The dirty truth: 41 million Pakistanis without toilets
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Recently, a Unicef warning announced that an alarming 41 million people in Pakistan lack access to adequate toilets; forcing them to defecate in public. Pakistan is in fact the third largest country, behind India and Indonesia, where people are forced to defecate in the open.
This troubling practice which has become the norm for 41 million Pakistanis has profound health and nutritional consequences. Open defecation has significant consequences and it is imperative that we explore this topic.
Also read: Finding a phone easier than finding a toilet: UN
The city of Lahore is home to millions of people and has only 21 public bathrooms. Many of these are in dire condition and in a state of chronic decay. It is tragic that in a country that receives millions of dollars of aid annually, we have failed to provide the most fundamental necessities such as clean bathrooms to our people! Forcing individuals to seek out places to defecate leads to stool withholding behavior, constipation, and stunting.
These consequences have lifelong implications and must be addressed immediately.
Stool withholding behaviour
When children are confronted with psycho-social stressors such as not being able to defecate in private or adequately; they have a tendency to develop stool withholding behavior – they refuse to defecate in a setting where they are uncomfortable or embarrassed, causing them to reflexively withhold bowel movement.
For a child to defecate in open, it is very embarrassing and anxiety-provoking. This can lead to serious problems known as Encopresis, in which children begin to soil their undergarments.
The colon normally removes water from our faeces, but stool remaining in our gut for too long from conditioned withholding will inevitably lead to constipation. The stool becomes so hard that it is difficult to expel and stretches the colon, impairing the sensations associated with a normal bowel movement. As a result, softer stool often leaks around the blockage, soiling a child’s undergarments.
As anyone can imagine, this has devastating effects on an individual's overall level of hygiene. The faecal contamination of hands, garments, and other clothing will allow infectious diseases to disseminate with ease.
Constipation
The health ramifications of constipation are severe, and unfortunately, frequently overlooked.
Our colon is home to a bacterial flora which is essential for maintaining gut health. Constipation leads to an imbalance in this bacterial flora giving rise to unfriendly strains of bacteria and impaired gut health. The normal helpful bacteria within the colon is disturbed when hard stools associated with constipation persist.
Also read: CDA to upgrade public toilets in Islamabad
Constipation can lead to abdominal pain and a decreased desire to eat as well. In cases where constipation goes unchecked, forceful straining and attempts to evacuate stool can lead to tears and bleeding around the lining of the rectum.
Stunting
A child’s degree of stunting can be evaluated by calculating a child’s height for age as a percentage of the population median. The severity of stunting is determined as a percentage of the expected height for age.
Stunting, along with wasting, is a universal marker of protein energy malnutrition in a child.
Chronic malnutrition is frequently characterised by stunting. Due to open defecation, children are unable to adequately wash themselves and consequently, a bacterial contamination of water ensues. This leads to chronic diarrhoea and malabsorption states in children. Such chronic malnutrition leads to cognitive deficiencies and insufficient brain development.
Read on: Pakistan among top five diarrhoea death victims
Sanitation, hygiene, and constructing more public toilets must become a priority in Pakistan.
Failing to provide our children with the basic necessity for living is inhumane, and detrimental to their well-being.
Instructing the masses on adequate hand hygiene, providing ample toileting facilities will help with combating this problem.
Open defecation must be discouraged. And, massive efforts must be implemented to create behavioural change, provide adequate facilities, and increase awareness about overall hygiene.
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Arif Mahmood is currently a medical doctor residing in the US with varied interests in South East Asian art, classical music, photography, and literature.
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Comments (95) Closed
Mar 10, 2015 03:48pm
We are shy to discuss this topic, because we think we have more bigger problems in Pakistan , like The Kalabagh Dam, Kashmir , Palestinian etc.
And we know very well in Arabic is “Tahara” which means “Purity. “Cleanliness is half of faith”.
I never heard from any religious scholars, NGOs or political parties, that how we should solve this big problem.
I am confident we can solve this problem easily, just give awareness to public and NGOs. There are so many mosques and Government properties all around if their management "Re-Design" toilets [ entrance from the out side the property ]. Then the public can get benefit.
