Poor sanitation directly contributes to rising cases of diarrhea, cholera, typhoid, hepatitis, and other water- and hygiene-related diseases.
Ali Nawaz Rahimoo
As cities expand and skylines grow denser, urban planning has quietly evolved into a matter of life and health. Decisions about infrastructure, land use, and public services increasingly determine how people breathe, move, work, and survive within rapidly growing urban environments. City planning is no longer only about aesthetics or economic growth; it has become a critical public health intervention.
Across the world, modern urban planning is now framed through a health lens. Walkable neighborhoods, cycling lanes, accessible parks, and green spaces are promoted to encourage physical activity and mental well-being. Efforts to curb air and water pollution through green infrastructure, improved wastewater management, and solid waste systems are central to healthier cities. Similarly, reducing vehicle emissions by promoting public transport directly lowers respiratory illnesses. Among these essential interventions, however, one foundational element remains persistently neglected public sanitation.
In rural areas, the sanitation crisis is even more visible. Toilets are largely unavailable or inaccessible for persons with disabilities and individuals with special needs. Even at petrol pumps, hotels, roadside restaurants, and other public spaces, functional and inclusive sanitation facilities are often missing. Bus stops rarely have proper toilets for women, and where facilities do exist, they frequently lack clean water, soap, privacy, lighting, and regular maintenance.
The consequences are severe. Poor sanitation directly contributes to rising cases of diarrhea, cholera, typhoid, hepatitis, and other water- and hygiene-related diseases. Bus stops and transport hubs urgently require functional, well-maintained, and separate toilets for men and women. Although toilets may exist in some locations, many are non-functional due to neglect, broken plumbing, lack of water supply, or absence of hygiene materials. Infrastructure without maintenance quickly becomes infrastructure in name only.
Equally critical to healthy cities is the promise of equity fair access to housing, healthcare, mobility, and basic services for all residents, not just the privileged few. Public sanitation sits at the intersection of health, dignity, and social justice. The absence of toilets disproportionately affects low-income populations, informal workers, street vendors, commuters, women, children, older adults, and persons with disabilities.
Each of these pillars’ health, equity, and infrastructure deserves independent attention. This article, however, narrows its focus to hygiene infrastructure and specifically examines the availability and condition of public toilets in Pakistan’s urban market areas, with particular attention to Karachi. In these dense commercial zones, the absence of basic sanitation poses a serious and ongoing public health risk.
Both cities and rural regions need well-designed public sanitation systems to ensure the health, safety, and dignity of their populations. In urban areas, rapid population growth and unplanned development have put enormous pressure on existing sanitation infrastructure, leading to overflowing drains, contaminated water sources, and unhygienic public toilets. Crowded markets, bus stations, and public offices often lack functional sanitation facilities, disproportionately affecting women, children, and vulnerable groups. Similarly, rural communities face critical gaps in sanitation access. Many villages lack even basic toilets, and where facilities exist, they are often inaccessible to persons with disabilities or inadequately maintained. The absence of clean, functional sanitation in both contexts contributes directly to the spread of preventable diseases such as diarrhea, cholera, typhoid, and hepatitis, while also creating social and gendered challenges. Properly planned sanitation systems integrating water supply, waste management, hygiene facilities, and maintenance can prevent disease, protect the environment, and improve quality of life. Strategic investments in both urban and rural sanitation infrastructure are therefore essential, not only as a public health measure but also as a step toward equitable, sustainable development that upholds the dignity of all community members.
Access to toilets is central to safe sanitation, which is fundamental to human health and dignity. Over the past two decades, this understanding has slowly gained global recognition. The establishment of the World Toilet Organization in 2001 marked a turning point by breaking long-standing taboos around sanitation. This momentum culminated in the United Nations’ recognition of World Toilet Day in 2013, observed annually on November 19.
Together, these milestones helped shift how governments and planners perceive public toilets. Long relegated to the margins of urban planning, sanitation facilities are increasingly recognized as essential urban infrastructure just as important as roads, electricity, and water supply. Yet recognition alone has not translated into adequate action.
The crisis is most pronounced in rural areas but is rapidly worsening in cities due to population growth, unplanned urbanization, weak infrastructure governance, recurring natural and man-made disasters, and economic pressures. Open defecation contaminates groundwater and surface water sources, allowing harmful bacteria and pathogens to spread widely.
Beyond public health, inadequate access to toilets carries profound social and gendered consequences. Women and girls are disproportionately affected by the lack of safe, private, and accessible sanitation facilities. Many are forced to restrict food and water intake or delay relieving themselves, practices that can lead to urinary tract infections, kidney problems, and other serious health complications.
The absence of toilets also exposes women to harassment, violence, and abuse, particularly in crowded public spaces and transport hubs. The Covid-19 pandemic and the continued emergence of infectious diseases further highlighted the importance of functional public toilets as a basic prerequisite for healthy and resilient cities.
Major cities of Pakistan, including Karachi an economic engine that contributes substantially to the national economy continue to function with a striking lack of basic public amenities. Bus stops, markets, public offices, transport terminals, and commercial districts remain largely devoid of hygienic and dignified sanitation facilities.
For millions of daily commuters, informal workers, and vendors, the need to use a toilet becomes a private struggle played out in public spaces. Embedding hygiene infrastructure into dense urban environments requires deliberate, people-centered planning. Well-designed, accessible, and regularly maintained public toilets can significantly enhance urban livability, protect public health, and restore dignity to everyday city life.
Read: Save the Wetlands of Sindh
_______________
Ali Nawaz Rahimoo, based in Umerkot, Sindh is a social development professional. He can be contacted on anrahimoo@gmail.com
