Climate change, disability, and water, sanitation and hygiene: A scoping review of evidence and interventions in low and middle-income countries.

Climate hazards, including extreme weather events, undermine essential water, sanitation and hygiene (WASH) services, exacerbating health disparities in people with disabilities. Despite this, WASH policies and adaptation strategies often overlook the need for disability inclusive measures. The scoping review objectives are to 1) map the evidence on how climate risks affect WASH services and coping strategies in low-and middle-income countries, with a particular focus on people with disabilities; and 2) assess evidence for the effectiveness of climate-resilient WASH interventions, emphasising their impact on people with disabilities. Our review identified substantial data on women and girls, so the results reflect binary gender considerations. A systematic search of nine databases, including CINAHL Complete, Global Health, GreenFILE, and MEDLINE via PubMed, was conducted to identify peer-reviewed and grey literature using relevant keywords related to extreme weather and climate hazards, WASH (including menstrual health), disability, and evaluations. We included studies in English, published between January 1, 2000 and December 31, 2023. Data were extracted and analysed thematically. Twenty-two studies met the inclusion criteria. Only two papers evaluated climate-resilient WASH interventions (rainwater harvesting), and neither considered disability. Most papers examined people's self-reported health impacts and experiences affected by drought-related water insecurity or WASH infrastructure damage due to extreme weather events. Data on the experiences of persons with disabilities were only included in two papers. They highlighted that persons with disabilities are disproportionately disadvantaged by climate-related damage to WASH infrastructure and emphasised the importance of social capital and social networks in supporting them when access to water is limited. Extreme weather events disrupt WASH services, yet evidence of the experiences and coping strategies of persons with disabilities remains extremely limited. This is a barrier to developing disability inclusive adaptation strategies. Evaluating climate-resilient WASH interventions is essential to enhance resilience and health equity for persons with disabilities.