Ghulam Hussain, a street vendor, is well known to the communities he’s been visiting for ages now. Most people in the areas he visits have known him since their childhood. They remember seeing him pushing his cart loaded with goods all through the year. He stops over wherever he can find a buyer.

Decades on, Hussain’s routine is more or less the same, except that his energy levels have dropped markedly. He has grown weak, and finds it hard to push the cart. His visits have become infrequent, and he’s always in a rush. Back in the day, he would pull by the roadside and wait patiently for his (regular) customers to arrive.

Hussain says that he’s got hypoglycemia (diabetes). Uncontrolled blood sugar levels over long periods of time have affected his health adversely, damaging his vital organs, and led to conditions such as excessive urination and irregular bowel movement. He has the urge to answer the call of nature multiple times in a day, which has restricted his movement to a great extent. He consumes as little water as he can, and tries to stay in his vicinity so that he can run back home and relieve himself when the need arises. His issue is aggravated by the fact that there are no public facilities around. Sometimes, he has to use the toilet in a nearby mosque, or simply find some deserted, less obvious place out in the open.

"In extreme cases, I request people to allow me [to use] their private toilets. But it doesn’t always work," he says, lamentingly. "People aren’t comfortable letting in a stranger."

To make matters worse, the mosque administration now keeps their toilets shut, except during the prayer times. "Even at these [prayer] times, only the namazis are allowed to use the toilets."

Open spaces are fast shrinking, and if an outsider is caught relieving himself at a street side or something, they are abused -- and even thrashed -- by the locals.

The case of Zahid Hussain, a middle-aged sales agent who gets to travel all through the day, is no different. He is always looking out for some public park on the way. The parks now offer the facility for free. He says he decided on parks after he was once stopped by the staff of a restaurant from using their toilet.

The women are worse off, in a similar situation; primarily, because they are not as mobile as men, and they cannot avail the ‘options’ the men can.

If one looks at the urban development plans and the existing building bylaws, one finds there are provisions to have toilets across the city and at all public places. The commercial plazas and centres are also required to have these, but very often they do not do the needful, and they even sell the spaces meant for the purpose.

Even where you find the public toilets, their maintenance is so poor that they are next to unusable.

No doubt the issue of safe sanitation and access to toilets is a top priority of global development organisations, especially those working on Water Sanitation & Hygiene (WASH) rights. Interestingly, the theme of this year’s World Toilet Day, which falls on November 19, is: "When Nature Calls… we need a toilet." This calls for the need for toilets and an end to open defecation.

An official of the City District Government Lahore (CDGL) tells TNS, on condition of anonymity, that a project has been initiated to "build model toilets in the city, at places such as Karim Block Market, Allama Iqbal Town, the Sabzi Mandi, and Regal Chowk. These [toilets] are of high quality, and user-friendly. There are separate toilets for male, females, and special people."

The official adds that the government intends to enforce the building bylaws about compulsory provision of toilets for public. He also hints at the possibility that "some of the land recovered [from land mafias] during the recent anti-encroachment drive shall be consumed for construction of these facilities throughout the province."

Recently, the World Bank came up with a report, titled ‘When Water Becomes a Hazard: A Diagnostic Report on The State of Water Supply, Sanitation and Poverty in Pakistan and Its Impact on Child Stunting,’ which states that 38 percent of children in Punjab contract diarrhea because they defecate in the open. The percentage would be reduced if they used toilets.

The report also points out that "management of drains and treatment of human waste is nonexistent for most rural dwellers as well as the poor in smaller urban towns and cities, and there has been almost no public-sector effort to regulate toilet quality or monitor water quality. As a result, there is a huge variation in the quality of latrines built. Most of the increase in access to improved latrines is from increase in the number of flush toilets connected to what are referred to as septic tanks."

Shahnawaz Khan, Regional Director of the Lahore-based Strengthening Participatory Organisation (SPO), points out that the current situation requires something more than just building public toilets in urban centres: "The need of the day is to create awareness among the masses, and inform them about the negative effects of open defecation."

Khan’s organisation has worked with the Punjab government’s Public Health Engineering Department (PHED), with support from the WaterAid UK on WASH rights. He says that under a pilot project they made, "Tehsil Jatoi in Muzaffarabad district is now free of open defecation. We are working to help the whole district gain the same status."

He also speaks of supporting the people in building low-cost (for Rs 6,000 or so) toilets in their houses. "The people had no idea that a toilet inside a house could be built for less than Rs 50,000; no wonder they avoided constructing one," he adds. "Many of them didn’t even know that the cause of many of the diseases they suffered from were unhealthy sanitation practices."

Siddiq Ahmed Khan, Country Director at WaterAid, also stresses on the importance of safe sanitation. "Presently, the facilities are available only to the 66 percent population in Punjab," he declares.

The Multiple Indicator Cluster Survey (MICS) gives a breakup of the situation in Punjab, according to which the rate of open defecation is 49 percent in Rajanpur, 43 percent in Muzaffargarh, 39 percent in Chiniot, 39 percent in Dera Ghazi Khan, 38 percent in Jhang, 35 percent in Khushab, 31 percent in Bhakkar, 31 percent in Bahawalnagar, 30 percent in Lodhran, and only one percent in Lahore.

The Punjab government has earmarked Rs20 billion for water and sanitation in this year’s provincial budget. Different quarters have urged the authorities to utilise the budget judiciously and not let it lapse as has happened in the past. Jahangir Humayun, Vice President, Youth Wing of PTI in Central Punjab, says water and sanitation are a priority with the party, and integral components of Prime Minister Imran Khan’s "Clean Green Pakistan Initiative."

The petrol pumps and CNG stations across the province have been given standing orders to maintain toilets for public.