K. Khosh-Chashm

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The severity of water scarcity in many countries of the Eastern Mediterranean Region of the World Health Organization (WHO) has started to assume an apocalyptic dimension. Of the 23 countries of the Region, 10 consume more than 100% of their annual renewable fresh water resources [1]. To illustrate the severe water shortage in the Middle East and North Africa (MENA) region, a part of a press release of the World Bank in March 1996 is cited as saying, "Although many areas in the world face water scarcity problems, the MENA region has the most severe situation. With about 5 percent of the world's population, it has less than 1 percent of the world's renewable freshwater" [2]. It goes on to say, "One of the most extreme examples of the water crisis looming in the Middle East and North Africa is Gaza, where each Palestinian now has access to less than 15 gallons of water per day, compared to 800 gallons of water for each American." With the Region having a very rapid population growth, the problem of water scarcity becomes even more critical. It is estimated that because of the population growth and increase in water demand, as a regional average, there will be a drop of almost 50% in annual per capita renewable water between 1995 and 2025 in the countries of the Middle East and North Africa [3].

An exceptionally high percentage of the available water in the WHO Eastern Mediterranean Region is being used for agriculture [2]. At the same time, pollution from domestic, industrial and agricultural sources is degrading the quality of these same water resources. If the present economic activities continue, and agricultural practices are not radically up-dated, the future water shortages will surpass crisis proportion and may produce severe social, economic and political disruption and cause conflicts, or even wars.

The purpose of this paper is: 1) to examine water conservation in the WHO Eastern Mediterranean Region from an economic development perspective and 2) to assess development patterns and the need for integrated regional collaboration. The paper also looks at the need for more aggressive water conservation measures and policies as part of overall water resources management for preventing misuse, minimizing wastage and optimizing the benefits from the available water resources.

Population

In 1995, the total population of the Region was estimated to be 454 million. This was almost 8% of the world population, which was estimated to be 5.61 billion. The average population growth rates in most countries of the Region are high. In 1990, out of 24 countries in the world with average annual population growth rates above 3.5%, 12 were in the WHO Eastern Mediterranean Region. The 12 countries constituted 59% of the total population of the Region [4]. Approximately 45% of the total population of the Region was under 15 years old [4]. Fortunately, successful family planning practices have reduced the figure to 9 countries [5]. Table 1 shows the population patterns of the countries of the Region. As can be seen, the Region is experiencing rapid population growth in its cities [6]. Table 2 shows data for growth of some cities [4].

Water resources and water use patterns

Water resources

Most countries of the Region are located in arid zones and a large part of the Region is one of the driest areas of the world. The total renewable water resources of all countries of the Region are estimated to be 566 km³ per year. This amount is approximately 1.4% of the total renewable fresh water in the world, which is estimated to be 40 000 km³ per year. To illustrate the water poverty of the Region, the per capita renewable water resources in the world is almost 7000 m³ per year [1]. In the countries of the WHO Eastern Mediterranean Region, the average per capita renewable water is 1427 m³ per year. This figure indicates that the average person in other parts of the world has almost 5 times more water than a person in the WHO Eastern Mediterranean Region.

The availability of 2000 m³ of renewable fresh water per person per year is considered the threshold for water shortage. If the availability is below 2000 m³ per person per year, then the area is considered a water-poor area. An availability of less than 1000 m³ per person per year is considered extreme water poverty. Table 3 shows that in 10 countries of the Region, the renewable fresh water availability is in the bottom range of extreme water poverty. The average renewable water resources per person per year have declined rapidly since 1960, as the population has rapidly increased in the Region. Table 4 depicts the decline in renewable water supply from 1960 to 2020 [1,6]. The reason for the decline is primarily due to population growth.

Water use patterns

Table 5 shows the pattern of water use for the countries of the Region [1]. The table clearly shows that almost all of the available water is used for agriculture, often poor productive agriculture [1]. The present water use for agriculture is above 90% in 10 countries, between 70% and 90% in 8 countries, and between 55% and 70% in 4 countries; these latter are small countries that have virtually no agriculture production.

The present water use for domestic purposes is high in 9 countries (Bahrain, Cyprus, Djibouti, Jordan, Kuwait, Lebanon, Libyan Arab Jamahiriya, Qatar and the United Arab Emirates). Djibouti's and the Republic of Yemen's water use is between 3 m³ per person per year and 17 m³ per person per year. All of these countries (with the exception of Cyprus and Lebanon) suffer from severe shortage of natural water resources.

Table 6 shows the pattern of water use in the Region compared with the world as a whole and the regions of Europe and North/Central America.

