literature review on right to water

• DOI: 10.3126/WN.V10I1.97
• Corpus ID: 111415208

The Human Right to Water

• Published 1 October 1998
• Environmental Science, Law
• Water Nepal

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Sustainable access to safe drinking water: fundamental human right in the international and national scene, the human right to water and unconventional energy, the human right to water: the importance of domestic and productive water rights, indian approach towards right to life with reference to water and sanitation, the significance of justiciability: legal rights, development, and the human right to water in the philippines, the human right to water and sanitation: is the obligation deliverable.

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Providing Safe Drinking Water to 1.1 Billion Unserved People

Africa’s water crisis: the miracle and the mirage: what policy mix, strategies and institutional steps are vital, the human right to water and common ownership of the earth: human right to water, 36 references, encyclopedia of human rights, comprehensive assessment of the freshwater resources of the world. sustaining our waters into the 21st century..

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World without end : economics, environment, and sustainable development - summary

The universal declaration of human rights: fifty years and beyond, the united nations and human rights, 1945-1995., the convention on the rights of the child, epidemiologic evidence for health benefits from improved water and sanitation in developing countries., convention on the law of the non-navigational uses of international watercourses, basic water requirements for human activities: meeting basic needs, human rights approaches to environmental protection, related papers.

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The Human Right to Water: The Importance of Domestic and Productive Water Rights

Ralph p. hall.

1 School of Public and International Affairs, Urban Affairs and Planning Program, Virginia Tech, 207 Architecture Annex, Blacksburg, VA 24061 USA

Barbara Van Koppen

2 International Water Management Institute (IWMI), Pretoria, South Africa

Emily Van Houweling

3 Women and Gender in International Development, Office of International Research, Education, and Development (OIRED), Virginia Tech, Blacksburg, VA 24061 USA

The United Nations (UN) Universal Declaration of Human Rights engenders important state commitments to respect, fulfill, and protect a broad range of socio-economic rights. In 2010, a milestone was reached when the UN General Assembly recognized the human right to safe and clean drinking water and sanitation. However, water plays an important role in realizing other human rights such as the right to food and livelihoods, and in realizing the Convention on the Elimination of All Forms of Discrimination against Women. These broader water-related rights have been recognized but have not yet been operationalized. This paper unravels these broader water-related rights in a more holistic interpretation of existing international human rights law. By focusing on an emerging approach to water services provision—known as ‘domestic-plus’ services—the paper argues how this approach operationalizes a comprehensive range of socio-economic rights in rural and peri-urban areas. Domestic-plus services provide water for domestic and productive uses around homesteads, which challenges the widespread practice in the public sector of planning and designing water infrastructure for a single-use. Evidence is presented to show that people in rural communities are already using their water supplies planned for domestic uses to support a wide range of productive activities. Domestic-plus services recognize and plan for these multiple-uses, while respecting the priority for clean and safe drinking water. The paper concludes that domestic-plus services operationalize the obligation to progressively fulfill a comprehensive range of indivisible socio-economic rights in rural and peri-urban areas.

Introduction

Globally, 768 million people lack access to an improved water source, and more than 80 % of these people live in rural areas (WHO and UNICEF 2013 ). Poor water access is associated with many water-related illnesses, food insecurity, lost productivity, and poor school attendance, especially for women and girls. Daily access to clean water is necessary to satisfy basic needs of drinking, cooking, washing, and bathing—i.e., domestic uses of water. In rural areas, water is also critical for livelihood activities, such as horticulture and crop irrigation, livestock-raising, brick-making, and small-scale commercial activities. These activities increase a household’s income and food security. In peri-urban areas as well, water is necessary for a range of livelihoods (Kurian and McCarney 2010 ). With rapid urbanization, urban agriculture is becoming particularly important (Zezza and Tasciotti 2010 ): already in the 1990s, 15–20 % of the world’s food was estimated to be produced in urban areas (Armar-Klemesu 2000 ).

The formal recognition of access to water as a human right in 2010 was an important milestone in addressing the lack of access to water in developing countries, especially for women. The human right to water was framed from a narrow public health perspective and prioritized the provision of safe and clean water for drinking, sanitation 1 , hygiene, and other domestic activities. Without contesting the priority for domestic uses in human rights law, this interpretation might be seen as ignoring the range of broader socio-economic human rights for which water plays an important role. In general, the operationalization of the human right to water is achieved by providing water services that are planned and designed for domestic uses only. Design norms for service delivery levels typically provide a minimum of 20 litres per capita per day (LPCD), supposedly for domestic activities only. Even in promoting the progressive realization of this right by providing higher service levels, it is assumed that such larger quantities are only used for domestic purposes. In this paper, we trace how the current framing of the human right to safe and clean drinking water as a priority in international law can, and should, go together with the recognition of other water-related human rights, in particular the rights to food, work, and an adequate and continuously improving standard of living. This interpretation accounts for how rural and peri-urban households actually use their water—i.e., for domestic and productive uses around the homestead. The paper links these findings to domestic-plus services that offer the opportunity to operationalize state obligations to fulfill the priority for people to access water for domestic uses and to realize other human rights.

The paper is structured as follows. Section two provides an overview of the evolution of water as a human right. We argue that the human right to water for domestic uses to meet public health and gender objectives, includes the right to water for livelihoods according to the broader human rights frameworks.

Section three focuses on rural and peri-urban people in low- and middle-income countries and on their norms and practices of water uses, which are not shaped by artificial administrative divides of single-use, sector-based water services provision. People use self-supply and public water schemes for multiple uses, regardless of the use intended by the planners of the scheme. In response to this observation, a new approach of multiple-use water services (MUS) has emerged. Domestic-plus services, which are a form of MUS, prioritize domestic uses at and around homesteads and also promote productive uses, conforming to a range of human rights laws and to the growing recognition that rights are indivisible.

The importance of domestic-plus services is explored in Section four, which presents some results from a multi-country study of household water use from rural piped water systems with and without household connections in Senegal, Kenya, and Colombia. The study offers empirical evidence of the extent (71–75 %) to which rural households engage in both domestic and productive uses of water to support their livelihood needs. Further, these activities are supported by low service levels (i.e., water quantities) that are widely seen as suitable for basic domestic uses only.

The paper concludes by summarizing the still untapped potential of domestic-plus services to realize the human right to water for domestic uses and for a range of other water-related socio-economic rights, while recognizing that human rights are indivisible and that people can co-create norms and practices for meeting their human rights.

The Human Right to Water and Sanitation and Other Water-Related Human Rights

The human right to water and sanitation has evolved from soft to hard international law, where it is now considered as a “distinct, composite human right” (Meier et al. 2012 , p. 4). In this section we track the emergence of the human right to water and sanitation, paying particular attention to the way in which the right to water is framed and what this framing implies for rural and peri-urban communities. The discussion reveals how international conventions and comments have been prioritizing the human right to safe and clean drinking water, but not at the exclusion of other uses. An examination of these texts shows a broader interpretation of the right to water without limiting prescriptions on its intended use. States are obliged to protect, respect, and fulfill these other rights too.

In 2010, UN General Assembly recognized “the right to safe and clean drinking water and sanitation as a human right that is essential for the full enjoyment of life and all human rights” (UN 2010b , p. 2). The General Assembly’s Resolution (64/292) brings significant international political weight behind the notion that access to clean and safe drinking water and sanitation is an independent human right.

Access to reliable and clean water and sanitation services is widely accepted as essential for the realization of a healthy and productive life (UNDP 2006 ; WHO and UNICEF 2011 , 2012 ). Prior to the UN General Assembly’s formal recognition of the right to drinking water and sanitation, access to water and sanitation services was generally considered as a prerequisite for the attainment of other human rights (Gleick 1998 ). The long road in explicitly recognizing water as a human right has been attributed to a lack of political will and resources in this area when compared to investment in other sectors (UNDP 2006 ). Since the poor—who suffer the most from a lack of access to improved water and sanitation services—tend to have a limited voice in political arenas, as is often argued, their claims for these services can be more easily ignored if the human right to water and sanitation is not explicit (ibid.). Although progress has been made, this lack of collective action and influence among the poor is one reason for the continuing low level of access to water and sanitation services over the past several decades in developing regions (WHO and UNICEF 2012 ).

In response to the UN General Assembly’s Resolution (64/292), the UN Human Rights Council ( 2010 , p. 3) called upon states to “develop appropriate tools and mechanisms, which may encompass legislation, comprehensive plans and strategies for the sector, including financial ones, to achieve progressively the full realization of human rights obligations related to access to safe drinking water and sanitation, including in currently unserved and underserved areas.”

Thus, establishing an explicit human right to drinking water and sanitation has created a new mechanism that obliges states to act and target public investments towards the water and sanitation sector.

The following discussion identifies where the focus on drinking water came from and argues that its narrow interpretation can be viewed as necessary to prioritize investments, but that this focus does not ignore other water-related human rights and states’ obligations to meet those rights.

The roots to the 2010 human right to water (for domestic uses) and other water-related rights can be traced to Article 25 of the 1948 Universal Declaration of Human Rights (UDHR) and Articles 11 and 12 of the 1966 International Covenant on Economic, Social, and Cultural Rights (ICESCR). As a group, the UDHR, ICESCR, and the 1966 International Covenant on Civil and Political Rights (ICCPR)—known collectively as the “International Bill of Human Rights”—provide the normative basis from which the human right to water and sanitation and other water-related rights have evolved in international law (Meier et al. 2012 ; Gupta et al. 2010 ). These foundational texts also stipulate the obligations for states.

