Climate Risks to Water, Sanitation and Hygiene Services and Evidence of Inclusive and Effective Interventions in Low and Middle-Income Countries: A Scoping Review

Abstract

People with disabilities face significant disparities in access to water, sanitation, and hygiene (WASH) services, negatively affecting their health. Climate change exacerbates this by damaging WASH infrastructure and disrupting behaviours. Despite their heightened vulnerability, the needs of people with disabilities are often overlooked in climate change response strategies, putting them at greater risk. This study explored how climate change impacts WASH services and behaviours and whether climate-resilient WASH interventions are disability-inclusive and gender equitable in low and middle income countries. Nine online databases were searched in July 2023 and May 2024 to identify peer-reviewed papers (CINAHL Complete, Embase, Global Health; Web of Science; ECONLIT; DESASTRES, GreenFILE, MEDLINE via PubMed, Education Resources Information Centre). Grey literature was identified through OPENGrey, WHO, AHRQ, BASE and Google Scholar. Eligible papers included data on the impact of weather or climate on WASH services and behaviours, particularly for people with disabilities and women. Studies focused on community-based WASH interventions in LMICs and were published between 2000 and 2023 in English. Twenty two studies were included. Thirteen included results about women and girls; two considered disability. Only two evaluated climate resilient WASH interventions (rainwater harvesting), and neither focused on disability. Most studies examined rainfall uncertainty and drought, covering diverse locations, including South Asia and East Africa. Most studies were published after 2020. Results show that climate change is exacerbating WASH inequalities, particularly affecting women and people with disabilities, while also adversely impacting public health by disrupting water availability, quality, and sanitation services. Variability in rainfall, droughts, floods, and saltwater intrusion significantly affect water reliability, quantity, and quality, leading to increased waterborne diseases, mental health issues, and other health problems. Social capital and kinship networks are critical during water scarcity. People with disabilities are especially vulnerable, often relying on people feeling morally obligated to support water collection. To cope, people diversify their water sources and prioritise water use for agriculture and livelihood security over hygiene, which elevates health risks. Extreme weather events further complicate the situation by damaging sanitation facilities, leading to increased open defecation and the spread of diseases. Rebuilding sanitation facilities is often deprioritised due to repeated damage, mental fatigue of constant reconstruction, and immediate survival needs. Water is frequently prioritised for agriculture over proper sanitation and hygiene practices, resulting in higher rates of open defecation and declining hygiene, as water use for handwashing, cleaning utensils, laundry, and menstrual hygiene is restricted. Consuming saline water is associated with high blood pressure, hypertension, preeclampsia, and respiratory infections. Women and girls who wash menstrual materials and bathe in saline water risk skin burns, rashes, blisters, and urinary tract infections. The role of governments and service providers in facilitating adaptation was inconsistent, with a lack of focus on community engagement and equitable service delivery. Climate change disproportionately impacts vulnerable populations' access to WASH services. This review highlights the urgent need for research on climate resilient WASH interventions, especially those addressing the needs of people with disabilities. Targeted support, sustainable management, and robust evidence are essential to building resilience and equality.