Health and water scarcity

Health is the complete state of physical, mental and spiritual well-being (WHO's definition). In addition to absence of disease, there should be a supportive physical, economic and social environment to facilitate achieving the state of well-being and full potential for health. Water scarcity has a profound direct and indirect adverse impact on human health. It can result in people not having access to adequate water for domestic use and for maintaining hygiene standards. Water scarcity further increases the risk of water contamination and reduces the capacity of agricultural, industrial and commercial sectors to grow, thus inhibiting economic growth. Without a minimal level of economic standing, a person's health and well-being are compromised.

The WHO Eastern Mediterranean Region is experiencing rapid urbanization with serious health and environmental consequences. One of the major factors contributing to the migration of rural people is the inability to expand agricultural land to absorb the increased rural population. Water scarcity is one of the main reasons that agricultural land has not been farmed in the rural areas. Because of this situation, rural migrants, who are usually poor farmers, go to cities in search of jobs and survival. They generally end up in slum areas of the city and join the ranks of the urban poor. Housing and environmental services in urban poor areas are usually in a substandard state and consequently the health status of people in these areas is precarious.

Water conservation

Water conservation is not only about saving water and reducing wastage, it is also about improving the quality of life and the environment, among other things. Because of the severe water scarcity in the WHO Eastern Mediterranean Region, water conservation has come to be regarded as a means of saving more water to provide for the urgent water requirements of agriculture, industry, and domestic and commercial activities. The drive for immediate and rapid economic growth is so intense that, in reality, concern for future availability of water does not enter the development equation. However, by the year 2020, the average per capita renewable fresh water in the Region will be around 700-800 m³ per year (not considering Afghanistan, Islamic Republic of Iran and Pakistan). This figure is well below the extreme water poverty level of 1000 m³ per person per year. With this in mind, one wonders whether there will be enough water to support the current pattern of development activities. Therefore, there is a clear and urgent need to question the existing development patterns and to call for a change in this policy. We recommend that countries of the WHO Eastern Mediterranean Region move from development for rapid economic growth to water-conscious development for sustainable economic growth.

With this in mind and in the context of the WHO Eastern Mediterranean Region, water conservation will be examined further from the stance of water-conscious development, as an integral part of water resources management, and from the aspects of health and environment.

Water-conscious development

Existing problems and status

The pattern of water use in the Region (Table 5) indicates that a large percentage of water is used for agriculture. This is not surprising as the Region has a low average rainfall and crops have to be irrigated. Hence more water is needed to irrigate the crops as compared with other regions that have more rainfall. However, one of the main causes of high water consumption is the limited use of water-saving irrigation techniques and the planting and growing of crops or cattle raising that need large amounts of water. For example, beef production is particularly water intensive. To produce 1 kg of beef, 100 000 kg of water are needed [7].

Despite all of its attempts to raise much of its own food, the Region continues to be a net food importer because of the lack of adequate rainfall and modern agricultural techniques. Table 7 shows the contribution of agriculture to the gross domestic product of the countries of the Region and the percentage of water withdrawal for agriculture production.

Strategies

It is not easy to apply a water-conscious development approach in a short time. The economic, social, administrative and, above all, political dimensions of such a change are so large that much more deliberation and effort is needed to address them. That notwithstanding, the future critical water shortage in the Region calls for an urgent focused debate on the subject.

The following are a few conceptual strategies which could be addressed:

• regional and subregional integrated agricultural collaboration for food security;

• comprehensive review of existing agriculture, urban development, and industrial and commercial sectors within a water-conscious approach;

• development of a framework for a water-conscious development approach by major development sectors receptive to the concept;

• water-friendly urban development allowing the building of efficient water supply systems and facilitating wastewater collection, treatment and reuse;

• development of industries not requiring much water;

• development of links between population policies and family planning and key sectors.

Water conservation as an integral part of water resources management

Elements and status

Water resources management is a classic approach to water conservation. It involves preventing misuse of water, minimizing wastage and optimizing the benefits of water resources. The efficient use of municipal water supplies for industrial, commercial and domestic purposes is an important element. Similarly, prevention of water pollution, wastage in water distribution systems, collection and reuse of wastewater are also included.

In this context, the status of water conservation in the Region is a mix of good effort and no effort at all. In relation to municipal and domestic use, the problem of leakage in distribution lines, which is sometimes above the 50% mark, is severe. In many countries, proper metering of water and pricing are not exercised and water wastage is common.

In addition, the percentage of the population having access to a sewerage system is estimated to be less than 50% for urban areas [4]. Hence, most wastewater is not collected, treated and reused. The use of treated wastewater is becoming quite widespread in the member countries of the Gulf Cooperation Council, especially Bahrain, and in Jordan and Cyprus, and to some extent in Tunisia.