Universal Declaration of Human Rights (UDHR) Article 25 : “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services,…” (UN 1948 ).

International Covenant on Economic, Social and Cultural Rights (ICESCR) Article 2 of the ICESCR calls on states to “individually and through international assistance and co-operation” … work towards “achieving progressively the full realization of the rights recognized in the present Covenant by all appropriate means, including particularly the adoption of legislative measures.” Article 11: “The States Parties to the present Covenant recognize the right of everyone to an adequate standard of living for himself and his family, including adequate food, clothing and housing, and to the continuous improvement of living conditions” (UN 1966b ). Article 12 : “The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. … The steps to be taken … to achieve the full realization of this right shall include those necessary for … (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases” (UN 1966b ).

International Covenant on Civil and Political Rights (ICCPR) The public health link to water is reinforced by the ICCPR. While the ICCPR does not explicitly mention water, it is considered to be a necessary condition for realizing the “inherent right to life” stated in Article 6 of the covenant (UN 1966a ).

Both the UDHR and ICESCR use the word “including” prior to listing component elements of the right to an adequate standard of living. The word “including” indicates that the elements listed were not meant to be exhaustive, opening the door for the inclusion of other fundamental elements such as water, sanitation, clean air, and food, needed to achieve an adequate living standard (Langford 2005 ; Gleick 1998 ). Article 2 of the ICESCR focuses on all rights within the Covenant and thus, arguably, includes a right to water for productive purposes derived from an integrated view of the rights to water, food, work, and standard of living.

Article 11 positions water as a necessary element in achieving an “adequate standard of living”. In rural and peri-urban settings, the interpretation of this article needs to be broad. Achieving an adequate standard of living is dependent on the availability of both safe and clean drinking water and on the availability of water to support other domestic and productive uses.

The reference to the “continuous improvement of living conditions” in Article 11 and “progressive realization” in Article 2 of the ICESCR is also worth highlighting. This implies that a priority for providing safe and clean drinking water in rural and peri-urban areas cannot be interpreted as denying families in these locations the opportunity to continually improve their circumstances through increasing access to both domestic and productive uses of water. Given the income generating (or expenditure saving), food security, nutritional, and health benefits from productive activities—such as raising animals or growing irrigated crops and vegetables, or aquaculture—an important question is why the right to water has been focused on safe and clean drinking water and what does this imply for other uses? One possible answer lies in Article 12 of the ICESCR, which elevates public health in the human rights dialogue. 2 The steps taken to attain the highest possible level of physical and mental health include actions that prevent and control diseases, such as the provision of safe and clean drinking water.

One of the first explicit references to the human right to water for domestic uses in an international text is found in the conference report from the 1977 United Nations Water Conference in Mar del Plata, which positioned the right to drinking water in the context of basic needs: “all peoples, whatever their stage of development and their social and economic conditions, have the right to have access to drinking water in quantities and of a quality equal to their basic needs” (UN 1977 , p. 1). The Mar del Plata conference led to an Action Plan that called for what became the International Drinking Water Supply and Sanitation Decade (1981–1990), which brought international attention and resources to expand access to drinking water supplies and sanitation services in developing regions.

Two years after the Mar del Plata conference, the 1979 Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) made an explicit reference to the rights of women to water. In the context of rural development , the Convention called for the elimination of discrimination against women and stated that women have the right to “enjoy adequate living conditions, particularly in relation to housing, sanitation, electricity and water supply, transport and communications” (UN 1979 , Article 14(2)).

A decade later, the 1989 Convention on the Rights of the Child (CRC) made a clear connection between water and the “highest attainable standard of health” (UN 1989 , Article 24(1))—paralleling Article 25 in the UDHR and Article 12 in the ICESCR. To fulfill this right, states are asked, among other measures, to “combat disease and malnutrition … through, inter alia, … the provision of adequate nutritious foods and clean drinking water” (UN 1989 , Article 24 (para. 2.c)).

CEDAW and the CRC are particularly relevant to rural and peri-urban communities. These two legally binding treaties establish state obligations and promote the need for monitoring mechanisms to track progress. CEDAW specifically focuses on rural development and references “water supply” in general, rather than focusing only on drinking water and other domestic uses. The CRC explicitly recognizes the right to the “highest attainable standard of health” with nutritious foods and the provision of clean drinking water. While the CRC does not refer to a specific geographic setting, if the rights are considered in a rural and peri-urban context there is a strong case for the operationalization of this right by providing water to grow crops and vegetables, raise poultry, breed livestock, etc. Both CEDAW and the CRC are referenced in Resolution 64/292, and underscore that a priority for domestic uses in operationalizing human rights law still leaves a similar obligation to operationalize rights to water for productive uses.

Turning to the 1990s, the international community began to focus its attention on sustainable development (Ashford and Hall 2011 ). A year before the Brundtland commission published its classic text on the subject (WCED 1987 ), the 1986 Declaration on the Right to Development (DRD) was adopted by the UN General Assembly. Article 8 of the Declaration says:

States should undertake … all necessary measures for the realization of the right to development and shall ensure, inter alia, equality of opportunity for all in their access to basic resources, education, health services, food, housing, employment and the fair distribution of income. Effective measures should be undertaken to ensure that women have an active role in the development process … (UN 1986 , Article 8).

Within this development framework, the right to water became oriented towards meeting “basic needs”, continuing the operational focus on drinking water as agreed during the 1977 Mar del Plata conference. While the DRD did not explicitly mention water, the UN later included water as a “basic resource” when interpreting the intent of Article 8 (UN 1995 ; Gleick 1998 ). Further, the emphasis on including women in the development process, builds on CEDAW. Given women’s and girl-children’s disproportional obligations for water provision for domestic uses, the provision of water services for domestic uses is particularly important to them (UN 2005 ; Thompson et al. 2001 ). Moreover, while much attention during the preceding decade was paid to water technology (the “hardware”), an important outcome was that equal attention needed to be paid to the planning and management (the “software”) of the services provided (Cairncross 1992 ). This demand responsive approach to water planning found expression in the 1992 Dublin Statement on Water and Sustainable Development, which considered water as both a social and economic good. Principle 4 of the statement recognizes “the basic right of all human beings to have access to clean water and sanitation at an affordable price” (UN 1992a ). The emphasis on water being “affordable” indicates that “the conception of water as an economic good must be limited by the concept of water as a human right in order to ensure equitable distribution of water” (Bluemel 2005 , p. 964). Principle 3 of the Dublin Statement also recognized the gender dimension of water, stating that:

Women play a central part in the provision, management and safeguarding of water . This pivotal role of women as providers and users of water and guardians of the living environment has seldom been reflected in institutional arrangements for the development and management of water resources. Acceptance and implementation of this principle requires positive policies to address women’s specific needs and to equip and empower women to participate at all levels in water resources programmes, including decision-making and implementation, in ways defined by them (UN 1992a ).

Later that year, the right to development was reaffirmed in the 1992 Rio Declaration. Principle 3 of the Declaration states that “the right to development must be fulfilled so as to equitably meet developmental and environmental needs of present and future generations” (UN 1992b ). The action plan for the Rio Declaration—Agenda 21—provided a detailed treatment of the need to protect public health by providing safe drinking water and controlling disease vectors in the aquatic environment. When discussing activities that could be implemented in the area of water supply and sanitation for the unserved rural poor, Agenda 21 asks states to “promote community ownership and rights to water supply and sanitation facilities” (United Nations (UN) 1993 , Section 18.76(A) (iv)). Again, in the rural setting, the declaration is about water in general, while its operationalization focuses on safe and clean drinking water.

In 2002, the UN Committee on Economic, Social, and Cultural Rights (CESCR) adopted General Comment No. 15 (GC15), which considers the legal bases of the right to water through Articles 11 and 12 of the ICESCR. (The earlier CESCR General Comments 12 (1999) and 14 (2000) had focused on the right to food and the right to the highest attainable standard of health, respectively, which address the right to an adequate standard of living under Article 11 of the ICESCR.) GC15 determined that the “human right to water is indispensable for leading a life in human dignity. It is a prerequisite for the realization of other human rights” (CESCR 2003 , p. 1). GC15 also directly addresses the productive use of water by referencing Article 1 of the ICESCR—which states that “in no case may a people be deprived of its own means of subsistence” (UN 1966b , Article 1, para. 2). The CESCR further states that “parties should ensure that there is adequate access to water for subsistence farming and for securing the livelihoods of indigenous peoples” (CESCR 2003 , p. 4). In its discussion, the CESCR makes a distinction between the right to water for personal and domestic uses that support the right to health, and adequate access to water for farming and livelihood activities that support the right to food and the right to work. While the CESCR recognized that water is needed for other purposes such as food production, supporting livelihoods, and cultural practices, it concluded that “priority in the allocation of water must be given to the right to water for personal and domestic uses” (CESCR 2003 , p. 3).

The human right to water entitles everyone to sufficient, safe, acceptable, physically accessible and affordable water for personal and domestic uses. An adequate amount of safe water is necessary to prevent death from dehydration, to reduce the risk of water-related disease and to provide for consumption, cooking, personal and domestic hygienic requirements (CESCR 2003 , p. 2).

Thus, GC15 prioritizes water for domestic uses, but simultaneously calls for a more inclusive and progressive interpretation of the human right to water for productive uses (Hellum 2014 ). The main components of the GC15 were later reinforced in a report by the United Nations High Commissioner for Human Rights (UNHRC 2007 ) on the scope and content of the obligations related to the human right to water and sanitation.