Together we can make a Difference :)
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Mar 10, 2015 03:52pm
No comments for pakistanis ? Huge shock right?
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Mar 10, 2015 03:54pm
Recently, a Unicef warning announced that an alarming 41 million people in Pakistan lack access to adequate toilets; forcing them to defecate in public.
Has UNICEF come up with a plan to help provide these 41 million peoples in Pakistan to defecate in private in a toilet. Enough of criticism let us do some thing productive to overcome the health hazard posed by non availability of proper toilets. In my opinion mere diagnostic of a problem without providing proper medicine for cure is waste of time & insulting those undergoing the trauma.
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Mar 10, 2015 04:02pm
@Rajesh "No comments for pakistanis ? Huge shock right?"
You should be more shocked that there are 690 million Indians who have no access to toilets however; this is not India vs Pakistan match. Both countries need to address this serious issue.
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Mar 10, 2015 04:19pm
atleast India realized to fulfill these needs and construct heavily on public health awareness, we are not even bothered to discuss this issues. before we show our fingers to India we have to correct from our mistake. nukes wont give hygiene
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Mar 10, 2015 04:20pm
Countries are busy building arsenals in the continent which needs toilets for its Aam public. ..Instead of kashmir etc both PM should share ideas on how to ensure 100% of its population gets their basic human right to poo in private..
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Mar 10, 2015 04:24pm
I thought India is the only country with no Public Toilets!
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Mar 10, 2015 04:31pm
@Abdulla Hussain Many Pakistani friends criticised India on toilet issue ,but India is very serious and paying Rs. 10000 (INR) for constructing toilet for every house hold !
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Mar 10, 2015 04:53pm
Wow! 41 million. I had no idea there was such a big problem. Some intelligent thinking is required. Public toilets need not be complicated. They can simply be a hole in the ground (which is covered) with some sort of platform around shed around it for privacy. Have a water pump nearby too.
All this faeces can then be recycled locally to generate bio-gas for energy.
The solution to poverty doesn't have to be global or national in scale, the budgets don't need to be in the billions, we need small cheap, localised solutions.
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Mar 10, 2015 05:06pm
@lafanga - 690 million....? Kidding right...?
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Mar 10, 2015 05:10pm
Recognition of problem is the first step in the direction of solving problem.
Here Modi rises above all the other leader who showed the courage to speak about it from the ramparts of the Red Fort on the independence day of India.
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Mar 10, 2015 05:23pm
@Rajesh, please wait a bit before making a comment. Pakistani do realize and acknowledge problems faced by our country.
We do not believe in deceiving people by showing all colours and dances in movies, while hiding the ugly reality of abject poverty prevailing in India.
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Mar 10, 2015 05:26pm
Build toilets? Start a competition with India? Who builds faster and better toilets and cleans up the environment?:):)
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Mar 10, 2015 05:38pm
Please do not turn this into an India-Pakistan issue.
This is a sad reality for humanity, irrespective of the nationality of those poor people.
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Mar 10, 2015 05:51pm
No innovation in the past 200 years has done more to save lives and improve health than the sanitation revolution triggered by invention of the toilet. But it did not go far enough. It only reached one-third of the world...sad but it is a fact...
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Mar 10, 2015 06:12pm
India has adopted a good campaign of toilets now temples later. Maybe Pakistan would benefit if they adopted a similar sentiment....
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Mar 10, 2015 07:08pm
And I have been laughing at India all this time!
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Mar 10, 2015 07:40pm
@Abdulla Hussain : I disagree with you. it is not UNICEF's responsibility to solve Pakistan's problems. It is us who need to prioritize and solve our problems. Our over-reliance on foreign agencies is crippling us. We need to own our problems, solutions and implementation of these problems.
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Mar 10, 2015 07:42pm
@Akhroot : Yes, and I can imagine why you thought that.
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Mar 10, 2015 07:45pm
Do not worry - India has a far more people without toilets. We are still ahead.
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Mar 10, 2015 07:49pm
40 million pakistani defacate in the open....meaning they do not have any toilets...and the government can spend millions on nuclear weapons whilst its people do not have this basic ammenity....
