People with disabilities were not expected to provide a service in return.
As extreme weather reshapes the availability of clean water and sanitation across the developing world, a new scoping review reveals that one of the most vulnerable groups — people with disabilities — has been rendered nearly invisible in two decades of research. Published in September 2025, the study found that of 22 qualifying papers on climate hazards and WASH services in low- and middle-income countries, only two acknowledged disability at all, and none evaluated whether any intervention actually served those populations. The silence in the data is itself a form of harm: without evidence, policy cannot protect, and without protection, the most precarious lives grow more precarious still.
- When floods collapse latrines and droughts dry up wells, people with disabilities cannot simply walk farther or adapt on the fly — their vulnerability is structural, specific, and almost entirely unstudied.
- Across Bangladesh, Kenya, and Sub-Saharan Africa, climate-disrupted water systems are already forcing communities into dangerous coping strategies: drinking untreated water, abandoning handwashing, returning to open defecation.
- People with disabilities in rural Kenya depend entirely on the goodwill of neighbors and church networks for water access — a fragile moral economy that may fracture precisely when scarcity is greatest.
- The only two studies evaluating climate-resilient WASH interventions focused on rainwater harvesting in Guatemala and Grenada, measured neither health outcomes nor disability access, and left the question of inclusive design completely unanswered.
- Researchers are now calling for urgent, disaggregated studies — by disability, gender, and marginalized identity — warning that without this evidence base, climate adaptation plans will continue to be written as if disabled populations do not exist.
A scoping review published in September 2025 has exposed a striking gap at the intersection of two urgent global challenges: climate change and disability. After systematically searching nine academic databases for studies published between 2000 and 2023, researchers — including scientists from the London School of Hygiene and Tropical Medicine — narrowed 1,265 initial records down to 22 studies meeting their criteria. Their finding was stark: of those 22 papers examining how climate hazards affect water, sanitation, and hygiene services in low- and middle-income countries, only two addressed people with disabilities at all, and none evaluated whether climate-resilient interventions worked for them.
The broader picture that emerged from those 22 studies is one of cascading disruption. In Bangladesh, Pakistan, and across Sub-Saharan Africa, droughts and floods force households to choose between water for crops and water for hygiene. Handwashing declines. Open defecation returns. One Bangladeshi study documented a 33 percent spike in diarrheal disease in the three months following a major weather event. Women and girls bear disproportionate burdens — walking longer distances, facing harassment at collection points, suffering dehydration in extreme heat. But people with disabilities face a distinct and largely invisible layer of vulnerability.
The two studies that did examine disability illustrated how differently climate impacts land. In rural Kenya, people with disabilities who could not independently collect water depended entirely on the moral goodwill of neighbors and community networks — an arrangement that holds in ordinary times but may dissolve as scarcity intensifies for everyone. In Cox's Bazar, Bangladesh, adolescents with disabilities found that flood-damaged roads made latrines physically unreachable. The infrastructure itself became a barrier.
On the side of solutions, the evidence is equally sparse. Only two studies evaluated climate-resilient WASH interventions — both on rainwater harvesting systems in Guatemala and Grenada. Neither considered disability, neither measured actual health outcomes, and neither assessed long-term maintenance. Whether such systems can be accessed or maintained by people with various impairments remains entirely unknown.
The researchers conclude that this is not merely an academic gap. Without disaggregated data and rigorous evaluation, policymakers designing climate adaptation strategies have no foundation on which to build inclusive systems. As extreme weather grows more frequent, the review warns, the invisibility of disabled populations in research will translate directly into deepening health inequity on the ground.
Researchers searching through two decades of published studies on climate change and water services have uncovered a troubling blind spot: almost nobody is studying what happens to people with disabilities when extreme weather destroys the systems that deliver clean water, sanitation, and hygiene. A scoping review published in September 2025 examined 22 studies from low- and middle-income countries and found that only two papers even mentioned people with disabilities, and none evaluated whether climate-resilient water interventions actually work for them.
The stakes are concrete. When drought dries up wells, when floods collapse latrines, when cyclones damage sewage systems, the immediate health consequences ripple through entire communities. Diarrheal disease spikes. Dehydration sets in. Waterborne infections spread. Women and girls often bear the heaviest burden, walking longer distances to find water, spending more time in the sun, facing harassment at collection points. But people with disabilities face a different kind of vulnerability—one that research has largely ignored. A person with incontinence needs reliable access to water and sanitation more than most. Someone with a mobility impairment cannot simply walk farther to find an alternative water source when the nearest well fails. A person with a cognitive disability may struggle to understand or implement new coping strategies. Yet the evidence on how these populations actually experience climate-driven water crises remains almost nonexistent.
The researchers, led by scientists at institutions including the London School of Hygiene and Tropical Medicine, systematically searched nine academic databases for studies published between 2000 and 2023. They looked for research examining how climate hazards—droughts, floods, extreme heat, cyclones—affected water, sanitation, and hygiene services, particularly for people with disabilities. They also searched for evaluations of climate-resilient interventions. The search yielded 1,265 initial records. After removing duplicates and screening titles and abstracts, 108 studies remained. Full-text review narrowed it to 22 that met the criteria.