In 2004, the UN General Assembly adopted Resolution 58/217 to establish the International Decade for Action, “Water for Life” (2005–2015). The emphasis on “action” was intentional and deemed necessary to achieve the internationally agreed water-related goals contained in Agenda 21, the Programme for the Further Implementation of Agenda 21, the United Nations Millennium Declaration, and the Johannesburg Plan of Implementation (UN 2004 ). These international texts further advocate the right to development and the right to attain an adequate standard of living, making reference to the International Bill of Human Rights and other key international agreements. In establishing development targets in the Millennium Declaration and the subsequent Millennium Development Goals (MDGs), only water for domestic uses was explicitly mentioned, which resulted in international resources being targeted at this narrower development objective. In fact, the MDGs of reducing by 50 percent the number of people without access to improved water and sanitation, is seen as an arbitrary target by those advocating for the human right to water (UN 2010a ; de Albuquerque and Roaf 2012 ). Instead, Albuquerque and Roaf ( 2012 , pp. 32–33) argue, a “progressive realization” approach should be followed that is based on a continual assessment of national priorities and resource constraints. The ultimate objective is to achieve the full realization of the human right to water and sanitation (i.e., universal access) by adopting a fluid approach to the “obligation to fulfill” the right to water and sanitation.

In 2010, the human right to water was declared in the UN Resolution 64/292. This focused exclusively on the priority for domestic uses as stated in GC15, while adding the right to sanitation. However, as we argued above, GC15, which is the basis for Resolution 64/292, also obligates states to respect, protect, and fulfill other human rights that critically depend on water, including the right to an adequate standard of living, dignity, food, and work.

The priority to provide water for drinking is justified from a public health perspective based on the fact that this is clearly a universal need for everyone, especially children. Moreover, there is political support for implementing the services to meet this need. There is also ample documentation of the direct links between safe and clean drinking water and public health improvements. Poor water quality and water shortage is linked to diarrhea, cholera, dysentery, and a variety of other illnesses responsible for high rates of mortality and morbidity in developing countries (Bartram and Cairncross 2010 ; WHO 2009 ). Universal access to water for other domestic water needs also contributes to implementing CEDAW because of society’s current gendered division of domestic chores (Hellum 2014 ).

The question is not about the priority for the human right to water for domestic uses and its progressive realization, but why there is still no operationalization of water for basic productive uses, let alone any effort for its progressive realization, in spite of GC15. Various factors play a role. Water is just one input in productive activities, so benefits are more indirect. Nevertheless, these benefits are important. For example, if water is used for horticulture or animal raising, the products from these activities improve the nutrition of family members and, hence, their health. They often also generate an income that can be used to purchase clothes or send children to school. These various benefits represent a composite group of rights, which fail to match the administrative categories of specific rights. Instead, these multiple interconnected benefits of water for domestic and a range of productive uses underline the importance of recognizing human rights as indivisible (Hellum 2014 ). Moreover, productive water uses vary and depend on highly diverse hydrological, technical, institutional, and socio-economic contexts. Uptake of water for productive uses depends on factors such as access to land, credit, and markets, and the level of income and education achieved by household members (Van Houweling et al. 2012 ; Hall et al. 2011 ). While the diversified livelihood strategies in rural and peri-urban areas depend in many ways on water, the universality of water for productive needs is less straightforward than for drinking. Further, there is less political support and funding for pro-poor agricultural water management.

Lastly, and the focus of the remainder of this paper, water use norms and practices tend to be overlooked in developing and operationalizing human rights law. While the indivisibility of water-related rights is recognized at abstract levels, this tends to be ignored in designing interventions to meet human rights. The following two sections look at how people in rural and peri-urban areas use water and how designing water services to match these uses might advance the realization of water-related human rights.

People’s Multiple Water Uses in Rural and Peri-Urban Settings

In the past decade, water professionals’ understanding of how rural and peri-urban people use water has been evolving beyond the fragmented disciplinary backgrounds and organization of the water sector that focuses on single water uses. In the early 1970s, the groundbreaking study on domestic water use in East Africa, entitled Drawers of Water , by White et al. ( 1972 ) developed three categories of water use— consumptive (drinking and cooking), hygiene (washing, cleaning, and bathing), and amenities (watering lawns and other non-essential activities). In a follow-up study some 30 years later, Thompson et al. ( 2001 ) added productive uses as a fourth category. Productive uses were considered to include “consumption by livestock (e.g., cattle, goats, pigs and sheep), brewing beer, distilling gin, making fruit juice, brick-making and the construction of homes, and irrigating tree and horticultural crops” (Thompson et al. 2001 , p. 31).

Drawers of Water II demonstrated that the productive use of water intended for domestic uses only by rural households (from piped and non-piped sources) was a largely unrecognized, but important factor supporting livelihoods.

What is interesting is the significant quantities [of water] used by rural households, particularly those with piped supplies. This suggests that access to piped water is beneficial to rural households from a productive as well as a health and well-being perspective (Thompson et al. 2001 , p. 31).

Others in the domestic sector also recognized the productive use of water around the homestead from water supplies planned for domestic uses, and the impact these activities have on reducing poverty, empowering women, and improving the sustainability of water services (Moriarty and Butterworth 2003 ; Moriarty et al. 2004 ; Torres et al. 2003 ; Thompson et al. 2001 ; van Koppen et al. 2006 ; World Bank, FOA and IFAD 2009 ). The same observations were made where schemes designed for irrigation were used for domestic uses and non-irrigation productive uses in the area around the homestead (Bakker et al. 1999 ; Li et al. 2005 ; Meinzen-Dick and van der Hoek 2001 ; Renwick 2001 ; Smith 2004 ).

Water projects typically supply water for a single-use—such as for domestic use or irrigation—while people use water for all their needs. Regulations or policies often try to forbid non-planned uses, or even declare these uses as illegal. It is true that such non-planned uses may cause damage, for example, when cattle trample ditches. On the other hand, these non-planned uses reflect people’s norms and priorities and meet basic livelihood needs. They realize a range of human rights.

Instead of forbidding non-planned uses, such uses should be planned for. This notion led to the new approach of MUS as a whole water approach that responds to the many water needs of rural and peri-urban households (de Vries et al. 2004 ; Penning de Vries 2006 ; Renwick et al. 2007 ; Smits et al. 2010 ; van Koppen et al. 2006 ; Restrepo Tarquino 2010 ; World Bank et al. 2009 ).

MUS is defined as “a participatory, integrated and poverty-reduction focused approach in poor rural and peri-urban areas, which takes people’s multiple water needs as a starting point for providing integrated services, moving beyond the conventional sectoral barriers of the domestic and productive [irrigation] sectors” (van Koppen et al. 2006 , p. v). The participatory (ground-up) nature of MUS means that the services respond to the full range of water needs, including productive activities such as agriculture, gardening, horticulture, livestock-raising, car-washing, arts, ice-making, brick-making, pottery, butchery, and other small-scale commercial activities (van Koppen et al. 2009 ; Smits et al. 2010 ). Water-dependent activities provide critical income streams, especially for the rural poor who often lack opportunities for wage and salary work (Smits et al. 2010 ; Noel et al. 2010 ). The concept of MUS holds much potential, since between 60 and 70 % of the rural poor are estimated to raise livestock, have access to small cultivable plots, and engage in water-dependent small enterprises (Renwick et al. 2007 ).

Three service categories have emerged in the past decade that explicitly recognize the need to provide water for domestic and productive uses. 3 First, in a “MUS-by-design” service, the multiple water needs of all community members are considered according to their prioritization in the design of the system(s). MUS-by-design is an approach that tries to match the available water sources with the users’ needs in a participatory way. Thus, there is no one blueprint that can be followed. An MUS-by-design water service could consist of one standalone system or several systems that utilize multiple sources supporting various uses.

The second services category is “irrigation-plus.” An irrigation-plus service prioritizes water for irrigation, but also includes add-on system components that enable the communities in the irrigated area or downstream to use the water for domestic and other productive activities.

The third category is “domestic-plus” services. Domestic-plus services prioritize domestic water uses at or around homesteads and provide services to meet other water-related basic needs. By increasing the design flow of the system (or service levels), greater quantities of water are provided to homesteads to enable more uses. Domestic-plus is progressively implemented by ‘climbing the multiple use water ladder’ (Renwick et al. 2007 ). Further, components can be added such as cattle troughs and water tanks to support productive activities. Thus, the domestic-plus approach aligns with the priority for domestic uses embedded in the current interpretation of the human right to water and simultaneously meets other water-related needs and human rights. Moreover, domestic-plus services can especially benefit women, the landless, and the sick, for whom homesteads are the best or only place to use water productively. The incremental investment costs to move to such higher service levels, for example, from 20 to 50 LPCD, generate high incremental benefits. Renwick et al. ( 2007 ) calculated that such incremental costs could be fully repaid within 6 months to 3 years from the income gained from the productive activities.

Domestic-plus recognizes the importance of health benefits from safe and clean drinking water—that remains safe and clean at the point of consumption. However, the focus is on 5–10 LPCD for drinking, cooking, and personal hygiene. For the larger quantities to support other domestic and productive activities, non-potable water could be used, also saving costs. Point of use (POU) technologies can be used to ensure the 5–10 LPCD is fit for consumption. Evidence on the link between water quality interventions (in general) and health, reveals that a 42 % reduction in child diarrhea morbidity can be achieved (Waddington et al. 2009 ). For POU treatment interventions, this figure increases to 46 %, but declines to 21 % for interventions that only improve the quality of the water source (ibid.).