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Mar 10, 2015 08:17pm
@Amer RAO - Toronto
That's an excellent point many mosques have toilets, and more often than not in Pakistan they are relatively well maintained. And serve as a public service (usually that's what I use when I have to go). Any plans can take this inot account
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Mar 10, 2015 08:26pm
The writer is missing one important point. All the mosques, big or small have toilets in addition to abulation areas, and i've seen people in the markets, small vendors, passerby's using these toilets. Mosques are public places and they numbers in thousand in any big city like Lahore and Karachi.
So these toilets serves the purpose of public toilets, and they are generally in good condition, build through donations.
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Mar 10, 2015 09:04pm
@Virumandi;
" 690 million....? Kidding right...?"
India has over 1200 million people, this number is just a little over 50%, sounds about right.
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Mar 10, 2015 10:04pm
@lafanga: 41 millions of pakistan's total population constitutes about 22% , whereas 690 million is nothing compared to 1.2 billion Indian population. That said, both of the countries need to tackle this issue and improve the living condition of their common people. Hopefully, the constant gloating from Pakistani friends about Indian sanitary conditions will stop now..it is going forever for quite some time now. And I do hope my Indian brothers and sisters will not commit the same mistake and indulge in mudslinging.
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Mar 10, 2015 10:09pm
Two contrasting News say it all about the HDI status of the nation . 1- More than 40 millions do not have the basic human need to afford attend to the call of nature in a humanely manner . 2- Pakistan test fired a ballistic missile (shaheen 3 ) capable of killing evrey thing in its vicinty , more than 2500KM from the place it would be fired if some one decides to do it !
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Mar 10, 2015 10:19pm
@lafanga
maths is not taught in subject in madrassa, eh. very weak with numbers , I see.
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Mar 10, 2015 10:39pm
@sj2015: Something is wrong with your math. However I agree with your suggestion.
Good article by the author!
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Mar 10, 2015 10:42pm
@Salman : Awww, is this all the competition you can think of with India? Let's focus on our problem and our solution to it dude. Infact if India, Indonesia and Pakistan can collaborate on bringing innovative solutions, that will be great.
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Mar 10, 2015 10:50pm
We should make help raise money to build at least locally.. Every little helps!
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Mar 10, 2015 11:05pm
Isn't it an Indian specific news. The word 'Open defecation' is Indian-centric news...680 million is huge.
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Mar 10, 2015 11:12pm
I think Indian friends are missing a point here. Yes it is true that a large part of our population has no toilet. But we are not the ones claiming to be a super power and shining and what not. It's you guys. We know we are a third world country, nothing more nothing less.
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Mar 10, 2015 11:29pm
@Abdulla Hussain Let Sharif brothers build highways and metro, the problem will be solved.
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Mar 10, 2015 11:32pm
@Salman No we are not worried because we know one day we will achieve our goal of building toilets as we achieved of being polio free country. Because our country is stable country which Pakistan never be.
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Mar 11, 2015 12:46am
typical basic hygiene issue prevailing in south asia.......
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Mar 11, 2015 12:55am
If only the elected politicians spent the money available for the greater good.
Instead they loot and steal leaving nothing for improvement and welfare.
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Mar 11, 2015 01:23am
@ROHIT PANDEY
It is about time we start competing with each other on who takes care of the ordinary people in both India and Pakistan instead of competing to produce bigger bombs to destroy each other.
Let us worry about our problems than worrying about Kashmir, Palestine and so on.
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Mar 11, 2015 01:46am
@lafanga I agree 100% with you.
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Mar 11, 2015 03:06am
@Virumandi "690 million....? Kidding right...?"
Not kidding. 640 million is the official GOI figure according to the latest census. You can look it up on the net. I am not off by much. Maybe my number is correct since govt generally uses the low figure.
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Mar 11, 2015 03:11am
@ZAK "maths is not taught in subject in madrassa"
They do in some madrassas I think. Maybe they should replace maths with "ancient Indian astronomy" and learn about all the wonders of space flight 5000 years ago. What do you think?
