It’s time public toilets are treated as core urban infrastructure

As cities swell and skylines thicken, urban planning has quietly become a matter of life and health. City planning and policy decisions increasingly dictate how people breathe, move, and survive within the urban sprawl.

From walkable neighbourhoods and cycling infrastructure to accessible parks and green spaces, modern urban planning is increasingly framed as a public health intervention. Efforts to curb air and water pollution through green infrastructure, wastewater management and hygiene facilities, alongside reducing vehicle emissions by promoting public transport, all sit at the heart of healthier cities.

Equally critical is the promise of equity: fair access to housing, healthcare and mobility for all residents, not just the privileged few.

Each of these pillars warrants scrutiny in its own right.

This article, however, narrows the lens to the provision of hygiene infrastructure and specifically examines the availability and condition of public toilets in Karachi’s market areas, where the absence of basic sanitation poses a serious public health risk.

Pakistan’s toilet crisis

Access to toilets is central to safe sanitation, which is fundamental to human health and dignity. This understanding has slowly gained global traction over the past two decades, beginning with the establishment of the World Toilet Organisation in 2001 and culminating in the United Nations’ recognition of World Toilet Day in 2013, observed annually on November 19.

Together, these milestones helped catalyse a broader shift in how cities approach public toilets. Long relegated to the margins of urban planning, public toilets have begun to enter mainstream policy conversations — a shift largely driven by efforts to break the silence surrounding sanitation and recognise toilets as essential urban infrastructure.

Despite this progress, the scale of the crisis remains staggering. According to the World Health Organisation (WHO) and Unicef, 3.4 billion people worldwide still lack access to safe toilets. As a result, drinking water sources are routinely contaminated with human waste, leading to the spread of preventable diseases.

Each day, nearly 1,000 children under the age of five die from illnesses linked to inadequate water, sanitation, and hygiene. Environmental damage is equally severe; lakes, rivers, and groundwater continue to be polluted due to insufficient sanitation infrastructure.

In Pakistan, the situation is particularly acute. An estimated 79 million people lack access to proper toilet facilities, per World Bank data. The crisis is most pronounced in rural areas, compounded by rapid population growth, weak infrastructure planning, recurring natural and man-made disasters, and shifting economic pressures. Open defecation contaminates groundwater and natural water sources, fostering bacteria and pathogens that make water unsafe for consumption.

Beyond public health, inadequate access to toilets has serious social and gendered implications. Limited or unsafe facilities disproportionately affect women, exposing them to harassment, abuse, and infection, while also forcing many to delay relieving themselves (behaviour that can result in severe medical complications). The Covid-19 pandemic and the continued emergence of infectious diseases have further underscored the importance of functional public toilets as a basic prerequisite for healthy cities.

A private struggle in a public space

Karachi, a city that contributes substantially to Pakistan’s national economy, continues........

© Dawn Prism