Within the past month, San Francisco made an important stride toward providing water to more unhoused San Franciscans. Yet as the City makes improvements to water access, it has taken significant steps backward when it comes to access to sanitation and hygiene. Just this month, the City’s plan to substantially reduce access to public toilets across San Francisco, targeting locations with high concentrations of unhoused San Franciscans, was unveiled.
Water, sanitation, and hygiene (WASH) are essential for every person on the planet. A person can only live about three days without access to drinking water. Adequate sanitation and hygiene, which also rely on access to water, are essential for mitigating illness, disease and plagues that have ravished humanity for millennia. Due to the central role that WASH plays in maintaining life and dignity, the United Nations (U.N.) Human Rights Council recognized access to safe drinking water and sanitation as a human right in 2010, requiring that “drinking water and water for personal and domestic usage as well as sanitation and hygiene facilities are available, accessible, safe, acceptable, and affordable for all without discrimination.” Soon after, California became the first state in the United States to legislatively recognize the human right to water and sanitation in 2012. California recognizes that “every human being has the right to safe, clean, affordable, and accessible water adequate for human consumption, cooking, and sanitary purposes.”
In 2015, the human right to water and sanitation was embedded in the Sustainable Development Goals (SDGs), a set of global goals designed to achieve a better and more sustainable future for all. The SDGs were established by the U.N. and agreed to by nearly 200 nations, including the United States. Goal #6 of the SDGs calls for the “availability and sustainable management of water and sanitation for all”, including targets to “achieve universal and equitable access to safe and affordable drinking water for all” and “achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations.” While many countries are striving to reach the goal of universal access to water and sanitation for all people on the planet, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) reported that in 2017 2.2 billion people were without safely managed water services and 2 billion people still did not have basic sanitation facilities, such as toilets or latrines.
In countries with high WASH coverage like the United States, universal SDG WASH targets will only be achieved when they are met for all subgroups within the population. With contexts like the U.S. in mind, the WHO and UNICEF have highlighted “informal urban settlements” and “disadvantaged groups” as high-risk subgroups that are routinely left without adequate access to WASH services, thereby keeping these countries from achieving universal access to WASH. According to UNICEF and the WHO, “equitable access implies progressive reduction and elimination of inequalities between population subgroups”. Within the U.S., unhoused Americans living in informal urban settlements are a high-risk subgroup that has too long been ignored.
San Francisco mirrors many urban contexts within the United States: It has a very high level of WASH services for the majority of its community members, but a very low level of WASH services for unhoused San Franciscans. In an effort to highlight this disparity, the Coalition on Homelessness launched the Water For All Campaign, which applied the international minimum standards for water access to unhoused San Franciscans. The coalition’s Water For All report revealed that 60% of unhoused San Franciscans fell below the lowest level standard of having access to 15 liters of water per person per day, while 74% of unhoused San Franciscans fell below the standard of 50 liters of water per person per day set for urban, middle-income settings. Furthermore, 78% of unhoused San Franciscans do not meet the combined minimum international standards for travel time and distance to a safe water source, set by the WHO, UNICEF, and the United Nations High Commissioner for Refugees (UNHCR).
When it comes to assessing a community’s sanitation status, a lack of open defecation is a central indicator used by the international community. Additional indicators, including the ratio of people per toilet, as well as distance to a toilet, are used to assess a community’s progress toward the goal of universal sanitation coverage. In emergency contexts, UNHCR sets sanitation standards that are lower than the sanitation standards set for stable contexts. For instance, within the first six months following an emergency, the international minimum standard for sanitation is one toilet for every 50 people. Following the initial surge of an emergency, the sanitation standard increases to one toilet for every 20 people during the timeframe of six months to two years following an emergency. After two years, the sanitation standard is one toilet for every 5 people, or one toilet for each household. Additionally, the Sphere Standards, which serve as an internationally agreed-upon set of humanitarian standards, states that there should be no more than 50 meters between a person’s dwelling and a shared toilet.