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Mar 11, 2015 03:25am
It was Pakistan Government job to keep track of internal issues, not UNICEF. It's a shame that Government is negligent about such basic issues like Housing, Toilets, food and Water. Pakistan should have compulsory clean toilet in every patrol pump, every food chain, every restaurant; ever school should have multiple toilets with running water. People should help neighbors in these facilities. In poor areas, government should help making a fabricated toilet attached to every two homes. It's not just toilet, putting water in the system is also important.
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Mar 11, 2015 03:28am
@Abdulla Hussain So are you looking for support from UNICEF now?
When the world criticizes India, we try to fix it ourself. Why can't you guys do the same? Pakistan's internal failure is not UNICEFS concern, its your country. If you can build nukes with the help if China then you can also build toilets or dams.
Unless you become self-sufficient, you can't teach good stuff to your future generations.
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Mar 11, 2015 04:10am
One way Canadian government has solved this problem is by enforcing all eating places and gas stations (petrol pums) to maintain clean toilets accessible by anyone. Since eating places and gas stations are almost every where, one is always near a toilet when needed.
May be Pakistani government can also explore and evaluate similar options.
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Mar 11, 2015 04:11am
@Dwaraka Nath "@Abdulla Hussain Many Pakistani friends criticised India on toilet issue ,but India is very serious and paying Rs. 10000 (INR) for constructing toilet for every house hold !"
Which is a good start....just wondering where the water to flush all these new toilets will come from.
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Mar 11, 2015 04:18am
@Shakeel good suggestion. Building covered drains would be a good idea too (for both countries) to control spread of water borne infectious diseases.
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Mar 11, 2015 06:27am
Not bad!
BIMARU (COWBELT) states in India + Haryana + Odisha (Orissa) is way higher than pakistan!
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Mar 11, 2015 06:38am
Those who do not defecate openly end up polluting the ocean and internal waterways. Soap Pits are the only healthy alternative. When deprived of sunlight they grow micro-organisms that can digest soap and return purified water to mother earth. Before the Soap Pits are compartments that create fertilizer ideal for growing vegetables in. No smell comes out. This knowledge was once upon a time taught in architecture courses. If mud goes into the Soap Pit it can be permanently damaged and hence the compartments before it are designed to make sure that even if it does get to them it won't make it to the Soap Pit.
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Mar 11, 2015 07:01am
Tax the rich and lower the spending on nuclear weapons and
Built tiolets! Very simple. Massage to pakistan and India
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Mar 11, 2015 07:07am
Toilets first,nuclear bomb later.
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Mar 11, 2015 07:30am
@Mustafa ;
" 41 million....? Kidding right...?"
Pakistan has the whole of its population over 178 million people, this number is just a little over 97%, sounds about right.
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Mar 11, 2015 08:02am
We fail to realize that human capital is the most important thing in any country. Protecting an individuals health should take priority over military spending, political spending, and everything else.
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Mar 11, 2015 08:36am
Nature has designed its system where the faeces of all animals are ultimately recycled and enrich the soil.It also brings around disease in case population increases and acts a natural population control.
However with modern societies the disease causing effects need to be controlled. The solutions are not without side effects.The drainage systems pollute water and ground,use a lot of water and by reducing diseases adds to the population.Where people do not have proper water to drink or cook ,it is cruel to talk of drainage systems.Also like the roads ,drainage systems are a very temporary solution.The only long term solution is population control. and proper water management
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Mar 11, 2015 08:42am
Could we have had sloved this problem with all the money spent on nukes?
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Mar 11, 2015 08:53am
Because Government is trying to win nuclear arms race from India there toliets are not basic necessity for 41 million people. We need to have more arms than India
so you people understand. What a Shame that after 67 years being independent we can not provide basic needs to our Citizen. Probably people were better off if we were not seperated.
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Mar 11, 2015 09:17am
@sj2015 sir please check your Maths
690 million of 1.2 billions means almost 50%
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Mar 11, 2015 09:20am
@Rajesh
Still more public defecation in India as you claim to flood us with it. Got the comment?
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Mar 11, 2015 09:21am
@Virumandi
Increase it then.
