What is the difference between urban and rural areas?

Access to improved sanitation services in the Mediterranean region is generally above the world average (MDG report, 2013). Yet, due to the migration from rural to urban areas, the consequent increase in urban populations, the emergence of 'pockets' of urban poverty, and the inequities between urban and rural areas, the planning of sanitation services in the ENP-South countries remains challenging. Ensuring access to sanitation services in unregulated peripheral quarters and in medium and small-sized towns involves the whole cycle of services delivery: mobilisation of financial and human resources, planning and design, construction, operation and maintenance as well as policymaking.

Figure 4.4 Percentage of urban population having access to improved sanitation systems in ENP-South countries for the time period from 2003 to 2011

Note: Data for Tunisia refer to 'communal' areas. No data are

provided by Israel for urban population fraction. Sources: Data for Jordan, Palestine, Tunisia and (Lebanon) are

provided by countries under the ENPI-SEIS South project. Data for Algeria, Egypt, Libya, Morocco and Syria are from the UN database.

Figure 4.5 Percentage of rural population having access to improved sanitation systems in ENP-South countries for the time period from 2003 to 2011

Note: In Palestine, refugee camps are considered a separate

locality type. Data for Tunisia refer to 'non-communal' areas. No data are provided by Israel for rural population fraction.

Source: Data for Jordan, Palestine, Tunisia and (Lebanon) are provided by countries in the context of the ENPI-SEIS South project. Data for Algeria, Egypt, Libya, Morocco and Syria are from the UN database.

40 50 60 70 80 90 100 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 % urban population Algeria Egypt Israel Jordan Lebanon Libya Morocco Palestine Syria Tunisia Algeria Egypt Israel Jordan Lebanon Libya Morocco Palestine rural Syria Tunisia 40 50 60 70 80 90 100 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 % rural population

Palestine refugee camps

The breakdown between the urban and rural population (see Figure 4.4 and Figure 4.5) shows that in most cases, access to improved sanitation in rural areas is lagging behind. More than 5.5 million people living in urban areas and no less than 12 million rural dwellers were deprived from access to improved sanitation systems in 2011, and had to revert to public or shared solutions and open defecation. The corresponding data from 2003 show that the number of people without access to improved sanitation systems was 5.5 million and 18 million in urban and rural areas, respectively. This implies that the gap between the urban and rural coverage has been gradually narrowing in most countries over the time period from 2003 to 2011.

Box 4.3 Social and economic benefits of improved sanitation systems

In a study by Larsen (2010), the cost of inadequate potable water, sanitation and hygiene in northern African and Middle Eastern countries (9_{) was assessed for the year 2007/08, as a follow-up to similar}

studies previously conducted by World Bank through its Mediterranean Environmental Technical Assistance Program (METAP). Estimates included further substantiated linkages between health and environmental quality, based on empirical direct and indirect health effects such as diarrheal infections and malnutrition. The annual cost of health effects associated with water, sanitation and hygiene in 2008 was estimated at USD 4.1 billion in the ENP-South region, equivalent to between 0.4 % and 0.9 % of the countries' GDP. These included both the cost of mortality (instances of death) and morbidity (instances of disease), with the cost of morbidity being higher than that of mortality in most of the nine countries.

Source: Larsen, 2010.

The benefits of enhanced environmental protection in the ENP-South region were further investigated in the recent project 'Environmental benefits' (Ten Brink et al., 2011). This study identified the health, environmental, economic and social benefits of an improved water and sanitation situation, to meet a set of targets for the year 2020. These targets included achieving 100 % population connection to a water supply and sewage network system (except in isolated rural areas), ensuring continuous, reliable and safe water provision to the population, serviced with a piped water supply, and providing improved sanitation to households in isolated rural areas that are currently without such facilities. The targets also considered improving hygiene practices to prevent the spread of contagious diseases. The assessment focused on the qualitative, quantitative and monetary benefits associated with reduced incidence of morbidity and mortality as a result of improved water, sanitation and hygienic conditions.

Based on the current population distribution connected to water supply and sanitation services in the ENP-South region, it was estimated that by achieving the targets, diarrheal disease and diarrheal mortality nationwide will decrease: by 15 % to 17 % in Israel, and by 33 % in Morocco. The assumption here is that the entire population already has good hygiene practices that are adequate for health protection.

(9_{) The overall geographical coverage of this study included the 16 countries of the Arab League: Algeria, Egypt, Jordan, Lebanon,} Libya, Morocco, West Bank and Gaza, Syria and Tunisia as well as Comoros, Djibouti, Iraq, Mauritania, Somalia, Sudan and Yemen. Figure 4.6 Annual costs of health effects associated with water, sanitation and hygiene in

ENP-South countries in USD, as a percentage of GDP

Algeria Egypt Jordan Lebanon Libya Morocco Syria Tunisia Palestine 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1.0 0 200 400 600 800 1 000 1 200 1 400 1 600

Box 4.3 Social and economic benefits of improved sanitation systems (cont.)

Assuming that the hygiene practices are also improved by 2020, the decrease in morbidity and mortality is estimated at 25 % to 27 %, to 65 %. This is equivalent to ~ 45 million and 100 million avoided annual cases of diarrhoea, and between 4 350 and 9 500 avoided deaths. Using the benefits methodology

developed as part of the project, the annual monetised benefits from the avoided incidences would amount to between EUR 2 136 and EUR 4 710 million for morbidity, and between EUR 1 673 and EUR 3 700 million for mortality. In total, the annual benefits for the entire region would range from EUR 3 808 million to EUR 8 412 million, representing between 0.06 % and 0.99 % of the GDP of individual countries in 2020.

References:

Larsen, B., 2010, 'Cost assessment of environmental degradation in the Middle East and North Africa region — selected issues', Economic Research Forum, working paper 583 (http://www.erf.org.eg/CMS/uploads/ pdf/1290798530_Envi_Nov_03.pdf) accessed 8 April 2014.

ten Brink, P. (IEEP), Bassi, S. (IEEP), Farmer, A. (IEEP), Hunt, A. (Metroeconomica), Lago, M. (Ecologic), Larsen, B., Spurgeon, J. (ERM), Tucker, G. (IEEP), Van Acoleyen, M. (Arcadis), Doumani, F. and Van Breusegem W. (Arcadis), 2011, Analysis for European Neighbourhood Policy (ENP) Countries and the Russian Federation on Social and Economic Benefits of Enhanced Environmental Protection.Regional Report: ENPI South. A synthesis report on Algeria, Egypt, Israel, Jordan, Lebanon, Morocco, occupied Palestinian territory, Syria and Tunisia (http://ieep.org.uk/assets/942/ENPI_South_benefits_of_ environmental_protection.pdf) accessed 8 April 2014.

4.3 What is the progress in municipal