The Quietest War

Preventable, yet tragic on a global scale, unsafe water, poor sanitation, and lack of hygiene kill millions each year—more than all acts of violence combined. Tracing the history of water treatment and today’s waterborne-disease crisis, calls for renewed commitment to clean water as humanity’s most essential defense.

By Eric Herman

It’s a life-and-death crisis that goes ignored far too often. Waterborne diseases are far more deadly than the sum of all human violence. Full stop!

Although surprising to many, nothing about that startling fact is new. Recognizing the crucial nature of clean water and its roll in human suffering begins with a simple look back in history, a survey that quickly reveals how radically water treatment changed the fate of human health—and how much more remains to be done.

In the 19th and early 20th centuries, outbreaks of typhoid, cholera and dysentery were common causes of high mortality rates in cities. All have long been proven to be linked to unclean water conditions. Water filtration along with the introduction of chlorination (around the early 1900s in many places), sewer infrastructure, and regulation of microbial concentrations, dramatically reduced these epidemics, and have continued to do so to this day.

For example, according to the Centers for Disease Control and Prevention, in the United States typhoid fever rates dropped from approximately 100 cases per 100,000 in 1900 to 0.1 per 100,000 by 2006. Researchers have shown that much of the decline in overall mortality in U.S. cities between about 1900 and 1936 (including infant mortality) can be attributed to clean water and sanitation—infant mortality dropped by more than 60 percent in those cities once clean water systems were in place.

Ongoing Battles

Fast‐forward to the present: unclean water, poor sanitation, and lack of hygiene (collectively WASH: Water, Sanitation, Hygiene) still kill—and often more quietly, more diffusely—than all forms of interpersonal violence combined, even in conflict‐affected zones. According to UN‐Water, about 1.7 billion people still lack even basic hygiene services, and unsafe water, sanitation and hygiene are linked to about 1,000 deaths every single day among children under five from diarrheal diseases.

Meanwhile, the World Health Organization has estimated that improving access to safe drinking water, sanitation, and hygiene could save 1.4 million lives per year—deaths that are largely preventable.

When comparing these WASH‐related deaths with deaths from violence and injuries, the contrast is stark. The World Health Organization reports around 4.4 million deaths globally per year from injuries (including both unintentional injuries and violence), of which about 1.25 million are from violence. WASH‐related disease alone claims more lives—particularly among children—such that in many contexts far more children die from diarrhoea due to unsafe water/sanitation/hygiene than by bullets or bombings.

In surveyed conflict or fragile countries, UNICEF found that about 85,700 children under 15 die annually from diarrheal disease linked to unsafe WASH compared with 30,900 from conflict, and about 72,000 under‐fives die from similar WASH causes versus 3,400 from war‐related violence.

The diseases involved are multiple. Diarrheal disease (acute diarrhea) remains the major killer in WASH terms; acute respiratory infections follow, often exacerbated by lack of hand hygiene and clean water. Undernutrition plays a role both as cause and effect, since repeated diarrhea or parasitic infections weaken nutritional status; soil‐transmitted helminths (intestinal worms) also contribute. Other specific waterborne pathogens include cholera, typhoid, hepatitis A, dysentery, and in industrialized settings pathogens from biofilms (e.g. Legionella, non-tuberculous mycobacteria) contribute to deaths, according to the WHO.

Children, especially those under five, are at greatest risk. Unsafe WASH is responsible for hundreds of thousands of deaths each year in that age group. For example, in 2019 the WHO estimated about 395,000 deaths among children under five due to WASH‐unsafe conditions: 273,000 from diarrhea, 112,000 from acute respiratory infections.

Areas of conflict, infrastructure breakdown, fragile states suffer worst. In such settings water infrastructure is damaged or destroyed, sanitation systems fail, people are displaced, and hygiene (soap, clean water, toilets) becomes hard or impossible to find. In such fragile conditions, safely managed drinking water and sanitation become scarce or non-existent.