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Mar 11, 2015 09:25am
@Khizr: Brother, please refer to the comment to which I replied! My computational skills by God's grace are still intact ;) But thanks for understanding the message I intended to convey.
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Mar 11, 2015 09:44am
There are many mosques in Pakistan and every mosque has minimum of 4-5 washrooms....So toilet problems in Pak very less than India..We have bigger problems like Terrorism and Load Shedding to counter...
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Mar 11, 2015 09:52am
@Khizr: LOL! My bad! I understand what you are pointing at. I stand corrected. But you got the message conveyed. Thanks!
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Mar 11, 2015 10:07am
@Abdulla Hussain it is Pakstan who should implement a solution consodering that the problem has been identied.
The Doctor diagnoses an illness but does not take the medicibe, it is for the patient to take the medicine.
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Mar 11, 2015 10:10am
@lafanga india recognizes the problem and is working on solving it. The Indian PM us even on record saying tht building a toilet is more importnt than buikding a new temple.
However, Pakistanis have frequentky been taunting India about open defecation as though the problem does not hapoen in India.
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Mar 11, 2015 10:16am
Not to worry, you have at least 120 Nuclear Bombs.
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Mar 11, 2015 10:16am
@Akram - Well said, we need to get out of this Imaginary Superpower mentality.. Thankfully the current Govt has realized this & is putting together all its resources together (including private parties) into the Clean India campaign, which includes building toilets on a war footing.. I am waiting for the new figures on open defecation in 2015..
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Mar 11, 2015 10:25am
Then what, these unprivileged Pakistanis, if they visit Islamabad, shall have the privilege of traveling on multi-billion ruppees Motorway, and of course Metro-bus.
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Mar 11, 2015 10:27am
@lafanga I saw you doing the audit in India last week, good on you, we need poeple like you to help us carry the audit for future problems whenever they arise.
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Mar 11, 2015 10:36am
Dear UNICEF, can help us to get rid of corrupt leadership, and please tell the West not to back them or even talk to them, than we will overcome our problems with in no time. Kind regards. Thank you
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Mar 11, 2015 10:37am
@Rajesh No comments for pakistanis ? Huge shock right?
dude grow up
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Mar 11, 2015 11:10am
On top of it, this nation eats spicy food.
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Mar 11, 2015 11:23am
I think these are the biggest issue India and Pakistan confront rather than other issues. If they solve these issues rest of co called politically sensitive issues will automatically solve and the Region will prosper. But it will not be easy as I see these issues are an outcome of immature and corrupt governance for decades along with lack of will and strength by political leaders to address such harsh/hard issues. Some efforts are being made by India in last few months by new PM. Let us see how they progress. Pakistan leadership also need to tackle these issues head-on, or at-least start some serious efforts.
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Mar 11, 2015 11:28am
@Stargazer Do you know how much is the rate of improvement in India ..govt of Indian provides around 10000 rs / house (20000 pkr)to build toilets in India.with plans of toilets for every one within next 5 years.......... what's is your Govt. doing?
with a huge population numbers in India will be always high .we are not just talking but are doing as well.
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Mar 11, 2015 11:29am
@Akram Indians don't claim that either, we do think we have the potential to become one In The future though. Nothing wrong with having big goals
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Mar 11, 2015 11:31am
I was waiting as yesterday a news appeared in DAWN India to build million toilets in India, if you visit India you can see the poverty as its best and the sanitation is completely, but how meticulously when a news appears for India a captioned news for Pakistan comes to either malign or degrade Pakistan and Pakistanis the hygine habits of Pakistanis comparing Indians are far better also contributing to the religious practice of ablution.. It shows in all walk of talk life, only waging media war and spreading sense of helplessness In Pakistan will not change the grand plan of Divine intervention its depends upon the individual which side of the history you stand...
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Mar 11, 2015 11:33am
@Haider no one denies India got a bigger toilet problem. The thing is that Pakistanis love bringing up India's toilet problem on different Internet forums, while Pakistan it self is only 3rd in the whole world.
