Earlier this month, Kohinoor Khatik came down with loose motions and bouts of vomiting. The doctor who examined her said she had contracted a water-borne illness.
“People keep falling ill here,” said her husband Jalil Khatik, who spent Rs 800 on medicines for his wife.
Khatik blames the frequent illnesses to the “open drains” and dirt in his neighbourhood in Maharashtra’s Jalgaon district.
More specifically, he blames the contaminated water around the community toilet near his house in Amalner town. “Waste overflows every time someone uses the toilet. The septic tank has not even been cleaned once,” Khatik claimed.
As a result, residents in the neighbourhood often suffer from diarrhoea. The frequent health expenses take a toll on his limited income, said Khatik, who runs a small butcher shop.
While Maharashtra recorded a steady decline in diarrhoea cases between 2011 and 2021, there has been a striking reversal in the last three years.
Between 2022 and 2024, the state saw an 80% rise in water-borne illnesses such as cholera, typhoid and gastroenteritis, which are categorised as acute diarrhoeal diseases.
In 2024, 1.95 lakh cases of acute diarrhoeal disease were reported, up from 1.35 lakh cases in 2023 and 1.08 lakh cases in 2022, data from the Integrated Disease Surveillance Programme and the state epidemiology department shows.
Jalgaon district, where Khatik lives, recorded a 219% rise in acute diarrhoeal diseases over these three years.
What explains this surge? A new analytical study undertaken by UNICEF Mumbai throws up a possible answer.
It suggests that poorly constructed septic tanks for toilets built under the Swachh Bharat Mission might have contributed to the contamination of water sources and the unprecedented rise in diarrhoea cases in Maharashtra.
The study looked at state government data on toilets constructed, the number of districts with septic tanks, and compared it with the rise in cases of diarrhoea over the last few years.
“We are not saying that septic tanks are bad,” said Yusuf Kabir, in-charge of water supply, sanitation and climate in UNICEF Mumbai. “What is problematic is the way they are constructed and faeces is managed.”
The study found that besides faulty construction, the delay in emptying septic tanks in rural Maharashtra is leading to ground water and soil contamination.
The ground reality
In 2014, the Narendra Modi government launched the Swachh Bharat Mission to provide financial assistance to households to build toilets.
It led to a significant adoption of septic tanks in rural areas. Until then, rural households mostly had single or double-pit toilets.
In Amalner taluka, former corporator Amin Patel said most toilets built under the government scheme were constructed with an adjoining septic tank.
Across rural Maharashtra, over 4.3 million toilets have septic tanks. The majority, about 2.5 million, were constructed between 2015 and 2019 during the government push for Swachh Bharat Abhiyaan (rural).
In nine districts, including Jalgaon where Khatik lives, septic tanks account for more than 50% of all types of toilets in rural areas.
For the first few years, these newly built toilets worked well, said sanitation expert Shrikant Navrekar.
The World Health Organisation noted 3 lakh fewer diarrhoea deaths in India in 2019, compared to 2014, which it attributed to “improved sanitation” , a statement cited on the Swachh Bharat Mission dashboard.
So, what went wrong?
“Now the septic pits have filled up, and nobody is cleaning them,” said Navrekar, who works with the Nirmal Gram Nirman Kendra. “The effluents of septic tanks are flowing out in many places I visited,” he added. “It is being directed into open drains without treatment.”
Delay in cleaning
In a rural household, a septic tank usually requires emptying every three to five years. If it is not cleaned, faecal matter can overflow or leak from the septic tank’s walls.
Both situations contaminate soil, ground water, and can pollute the water supply system.
By now, the septic tanks of toilets constructed between 2015 and 2019 would ideally require at least one round of emptying.
But that has largely not happened, a survey by the All India Institute of Local Self Government, or AIILSG, found.
The survey was funded by the Maharashtra government and covered 6,448 septic tank toilets in four districts – Ahilyanagar, Chandrapur, Parbhani and Pune. It was carried out with technical support from UNICEF for the water supply and sanitation department.
The survey found that 78% septic tanks built between 2000 and 2020 have never undergone faecal sludge cleaning.
Sagar Patil, senior technical officer with AIILSG, told Scroll that of the 6,448 toilets, 68% were constructed under the Swachh Bharat Abhiyaan. “In the septic tanks that were never cleaned, we found that faecal sludge was percolating into the soil,” Patil said.
In Dhar village in Jalgaon, Kabir Mujawar built a toilet in his home in 2017. He also created a septic tank with it. Mujawar has not emptied it once in these seven years.
“We don’t know who to approach and how to empty it,” Mujawar said.
In Amalner town, Shaukat Fakir constructed a toilet with a septic tank in 2018. Five people in his house use the toilet daily. “Nobody explained the process of emptying the tank to me when the toilet was built,” he told Scroll.
The municipal body in Amalner is tasked with the cleaning of household septic tanks, but it has not once emptied Fakir’s tank. Fakir has not even contacted the civic body to clean the tank. His neighbour’s septic tank, he claims, has begun to overflow. His 16-year-old daughter has fallen ill multiple times.
