Triple Threat

How disease, climate risks, and unsafe water, sanitation and hygiene create a deadly combination for children

March 17, 2023

Safe water is essential to life itself. Without the essential WASH services, the most basic needs of life are unmet. Lack of access to these services causes children to die of preventable diseases, their education to be disrupted and malnutrition to be magnified due to growing food insecurity, driven in part by water resource challenges. It also forces families to migrate and armed conflict and child labour to proliferate.

This report examines the WASH-related threats facing children at the intersection of access to WASH services, the burden of WASH-related diseases and climate threats. The triple burden is defined in this brief as: less than 50 per cent access to at least basic water or sanitation services; within the top 20 countries with the highest burden of deaths attributable to unsafe WASH among children under 5; and within the top 25 per cent of countries facing the highest risk of climate and environmental hazards in UNICEF’s Children’s Climate Risk Index (CCRI).


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Some of the key findings in the brief highlight that:

  • Globally, 600 million children still lack safely managed drinking water, 1.1 billion lack safely managed sanitation and 689 million lack basic hygiene service.
  • 149 million children still face the indignity of practising open defecation.
  • Unsafe WASH is still responsible for the deaths of around 400,000 children under the age of 5 each year.
  • The challenge of extending WASH services to children in need is further compounded by water scarcity, floods and cyclones – all exacerbated by the climate crisis.
  • The triple burden of WASH-related threats facing children is primarily concentrated in a small number of countries.