Prior to promoting a widespread scaling of domestic-plus services as a cost-effective way to meet a range of human rights, the extent to which domestic water supplies are used for productive activities needs to be understood. The following empirical study of household water use from rural piped water systems in Senegal, Kenya, and Colombia provides some evidence of the extent to which domestic water is repurposed in rural communities across these three countries.

The Productive Use of Rural Water Supplies Designed for Domestic Uses: Evidence from Senegal, Kenya, and Colombia

Given the growing interest in MUS, the Water and Sanitation Program (WSP), World Bank, funded a multi-country study to assess the link between the productive use of piped, rural domestic water systems, poverty-reduction, and system sustainability. The study—undertaken during the summers of 2008 and 2009 under the direction of the lead author and two colleagues at Stanford University and the University of Oxford—used a cross-sectional research design and focused on rural communities in Senegal, Kenya, and Columbia. 4 A typical water system in Colombia used mountain spring sources and had a gravity fed distribution system. In Kenya, a mix of gravity and pumped systems supplied communities. In Senegal, all the systems used groundwater that was pumped to an elevated storage tank and then piped to communal taps and a limited number of yard/compound connections. The systems studied in Senegal can be classified as providing domestic-plus services, whereas the systems in Kenya and Colombia were primarily designed as single-use, domestic water services.

The study revealed that a high proportion of households were engaged in productive uses of water (see Table  1 ). In the three countries, between 71 and 75 % of all households interviewed were engaged in one or more productive activities that used any water source. Piped water supplies were a more important source than other water sources: between 54 and 61 % of households used piped water to support their activities. These uses met various needs: between 34 and 43 % of the households generated an income from their piped-water-based activities. When considering productive activities supported by any water source, between 49 and 55 % of households reported generating an income from their activities. Based on these descriptive data, the potential income from the productive use of water may provide sufficient financial resources to repay the incremental improvement in water supply from domestic services only to domestic-plus water services.

Table 1

Household engagement in productive activities in Senegal, Kenya, and Colombia

Given the variation that exists in the types of piped water systems studied, the similarity in proportions of households engaged in piped-water-based productive activities in the three countries is even more remarkable. It is also interesting that the systems in Senegal, which were designed to provide water for livestock and small-scale agriculture, and can thus be classified as domestic-plus services, had the same proportion of households engaged in productive activities as in Kenya and Colombia, where the systems were designed for domestic uses only. This consistent pattern implies that rural households use their water as needed and do not limit their engagement in activities due to limitations in the design of services. Further research is required to determine whether the pattern of engagement in productive activities across the three countries is a more universal phenomenon, or is limited to the purposefully-sampled piped systems included in the study.

We note that the amount of water used, the types of activities undertaken, and the amount of income generated from productive activities varies significantly (between countries and between different regions within countries). For example, in Senegal, the regions of St. Louis and Matam can be characterized as the dominant livestock regions, whereas agriculture is more important in Diourbel and Kaffrine. Further, the median water use per capita in Colombia was several times that of the African households. This high level of piped water consumption can be attributed to the fact that virtually all of the households interviewed in Colombia had access to a private tap. In contrast, only around one third of households in Senegal and Kenya had a comparable level of service. In these countries, far more households relied on public taps or a neighbor’s tap.

The data in Table  1 highlight the fact that while there may be a consistent pattern for household engagement in piped-water-related productive activities, the quantity of water used for these activities is dependent on the level of water access and availability. With regards to Senegal and Kenya, households use a median of 23 and 31 LPCD, respectively. This is in sharp contrast to the general global consensus that around 50 LPCD is required to satisfy an individual’s personal and domestic water needs, with 20 LPCD set as a minimum for consumption and hygiene requirements (Gleick 1996 ; Langford 2005 ; Howard and Bartram 2003 ). The WSP study found that even at these minimum levels, people prioritize water uses for a wide range of livelihood-related activities over domestic uses. This finding reinforces the argument that human rights law and water services planning should better align with people’s priorities.

While homestead-based production is generally considered to consist of a ‘kitchen garden’ for family consumption, Table  1 sheds new light on the importance of the income generated. In Senegal, where the systems were designed to support both domestic and productive uses of water, water-based income represented around one half of total household income (for the 49 % of households engaged in water-based income generating activities). Similarly, in Colombia, income from water-based activities represented, on average, 52 % of total household income (for the 51 % of households engaged in water-based income generating activities).

The income generated was particularly relevant for women. Evidence from the women’s focus groups in Senegal shows that after the construction of the domestic-plus water services, women were able to expand their existing livelihood activities and initiate new enterprises. One half of women’s income was linked to productive water use, namely through livestock-raising and gardening (Van Houweling et al. 2012 ). This confirms that water provided for productive uses gives women opportunities to diversify their livelihood activities, and earn income from activities that they tend to have greater control over (Van Houweling et al. 2012 ; van Koppen et al. 2009 ).

The WSP study shows that productive water use occurs across a range of piped water systems and the types of productive activities vary by context. This finding implies that expanding the human right to water should not target (or exclude) certain uses or technologies, and should, instead, explicitly address the right to water to meet the full range of domestic, health, sanitation, and livelihood needs.

An important question underlying this paper is whether the current formulation of the human right to safe and clean drinking water (in UN Resolution 64/292), could limit development opportunities for rural and peri-urban communities. Emerging evidence shows that a significant proportion of households in rural and peri-urban communities use water for both domestic and productive activities, regardless of whether these dual uses were considered in the design of their water services.

The UN General Assembly Resolution is likely to lead to “enhanced opportunities for rights-based water and sanitation policy” (Meier et al. 2012 , p. 3). The key issue is what types of water interventions will be implemented if the focus remains solely on safe and clean drinking water. The UN Human Rights Council ( 2010 , p. 3) has already called on states to develop a broad range of approaches “to achieve progressively the full realization of human rights obligations related to access to safe drinking water and sanitation, including in currently unserved and underserved areas”. Here, we have argued that, within the broad range of possible approaches to translate this state obligation into actual interventions, domestic-plus services address the priority right of water for domestic uses, and also enable other human rights such as the right to food, work, and an adequate standard of living.

When water is provided to meet both domestic and productive water needs, a wide range of benefits can be realized. The domestic-plus approach has been associated with multiple poverty impacts, including income, food security/nutrition, health, gender equity, and reduced vulnerability and livelihood diversification. These impacts align well with Article 12 of the ICESCR, which states that everyone has the right to “the continuous improvement of living conditions”. If water service providers interpret the priority for safe and clean drinking water at the exclusion of meeting other human rights, the potential benefits from productive activities may be undermined, contradicting the intent of Article 12.

There are two potential outcomes from a failure to account for the productive use of water in the design of rural and peri-urban services: (1) a higher than expected water demand may prevent the services from reaching all of the intended users, and cause unplanned stress on the water system, potentially undermining the technical and financial performance of the services, and hence, their long-term sustainability; and (2) the households may have no choice but to reorient their domestic and productive uses of water so they live within the service design parameters. In the latter scenario, the water services may operate for their design life, but the potential development opportunities for households could be constrained. The results from the WSP study show that the percentage of households engaged in the productive use of water was relatively consistent across a wide range of water consumption—i.e., from 23 LPCD in Senegal to 133 LPCD in Colombia. These findings challenge the notion that the way in which water is used is constrained by its availability. While the international standard of 50 LPCD is a valuable target, an equally important factor in rural and peri-urban areas is that domestic and productive uses of water are taken into account in the design of a water service to maximize health and economic benefits. Attention should also be paid to the gendered nature of water to ensure that the benefits from productive water use accrue to women as well as men.

The current focus on the human right to safe and clean drinking water, does not explicitly address the gendered nature of water collection and use. The Dublin statement, CEDAW, and the DRD explicitly recognize the importance of including women in the design and management of water services to ensure that the services respond to their basic needs, however, most water planning approaches do not involve women, and may therefore marginalize their needs. The domestic-plus approach, strives to provide a new model that considers the full range of needs of women and other vulnerable groups. Following this approach, systems are creatively designed to facilitate women’s water-based domestic activities, as well as their productive activities.

While a water system may be designed to support productive uses of water, not all households will engage in such activities. Around one quarter of all households in Senegal, Kenya, and Colombia did not undertake any productive activities that relied on water. These data indicate that the right to water for productive uses is perhaps less universal that the right to water for domestic uses. However, given the potential benefits that can be realized from productive uses of water, all households should have the opportunity to engage in such activities.

The main concern expressed throughout this paper is that the current focus on the human right to safe and clean drinking water may limit the impact of water service provision if it focuses solely on domestic water supply. However, the human rights framework is one of several factors that shape investment in water services. For example, the Millennium Development Goal to “halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation”, has led to a significant global investment in enhancing access to improved water sources, but does not recognize the need for water for productive uses. Thus, reorienting the human right to water to incorporate a more holistic concept of water use is one critical step forward. But international development initiatives (such as the MDGs and their successors) also need to be reframed to consider the importance of water for food, livelihood, and standard of living.

Water is vital to livelihoods and to the prospects of rural and peri-urban residents escaping poverty. The human right to water is fundamental to the right to life, health, and food, and as the Vienna Declaration of Human Rights proclaimed “human rights are universal, indivisible and interdependent and interrelated.” We conclude that the human right to water should not be limited to safe and clean drinking water and a more progressive interpretation of existing international law, focusing on the human right to water (in general), may be a more effective way to address a comprehensive range of socio-economic rights in rural and peri-urban areas. This more open interpretation also provides states with more options for the provision of water services when taking concrete actions to respect, fulfill, and protect the human right to water. We present the domestic-plus, irrigation-plus, and MUS approaches to the delivery of water services as important options to help progressively realize a broad range of water-related human rights.