In urban areas or towns, the municipal body or Nagar Parishad is entrusted to clean the septic tanks but in villages no such authority is assigned.
Even in cities, sanitation expert Anand Jagtap, formerly head of Mumbai’s slum sanitation department, said most municipal bodies are lax in undertaking the cleaning of tanks. “They authorise private contractors to do it but there is no mechanism to supervise,” he said.
A costlier alternative
It is not the lack of cleaning that has made septic tanks a source of pollution. Many tanks, especially in rural areas, have been built poorly.
Kabir, from UNICEF, said local masons in villages often do not have technical knowledge of constructing a septic tank. “Many still promote septic tanks because there are higher profit margins in its construction,” he said.
The government assistance of Rs 15,000 per household is not enough to construct a good quality toilet, said former corporator Amin Patel. “As a result construction is compromised and technical specifications are skipped,” he said.
Kabir argued that it is a myth that “septic tanks are better than single or twin pit toilets.”
A single pit toilet stores faecal sludge in an underground circular chamber attached to the toilet and has to be cleaned once it is filled to capacity. It requires little or no water. A twin pit allows the use of a second pit when the first pit or chamber is filled. The faecal matter in the first pit takes up to a year to convert into compost.
In contrast, a septic tank has two underground chambers attached to the toilet. One chamber stores the solid matter or faecal sludge while waste water flows into a smaller second chamber from where it is discharged into the soil after undergoing anaerobic decomposition.
Besides being more expensive, septic tanks are more difficult to clean.
The faecal sludge has to be removed once the tank is full by a hired contractor and further processed at a sewage treatment plant. In contrast, a single or twin pit can be cleaned by a resident and it yields manure that can be used in farming.
Moreover, the septic tank chamber requires a water-proof wall lining that stops the faecal sludge from leaking.
But the household survey by AIILSG, cited by the Unicef, found that most of the septic tanks had no waterproof lining at the base or at the sides. “Most tanks were made of bricks, with no waterproof plastering,” said Patil, the senior technical officer of AILLSG.
Villages residents were also not aware about the technical requirements for constructing a septic tank or that it is supposed to be emptied once every three to five years, he added.
Lack of sewage treatment plants
Even if the faecal sludge is emptied, villagers do not know where to dispose of it. The sludge must undergo treatment at a sewage treatment plant before it is discharged.
UNICEF’s Kabir said that out of 4.3 million toilets with septic tanks in rural Maharashtra, only over 55,000 are connected with fecal sludge and sewage treatment plants.
Of 40,300 villages, over 1,000 are connected with a treatment plant. “This means that the rest of the rural households have no option of emptying the septic tank and discharging the feces in a treatment plant. Instead, it ends up in surface water bodies, dumping ground or agricultural fields,” Kabir said.
Across Maharashtra, there are only 155 operational sewage treatment plants, state environment minister Pankaja Munde informed the state assembly on March 17.
In Jalgaon city, social activist Farukh Qadri has helped many slum dwellers build toilets. He said private contractors are hired to clean the tank. “They throw the sludge in open drains,” he said.
Minister Munde informed the assembly that 47% of the state’s total sewage, or 4,344 million liters, is discharged into rivers by villages, nagar palikas and municipal corporations without treatment.
In villages, unsafe disposal could have worrying implications.
In Maharashtra, 81.4% piped drinking water schemes draw their water from underground sources, the Unicef study pointed. Groundwater contamination due to septic tanks or unsafe disposal in water bodies could directly affect drinking water supply. In Jalgaon, which has a high number of septic tanks, at least 93.8% of piped water schemes rely on groundwater for supply.
Except Gadchiroli, Gondia, Hingoli and Nashik, diarrhoea cases have increased across all districts of Maharashtra.
Districts such as Jalgaon, Pune, Raigad, Satara, Sangli, Sindhudurg, Kolhapur and Ratnagiri, which have a large number of septic tanks, have seen a significant spike in diarrhoea cases.
Sanitation expert Navrekar said he often found the location of septic tanks too close to water bodies, leading to risk of contamination.
Dr Raju Sule, from the epidemiology cell of Maharashtra’s health department, said there has been a general rise in communicable diseases after Covid-19. He agreed that poor sanitation directly causes water-borne illnesses. “But we will have to specifically map whether water-borne diseases have any link with how septic tanks are built and maintained,” he said.
Data from state health department accessed by Scroll shows that cholera cases rose from five in 2023 to 1,028 in 2024, gastroenteritis cases rose from 0 to 669 in the same period and jaundice cases from 23 to 827 cases across Maharashtra.
Anand Jagtap, former Mumbai’s sanitation head, said water-borne illnesses could also happen from poor hand washing practices and unclean cooking. “But the threat of such infections increases significantly if faecal matter comes in easy contact,” he said.
“Swachh Bharat mission focussed on construction of toilets, but it neglects disposal of waste,” Jagtap added. “The programme needs to look at safe excreta management to make it a success.”