The Burden on Women

In much of the developing world, the daily burden of fetching water falls disproportionately on women and girls. Across sub-Saharan Africa, Asia, and parts of Latin America, they walk miles each day—sometimes several hours round trip—to collect water from rivers, wells, or community taps. The water is often unsafe, carrying pathogens that lead to chronic illness or death, especially among their children. But the act of collecting it carries dangers of its own.

Women in remote or conflict zones face harassment, assault, and rape along desolate routes to water points. The UN and international NGOs have documented widespread gender-based violence connected to water collection in regions of South Sudan, Somalia, Ethiopia, and the Democratic Republic of Congo. A 2022 UNICEF report noted that in some areas, fear of attack is so severe that women travel in groups or at night, further compounding their vulnerability and exhaustion.

The irony is that the very act of sustaining life—fetching water—often imperils it. The physical toll of carrying heavy containers over long distances damages women’s spines, hips, and joints; the psychological toll of danger and deprivation deepens inequality and trauma. Time lost to water collection also keeps millions of girls from attending school, perpetuating cycles of poverty and illiteracy. In these circumstances, WASH is not just a matter of health—it is a matter of safety, gender equity, and human rights.

As water scarcity grows, so does the potential for social unrest. The “water riots” that have erupted in places like Iran, South Africa, Bolivia, and India are warnings of a destabilizing future. In impoverished nations where infrastructure fails and prices rise, people have taken to the streets—sometimes violently—when taps run dry.

Climate change, urbanization, and aquifer depletion are already turning water into a political weapon and a flashpoint for revolt. Analysts at the Pacific Institute and UN University have warned that water scarcity, if unaddressed, could become one of the most volatile drivers of global instability this century.

Unclean Risk

The importance of proper sanitation cannot be overstated: either via large‐scale utility systems or smaller scale personal/personal‐community methods. Filtration and chlorine disinfection are among the simplest, most cost-effective, scalable means to reduce pathogen load in water. Filtration removes many organisms and particulates; chlorine (or other chemical disinfectants) kills or inactivates many bacteria, viruses, parasites.

International efforts to reduce WASH-related disease range from global monitoring (WHO/UNICEF JMP) to direct interventions: programs for sanitation, hygiene promotion (handwashing, safe toilets), clean water supply, emergency WASH interventions in disasters and conflict, and vaccination where possible (e.g. for cholera or rotavirus). Funding agencies, NGOs, UN bodies are involved; progress toward SDG 6 (clean water and sanitation for all) is a thread in many international treaties and development goals.

One reason deaths from WASH deficits remain underappreciated is their quiet nature. Violent deaths are sudden, dramatic, visible, sometimes politicized. Disease deaths from poor water and inadequate sanitation tend to happen at home, often among the young or elderly, spread over time, not always traced or blamed in headlines. There is less immediate societal outrage (though there is sometimes in the case of epidemics), less media coverage, and less political capital devoted.

Cross-border, cross-sector partnerships are essential. Governments must work with NGOs, community groups, private sector firms (especially those able to build water, sanitation, and hygiene infrastructure, or supply chlorine, filtration materials, pumps etc.), international finance bodies (World Bank, regional development banks), donor countries, and health agencies. Partnerships must also deal with climate change impacts (floods, droughts), urbanization, population displacement, maintenance of aging infrastructure, and equity—ensuring that remote, marginalized, conflict-affected populations are included.

No Immunity

Though industrialized nations have largely controlled traditional diseases like cholera or typhoid in treated municipal water systems, WASH remains a risk even there. Aging pipes, intermittent service, non-regulated private wells, stormwater overflows, biofilm pathogens, and inequalities in access still produce measurable morbidity and mortality. For example the United States still records thousands of waterborne illnesses and several thousand deaths annually from pathogens and failures in water systems.

Indeed, water treatment—filtration, chlorination, protection of water sources, sanitation, hygiene—is not optional. The historical evidence shows its power to reduce mortality and transform societies.

In our era, failure to ensure WASH systems reach everywhere means millions more deaths, almost all of which is preventable. Reliable water treatment and safe sanitation and hygiene are among the most indispensable foundations for human health, dignity, and development.

Opening image from Magsi | Shutterstock; second image from Praddep Guurs | Shutterstock; bottom Manoe Paateel | Shutterstock