Acknowledgments

We would like to thank the Laboratory for Interdisciplinary Statistical Analysis (LISA) at Virginia Tech for its statistical assistance in developing the data presented in this paper. Support was also received through the project “Gender, human rights, and water governance in Southern and Eastern Africa: Actors, norms, and institutions”, funded by the Norwegian Research Council. We would like to thank Virginia Tech’s Open Access Subvention Fund and the International Water Management Institute (IWMI) for providing funds to allow this article to be open access. Finally, we would like to thank the anonymous reviewers whose insightful comments helped clarify the central arguments in the paper. The authors are responsible for any errors or omissions in this paper.

1 While we recognize the urgent need to realize the human right to sanitation services, this paper focuses on the need to include productive water uses in the formulation of the human right to water. This more holistic approach implicitly supports the delivery of sanitation services. For example, eco-sanitation services could provide valuable nutrients for small-scale horticulture activities supported by a domestic-plus water service, and adequate sanitation is necessary to achieve the desired health benefits of improved water systems. For an explicit discussion on the right to sanitation and hygiene, see de Albuquerque ( 2009 ).

2 The public health link to water is reinforced by the ICCPR.

3 These groups were agreed upon during an MUS Roundtable Workshop held at the Rockefeller Bellagio Center in Italy, September 3–7, 2012. The workshop was attended by nineteen participants from around the world representing government, non-governmental organizations, and academia who are active in the implementation or evaluation of MUS. The first two authors of this paper attended this workshop.

4 Within each country, a purposive sampling strategy was used to select around 50 communities with piped water systems (147 systems were studied in total). The sample was designed to capture some variation in the extent of household-based productive activities undertaken in the communities, such that ‘similar’ communities with different levels of productive activity could be compared. Given this approach, the results cannot be considered as representative at the national level in each country. The data collection instruments included household surveys; an engineering assessment of installed infrastructure; interviews with community leaders, water committees, and water system operators; and focus groups with women (and men in Colombia).

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An Assessment of Law and Practice of the Right to Water: Evidence from Zimbabwe

This paper seeks to present legal and policy frameworks that govern and promote the right to water. Two case law studies are presented to show legal provisions and associated challenges to the realisation of the right to water. In Zimbabwe, successive Ministries superintending over the provision of water in the country have not been clear on free water. Perennial economic challenges and a general lack of political will to promote the right to water have been debilitating aspects to the right to water. Attempts at privatisation of the provision of water through ZINWA , has culminated in a total failure as the parastatal was bedevilled with a myriad of challenges. The privatisation of water has made it less accessible to the rural and poor urban communities. The constitutionalisation of the right to water has transformed access to water in Zimbabwe, though economic challenges have continued to hamstring local authorities’ and government’s capacity to realise this right. The Mazibuko and SERAC case laws have been given as ground-breaking legal challenges mounted by residents of communities in South Africa and Nigeria respectively as affected citizens have challenged authorities on the need for the realisation of the right to water to the public.

• 1 Introduction

Water is a natural resource which every person should have access to without limitation. As such it cannot be restricted in any way thereby making water an undeniable right. However, events common to many communities in Zimbabwe have suggested that water as a commodity has been accessible mainly to the privileged few. International, regional and local legislative and policy frameworks have provided that water should be made available free of charge and in abundance. Basically, the well-being of humanity revolves around the availability, quality and accessibility to safe drinking water that meet WHO standards, including water for other domestic uses. Zimbabwe has been one country whose economic and political dynamics have undermined various human rights, including the right to water. Human rights are those entitlements bestowed upon people by virtue of their being human. In polities, it is obligatory for citizens to enjoy human rights in their varieties-namely civil and political rights on the one hand and socio-economic and cultural rights on the other. Unlike civil and political rights which should be realized progressively, economic, social and cultural rights are of immediate realization. As such States parties are obligated to ensure that people enjoy these rights. Economic, social and cultural rights include the right to education, social security, food, water, health and other rights that enable people to live a dignified life. While there are several rights that are provided in different international and regional instruments such as the Universal Declaration of Human and People’s Rights ( UDHR ) and the International Convention on Economic, Social and Cultural Rights ( ICESCR ), this paper deals with economic, social and cultural rights ( ESCR  s). The African Charter explicitly provides for three ESCR  s which are the right to work, 1 the right to health 2 and the right to education. 3 Case laws of the Mazibuko (Phiri case) and SERAC cases are incorporated in this paper.

• 2 Selected International Instruments Providing for the Right to Water

Several international instruments have been provided to highlight that access to adequate water for drinking and domestic use is not a luxury but a basic human right which State parties should strive to realize for their citizens. There are several legally binding international human right conventions that allude to the right to water. Among these are the 1966 Conventions which include the International Covenant on Civil and Political Rights ( ICCPR ) 14 as well as the International Covenant on Economic, Social and Cultural Rights ( ICESCR ) 15. These conventions implicitly recognize the right to water, especially more so in the ICESCR .

3 Convention on the Elimination of All Forms of Discrimination Against Women ( CEDAW )

Rural women have been singled out by virtue of the fact that they constitute the poorest category of people, especially in Africa. The CEDAW has credited rural women for most socio-economic development in most rural areas. By that token, Article 14 (1) has exhorted that

States Parties shall take into account the particular problems faced by rural women and the significant roles which rural women play in the economic survival of their families, including their work in the non-monetized sectors of the economy, and shall take all appropriate measures to ensure the application of the provisions of the present Convention to women in rural areas. Article 14 (1), African Charter on Human and Peoples Rights

It has been noted that the right to water has been recognized in a wide range of international treaties, declarations and in a number of national constitutions. For instance, Article 14(2) of the Convention on the Elimination of All Forms of Discrimination Against Women and the constitution of South Africa. Pertaining to rural women, the CEDAW has provided that this group of people should

enjoy adequate living conditions, particularly in relation to housing, sanitation, electricity and water supply, transport and communication. Article 14(2), CEDAW

• 4 Socio-Economic Rights in the African Charter and the Maastricht Guidelines

One of the principal instruments that govern the dispensing of human rights on the African continent is the African Charter and the Maastricht Guidelines. Both the African Charter and the Maastricht Guidelines prescribe what State parties should do to realize the different socio-economic rights. Although the African Charter does not expressly include the right to water, the guidance is grounded in the regional treaties’ protection of economic, social, and cultural development, health, access to natural resources, the environment, and food (International Justice Resource Center). The Charter, provides a generic view of entitlements whose prerequisite require access to water, notably health, life and housing. The Maastricht exhorts State parties to exhaust all means in an effort to provide for the socio-economic needs to people, including the realization of the minimum core obligations. In the African Charter, the right to water is enveloped in other associated and attendant provisions. For example, in Article 16 which provides for the right to health, the right to water is implicit in that one cannot talk of good health without involving water as a constituency of a healthy environment. Article 16 (1) provides that

Every individual shall have the right to enjoy the best attainable state of physical and mental health. Article 16 (1), African Charter

In all instances, the enjoyment of the best attainable state of physical and mental health would not be achieved without the utilization and availability of water. For example, extended lack of water in one’s body would result in dehydration, which in itself is a danger to health. Additionally, the absence of clean water for drinking and domestic use would culminate in disease outbreaks.

Article 16 (2) which states that

States parties to the present Charter shall take the necessary measures to protect the health of their people and to ensure that they receive medical attention when they are sick. Article 16 (2), African Charter

The Charter exhorts State parties to take the necessary measures to ensure that in the event of a disease outbreak, remedial measures are taken to sustain health. These African Charter provisions are both implicit and generic and may not in some cases exclusively make explicit reference to water.

In addition to Article 16 of the African Charter, there are other additional provisions in the same documents, which are similarly generic and implicit, notably Articles 4 and 5. Article 4 states that

Human beings are inviolable. Every human being shall be entitled to respect for his life and the integrity of his person. No one may be arbitrarily deprived of this right. Articles 4 and 5, African Charter

This article suggests that the realization of basic socio-economic rights by State parties brings about respect, dignity and integrity to human beings.

The Maastricht is very strong on its exhortation of State parties to dispense the cited socio-economic rights. In its guidelines it obligates state parties to respect, protect and fulfil all rights and entitlements to its citizens. It also recognises the minimum core obligation which entitles citizens to enjoy a free quota of services rendered by the State. In South Africa, there is a free water allocation of 6,000 litres of safe water per household per month under the country’s Free Basic Water Policy of the Department of Water Affairs. 4 It should however be noted that minimum core obligations are mandatory irrespective of the availability of resources in the country concerned as well as any other factors and difficulties the country might be encountering. According to the Maastricht Guidelines, 5 failure to realise this obligation constitutes a violation of such rights. 6 The obligation to respect requires States to refrain from interfering with the enjoyment of economic, social and cultural rights. Thus, the failure of States to provide essential water and sanitary conditions to those in need amounts to a violation.

The Maastricht also provides for the obligations of conduct and of result. In the case of the right to water, the obligation of conduct requires action reasonably calculated to realize that clean drinking water is made available to those in need and involves the adoption and implementation of a plan of action to reduce non-availability of clean drinking water and the subsequent outbreak of communicable diseases. 7 Under the obligation of result, the State parties would ensure that adequate availability of water would culminate in limited water-borne diseases and healthy communities This justifies South Africa’s Free Basic Water Policy as a fulfilment of the Maastricht Guidelines.

