November 2024 An Urgent Call to Protect Sanitation Workers' Health and Safety Adnan Hakeem and Sterenn Philippe
Tasleem Mai, 50, sanitation worker from Muzaffargarh, Punjab, Pakistan. September 2021. Image: WaterAid/ Sibtain Haider
In Pakistan, sanitation workers, like 50-year-old Tasleem Mai from Muzaffargarh, reveal a side of public health that few ever see: toxic fumes, makeshift safety practices, and the relentless physical toll of dangerous work. This blog shares their unfiltered stories—from Adnan Zaib’s painful recovery after a severe injury to the desperate need for better equipment and health support across cities like Karachi and Peshawar. It’s a raw look at the lives behind the labor, and what it would take to turn promises of safety into reality. Take a moment to hear their voices and join the call for change.
In March 2024, the tragic deaths of two more sewer men in Faisalabad, Pakistan, underscored the grave risks sanitation workers face daily to protect public health. Punjab Chief Minister, Maryam Nawaz Sharif, visited the bereaved families and expressed her condolences, a gesture highlighting the increasing awareness of the hazardous nature of this essential yet perilous profession. Khalil Tahir Sandhu, provincial minister of human rights, also visited the families, stating that the Punjab government will take care of the children of the two workers and that their educational expenses will be covered by the government.
While the government's commitment to supporting the families of the deceased workers is commendable, it highlights the broader need for systemic change (read recommendations below). Unfortunately, this incident is not an isolated one. You may remember, the death of Irfan Masih in 2017, a 30-year-old Christian sewer man in Sindh Province, which sparked the #IamChoorha movement. According to his family, Masih died in hospital after inhaling toxic fumes to clear a blocked sewer. They also alleged that he faced discriminatory neglect, highlighting the compounded challenges faced by sanitation workers, particularly those from minority communities.
Tasleem Mai, 50, sanitation worker from Muzaffargarh, Punjab, Pakistan. September 2021. Image: WaterAid/ Sibtain Haider
The unheard stories
The reality is that no one knows the exact number of sanitation workers who have passed away as there are no official records of the fatalities or injuries suffered by sanitation workers in Pakistan, but the risks are evident. To gain a deeper understanding of these dangers, WaterAid Pakistan conducted a study, including 33 interviews with sanitation workers across Islamabad Capital Territory (ICT), Khyber Pakhtunkhwa, Punjab, and Sindh. Their stories paint a harrowing picture of inadequate protection and support.
In Landhi, Karachi, sanitation workers shared distressing accounts of their colleagues succumbing to poisonous gases due to the absence of basic protective equipment. “Many times, those who attempt to save a sanitary worker in trouble either die themselves or pass out.”, they explained, highlighting their helplessness in supporting their colleagues. They noted that the maintenance of sewers by the Karachi Water and Sewerage Board (KWSB) is still done manually.
Meanwhile, in Peshawar, Adnan Zaib, a father of two and a permanent employee of Tehsil Municipal Administration (TMA), recounted his own experience with workplace injury. A piece of metal pierced his thigh, leading to a severe infection, two surgeries, and six months confined to bed. Although the Water and Sanitation Services Peshawar (WSSP) reimbursed part of his medical bills, Adnan had to bear much of the cost himself. "The wounds are healed, but they still cause pain when I do sanitary work," he said, underscoring the long-term impacts of inadequate safety measures.
The government response
Despite the grim realities reported by sanitation workers, government officials presented a different point of view. The Director General of the Water and Sanitation Agency (WASA) at the time of the study, S. Zahid Aziz, asserted that regular training and provision of protective equipment (compressors, oxygen cylinders, gloves, dry suits, masks, and gas detectors) are standard practice. Similarly, officials in ICT and other provinces claimed adherence to strict safety protocols and the use of mechanized cleaning methods to minimize risk.
However, officials from KWSB admitted to resource constraints that lead to gaps in safety provisions. While acknowledging efforts to provide safety kits, one official also attributed some of the responsibility to workers' "carelessness," suggesting accountability is complex.
The Way Forward: Protecting Our Hidden Heroes
The Pakistani government has invested significantly in sanitation infrastructure, but there remains a critical need to prioritize the safety of the workers who maintain these systems. This requires a dedicated budget for Personal Protective Equipment (PPE) and machinery to reduce the risks for sanitation workers, including reducing the need to enter the sewers in the first place.
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Recommendations National and Provincial governments must review policy to ensure: 1. Health coverage and support: Provide comprehensive health insurance and financial support for injured workers and the families of deceased workers, and make medical checkups mandatory. 2. Mechanization of sewer maintenance: Invest in technology to perform sewer maintenance, reducing the need for workers to enter dangerous environments. 3. The tracking of illnesses and accidents: Develop and implement a reporting mechanism to keep track of illnesses, injuries, and accidents. WASAs and Pakistan Water Operators Network must provide: 1. Adequate PPE provision: Ensure all sanitation workers are equipped with proper PPE, including masks, gloves, and gas detectors. 2. Standard Operating Procedure (SOP): Develop and enforce SOPs to ensure PPE is available and used at all times. 3. Capacity strengthening on health and safety: Provide regular and adequate training on health and safety for sanitation workers. |
Sanitation workers are the unsung and invisible heroes of public health. Protecting them is not just a moral imperative but a crucial step towards a cleaner, safer, and more just society.
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For more information on sanitation workers in Pakistan, read the policy brief.
Authors: Adnan Hakeem is the WASH Specialist at WaterAid Pakistan. Sterenn Philippe is a consultant supporting WaterAid on sanitation initiatives.