The List: The Hardest Places in the World to Find a Bathroom

China has made great efforts to make its capital city’s commodes more hospitable for the Olympics. But in this International Year of Sanitation, 2.5 billion people around the world don’t have access to hygienic bathroom facilities. Here are some of the countries where you should be prepared to hold it.

Worst in Africa

Percentage with improved sanitation*: 5%

Percentage relieving themselves in the open**: 85%

Annual child sanitation-related deaths***: 3,360

The toilet situation: Not only does Eritrea rank worst in Africa, but it ranks worst in the world in terms of the percentage of people without access to improved sanitation facilitiesi.e. those that separate excreta from human contact, and that arent shared between households. If you travel in the countryside, expect to go in the open, the way 95 percent of the rural population does. The lack of sanitation is exacerbated by many factors: poverty, drought (which keeps flush toilets from operating), and a 1998-2000 border war that left 1.2 million of the countys 3.7 million population at the time internally displaced. Unsurprisingly, diarrhea is a leading cause of illness among children under 5.

Worst in the Americas

Percentage with improved sanitation: 19%

Percentage relieving themselves in the open: 34%

Annual child sanitation-related deaths: 6,930

The toilet situation: Turbulent Haiti has actually been backsliding on sanitation. The United Nations seventh Millennium Development Goal (MDG) includes cutting in half, by 2015, the proportion of people without basic sanitation, relative to 1990s level. But by 2006, the level had actually increased from 71 to 81 percent. The island countrys political instability undoubtedly contributed to the deterioration. The 1991 coup resulted in an international embargo and a collapse of infrastructure in the early 1990s, and additional political turmoil brought a reduction in foreign aid in the late 1990s and early 2000s. Today, Haitis capital, Port-au-Prince, ranks fourth dirtiest in the world in the Mercer Health and Sanitation Index, which factors in the performance of waste-removal and sewage systems. Activists have criticized the U.S. government for holding up, allegedly for political reasons, a $54 million Inter-American Development Bank loan intended to help bring cleaner water and more sanitary conditions to Haiti.

Worst in Asia

Percentage with improved sanitation: 27%

Percentage relieving themselves in the open: 50%

Annual child sanitation-related deaths: 17,220

The toilet situation: Nepal ranks the lowest in Asia, but its on track to reach its MDG sanitation goal, according to a September 2006 UNICEF report card on water and sanitation. Between 1990 and 2006, 6 million Nepalis gained access to improved sanitation, and the percentage of people relieving themselves in the open plummeted from 84 percent to 50 percent, the largest percentage-point drop of any country. Nevertheless, 14 million still relieve themselves in the open, the 10th-highest number in the world. Additionally, for Nepal to reach its MDG sanitation goal, at least 14,000 latrines will have to be built each month from now until 2015, according to the Water Supply Sanitation Collaborative Council. To support that effort, a coalition of sanitation advocates has been distributing calendars featuring cartoons that promote sanitation and clean water.

Worst in the Middle East

Percentage with improved sanitation: 46%

Percentage relieving themselves in the open: 35%

Annual child sanitation-related deaths: 20,580

The toilet situation: Nearly half of Yemenis have access to improved sanitation, but that statistic masks a large disparity between the urban and rural populations. In Yemens teeming cities, 88 percent have access to improved sanitation, but only 30 percent in rural areas do. Sewage treatment facilities are located only in major cities, and various factors, such as mountainous terrain, water scarcity, and low population density, make it tough to provide such facilities elsewhere. Still, conditions in the capital, Sana, are nothing to brag about. The citys public schools have three to six toilets for every 4,000 to 5,000 children, and they are practically unusable due to lack of water, soap, and cleanliness, reports the Yemen Times. Some students just develop bladders of steel and hold it all day long. Others (usually boys) relieve themselves on school walls. One recent high school graduate told the Yemen Times that it was common for students to bring empty water bottles to urinate in.

Worst in Europe

Percentage with improved sanitation: 72%

Percentage relieving themselves in the open: statistic unavailable

Annual child sanitation-related deaths: 850

The toilet situation: Romania joined the European Union last year, but that doesnt mean everyone in the country suddenly got a shiny porcelain toilet. While 88 percent of the urban population has access to improved sanitation, just 54 percent of the rural population does. At schools in the countryside, many students report holding it all day and then dashing home when school lets out. Romania is expected to spend billions of euros on sewage systems during the next decade to comply with EU standards. In the meantime, charities are helping out. In June, for instance, World Vision Romania installed toilets in a school in the village of Iacobeni in Iasi county. Previously, students went outdoors to use what passed for a bathroom. Similarly, Women in Europe for a Common Future, an NGO, is coordinating projects across 20 villages to replace pit latrines and soak-away pits with more sanitary and ecological toilets.