Furthermore, State policies should take into consideration the obligations that Sate parties are supposed to fulfil and the avoidance of violations of obligations. The Guidelines provides that

a violation of economic, social and cultural rights occurs when a State pursues, by action or omission, a policy or practice which deliberately contravenes or ignores obligations of the Covenant, or fails to achieve the required standard of conduct or result. Maastricht Guidelines (1997)

• 5 Case Laws on the Right to Water

This article deliberates on two major cases that speak to the right to water, namely the Social and Economic Rights Action Center ( SERAC ) and Center for Economic and Social Rights ( CESR ) / Nigeria (commonly known as the SERAC case); as well as the South Africa’s Constitutional Court in Mazibuko vs City of Johannesburg (also known as “the Phiri case”) decided on 8 October 2009, the country’s first test case on the right to water.

• 6 Summary of the Mazibuko Case

The nature of the Mazibuko Case is such that there are allegations of violation of the South African Constitution in terms of the right to the progressive realization of the right to water within maximum available resources. The case further raises the question of the scope of the right to access to sufficient water. The legal issue further brings into question the legality of the installation and existence of pre-paid water meters in the affected jurisdictional area. The summary of the facts of the case are such that five residents of Phiri in Soweto brought a case against the water provider, Johannesburg Water which is a company jointly owned by The City of Johannesburg and the Ministry of Water Affairs and Forestry. Arising from this legal challenge by the residents of Phiri was the legality of the City’s policy in relation to the supply of free basic water of 6,000 liters to every account holder. The residents further questioned whether this practice was in conflict with the Water Services Act. In the same breath, the residents were questioning the constitutionality of the City’s Water policy on the access to sufficient water as set out in Section 27 of the Constitution of South Africa. In addition to the above questions, the residents also challenged the legality of the installation of water meters in Phiri, which were used to facilitate the charging of consumers for the use of water in excess of the free basic water allowance. 8

In its verdict, The South Gauteng High Court found that the installation of pre-paid water meters in Phiri was both unlawful and unfair. The court further held that the city’s Free Basic Water Policy was unreasonable in terms of Section 27(2) of the Constitution and therefore unlawful. It eventually ruled that the city should provide the Phiri residents with 50 liters of free basic water daily as well as to other people who were under the jurisdiction of the city of Johannesburg. However, on appeal, the Supreme Court of Appeal varied this order, and reduced its initial ruling of 50 milliliters daily to 42 liters, regarding such an amount as sufficient. The Court of Appeal further directed the city to reformulate its policy accordingly to align with this ruling. In its judgement, the Supreme Court of Appeal castigated the installation of the pre-paid water meters which it viewed as unlawful, especially given that the city’s by-laws did not have such a provision. Eventually, the Supreme Court of Appeal expressed the view that the cut-off in water supply that occurs when the free basic water limit was exhausted constituted an unlawful discontinuation of the water supply, and therefore unconstitutional.

Although the court suspended its order for two years but held that, pending the reformulation of the water policy, it demanded that any accountholder in Phiri who is registered as an ‘indigent’ must be supplied with 42 liters of free water per day per member of his or her household. This gave the city enough grace period to regularize their policy framework on water provision and the modalities around the installation of water meters and cut-off of non-payment while also preparing residents for such eventuality.

Upon further appeal to the Constitutional Court, the latter court overturned the Appeals Court decision and held that the right of access to sufficient water does not require the state to provide, upon demand, every person with sufficient water. The court left the responsibility of water provision to the State to take reasonable legislative and other measures progressively to realize the right of access to sufficient water, within available resources. On the residents’ challenge on the legality and constitutionality of the water case in Phiri, the Constitutional Court rejected the applicants’ request for the adoption of a prescribed quantity of daily water ration as a standard. The Constitutional Court eventually left the interpretation and implementation of the relevant legislation and policies to government to ensure the progressive realization of the right to water. The court found that government had taken the right direction taking steps to realize and ensure the achievement of access to water, the. The court also commended the government for having appropriate policy framework to facilitate the provision of water to residents of Phiri which policy is in consonant with the obligation of progressive realization and achievement of the right to water. The court also concurred that the city’s Free Basic Water Policy fell within the boundaries of reasonableness and was not in conflict with either Section 27 of the Constitution or national legislation regulating water services. The Court was not critical of the installation of water meters. The court also concurred that cut-off of water supply was not a violation of their right to water per se put a stop-gap measure to persuade residents to pay for services rendered. In addition, the decision of the superior court was received with mixed feelings with activists expressing dismay, but expressing that progress and sanity should prevail.

The significance of this case was that it was a ground-breaking legal challenge on the right to water in South Africa as it provided a precedence for similar cases in other jurisdictions elsewhere and did not contravene Section 27 (2) of the South Africa Constitution. 9

• 7 Summary of the SERAC Case

The SERAC case communication alleges a determined violation of a wide range of rights guaranteed under the African Charter, most of them having a bearing on the right to water. Before embarking on an inquiry whether the Government of Nigeria has violated various rights as alleged in the complaint, it would be prudent and proper to establish what is generally expected of governments under the [African] Charter and more specifically vis-à-vis the rights themselves. The summary of facts of the SERAC case revolves around the allegations that the military government in Nigeria was directly involved in oil production through a state oil company, the Nigerian National Petroleum Company ( NNPC ). The bone of contestation arose from the operations at the NNPC which ostensibly caused environmental degradation and health problems emanating from contamination of drinking water of the Ogoni people. The Ogoni community alleged that the oil consortium exploited oil reserves in Ogoniland with no due regard for health or the environment of the local people, with specific reference to the disposal of toxic waste into the local communities’ waterways, in violation of applicable national, regional and international health standards. Despite continued complaints by the affected communities, the oil consortium failed to take reasonable measures to avoid oil spillages into the local communities’ waterways, which in itself jeopardised the health of the Ogoni people. This culminated in long-term health problems which mostly revolved around the drinking of contaminated water. The allegations further noted that health problems encountered included skin infections, gastrointestinal and respiratory ailments as well as increased risk of cancers and neurological and reproductive challenges to the affected communities. 10

Due to its affinity with the military, the Nigerian government became an accomplice to this heinous human rights violation act in that they placed the military to guard the oil company’s equipment at the oil fields. This helped to facilitate the continuous violation of the rights of the Ogoni people to clean and uncontaminated drinking water. The government liability and blameworthy was further exacerbated by the fact that it neither monitored operations of the oil companies nor required safety measures. This negligence culminated in unrestrained contamination of waterways in Ogoniland communities. This violation of human rights was further exacerbated by the calling by the Rivers State Internal Security Task Force, for “ruthless military operations” 11 against local communities who were opposed to the operations of the oil consortium. Of note was the allegation levelled again the Nigerian Government military that supported irresponsible oil development, resulting in the poisoning of much of the soil and water on which the people of Ogoni farming and fishing communities had depended over the years. The terror caused by the security forces had created so much terror and insecurity, that it became impossible for the Ogoni people to engage in farming and fishing activities and to herd their livestock, leading to malnutrition and starvation.

• 8 Critical Analysis of the Case Laws in Relation to the Right to Water

Drawing from the SERAC and Mazibuko cases, there was deliberate violation of the right to water as evidenced by the content of judgements by the respective courts. With close reference to the content and context of the two cases, the right of water transcends its availability and revolves around several key considerations, which encompass its availability, quality and accessibility. The ‘term’ availability denotes whether the supply of water is sufficient and continuous, especially for personal and domestic use. Ordinarily, domestic use would incorporate drinking, personal sanitation as well as attendant uses such as washing of clothes, food preparation and the general household cleanliness.

Consequently, availability and accessibility are some of the components that constitute a complete the cycle of the right to water. Water quality, availability and accessibility are significant determinants of the right to water. It is commonplace that these components including water quality for domestic use must be safe, meeting WHO standards of cleanliness, and free from micro-organisms that would translate to contamination are significant. The quality of water should be free from chemicals with no outstanding stench to constitute a health hazard. Colored water is indicative of contamination and such water quality would not be safe for drinking or domestic use.

There has to be available water facilities that are accessible to all people, without discrimination. Zuniga et al. (2013) identifies four overlapping dimensions to accessibility which are accessible without discrimination; physically accessible; economically accessible (i.e., affordable); and accessible health-related information.

Consequently, this argument presents water as a vital component to good health (Zuniga et al., 2013). These are some of the components that are used to determine the right to water in Zimbabwe overtime. As has been highlighted elsewhere in this paper, physical and economic accessibility to water are some of the major impediments that hinder the progressive realization of the right to water in Zimbabwe.

• 9 Privatization of a Public Good

The right to water in Zimbabwe has courted controversy with the privatization of water through the creation of the Zimbabwe National Water Authority ( ZINWA ). The Water Act of 1976 portrayed the colonial mentality of treating indigenous groups as not worthy of basic human rights and entitlements, including the right to water. The post-colonial dispensation made an attempt to amend the Water Act of 1976 by promulgating the Water Act of 1998 which expanded the provision of water without making it a human right. The Water Act of 1998 was further re-worked, culminating in the Zimbabwe National Water Authority ( ZINWA ) of 1998, which privatized the provision of water, further making economic accessibility to water difficult for many citizens. The situation was further worsened by the cabinet directive to the city of Harare in 2005 to hand over its water and sewer infrastructure to ZINWA . This made water expensive and beyond the reach of many. Further political developments led to the promulgation of a new constitution in 2013, incorporating a bill of rights, including the right to water.

