This is Eileen Wray-McCann for Circle of Blue. And this is What’s Up with Water, your “need-to-know news” of the world’s water, made possible by support from people like you.

In Cambodia, environmental campaigners cheered the announcement by a senior energy official that the Southeast Asian country would not build hydropower dams on the main stem of the Mekong River in the next 10 years. Reuters news reports that Cambodia will instead look to coal, imported natural gas, and solar power to alleviate electricity shortages. The decision was based on a consultant’s report. While it avoids hydropower dams on the main stem of the Mekong, it does not rule out dams on tributaries flowing from the trunk of the Mekong. Cambodia is one of four countries in the Mekong’s lower basin, but Laos is the only one to build a dam on the main stem of the vital waterway. In the upper basin, China has completed six mainstem dams and is building several more in order to maximize the river’s hydropower potential. However, blocking the river to generate power is creating ripple effects downstream. Scientists point to a cascade of ecological troubles. The dams destroy fish habitat, alter river flows, and trap the sediments that are the building blocks of the river’s delta. Without those sediments, the delta is more vulnerable to pollution from saltwater and from rising seas.

In one of India’s largest cities, a team of concerned citizens is doing its part to make sure that water is not wasted. Vijay Aggarwal is the leader of Active Citizens Together for Sustainability. It’s a civic group that operates in Kolkata, a city of 5 million people in eastern India. The Guardian reports that every weekend the group travels through alleys and slums to find communal water pipes that don’t have taps. Without a tap, a pipe can’t be turned off when it’s not in use, and water continuously flows out, wasting the valuable resource. The city estimates that there are 17,000 communal pipes in Kolkata. On a good day, Aggarwal said that his crew can fix 30 to 35 of them. They recognize that the tap installation campaign is filling a gap that could be addressed more readily by the municipal authorities. If the government made tap installations a priority, said one crew member, “we could solve this problem in a week.”

In the Middle East, aid agencies and host governments worry that the coronavirus could ravage refugee camps. The civil war in Syria in the last decade resulted in a massive exodus from that country. More than 5.5 million people fled across borders. Many took shelter in makeshift camps that now function as pop-up cities. Nearly one million refugees ended up in Lebanon, where Reuters news reports that aid workers are ramping up efforts to slow the spread of the virus, which could take root in the densely populated camps. Their efforts include distribution of soap and water for hand washing, and construction of field hospitals to treat and quarantine the sick.

This week, Circle of Blue’s feature story looks at the potential impacts of the coronavirus in developing countries.

The front lines in the battle to limit damage from the new virus are expanding. Covid-19, the disease caused by the virus, emerged in China and then blossomed in comparatively wealthy countries such as Italy, South Korea, and the United States. Now, the virus is spreading in poorer regions — in sub-Saharan Africa, South Asia, and parts of Latin America — where essential defensive measures against infectious disease are often absent.

Healthcare facilities in low- and middle-income countries are a potential weak link in the fight against Covid-19. That’s according to health experts. Hospitals and clinics in countries like Nepal and Tanzania often lack hand washing stations, proper waste disposal, hygienic equipment, and even running water.

Maggie Montgomery is the World Health Organization technical officer for water, sanitation, and hygiene, also called WASH. She told Circle of Blue “Fundamentally, hand hygiene is the number one means of prevention. For a disease with no vaccine, no clear course of treatment, it’s even more important.” She added that due to the lack of personal protective equipment such as masks and gloves — “hand hygiene becomes the fundamental measure to interrupt disease transmission.”

The World Health Organization says that “frequent and proper” hand washing is one of the most important bulwarks against spreading the virus. But in many healthcare facilities, it is difficult even to find soap. Global experts worry that without these basic precautions, healthcare workers in developing countries could be a vector for spreading the virus.

Om Prasad Gautam is the global hygiene lead for WaterAid, a charity that focuses on WASH. He told Circle of Blue “It is very vital to offer quality hand washing services and reduce cross infection. If those facilities are not there, workers will act as an epicenter of transmitting disease.” Gautam added that in places where hand washing facilities are limited, especially in countries in Africa and Asia, it may be very difficult to control the virus once it is established. “If the virus started spreading in these countries,” he said, “it may spread very fast.”

Clinics in developing countries are underfunded and neglected. Doctors there often tend to ill patients without minimum protections against disease transmission. University of North Carolina researchers examined environmental conditions in healthcare facilities in 78 low- and middle-income countries. The results, published in 2018, paint a dismal picture. Of the nearly 130,000 healthcare facilities in the analysis, only half had piped water. Thirty-nine percent did not have hand washing soap. One-third did not have satisfactory toilets. Nearly three-quarters were without sterilization equipment. Only two percent of facilities had the complete package of water, sanitation, hygiene, and proper waste disposal. “The statistics” said Gautam, “are quite alarming.”

These numbers may not tell the whole story, cautions Aaron Salzberg. He’s the director of the Water Institute at the University of North Carolina, Chapel Hill. Data on Covid-19 transmission is limited and healthcare facilities are challenged by a host of other pressures in their efforts to treat and control the disease. Clinics may not have enough masks and gloves. Or their facilities may be cramped, putting ill people in close contact with one other. “At this point,” Salzberg told Circle of Blue,” we have to be cautious stating that the lack of access to WASH services is a major pathway for transmission of Covid-19. Many factors, including overcrowding, the lack of physical space, and the absence of supplies to protect healthcare workers may be bigger issues.”

For WaterAid, factors like population figures and potential overcrowding of hospitals are informing its response to the pandemic. The main transmission pathway for the virus is close, personal contact. It is spread mainly through coughs, sneezes, and handshakes. The virus can survive on surfaces: roughly four hours on copper, 24 hours on cardboard, and several days on steel and plastic. Thus the medical community’s recommendation for social isolation, disinfection of surfaces, and frequent hand washing.

Gautam said that WaterAid’s top-priority countries are those with a trio of risk factors: inadequate hygiene in healthcare facilities, large populations, and recorded Covid-19 cases. Those priority countries are Bangladesh, Ethiopia, India, Nigeria, and Pakistan.

And that’s What’s Up With Water from Circle of Blue, which depends on your support for independent water news and analysis. Please visit and make a difference through your tax-deductible donation.