A new World Bank report warns that climate change is rapidly worsening an already severe global sanitation crisis, particularly in fast-growing cities in low- and middle-income countries, where billions remain without safely managed sanitation.
The report, The Global Sanitation Crisis: Pathways to Urgent Action, was produced by the World Bank Group’s Global Department for Water and released in 2025. It was prepared by a World Bank team led by Sanyu Lutalo, Nishtha Mehta, and Gustavo Saltiel, with contributions from water, climate, and sanitation specialists across the institution.
Background
Urban sanitation systems worldwide are falling far behind global targets, including Sustainable Development Goal 6, which aims for universal access to safely managed sanitation by 2030. According to the report, progress must accelerate fivefold to meet this goal. Climate change is compounding the challenge by increasing floods, droughts, extreme weather, and sea-level rise—placing enormous strain on sanitation infrastructure that is already inadequate in many cities.
The crisis is most acute in low- and middle-income countries, where rapid urbanization has pushed millions of poor households into flood-prone and environmentally fragile areas. In these settings, sanitation failures worsen public health risks, deepen poverty, damage ecosystems, and undermine economic growth.
Key findings
The report finds that 3.5 billion people globally lack access to safely managed sanitation, with urban areas increasingly at risk. In cities across low- and middle-income countries, up to one-third of residents face a “triple burden” of poverty, high climate risk, and poor sanitation access. About 919 million urban residents are exposed to poverty, water stress, and inadequate sanitation, while 1.1 billion people face poverty, flooding, and sanitation deficits.
Climate change is also intensifying sanitation-related health risks. Flooding and system failures lead to the release of untreated sewage, increasing exposure to waterborne diseases. The report notes that unsafe sanitation contributes significantly to preventable deaths and lost productivity, particularly among women, children, and vulnerable communities.
Beyond health impacts, the report highlights sanitation’s economic and environmental dimensions. Poor sanitation undermines human capital and city productivity, while well-designed systems can deliver strong economic returns. In Africa, for example, every dollar invested in water and sanitation yields an estimated seven-dollar return, with the potential to boost GDP by more than five percent. The sanitation sector is also linked to greenhouse gas emissions, particularly methane, making it both a climate victim and a contributor.
Policy direction
The report calls for a shift from a “vicious cycle” of failing, climate-vulnerable sanitation systems to a “virtuous cycle” of climate-resilient sanitation. It urges governments and cities to adopt citywide inclusive sanitation approaches, integrate sanitation into climate and urban planning, expand financing through public and private sources, and embrace circular economy solutions that recover water, nutrients, and energy from waste.
The authors conclude that sanitation must be treated as a core public service and climate priority, warning that without urgent, coordinated action, climate change will continue to widen health, economic, and social inequalities in cities worldwide.
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