It is one of the most edifying issues that the right to water has been enshrined in Zimbabwe’s constitution, which in all senses is a significant development, given that over the years, Zimbabwe did not have a bill of rights where basic and fundamental human right would be enshrined. Given that Zimbabwe is party to the Committee on Economic Social and Cultural Rights, is became incumbent upon the country to constitutionalize the right to water. The right to water is a justifiable right to which the State has an obligation to fulfill, in accordance with Article 11 (1) of ICESCR which among other rights, guarantees the right to food, clothing and housing. 12 Similarly, CEDAW has also assimilated the right to water in Article 24 (2) and states that

States parties shall ensure to women the right to “enjoy adequate living conditions, particularly in relation to … water supply”. Article 24 (2), CEDAW

Additionally, Article 24 (2) of the Convention on the Rights of the Child exhorts State parties to provide a conducive environment for the combat disease and malnutrition by providing

adequate nutritious foods and clean drinking water. Article 24 (2) of the Convention on the Rights of the Child

As has been indicated in the Mazibuko (Phiri Water) case, it was found that the right to water contains both freedoms and entitlements. Among the freedoms manifested in the Mazibuko Case and to some extent in the SERAC case, include the right to maintain access to existing water supplies necessary for access to water and free from interference, such as the arbitrary disconnections or contamination of water supplies (The Crisis in Zimbabwe Coalition, 2010).

• 10 Towards Privatization of Water Provision in Zimbabwe

The origins of privatization of public entities have been the ESAP adopted by the Government of Zimbabwe in 1990 as one of the conditions for balance of payment support from the Bretton Woods institutions. Since then, privatization has been an enigma applied in wrong places. One of the most prevalent violation of the right to water in post-independent Zimbabwe has been through the transfer of water provision from the Ministry of Water to the Zimbabwe National Water Authority ( ZINWA ) and later back to the Ministry of Water, a move which was evident of a lack of a strong water policy. The right to water was superseded by a desire by government to make profit at the expense, thereby exposing a crop of uncaring politicians whose brazen focus deviated from the provisions of international instruments on the right to water, a socio-economic right which State parties are exhorted by the international community to comply with.

Kamete (2009) has pointed out that privatization of water and sanitation provision has been an illegal venture by government. One of the most authoritative international instruments that bestow provide clean drinking water as well as appropriate sanitary conditions is the International Covenant on Economic, Social and Cultural Rights, as read with General Assembly resolution 2200A ( XXI ) of 16 December 1966. Additionally, Resolution 8/2 of 18 June 2008 of the Optional Protocol to the International Covenant on Economic, Social and Cultural Rights, further places an obligation on the state to ensure the provision of safe drinking water and to ensure that sharing of information with other states on how best to provide socio-economic rights to their citizens is promoted. In Zimbabwe, the provision of water has been the preserve of the state and local authorities, with water having been highly subsidized and a public utility.

However, the privatization of water through the establishment of ZINWA made water expensive and beyond the reach of many. However, the inclusion of the provision of water in the new Zimbabwean Constitution (2013) heralded a new dawn where the right to water became an entitlement for all citizens as enshrined under Sec 77 (a), with Sec 77 (b) which obligates the State to

take reasonable legislative and other measures, within the limits of the resources available to it, to achieve the progressive realisation of this right. Sec 77 (a) (b), Constitution of Zimbabwe 2013

• 11 The ZINWA Debacle

The most outstanding aspect of The Water Act (1998: Ch. 20:25) sought to reform the water sector by ensuring a more equitable distribution of water. The reform process culminated in more stakeholder involvement in the management of water resources, including ownership of water and water sources. Government established the Zimbabwe National Water Authority to ensure equitable distribution of water. The Mission of ZINWA states that they strive

(t)o sustainably deliver quality water to all our communities (rural and urban) whilst making strategic water infrastructure investments that facilitate human and economic development.

The new policy dispensation meant that water supply and water permits would come under the ambit of ZINWA and the water right system eliminated. The policy provision also recognized that water is an economic good and the pollution of water and water sources be criminalized with the “polluter pays” principle applying. In its existence, ZINWA sought to plan and manage water resources on a catchment basis. This is in addition to the management of the water permit system, operationalization of water pricing, operating and maintaining existing infrastructure and executing development projects (Kamete, 2009). Most importantly, ZINWA took the responsibility for the supply and management of domestic water in urban areas, where tapped water is the major source, unlike in rural areas where there are numerous alternative sources of water.

With the spirit of commercialization, the establishment of ZINWA sought to operate on a commercial and self-financing basis. This meant that it provided services at a significant fee to generate the revenue for its needs to finance administrative and water supply functions. This is despite the fact that it was government venture which should be focused on offering public goods for free to citizens. However, the increasing demand for water, mostly in urban areas due to rural-urban migration also saw an equally increased demand for water, which in most cases surpassed the capacity of ZINWA to provide water to citizens. This was on the backdrop of economic challenges that saw ZINWA failing to cope with the demand for clean drinking water, culminating in serious challenges such as disbursing dirty, discolored water, resulting in disease outbreaks, notably cholera in some parts of Zimbabwe. As a result of privatization of water supply, water rates have continued to soar and becoming unaffordable for most citizens. This desperate situation was further compounded by the failure of most local authorities to provide clean drinking water to their residents due to economic challenges that saw most councils failing to procure water-treating chemicals.

The origination of the cholera outbreak in Budiriro and Glen View in 2018 are evident of ZINWA ’s failure to provide adequate clean drinking water to citizens. The situation has further been exacerbated by lack of political will to provide water for citizens. This is evident in the failure by government of Zimbabwe to complete the Zambezi Water Project that has been on the cards since the 1980s. Additionally, most residential areas in Bulawayo continue to endure perennial water shortages despite the fact that the Umzingwane Dam is a water body that has the potential to supply water to the city of Bulawayo. As a result, there has been numerous complaints against failure of ZINWA to fulfill its mandate of delivering water to citizens of Zimbabwe. that the major cause for ZINWA ’s challenges is that the parastatal inherited a sophisticated, yet defunct network of urban water supply infrastructure from local authorities. Most local authorities had been notorious for failure to repair the water supply infrastructure, leading to perennial water and sewer bursts.

Another of the challenges that culminated in its demise was the lack of prior planning in the establishment of the parastatal. The infrastructure inherited by ZINWA required effective maintenance and management and on its own, ZINWA , being a new parastatal hastily established, lacked the necessary human, technical and financial resources to institute the required repairs and upgrades, resulting in infrastructure further falling into a state of disrepair, leading to. constant leakages as evidenced by sewage flows in high-density streets. This explains why disease outbreaks have been a common feature in most poor and densely populated suburbs in the country.

What has further exacerbated ZINWA ’s demise has been lack of adequate expertise to attend to the old and dysfunctional infrastructure, especially at a time when ZINWA lacked the financial resource to manage the supply of safe water to residents. This was further compounded by the scarcity of foreign currency which could only be accessed through the Reserve Bank of Zimbabwe ( RBZ ). This is in view of the fact that in order to procure water treatment chemicals, ZINWA depended on RBZ to finance its core activities. Consequently, the general shortage of foreign currency in the country has led to ZINWA failing to carry out its core mandate of water provision and meeting other operational costs, an undeniable contributory fact that led to water shortages and the disbursement of dirty water to citizens. Failure by ZINWA on its mandate of water provision has resulted in the sprouting of boreholes in most homesteads Despite the fact that it is the function of government to ensure that citizens get clean drinking water as cited in the Mazibuko case as well as by various international legal instruments on socio-economic rights, which make the right to water mandatory and justifiable.

• 12 Limitation of the Right to Water in Zimbabwe

The right to water in the Zimbabwean Constitution, is subject to certain limitations, notably the prevailing economic conditions at any given time for the state to be able to provide water. Zimbabwe has had its fair share of economic challenges over the last 4 decades with no solution in sight. Even the constitution, under Section 77, exonerates the state from this obligation by implying that the state must take measures to implement the right to water, but only “within the limits of the resources available to it”. In South Africa, where legal court challenges on the right to water have been mounted through the local courts of law and where the constitution has a similar provision, the courts in different cases laws, such as the Mazibuko case, have interpreted this as follows: In determining the reasonableness of a government programs for implementing a socio-economic right, it is noteworthy that a court should decide reasonableness on a case-by-case basis. The State is not required to do more than what its resources permit it to do, but it has a duty to ensure the provision of minimum amount of water, despite prevailing economic circumstances. The right to water is subject to prevailing legislative and constitutional provisions that obligate the state to realize this right. Furthermore, the state should also be in a position to prove that it is incapacitated to realize the right to water. Consequently, due to the vital significance of the right to water, it would be difficult for the state to prove that it is unable to provide water. The establishment of ZINWA in Zimbabwe is testimony of acceptance by government to provide water.

• 13 Conclusion

The perennial socio-economic challenges and lack of political will have been stumbling blocks in the realization of the right to water in Zimbabwe. This has been happening on the backdrop of high levels of corruption. While a plethora of legislative and policy frameworks have been proffered to obligate and guide State parties towards the realization of the right to water, not much has been realized. The establishment of ZINWA was evident of Government’s commitment to provide adequate, clean drinking water to citizens, but challenges cited above have inhibited the realization of the right to water. Natural calamities such as those emanating from climate change may have claimed a fair share of the challenges encountered in the provision of clean drinking water. The way forward would be increased investment in water bodies and the completion of existing projects.

Kamete , Y. A. ( 2009 ). Governing the Poor in Harare, Zimbabwe: Shifting Perceptions and Changing Responses . Research Report No. 122, Nordiska Afrikainstitutet , Uppsala .

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The Crisis in Zimbabwe Coalition. (2010). Zimbabwe and the right to water . Retrieved January 20, 2018, from http://archive.kubatana.net/docs/watsan/ciz_right_to_water_091027.pdf .