Similar to its disparity in access to water, San Francisco has a very high level of sanitation coverage for the majority of its community members, while having a very low level of sanitation coverage for unhoused San Franciscans. For residents of and visitors to San Francisco, as well as those paying attention to national and international media coverage highlighting San Francisco’s infamous “Poop Maps”, open defecation is a clear and present reality in San Francisco. Furthermore, San Francisco falls below international minimum standards for the number of people sharing a toilet, as well as for the distance to a toilet.
At the onset of the COVID-19 pandemic, San Francisco set out to increase WASH access among its subgroup of unhoused San Franciscans. The severe lack of public water access points was mitigated by connecting temporary water taps to fire hydrants. Furthermore, San Francisco increased the number of public toilets throughout the city, calculating the number of toilets needed by using the international standard of one toilet for every 50 unhoused people set by UNHCR. While this effort began moving San Francisco in the right direction, it fell short of achieving the international minimum standards for access to both water and sanitation, and failed to ensure that all San Franciscans have access to a toilet within 50 meters from their dwelling. Furthermore, despite having proven its ability to achieve the target of one toilet for every 50 unhoused San Franciscans during the year of sheltering in place, San Francisco recently began removing public toilets throughout the city. According to a Public Toilets Policy Analysis Report, issued by San Francisco’s Budget and Legislative Analyst on June 9, 2021, San Francisco has removed toilets from 17 city sites during the period of May 2020 to May 2021. Furthermore, the Mayor’s proposed budget for Fiscal Year 2021/2022 included a $2.4 million cut to the City’s 24-hour “Pit Stop” public toilet program, reducing the number of 24-hour public toilets to zero. At the very point in time that San Francisco should be increasing its efforts to adhere to the international minimum standards of one toilet for every 20 people during the transition phase following an emergency (e.g COVID-19), San Francisco has instead quietly cut funding for public toilets, thereby eroding the significant progress that has been made over the past year. This action will move the community further away from the goal of universal sanitation coverage and increase the inequality of WASH services between San Francisco’s subgroups.
At the same time that San Francisco is losing ground on sanitation access, there is a glimmer of hope for unhoused San Franciscans when it comes to water access. The City recently approved the addition of three permanent drinking water stations within the Tenderloin, the district with the highest concentration of unhoused San Franciscans. This increase was an emergency recommendation of the Water For All Campaign, and the result of a lot of work among homeless advocates. It also highlights the willingness of San Francisco’s Public Utilities Commission (SFPUC) to partner in the shared goal of providing water access and prioritizing the expansion of water access to unhoused San Franciscans. While the SFPUC has publicly acknowledged that access to water is a human right, achieving this goal is dependent on a commitment from the City to fund these critical WASH facilities.
San Francisco is one of the wealthiest cities on earth, yet it has not achieved universal WASH access. As long as San Francisco continues to ignore unhoused San Franciscans, it will never achieve universal WASH access. Barriers to achieving universal WASH access in San Francisco have less to do with financial resources and more to do with political will. According to a report by the United Nations, San Francisco’s failure to achieve universal WASH access is more than passive negligence, but rather an active strategy to discourage unhoused San Franciscans from residing in the community. Leilani Farha, U.N. Special Rapporteur on the Human Right to Adequate Housing called this strategy a human rights violation in a 2018 report, which said that “attempting to discourage residents from remaining in informal settlements or encampments by denying access to water, sanitation and health services and other basic necessities, as has been witnessed by the Special Rapporteur in San Francisco and Oakland, California, United States of America, constitutes cruel and inhuman treatment and is a violation of multiple human rights, including the rights to life, housing, health and water and sanitation.”
The United Nations, the United States, the State of California, and San Francisco’s Public Utilities Commission all acknowledge that WASH is a human right. Yet as San Francisco agrees to expand access to water, its simultaneous removal of public toilets exposes a more underlying issue that has been stunting the community for decades: Its dismissal of unhoused San Franciscans. San Francisco must ensure WASH access for all of its residents, including those who are unhoused.