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Women, WASH & COVID-19: The 'burdens of' and 'opportunities for' the
vulnerable

Article · July 2020

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Zoha Anjum Nidhi Nagabhatla

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 Women, WASH & COVID-19: The ‘burdens of’ and ‘opportunities for’ the
vulnerable
Zoha Anjum1 and Nidhi Nagabhatla2
1 Faculty of Dentistry, University of Toronto, Toronto, Canada.
2United Nations University Institute for Water, Environment and Health (UNU INWEH), Hamilton,
Canada and School of Geography and Earth Science, McMaster University, Hamilton, Canada.

As water-bearers and care-providers, women and girls carry the burden of fulfilling water needs of
their households. Water collection often exposes women to attacks from wild animals, sexual assault
and severe health outcomes (Pommells et al., 2018). In 2017, more than 140 million people relied on
contaminated surface water for drinking, sanitation and hygiene (WASH) needs (World Health
Organization & UNICEF, 2019). Contact with waterborne pathogens can lead to both acute (i.e.,
waterborne infections) and chronic (e.g., malnutrition and growth stunting) conditions for
individuals (Pouramin et al., 2020).
At the outset of the COVID-19 pandemic, several public health interventions were implemented to
mitigate the spread of the virus. Examples included partial/complete lockdowns, wide enforcement
of physical distancing, and recommendations for facemasks use and frequent handwashing (World
Health Organization, 2020). However, these recommendations were far from reality for communities
that lack access to WASH and/or reside in overcrowded spaces, where clean water is a luxury and
physical distancing is impossible. The impact of COVID-19 on individuals and communities has been
unequal. The vulnerable are further burdened, not just economically, but for provisions essential for
survival and good health.
Migrant and refugee populations, particularly women, are at most risk
Globally, approximately 79.5 million individuals were forcibly displaced as of 2019 (The UN Refugee
Agency, 2019). Human displacement is typically pursued to escape conflict, seek better access to
resources and economics or in response to environmental and climate triggers. Water crises can be
a major driver of human migration as polluted water, no access and/or lack of WASH service supply
may force people to migrate. These aspects apply to the displaced populations and those hosted in
refugee camps (Singh et al., 2020). For undocumented migrants and refugees, poor or lacking access
to healthcare may lead to a higher number of COVID-19 infections and consequently, a higher
mortality. Besides, overcrowding and lack of access to handwashing stations among informal
settlements and refugee camps are a recipe for cascading health outcomes – if COVID-19 strikes. It is
likely that COVID-19 has made these populations even more susceptible due to their living conditions
– their burdens multiplied and resources crunched (Singh et al., 2020). Therefore, the call for better
access to WASH and healthcare remains crucial to implement adequate prevention strategies and
maintain sufficient resources to treat the sick during the pandemic.
COVID-19 has compromised women’s access to WASH
COVID-19 has flagged WASH as a crucial concern, especially for women and vulnerable populations
including migrants and refugees (Fuhrman et al., 2020; Singh et al., 2020). The 2019 Joint Monitoring
Report reflected that 8 of 10 individuals that lacked access to basic water services resided in rural
areas and half of them lived in the least developed countries. More than 70% that lack access to basic

1
sanitation facilities were in rural areas and of which, a third were based in the least developed
countries (World Health Organization & UNICEF, 2019). This situation may have worsened in the
past few months as a greater quantity of water and more sanitation facilities may be required to
practice frequent handwashing for COVID-19 prevention. Surprisingly, only 60% of the world’s
population has access to soap and water within their household, which highlights that the
recommendation to frequently wash hands cannot be universally adopted (World Health
Organization & UNICEF, 2019).
For women that are still continuing to fetch water from off-site waterpoints or using communal
toilets, which may be the case for many migrant and rural populations, the waiting time at the
waterpoint/toilet site may make it difficult to practice physical distancing (Centre for Policy
Research, 2020). Furthermore, women’s access to safe menstrual hygiene management (MHM) may
also be limited due to disruptions in the supply-chain or stigma that prevents women from asking
their male relatives to purchase pads for them (Anjum et al., 2019; Centre for Policy Research, 2020).
Women and girls dwelling in informal settlements and camps, where they may not have had access
to safe MHM prior to COVID-19, may find it difficult to wash their reusable pads given the elevated
water needs for handwashing. Use of non-reusable pads may increase the waste at the settlement
area and improperly-washed pads may expose young girls and women to poor physical, mental and
psychosocial health outcomes (Anjum et al., 2019; Pouramin et al., 2020).
COVID-19 has impacted women’s socio-economic wellbeing
Enforcement of complete lockdowns has consequences for household incomes, particularly for daily
wage earners or uninsured/migrant workers. For families that rely on paid water service, this may
force them to consume unsafe water, thus leading to a heightened waterborne disease burden.
Households with a higher income are more likely to be able to afford and buy safe water from water
vendors or water-provider companies, leading to an inequitable access to water where richer
individuals can afford to keep themselves protected from COVID-19 and waterborne diseases;
whereas, poor individuals do not have adequate resources to even survive.
Socio-economic impacts of COVID-19 are worse for women who were already working precarious
jobs, earning less than a living wage, or residing in informal settlements (UN Women, 2020b). For
migrant women working abroad, the travel bans may prevent women from returning to their families
and expose them to exploitation, human rights violation and social isolation in a foreign place (UN
Women, 2020a). School closures have led to higher childcare and home-schooling needs (Centre for
Policy Research, 2020). Disruption in education has also induced serious consequences for women
and girls as education is a way for them to seek social mobility within the society. For girls residing
in refugee camps, the consequences are even worse as they are only half as likely to enrol in
secondary school compared to their male counterparts (Anne-Birgitte Albrectsen & Stefania
Giannini, 2020). It is likely that some of the girls may never return to school even after the pandemic
has ended, thereby jeopardising the progress made towards the Sustainable Development Goal (SDG)
4 (Quality Education) and 5 (Gender Equality) targets.
COVID-19 has threatened women’s health and safety
Globally, women form most of the healthcare workforce. Hence, women are at a higher risk of
contracting COVID-19 virus from their workplace. When access to WASH at healthcare facilities is
inadequate, women are exposed to other contagious pathogens as well. Substantial risks to health
and safety exist even for women who are not healthcare workers. Since the lockdowns were imposed,