Zuniga , J. M. , Marks , S. P. & Gostin , L. (Eds.) ( 2013 ). Advancing the human right to health . Oxford University Press .

Article 16, African Charter on Human and Peoples Rights.

Article 17, African Charter on Human and Peoples Rights.

Department of Water Affairs: Free Basic Water Implementation Guidelines for local authorities.

Maastricht Guidelines on Violations of Economic, Social and Cultural Rights, Maastricht, January 22–26, 1997.

Mazibuko vs City of Johannesburg .

Section 27 (2) of the South Africa Constitution says that the State must respect, protect, promote and fulfil the rights in the Bill of Rights, but does not have to necessarily fulfil most socio-economic rights immediately, though it must take reasonable legislative and other measures within its available resources, to achieve the progressive realization of the rights to water.

SERAC vs Nigeria (n 33) para 3.

United Nations Environmental Programme: https://leap.unep.org/sites/default/files/court-case/achpr30_155_96_eng.pdf .

Article 11 (1), ICESCR .

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Proposition and application of a conceptual model for risk management in rural areas: rural basic sanitation safety plan (rbssp).

1. Introduction

2. materials and methods, 2.1. rbssp conceptual model (cm rbssp ), 2.1.1. first phase, 2.1.2. second phase.

• Fundamental principles that will be the basis for plan preparation;
• RBSSP steps, which will demonstrate their logical sequence;
• Objective that will explain the purpose of the each stage;
• List of actions with activity sequence, and how they should be performed in order to achieve the objective;
• Instruments that will be used to perform the listed actions;
• Products that must be obtained at each stage end of RBSSP;
• Implementation of a summary figure, instrument used to facilitate the visualization of the steps, and the general structure of the RBSSP.

2.1.3. Third Phase

2.2. case study, 3.1. rbssp conceptual model (cm rbssp ), 3.1.1. first phase, 3.1.2. second phase, 3.1.3. third phase, 3.2. case study, 4. discussion, 4.1. rbssp conceptual model (cm rbssp ), 4.1.1. phase 1.1, 4.1.2. phase 1.2, 4.1.3. phase 1.3, 4.1.4. second phase, 4.1.5. third phase, 4.2. case study, 5. conclusions.

• The WSP and SSP frameworks consist of multiple steps and must include phases for diagnosis, risk assessment, management plans and continuous improvement phases, which are relevant for any safety plan methodology.
• A methodology for the preparation of safety plans for rural areas, related to basic sanitation, can be used as it is or adapted, depending on the local reality, such as cultural, economic, regulatory and community involvement aspects. However, there is a gap in the adaptation process. The methodology adaptation to rural settlements and to include the four components of basic sanitation remains a gap in the literature, which evidences the importance of RBSSP.
• It is possible to develop a comprehensive safety plan that integrates water supply, sewage, solid waste management and rainwater management in rural settlements. This plan should be based on the principles of basic sanitation, ensuring that all steps are applied to these four services.
• The methodology for the preparation of RBSSP must address specific and/or greater impact issues, such as the community representation team for its preparation, and the expanded concept of health application connected to each one of the basic sanitation services (water supply, sewage, solid waste management and rainwater management), which differentiates it from urban areas.
• Community participation, involvement and empowerment must be considered in RBSSP methodology, as these are factors of greater relevance in its implementation, specially to ensure the connection between the four components of basic sanitation and because most of these services are provided by the population.
• It is important that RBSSP fundamental principles are explicit and are used during its preparation, implementation and for decision-making. This can strengthen the implementation of RBSSP, ensuring that it focuses on the most important issues in rural basic sanitation.
• The necessary tools for the preparation of RBSSP, such as risk assessment methodologies and management plans, must be applied considering RBSSP fundamental principles.
• The application simulation of the conceptual model showed that it is necessary to adapt the actions, to apply appropriate methods and techniques developed for the rural area, as a way to properly prepare RBSSP, according to the scenario. After conducting the case study, the final RBSSP framework consists of six fundamental principles, six steps, and twenty actions to be implemented in any type of rural settlement.

Supplementary Materials

Author contributions, data availability statement, acknowledgments, conflicts of interest.

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Baracho, R.O.; Bezerra, N.R.; Scalize, P.S. Proposition and Application of a Conceptual Model for Risk Management in Rural Areas: Rural Basic Sanitation Safety Plan (RBSSP). Resources 2024 , 13 , 90. https://doi.org/10.3390/resources13070090

Baracho RO, Bezerra NR, Scalize PS. Proposition and Application of a Conceptual Model for Risk Management in Rural Areas: Rural Basic Sanitation Safety Plan (RBSSP). Resources . 2024; 13(7):90. https://doi.org/10.3390/resources13070090

Baracho, Rafaella Oliveira, Nolan Ribeiro Bezerra, and Paulo Sérgio Scalize. 2024. "Proposition and Application of a Conceptual Model for Risk Management in Rural Areas: Rural Basic Sanitation Safety Plan (RBSSP)" Resources 13, no. 7: 90. https://doi.org/10.3390/resources13070090

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Developing markets for watershed protection services and improved livelihoods: a diagnostic for South Africa Conclusions The following general comments can be made relating to the water sector and land-use practices in South Africa: No fully working markets for watershed ...

Irene Guijt

Bacha Mekonnen

Watershed management has emerged as a potential concept, which harmonizes the use of natural resources for their long-term sustainability and optimal productivity. It has also been accepted as a sound development paradigm by the local governments and donor agencies for upliftment of the rural masses living in rainfed and fragile ecosystems. Though sound on hydrological and biophysical principles, the approach is confronted with several challenges related to equity, effective participation, scaling-up, water rights, conflict resolution, cost sharing and subsidies, public and private gains and crafting of suitable policies and institutions. This publication is an attempt to effectively address these and related issues from scientific, socioeconomic , institutional and policy perspectives through integration of Indian and international knowledge and experience. This book is also an attempt to broker the Indian and international experiences on watershed management to the researchers, policy makers, donors and program implementing agencies in the African continent. It will be of significant interest to those working in the areas of hydrology and engineering, land and water management, development studies, knowledge management, and policies and institutions.

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Nadine Reis

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Is Joe Biden sick? First presidential debate viewers surprised at hoarse voice

President Joe Biden started the first presidential debate with a noticeably hoarse voice.

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Contributing: Francesca Chambers

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WA Cares is a cost-effective, convenient safety net for long-term care

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• The incidence of infratentorial arteriovenous malformation-associated aneurysms: an institutional case series and systematic literature review
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• http://orcid.org/0000-0003-3918-5869 Mark Davison 1 ,
• Maximos McCune 2 ,
• Nishanth Thiyagarajah 2 ,
• http://orcid.org/0000-0002-2045-972X Ahmed Kashkoush 1 ,
• http://orcid.org/0009-0001-1362-1944 Rebecca Achey 1 ,
• Michael Shost 3 ,
• http://orcid.org/0000-0002-3646-3635 Gabor Toth 2 ,
• Mark Bain 1 , 2 ,
• Nina Moore 1 , 2 , 4
• 1 Department of Neurosurgery , Cleveland Clinic Foundation , Cleveland , Ohio , USA
• 2 Cerebrovascular Center , CCF , Cleveland Heights , Ohio , USA
• 3 Case Western Reserve University School of Medicine , Cleveland , OH , USA
• 4 Department of Biomedical Engineering , Lerner Research Institute , Cleveland , OH , USA
• Correspondence to Dr Mark Davison, Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; davisom{at}ccf.org

Background Arteriovenous malformation (AVM)-associated aneurysms represent a high-risk feature predisposing them to rupture. Infratentorial AVMs have been shown to have a greater incidence of associated aneurysms, however the existing data is outdated and biased. The aim of our research was to compare the incidence of supratentorial vs infratentorial AVM-associated aneurysms.

Methods Patients were identified from our institutional AVM registry, which includes all patients with an intracranial AVM diagnosis since 2000, regardless of treatment. Records were reviewed for clinical details, AVM characteristics, nidus location (supratentorial or infratentorial), and presence of associated aneurysms. Statistical comparisons were made using Fisher’s exact or Wilcoxon rank sum tests as appropriate. Multivariable logistic regression analysis determined independent predictors of AVM-associated aneurysms. As a secondary analysis, a systematic literature review was performed, where studies documenting the incidence of AVM-associated aneurysms stratified by location were of interest.

Results From 2000–2024, 706 patients with 720 AVMs were identified, of which 152 (21.1%) were infratentorial. Intracranial hemorrhage was the most common AVM presentation (42.1%). The incidence of associated aneurysms was greater in infratentorial AVMs compared with supratentorial cases (45.4% vs 20.1%; P<0.0001). Multivariable logistic regression demonstrated that infratentorial nidus location was the singular predictor of an associated aneurysm, odds ratio: 2.9 (P<0.0001). Systematic literature review identified eight studies satisfying inclusion criteria. Aggregate analysis indicated infratentorial AVMs were more likely to harbor an associated aneurysm (OR 1.7) and present as ruptured (OR 3.9), P<0.0001.

Conclusions In this modern consecutive patient series, infratentorial nidus location was a significant predictor of an associated aneurysm and hemorrhagic presentation.

• Arteriovenous Malformation
• Posterior fossa
• Angiography

https://doi.org/10.1136/jnis-2024-022003

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Contributors All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by MD, MM, and NT. Manuscript preparation was performed by MD and all authors participated in manuscript revisions. All authors reviewed and approved the final manuscript.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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