Racial and ethnic disparities in access to safe water and sanitation in high-income countries: a case study among the Arab-Bedouins of Southern Israel.

Disparities in access to water, sanitation, and hygiene within high-income countries are common and often occur across racial/ethnic lines. The Arab-Bedouins in Israel, a formerly nomadic ethno-national minority, have experienced displacement, forced sedentarization, and poverty since Israel was founded. Land disputes with the government have led to precarious living arrangements, including unrecognized villages that the government considers illegal. We administered a structured questionnaire in one government-planned, two legally recognized, and two unrecognized Bedouin communities in the Negev (190 households). Only 44% (95% CI 37%, 51%) of households had access to both safely managed drinking water and sanitation; nationally Israel reports over 99% coverage for each. In one unrecognized village, only 15% of households had access to safely managed water and sanitation, comparable to low-income countries. The overall 1-week prevalence of diarrhea in children under 5 years of age was 22% (95% CI 17%, 27%), with substantial variation between communities. These results highlight that universal access to safely managed drinking water and sanitation remains a relevant goal, not only for low- and middle-income countries but for high-income countries. Bedouin communities in the Negev are a prime example, emphasizing that historic gains in global development have not uniformly reached marginalized groups within high-income countries.