2
women have been subjected to gender-based violence, sexual exploitation, and abuse (UN Women,
2020b). There has also been a greater risk of female genital mutilation (FGM) due to the closure of
schools where girls are usually safer (Kate Hodal, 2020). In some cultures, FGM is considered a rite
of passage which needs to be performed before the girls are married. COVID-19 school closures have
provided the optimal time to get these procedures done; thus, risking the lives of young girls.
The situation women face can vary depending on the settings of their dwelling. In high stress
environments such as refugee camps, lack of economic opportunity and material deprivation may
expose women to vulnerable situations, wherein women may be forced to engage in transactional
sex (sex in exchange of sanitary pads, food, water etc.) as a survival mechanism (Williams et al.,
2018). This may lead to unintended pregnancies and sexually-transmitted diseases. COVID-19 may
exacerbate these situations compromising girls’ and women’s safety and dignity (Williams et al.,
2018).
COVID-19 has also had an impact on women’s mental health. For women, physical distancing from
loved ones, fear of the virus and lacking social support during a pandemic will affect their mental
health (UN Women, 2020b). Furthermore, other barriers to access, violence, increased
responsibilities and other factors discussed above may also be a source of stress (UN Women, 2020a).
Women, COVID-19, WASH and the SDGs
The interlinkage of the pandemic, gender and WASH will impact the future of many SDGs and related
targets in a mixed manner (Figure 1). The “leaving no one behind” vision in this context sounds more
relevant than ever. The COVID-19 pandemic has halted the global economy, which may push people
further below the poverty line. This has implications for the SDG 1 (No poverty), 2 (Zero hunger), 4
(Quality education), and 10 (Reduced inequalities) due to disruptions in income and education
(United Nations, 2020).
The prevention and treatment of the COVID-19 virus is fundamentally reliant on uninterrupted and
equitable access to WASH (SDG 6) and to good health and healthcare (SDG 3). As noted, women are
disproportionately affected by the pandemic and therefore, any progress made towards SDG 5
(Gender equality) will be affected and should be reviewed considering multifaceted impacts of the
pandemic.

SDG 10:
Reduced
Inequalities
SDG 6:
SDG 1: No Clean
Poverty Water &
Sanitation

Women,
WASH &
SDG 2: COVID- SDG 5:
Zero 19 Gender
Hunger Equality

SDG 3:
SDG 4:
Good
Quality
Health &
Education
Wellbeing

3
Figure 1: Interlinkages in gender, water and COVID-19 and the SDG agenda

The way forward

The pandemic has exposed the inequities and exacerbated the fragility of our existing health and
welfare systems. At the same time, it presents an opportunity to reform our systems and approaches
to provide universal access to WASH and healthcare. The road to recovery must be based on an
equitable, inclusive and gender-sensitive approach, where women and other vulnerable groups form
the centre of the COVID-19 response discussion and planning, especially in humanitarian
emergencies. For supporting pandemic-related interventions, the need for data, disaggregated by
gender, age and circumstances, is evident (UN Women, 2020a). To conclude, women need to be
actively involved while keeping their roles, responsibilities and social norms in mind (Fuhrman et al.,
2020). The lessons for addressing COVID-19 can go a long way to tackle gender inequalities, WASH
access and needs of mainstream and migrant communities if interlinkages are carefully noted and
tactically handled.
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