from preventable diarrheal disease.
Girls suffer additional harms from the lack of access to water, sanitation, and hygiene at home or at school, including absenteeism for collecting water or due to lack of adequate menstrual hygiene management. We spoke with girls in Haiti who leave school to go home to wash and change the materials they use to manage their menstruation, because they cannot do that at school. Some teachers told Human Rights Watch that girls sometimes stay at home during menstruation because they have no option to manage their hygiene at school. Girls in Haiti need access to clean water and sanitation facilities, as well as hygiene education and materials, to ensure their consistent attendance in school.
The government of Haiti, the World Bank, and other donors have made commitments to improve access to education in Haiti. The relationship between the human rights to water and sanitation and to education is clear.
A focus on improving water and sanitation in schools is crucial to any discussions regarding investments aimed at decreasing the risk of water-borne diseases and preventable child deaths in Haiti. No plan to improve water and sanitation in Haiti is complete without a comprehensive approach to schools, which will reach many more millions of children. The World Bank should take the opportunity on October 9 to pledge support to the government of Haiti, and to the Ministry of National Education and Professional Development in particular, to address the water and sanitation needs of school children as a matter of priority. This should include commitments to:
- Support the development, adoption, and implementation of a national plan on water and sanitation in schools, which should include rights-respecting benchmarks and indicators, including ones on gender equality, in collaboration with the “l’Alliance pour l’Eau, l’Assainissement et l’Hygiène en Milieu Scolaire” (Alliance EAHMS).
- Commit, and encourage other donors to commit, to meeting Ministry of National Education and Professional Development and DINEPA guidelines regarding basic requirements for the construction of sanitation facilities in rehabilitation and construction of schools.
- Integrate water and sanitation programming into existing education investments and amend results frameworks to include water and sanitation indicators, and work with other donors, including the Inter-American Development Bank, bilateral institutions, and United Nations agencies, to do the same.
- Ensure that schools are included in water and sanitation infrastructure plans and funding as part of the Government of Haiti’s Plan of Action for the Elimination of Cholera in Haiti.
As co-host of the conference, the World Bank has the opportunity to take leadership and support the government of Haiti in addressing the water and sanitation needs of some of its most vulnerable citizens, starting with school-age children.
We would welcome the opportunity to discuss our recommendations further.
Amanda Klasing, Researcher, Women’s Rights, Human Rights Watch
Jessica Evans, Senior Advocate and Researcher, International Financial Institutions, Human Rights Watch
Cc. Junaid Ahmad, senior director for water
Claudia Costin, senior director for education
Tim Evans, senior director for health, nutrition & population
Caren Grown, senior director for gender cross-cutting solutions
 La Santé et les Infrastructures Scolaires, Recensement Scolaire 2003, cited in Ministère de l’Education Nationale et de la Formation Professionelle, Direction de la Santé Scolaire, Ligne directrice pour la Promotion de l’Hygiène en Milieu Scolaire, Document Cadre, Juillet 2012, p. 9, http://www.washinschoolsmapping.com/projects/pdf/Haiti_Lignes%20directrices%20PH-EAHMS.pdf (October 7, 2014).
 Inter-American Development Bank, Increasing Access to Quality Education in Haiti (HA-L1077), Grant Proposal, p. 5, http://idbdocs.iadb.org/wsdocs/getdocument.aspx?docnum=37302335 (October 8, 2014).
 Enquête Mortalité, Morbidité et Utilisation des Services, EMMUS-V, p. 349, http://www.mspp.gouv.ht/site/downloads/EMMUS%20V%20web.pdf (October 7, 2014)
 A systematic review of public health studies has shown that access to safe drinking water and clean, private toilets has potential to beneficially impact children’s health, which in turn would increase attendance. See Christian Jasper, Thanh-Tam Le and Jamie Bartram, “Water and Sanitation in Schools: A systematic review of the health and educational outcomes,” International Journal of Environmental Research and Public Health, vol. 9, no. 8, August 3, 2012, pp. 2772–2787, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447586/ (accessed June 23, 2014). Incidents of diarrheal disease can be reduced by 30 percent when children and staff at primary schools wash hands properly, according to one study. See Ejemot, R. Regina I., et al., “Hand Washing for Preventing Diarrhea ,” Cochrane Database of Systematic Reviews, no. 3, article no. CD004265, 2009, pp. 1–44, http://www.childsurvival.net/?content=com_articles&artid=498&alert=yes (accessed June 23, 2014).