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Mar 11, 2015 11:39am
Toilets!! that's not an issue for a nuclear power country
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Mar 11, 2015 11:52am
@Stargazer Good one. :)
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Mar 11, 2015 11:53am
Yes Pakistan has nuclear weapons, but no toilets for all its citizens, no drinking water for all its citizens, no schools for all its children, no food for all its hungry, no housing for its masses, no power, no public transport, most of all no law and order, no security, but we are suppose to think that we are secure because we have nuclear weapons, it does not matter who takes your life, who robs you at gun point, who robs your home, your family, as long as India does not do anything. That is Pakistan's doctrine for the last 67 years. Please correct me.
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Mar 11, 2015 12:07pm
nothing compared to half a billion Indians without access
to toilets and clean drinking water.
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Mar 11, 2015 12:34pm
you know the rate at which India is working on it..Govt spending 10000 /house in India and have plans to provide toilets for all by 2019
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Mar 11, 2015 12:36pm
@Stargazer LOL from toilets to movies. Well Pakistanis are bad in both.
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Mar 11, 2015 02:05pm
@Rajesh, Still less than Indians. We can not beat you in his matter.
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Mar 11, 2015 02:21pm
India and Pakistan are not doing enough for the betterment of poor/downtrodden people. Spending money lavishly for arms. poor people.
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Mar 11, 2015 02:50pm
India (680mn) or Pakistan(41mn), we need to address this issue. Fighting on the comment section of a news site will not solve the issue.
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Mar 11, 2015 03:09pm
There was a person and her institution that focused on improving sanitary conditions in the low income communities in this country. Her name was Perween Rahman. She was an architect by profession and training. She left the conventional career path of designing and making palaces for the rich to devote her life to work for the poor of this country. What happened to her? She was gunned down while on the way home from her office in Orangi Town on 13 March 2013. Eight months later, her successor, Mr Salim Alimuddin was attacked with a bomb. He miraculously survived. Result: Very few people are now interested to help the poor and needy in this country.
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Mar 11, 2015 03:12pm
@Stargazer Cinema is entertainment my friend. Do you go to a theatre to watch people defacating in open?
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Mar 11, 2015 03:17pm
@Akram Who stopped you from claiming to be a super power? Just that you need to have achievements to match. Its bad that a to be super power cannot have toilets for its people but does that stop it from achieving big things? Can I say that your team cannot play great cricket or build sophisticated nuclear weapons because your people defecate in open?
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Mar 11, 2015 03:31pm
shame Pakistan
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Mar 11, 2015 03:56pm
Tiolet brings happiness not nuclear weapons.
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Mar 11, 2015 04:20pm
@Devendra, still we are better off in many things then you Indians. You should watch "Daughter of India" on You tube. Because your government do not want your people to the truth.
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Mar 11, 2015 04:25pm
another proof that we are all in this together.
the reason we cannot afford toilets is that we spend All our money on defence, developing missiles and building New ways to kill each other. every time our blood starts to boils with pride in the name of an agni or shaheen, let us ask ourselves, shouldn't we be actually more ashamed?
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Mar 12, 2015 10:03am
I agree with you. We need to solve these problems. Always some one else do it attitude is destroying us.
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Mar 12, 2015 11:51am
@Kamal Pasha. but U tube is banned in Pak
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Mar 12, 2015 04:55pm
Well, we have so many other issues (more important) and we are still struggling to manage those. Perhaps, this issue and like others should have addressed way before this article is written.
The many other issues (more important), our government's priorities have been different all the way. They minds have been stolen for a cause, that is the reason they have not been the RIGHT THINK TANK of the country, PERIOD.
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Mar 13, 2015 08:32am
The problem is common even in india. The public toilets built are never maintained well and eventually are abandoned and then it is back to open defecation again.
Such issues are never again importance in these countries where political issues occupy the public space.
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Mar 13, 2015 10:43am
@Kamal Pasha.
Pasha sahib... We did watch it... You also read this.
http://www.thehindu.com/opinion/op-ed/comment-article-rape-rhetoric-and-reality/article6705077.ece
And then Watch this if you have YouTube working...
If not then Gist of this video is there is less than 5% of Crimes are being reported.
https://www.youtube.com/watch?v=S64VMuW21u0
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