A/HRC/42/47/Add.1 5. In Lesotho, where over 1 million people are categorized as poor, water, sanitation and hygiene lie at the centre of the poverty cycle. 5 The World Bank estimates for 2017 suggest that 51.8 per cent of the population is still trapped under the poverty line of $1.90 a day. In search of jobs and better living conditions, there has been an increase in rural-urban migration, which has resulted in a significant rise in the urban population over the past 35 years, from 10.5 per cent of the total population to 23.7 per cent in 2011. Poverty, unemployment, a high degree of inequality and a high prevalence of HIV/AIDS and of orphans are some of the existing vulnerabilities of the people of Lesotho. The lack of adequate water and sanitation services constitutes a key additional layer of vulnerability. B. Water and sanitation: a bottleneck for human development 6. The Special Rapporteur finds that water, sanitation and hygiene are a bottleneck that holds the Basotho back from improving their lives, making autonomous choices on their way of living and enlarging their freedom. In Lesotho, water, sanitation and hygiene are a driver and multiplier of vulnerability that lead to negative impacts on human development. Indeed, the Human Development Index for Lesotho is estimated at 0.520 for 2017, which falls into the low human development category, positioning it at 159th out of 189 countries.6 The lives of many Basotho are impacted when they live without, or with only precarious, access to water, toilet facilities and hygienic products. The Special Rapporteur stresses that ensuring access to water and sanitation is a cross-cutting issue that is a prerequisite for an adequate standard of living. 7. The Special Rapporteur illustrates some of these elements through the story of a fictional character, Palesa, a Mosotho girl living in the mountainous rural area of Lesotho. Palesa’s mother was HIV-positive and had to take antiretroviral medication to protect Palesa from mother-to-child transmission. As she needed clean water to take the medication, Palesa’s pregnant mother had to walk long distances to fetch water, carrying heavy buckets and putting the pregnancy at risk. As a newborn, Palesa consumed a large share of the water used by the family for bathing, cooking and washing diapers and her mother had to take on the burden of collecting additional water. At the age of 5, Palesa’s parents could not afford access to clean water and hygiene products and Palesa suffered from diarrhoea and stunting. There was no toilet at Palesa’s preschool and the children defecated in the open where all their peers could see each other half-naked. When Palesa started primary school, she found it hard to use the large toilet seats made for adults and to urinate and defecate in a closed toilet, which she was not used to. Sadly, when Palesa was 15 years old, her parents passed away and she became the head of the household. When Palesa was menstruating, she could not go to school because she could not afford to buy sanitary pads and had to use cloths that smelt and had to be changed regularly. She also missed school as she had to go and fetch water. It was hard for Palesa to walk on the rocky roads for long distances and she was scared. One of her friends who used to collect water with her cried for days after a frightening man did terrible things to her. Another friend got married and stopped coming to school. 8. The fictional character, Palesa’s mother, represents the 25 per cent of the population aged between 15 and 49 who are living with HIV/AIDS in Lesotho. In 2017, the country ranked second in the world in terms of HIV/AIDS prevalence.7 Field studies have revealed that the treatment of symptoms for people living with HIV/AIDS requires a significant additional amount of clean drinking water and that access to water is essential for recovery and psychosocial well-being.8 Further, the HIV/AIDS pandemic is one of the contributing factors to the increase in the number of orphans: as of 2016, 210,712 Basotho children aged 5 6 7 8 See United Nations country team, “Lesotho country analysis working document, final draft” (September 2017). See UNDP, Human Development Indices and Indicators: 2018 Statistical Update. See United Nations country team, “Lesotho country analysis working document, final draft”. See B.N. Ngwenya and D.L. Kgathi, “HIV/AIDS and access to water: a case study of home-based care in Ngamiland, Botswana”, Physics and Chemistry of the Earth, vol. 31, No. 15–16 (2006). 3