A/HRC/43/53/Add.1 are much improved but they continue to be a problem in Fiji. Inadequate sanitation facilities cause water pollution, threatening human health and ecosystem health by contaminating soil, food, fresh water and the ocean. For example, some urban creeks have high levels of faecal coliform bacteria, probably due to inadequate sanitation. The impressive total percentages for access to improved sources of drinking water and sanitation mask the fact that urban populations enjoy significantly higher access than rural populations. 68. Many people living in informal settlements and some people living in rural areas and remote islands, including children, still lack access to safe water sources and adequate sanitation. Poor water quality and limited water availability have disproportionate impacts on women because women are primarily responsible for activities that require water, such as cooking, cleaning, laundry, bathing young children and caring for family members who are ill. 69. Inadequate sanitation in rural areas and informal settlements is a leading cause of waterborne disease in Fiji. The Institute for Health Metrics and Evaluation estimates that unsafe water, inadequate sanitation and improper handwashing are responsible for 4.4 per cent of all deaths of Fijian children under 5 years of age, and 5.5 per cent in the age group 5–14 years. Levels of waterborne diseases such as typhoid fever and dysentery, relating to pollution from inadequate sanitation, rose in Fiji between 2003 and 2010. An investigation into this problem, published in 2018, revealed that the largest risk factor for typhoid fever in Fiji was inadequate sanitation facilities. Both rural and urban residents are affected, by drinking contaminated surface water and consuming unwashed produce. Poor hygiene practices increase the risk. Both informal settlements that the Special Rapporteur visited are located in regularly flooded areas, yet residents rely on pit toilets or home-made septic tanks, raising risks of waterborne disease. During his visit, there was an outbreak of typhoid fever in Naitasiri, with 31 confirmed and 14 suspected cases. 70. Fiji needs to connect more households to public wastewater collection and treatment systems. Fewer than half of Fijian households are connected to sewage systems, while the most common form of wastewater disposal is septic tanks, which are vulnerable to poor design, faulty construction and inadequate maintenance. 71. In recent years there have been problems with water quantity or availability due to the growing use of water and occasional droughts. Agriculture is the main water user in Fiji (61 per cent), followed by industry (11 per cent) and domestic consumption (28 per cent). There is a lack of information on groundwater quantity. 72. Fiji is attempting to address its water and sanitation challenges. A national water resources and sanitation strategy has been under development for some years but does not appear to have been passed by the Cabinet. There is also a rural water and sanitation strategy and the National Liquid Waste Management Strategy and Action Plan. The Water Authority of Fiji conducted an outfall testing programme across major rivers and creeks in Fiji to identify chief sources of sewage, with the intent to prioritize these areas for sewage connections or education campaigns. 73. Vuniivi and Qauia, the two informal settlements visited by the Special Rapporteur, are part of an initiative led by the United Nations Human Settlements Programme to upgrade housing and infrastructure in 16 informal settlements. In addition, the Government is striving to secure 99-year leases for residents of these settlements so that they have security of title and can invest in their future without the fear of being evicted. 74. In the most recent universal periodic review of Fiji, it was recommended that the State continue to strengthen the implementation of the rights to drinking water and sanitation for the whole population, especially for rural communities (A/HRC/28/8, para. 99.78). A recent report from the Pacific Region Infrastructure Facility recommended that Fiji set ambitious delivery targets for sanitation services, integrate human rights, health and environmental outcomes, identify the responsible agencies and prioritize funding to meet the targets set. 75. The Government is making commendable efforts to extend services to informal settlements, but greater emphasis needs to be placed on upgrading sanitation facilities and protecting water sources in order to fulfil its obligations relating to the human rights to water, adequate sanitation and a clean and healthy environment. In the short term, people 13