Municipal and domestic water conservation strategies

Some strategies for municipal water conservation are:

• detecting and repairing leakage in the distribution systems;

• metering water consumption and charging higher rates above a certain amount of usage per month (rising block tariffs);

• encouraging the use of water-saving devices through legislation and building codes, and lowering taxes on water-saving devices;

• connecting sewerage rates with water rates;

• implementing public education and awareness programmes.

To encourage domestic water conservation, the water utility should educate consumers to apply at the household level the three golden rules: reduce, repair and retrofit. Reduce is to cut out unnecessary water use, such as taking long showers. Repair is to stop water leaks in the home. One drop per second wastes 10 000 L per year. Retrofit means adapting or replacing older, less efficient fixtures or appliances with water-saving devices available on the market.

Based on these three rules, there are many ways and means to save water around the house, both indoors and outdoors. Many of these tips and checklists are available on the Internet [8].

Commercial and industrial water conservation strategies

This category includes private and public institutions, shops, various tourism facilities and industries. Conservation measures include the following strategies.

• There should be comprehensive metering of all commercial, institutional and industrial water consumption. The tariff structure for these users should reflect complete cost recovery of capital investment and operation and maintenance of water supply facilities.

• Water auditing should be applied and education campaigns implemented within the commercial, industrial and institutional facilities to reduce water consumption.

• Water consumption should be minimized by increasing efficient water use, introducing multiple uses of water, applying alternative technologies and by directing recycling in industrial and commercial enterprises.

• The reuse of treated wastewater in industrial applications, such as cooling towers, should be encouraged [3].

Health and environmental aspects of water conservation

Status

In the WHO Eastern Mediterranean Region, there is a substantial degree of surface water and, to a lesser extent, groundwater pollution. In many cities, the municipal and industrial wastewater is not properly treated. It contaminates the receiving streams and in some cases ground aquifers. Also, coastal waters are often contaminated as a result of industrial and municipal discharges. These conditions may lead to the spread of infectious diseases and contaminate seafood and seawater used for desalination [4].

As water scarcity becomes more acute in the Region, water will have to be recycled and reused more frequently in the future. The recycling will increase the chance of water being polluted. Also, because of the impending water shortage, water supply systems will only be able to provide water to customers on an intermittent basis. Naturally, this will increase the chance of water supply contamination. Already in many cities and rural communities, intermittent water supplies are common. As the water scarcity increases, intermittent water supply will increase even more. In addition, a water supply system that leaks and whose pipe joints are not watertight is in danger of being polluted by contaminated groundwater outside the pipes. This is a particular hazard when sewer pipes are laid close to water supply lines. The problem of cross-connection between water and sewer pipes has been cited as the cause of outbreaks of cholera, hepatitis, typhoid and other waterborne diseases in some cities in the Region [9].

Lastly, the reuse of treated wastewater for agriculture (which is an excellent way to conserve water) will surely increase. Such an increase may bring with it additional potential health risks.

Strategies

To cope with the above-mentioned situation, the following strategies are suggested.

• Identify major polluters and devise ways to clean them up and then strictly control their discharges.

• Levy a heavy pollution charge on municipalities and industries that contaminate water bodies.

• Improve and strictly observe the monitoring of water quality.

• Strengthen the monitoring and reinforcement of health measures and control the reuse of wastewater.

• Improve the quality of piping and water-tight distribution systems.

References

1. Irrigation in the Near East Region in figures. Rome, Food and Agriculture Organization, 1997 (FAO Water Report 9).

2. The World Bank Press release No. 96/49/S. Washington DC, The World Bank Group, 1996 (http://www.worldbank.org/html/extdr/extme/96/49/S.htm).

3. Bakir HA. Water conservation, wastewater reuse and pollution control: key elements of integrated water resources management. Amman, World Health Organization Centre for Environmental Health Activities.

4. Khosh-Chashm K. The impact of urbanization on health in the countries of the Eastern Mediterranean Region. Eastern Mediterranean health journal, 1998, 4(suppl.):S137-48.

5. Demographics and health indicators for countries of the Eastern Mediterranean, 1996. Alexandria, World Health Organization Regional Office for the Eastern Mediterranean, 1997.

6. World population prospects. New York, United Nations, 1988.

7. Health environment in sustainable development: five years after the Earth Summit. Geneva, World Health Organization, 1997.

8. Water: no time to waste. A consumer's guide to water conservation. Quebec, Informational Resources and Services, Environment Canada (http://www.ec.gc. ca/water/en/info/pubs/nttw/e-nttwi.htm).

9. Report on the Joint WHO and the Islamic Development Bank training course on strengthening of leakage detection/reduction programmes in the Eastern Mediterranean Region of WHO, Alexandria, Egypt, 4-9 June, 1995. Alexandria, World Health Organization Regional Office for the Eastern Mediterranean, 1995 (WHO-EM/PEH/476/E).