A/HRC/39/55 have clearly defined roles, responsibilities and performance standards; accountability of such organizations is however weak and vague in the context of forced displacement. 58. In the humanitarian-development nexus, unclear accountability mechanisms for both humanitarian and development actors are contributing to unsustainable or discontinuous interventions. The primary accountability mechanisms for both actors are centred on accountability to donors, even though accountability to service users is increasingly acknowledged as a shared goal in the water, sanitation and hygiene sector. 50 Both humanitarian and development organizations have thus increasingly developed different accountability mechanisms, such as feedback and complaints mechanisms (including hotlines), despite the fact that there are no established standards on the extent to which they would hold themselves accountable, the kinds of remedies provided, or the handling of complaints received (including data protection). Human rights can offer an accountability framework for organizations; in other words, a basis for defining what people can and cannot claim and how to do it. 59. When many actors are involved without any clear allocation of roles or responsibilities, which is often the case in humanitarian situations, affected persons are unable to claim remedies when their human rights are violated or not realized. The situation in Haiti after the 2010 earthquake was an example of unclear accountability, where nongovernmental organizations running camps for internally displaced persons were able to ensure better provision of water, sanitation and clinics in their operational areas, but neither the Government, United Nations agencies or the International Organization for Migration were able to persuade them to work in harder-hit areas. 51 In October 2010, substandard access to safe water and sanitation contributed to an outbreak of cholera, which led to the death of more than 9,000 people and the hospitalization of thousands more.52 The victims have not had access to remedies either from the United Nations (which was responsible for introducing cholera to the country owing to negligence) or from the State or other organizations, which failed to provide the minimum standard of water and sanitation services. C. Preparedness 60. International humanitarian actors are usually required to address inadequacies in water and sanitation services and the environmental sustainability issues that predate the onset of a crisis, which then exacerbates these vulnerabilities. Strong human rights protection prior to the onset of the crisis can, however, mitigate vulnerabilities during emergencies and increase the effectiveness of humanitarian assistance. The effects of the realization — or lack thereof — of human rights during times of stability are often repeated or even exacerbated in humanitarian responses. Globally, water services tend to receive more attention, funds and priority than sanitation owing to various reasons, including the greater visibility of water projects, and the stigma and taboos attached to sanitation. As a consequence, 2.3 billion people still do not have basic sanitation services and 4.5 billion people do not have safely managed sanitation, while 892 million have no choice but to defecate in the open,53 making access to basic sanitation one of the least achieved targets under the Millennium Development Goals. Menstrual hygiene management is most behind in terms of the development of standards and of a comprehensive approach, which would comprise, inter alia, heeding the voices of adolescent girls, their privacy and dignity, and tackling taboos and discrimination. The issue therefore faces challenges similar to those faced by sanitation, but it complicated by the fact that it concerns a women’s intimate 50 51 52 53 16 Mason and Mosello, “Making humanitarian and development WASH work better together” (see footnote 40). Schuller and Levey, “Kabrit ki gen twòp mèt” (see footnote 29). See A/HRC/31/79, chap. II, communication HTI 3/2014, and A/71/367; see also A/HRC/29/34/Add.2. WHO and UNICEF, Progress on drinking water, sanitation and hygiene: 2017 update and SDG baselines, Geneva, 2017.