DAR ES SALAAM, Tanzania – For Khadija Kambi, the country’s water shortage presents a tricky moral dilemma for her family: either she lets her children drink murky water and fall sick or she lets them suffer from extreme thirst.

“I don’t have the money to buy clean piped water. Well water is the cheaper option for me. But the groundwater is dirty, smelly and too salty to drink. My daughter got ill when she drank it,” said Kambi, a 42-year-old mother of four who lives in the Temeke district of the country’s capital.

Getting enough water supply is a constant struggle. Every morning she straps her baby to her back and walks down the hill to fetch water from the community well despite the risks posed by the water.

For Kambi, who makes her living by selling small bags of charcoal and vegetables at a local market, the water crisis has inflicted a huge economic burden on her family.

“When my children get sick, I spend a huge chunk of my money to buy medicines,” she lamented.

In early November, Kambi’s 14-year-old daughter, Zulfa, suffered an intense stomach ache and was rushed to the hospital. Doctors diagnosed her with stomach ulcers and typhoid fever, which they suspect was caused by drinking contaminated water.

“I was feeling very exhausted, my body temperature rose and I was vomiting,” Zulfa told Health Policy Watch.

Typhoid fever, caused by the salmonella Typhi bacteria, is a highly infectious disease transmitted by contaminated food or water. It causes high fevers, headaches and vomiting. About 21 million people suffer from typhoid each year and about 161,000 die, according to World Health Organization (WHO).

Extreme drought spells have pushed most of Tanzania’s 5.5 million residents to the wobbly edge of survival. In Temeke, the number of people without access to safe water is rapidly rising, putting families in danger of contracting diseases.

Most Temeke residents used to rely on water delivered by vendors with wheelbarrows or motorbikes. But the water scarcity has pushed up prices and the service is no longer affordable for many families.  

“A 20-litre container of water is sold for up to Tanzania shillings 2300 ($1). Who can afford that?” asked Kambi

Like other coastal areas, freshwater sources in Temeke are becoming increasingly contaminated by seawater seeping into the ground aquifers from the Indian Ocean. This is caused mainly by the uncontrolled depletion of aquifers as more and more people move to the city.

The fresh water in the ground aquifers – the main source of drinking water for many people in Temeke – has become increasingly contaminated with chloride, sulphate and sodium.

The prolonged drought being experienced across east Africa has made it harder for the ground aquifers to replenish with fresh water, forcing many people to drink the salty water anyway.

But the salty water is causing a barrage of ailments including stomach aches, headaches and even ulcers, local residents said.

Like Zulfa, a cross-section of Temeke residents interviewed by Health Policy Watch have attested to the resurgence of waterborne diseases with symptoms like dizziness, nausea, vomiting and diarrhoea.

The water crisis in Temeke is the tip of the iceberg for the capital city, which has experienced about 60% decline of its water supply over the last four months, putting millions of city dwellers at increased risk of contracting waterborne diseases.

Changing weather patterns, characterised by long dry spells, coupled with the rising population, is exerting huge pressure on the limited water supply in Dar es Salaam, forcing thousands of residents to find water from unsafe sources, officials said.

The region is experiencing its fourth year of drought, and Dar es Salaam, which relies heavily on water from Ruvu River, is experiencing its worst water shortage in decades.

As the Ruvu’s water level dropped to its lowest ebb, the Dar es Salaam Water and Sewage Authority (DAWASA) started to ration water in late October to cope with galloping city demand.

According to DAWASA, the city’s water production dropped from 466 million litres a day to 300 million litres, but citizens consume approximately 500 million litres a day.

While October was supposed to bring the onset of summer rains, the city instead got an unpleasant surprise, with dry spells and fiery heat including temperatures that reached 33ºC.

Water loss from poor infrastructure

As a result, the Ruvu River, the main source of water in the smoke-belching city, reached dangerously low levels.

To make matters worse, local experts that estimate about 60% of the water is lost due to leaks and theft.

“DAWASA has one of the highest rates of water loss,” said Herbert Kashililah, chair of the Tanzania Water and Sanitation Network. “Almost half of the water is lost through faulty equipment but also from illegal connections,” he said.

The water crisis in Dar es Salaam is threatening the health and livelihoods of many city dwellers.

“When people can’t get enough water for sanitation and handwashing, respiratory and gastrointestinal illnesses tend to spread more easily,” said Medrad Kahumba, a public health expert at Muhimbili National Hospital.

As sanitation is increasingly being compromised by the drought, waterborne diseases including typhoid, dysentery and diarrhoea are rising, Kahumba added.

Meanwhile, Deus Kitapondya, an independent public health and emergency medicine consultant, told Health Policy Watch that water scarcity can have far-reaching consequences for health due to an increased concentration of harmful pollutants.

“Lack of water will always force poor people to look for water from unclean and unsafe sources, which expose them to waterborne disease,” said Kitapondya.

“Waterborne diseases are prevalent in our areas, and people should make sure they obtain clean and always drink boiled water,” he said, adding that waterborne diseases are among the top 10 causes of emergency hospital admissions in sub-Sahara Africa.

Diseases on the rise

In Temeke, cases of waterborne diseases have been reported in almost all drought-stricken areas, officials said

Irene Haule Temeke, a municipal council medical officer, said the number of patients treated for waterborne diseases had jumped from 370 cases in mid-August to 1270 in November.

“I am certain water problems and poor hygiene are the reasons behind the increase of diarrhoeal diseases,” he said.

Globally, an estimated 884 million people don’t have access to clean water and 2.4 billion people do not have access to basic sanitation 

Dar es Salaam is one of Africa’s fastest-growing cities, but almost 70% of its 5.8 million inhabitants are living in informal dwellings with limited access to clean running water.In addition, the sewerage networks are often wrecked by flooding during the rainy season, forcing stinking sludge into the streets and exposing residents to pollutants, public health experts said.

Shifting weather patterns

Climate change is playing a role in increased cases of infectious diseases by shifting weather patterns, according to Rubhera Mato, professor of water engineering and environmental health at Ardhi University.

Heavy rainfall, flooding and drought – all predicted to rise as the planet heats up – can all increase contaminants in drinking and recreational water.

“The worst is yet to come, we better get prepared,” Mato said.

Lack of sanitation is one of the world’s leading development challenges. Globally, around a billion people have no toilets. While many city dwellers prefer flush toilets, the acute shortage of water in many areas makes this a distant dream.

Between August 2015 and January 2018 a total of 33,421 cases of cholera including 542 deaths had been reported across 26 regions of Tanzania. Children under five years old accounted for 11.4% of cases, according to the WHO.

The water crisis in Dar es Salaam is hardly surprising. Across Africa, cities are reeling from the agony of acute water scarcity.

From Cape Town to Nairobi to Kigali, water scarcity is creating growing stresses for city dwellers as climate change takes its deadly toll on humanity.

“While people in urban areas are being threatened by water shortages due to climate change and rapid population growth, the effects of urban development patterns on future water shortage in cities are rarely investigated,” warned Mato

As part of its broader push to improve public health, Amos Makala, the regional commissioner for Dar es Salaam is confident that the government increase access to sanitation to 95% by 2025.

But in the face of climate change, the city’s growing popultion and dwindling water resources, waterborne diseases continue to increase their deadly toll on the humans living in the city.

In the meantime, Kambi will continue to be haunted by the nightmare of whether to spend her hard-earned money on expensive bottled water for her children or risk letting them drink well water with potentially deadly pathogens.

Image Credits: Peter Mgongo.