What emerged from those 22 studies paints a picture of cascading disruption. In Bangladesh, Pakistan, and across Sub-Saharan Africa, researchers documented how water scarcity forces impossible choices. Households prioritize water for agriculture and drinking over sanitation and hygiene. Handwashing declines. Open defecation increases. In Bolivia, 92 percent of households reported experiencing fear related to water insecurity. In Pakistan, women collecting water in extreme heat reported dehydration, exhaustion, and reduced lactation. When flooding damaged latrines in Bangladesh and Burkina Faso, people returned to open defecation or used neighbors' facilities. A study from Bangladesh documented a 33 percent increase in diarrheal disease in the three months after a major weather event, with an average loss of 18 working days per person.
The two studies that did address people with disabilities revealed how differently climate impacts affect them. In rural Kenya, people with disabilities who could not independently collect water relied entirely on the moral obligation of social networks—friends, neighbors, the church—to bring them water. They were not expected to reciprocate with labor or goods, as others were. But this arrangement is fragile. As water becomes scarcer for everyone, the willingness to share may evaporate. In Cox's Bazar, Bangladesh, where Rohingya refugees live in long-term settlements, adolescents with disabilities faced additional barriers reaching latrines when heavy rains damaged roads and paths. The infrastructure itself became inaccessible.
The evidence on solutions is equally thin. Only two studies evaluated climate-resilient WASH interventions—both focused on rainwater harvesting systems in Guatemala and Grenada. Neither considered disability. Both found that rainwater harvesting increased water quantity and reduced the number of trips women had to make to public water points. But neither measured whether health outcomes actually improved, whether water was being treated safely before drinking, or whether the systems could be maintained over time. No research exists on whether such interventions work for people with disabilities, whether they can physically access the systems, or whether they address the specific health needs of people with particular impairments.
The researchers emphasize that this gap is not merely an academic problem. Without evidence on how climate change affects people with disabilities, without data on what interventions actually help them, policymakers cannot design inclusive adaptation strategies. Water and sanitation policies continue to overlook disability. Climate adaptation plans do not account for the specific vulnerabilities of people with disabilities. The result is that as extreme weather becomes more frequent and intense, one of the most vulnerable populations remains invisible in the planning and response. The review calls for urgent research: rigorous evaluations of climate-resilient WASH technologies that disaggregate data by disability, gender, and other marginalized identities; studies of the lived experiences and coping strategies of people with disabilities during water crises; and transformative approaches that address not just the physical infrastructure but the social and economic barriers that prevent equitable access. Without this evidence, climate resilience will remain incomplete, and health inequities will deepen.
Notable Quotes
Climate-resilient WASH systems are only possible when gender equality, disability, and social inclusion principles are applied, ensuring all community members can adapt to and withstand climate events.— Water for Women (Australian Government's flagship WASH programme)
Extreme weather events disrupt WASH services, yet evidence of the experiences and coping strategies of persons with disabilities remains extremely limited. This is a barrier to developing disability inclusive adaptation strategies.— Wilbur et al., PLOS Global Public Health review authors
The Hearth Conversation Another angle on the story
Why does disability matter so much in a climate and water story? Isn't the problem just that infrastructure breaks in extreme weather?
Infrastructure breaking is part of it, but it's not the whole story. When a well dries up, a person without a disability can walk farther to find water. A person with a mobility impairment cannot. When a latrine floods, someone can use a neighbor's. But if you have incontinence, you need reliable access—you can't just manage without it. The disability dimension changes what the problem actually is.
The review found that only two papers out of 22 mentioned people with disabilities at all. How did that happen?
The research community has been focused on other vulnerable groups—women and girls, mostly. That's important work. But it created a blind spot. When researchers design studies about water crises, they don't automatically think to ask how disability intersects with it. And people with disabilities are often excluded from the communities being studied in the first place, so they don't show up in the data.
You mentioned social networks being crucial for people with disabilities in Kenya. That sounds like it could be a strength, not just a vulnerability.
It is a strength, but it's also precarious. When water is abundant, neighbors help. But when scarcity deepens, that moral obligation can wear thin. You're relying on someone else's goodwill, not on a system that guarantees your access. That's not resilience—that's dependency on charity.
The review says only two studies evaluated climate-resilient interventions, and neither looked at disability. What would a good evaluation actually look like?
It would measure whether people with disabilities can physically access the technology. Whether they can maintain it. Whether it actually improves their health outcomes. Whether it addresses their specific needs—like someone with a skin condition needing reliable water for hygiene. Right now we're building systems without knowing if they work for the people most at risk.
What's the most urgent gap the review identifies?
The absence of evidence itself. We don't know how climate change is affecting people with disabilities because nobody's asking. We don't know what helps because nothing's been evaluated through a disability lens. That gap means policies keep getting made without them in mind. It's not just a research problem—it's a justice problem.