Abstract

This study explores the critical intersection between the human right to water and the resilience of public health systems, particularly in marginalized and resource-poor communities. Access to clean water and sanitation is not merely a human rights issue but a foundational pillar of public health security. Ensuring equitable water access is essential for preventing health crises, controlling disease outbreaks, safeguarding food security, and promoting maternal and child health. However, systemic inequities continue to exacerbate disparities in water access, disproportionately affecting vulnerable populations during public health emergencies. This research investigates how integrating the human right to water into public health strategies can enhance crisis preparedness and resilience, particularly for communities lacking robust infrastructure. By analyzing the role of water justice in mitigating public health risks, this study highlights the necessity of incorporating equity-driven policies into health strategies. The paper identifies key indicators and issues that link water accessibility to health resilience, offering a framework for equitable resource distribution and community-centered crisis response. Ultimately, this research advocates for a paradigm shift in public health preparedness—one that recognizes access to water as a core determinant of health justice and a fundamental strategy for building resilient communities in the face of global health threats.

1 Introduction

Access to clean water is fundamental to public health, yet millions of people, particularly in low-income and marginalized communities, continue to experience water insecurity. The human right to water is not just a legal or ethical principle; it is a crucial determinant of health resilience, impacting hygiene, disease prevention, food security, and overall well-being. This right, which is recognized by international law, asserts that everyone has the right to safe, clean, and accessible water for personal and domestic use. It is essential for the survival, dignity, and welfare of individuals and is rooted in the inherent dignity of every person. Recognizing and respecting the right to water is vital for addressing global water scarcity and ensuring an equitable water supply for all, especially during health emergencies. Access to water is a basic human need and denying it can be viewed as a violation of human dignity and discrimination. Furthermore, the right to water is closely linked to other rights, such as the right to life, health, and an adequate standard of living. Its availability, quality, and distribution are key to people’s well-being, making the provision of water an important measure to protect and promote these other rights. Having easy access to clean water, proper sanitation, nutritious food, and personal hygiene in agricultural practices is crucial for disease prevention. Water is a common good that must be managed sustainably to meet the needs of both present and future generations. Denying access to water for one person or community can complicate their ability to secure water in the future, raising ethical concerns about intergenerational equity (Lenton et al. 2005, Gilabert 2018).

Water-related issues, such as scarcity, pollution, and inadequate sanitation, significantly affect public health. Climate change, population growth, and economic disparities exacerbate these challenges, potentially leading to serious problems like waterborne diseases and malnutrition. Waterborne diseases, which are caused by contaminated water, pose a significant public health threat, with examples including diarrhea, typhoid fever, cholera, dysentery, and giardiasis. Poor sanitation practices, such as open defecation, can contaminate water sources and facilitate the transmission of these diseases. Water scarcity and droughts are intensifying due to climate change. The uncertainty regarding water availability, worsened by rising temperatures and shifting rainfall patterns, limits options for effective mitigation. When access to water for drinking, sanitation, and agriculture becomes increasingly restricted, the risk of water-related health crises rises. The lack of clean drinking water and sanitation creates more than just a risk of waterborne pathogens; poor sanitation can also lead to deteriorating air quality and an increased likelihood of respiratory illnesses. Additionally, water scarcity affects agricultural production and food availability, leading to malnutrition and related health issues (Winkler 2019; García-Searcy et al. 2022). The COVID-19 pandemic, climate-induced water shortages, and ongoing sanitation challenges have highlighted the critical connection between water security and public health. Communities lacking reliable access to clean water are disproportionately vulnerable to infectious diseases, exacerbating existing health disparities and undermining preparedness in crises. Despite international recognition of water as a fundamental human right, its implementation is often inconsistent due to systemic barriers, including inadequate infrastructure, fragmented governance, and economic constraints. Many crisis response strategies fail to consider the importance of equitable water access in bolstering health systems, leaving vulnerable populations at greater risk during public health emergencies.

This paper argues that integrating the human right to water into public health strategies is essential for improving crisis preparedness and resilience, especially in communities with weak infrastructure. A rights-based approach to water governance should prioritize water security as a central element of health justice and emergency response. The COVID-19 pandemic has further illustrated how water insecurity increases vulnerability, as effective hygiene practices—such as frequent handwashing—were impossible for communities without adequate water supplies. Beyond immediate health risks, the absence of reliable water access disrupts broader determinants of public health, including maternal and child health, food security, and antimicrobial resistance management (Victral and Heller 2021; Loftus and Sultana 2020). Addressing these challenges requires a comprehensive framework that links water security with health equity, crisis preparedness, and systemic resilience. This study highlights the need for a paradigm shift in public health governance, one that embeds the human right to water into policy frameworks, infrastructure investment strategies, and health system resilience planning. To achieve this, five key issues must be prioritized, as shown in Figure 1:

Figure 1 Identified issues when integrating water rights for enhanced public health resilience.

Policy integration – Embedding water rights into health policies

Water access is a fundamental determinant of public health, yet many health policies do not explicitly incorporate water rights as a priority in crisis preparedness. By integrating water rights into health policies, governments and international agencies can ensure that emergency response plans, disease prevention strategies, and healthcare infrastructure planning all prioritize equitable access to clean water and sanitation. Without this integration, water security remains a secondary concern, exacerbating health disparities during crises such as pandemics and climate-induced disasters. 

Investment in infrastructure – Building sustainable and decentralized systems

Many underserved communities lack reliable water and sanitation infrastructure, increasing their vulnerability to public health emergencies. Large-scale, centralized systems often fail to reach rural or low-income urban populations, necessitating investments in decentralized, adaptable, and cost-effective water solutions. Sustainable infrastructure, such as rainwater harvesting, small-scale treatment plants, and improved sanitation systems, enhances long-term resilience by ensuring continuous access to clean water regardless of external crises.

Community-led water governance – Ensuring local ownership and cultural relevance

Historically, top-down approaches to water management have overlooked local needs, cultural contexts, and indigenous knowledge, leading to ineffective or unsustainable solutions. Empowering communities to participate in water governance fosters a sense of ownership, encourages locally relevant solutions, and ensures long-term sustainability. Community-led governance also enhances accountability and responsiveness, allowing for adaptive management that addresses evolving public health risks.

Equitable resource distribution – Addressing disparities in water access

Resource allocation for water infrastructure and sanitation services has historically been inequitable, with wealthier regions benefiting from better services while marginalized communities remain underserved. Prioritizing equitable distribution of public health funding and infrastructure investments is essential to bridge this gap. This will help to ensure that the most at-risk communities receive adequate funding, and infrastructure development can reduce water-related health disparities and improve overall public health resilience.

Data-driven decision making – Leveraging wastewater surveillance for public health protection

Advancements in wastewater surveillance and epidemiological monitoring provide valuable insights into disease outbreaks, antimicrobial resistance, and environmental contamination. By using data-driven approaches, governments and health agencies can implement targeted interventions, allocate resources efficiently, and respond proactively to emerging health threats. Integrating wastewater-based epidemiology (WBE) into public health strategies ensures early detection of outbreaks, enabling timely interventions that prevent widespread health crises.

Water is a social and cultural resource deeply intertwined with issues of power, governance, and inequality. Its availability and management reflect broader structural inequities that shape public health outcomes. Understanding the relationship between water security and health resilience requires a multidisciplinary approach that integrates legal, economic, and sociopolitical perspectives. This study employs an interpretive analysis approach to examine the intersection of water rights and health emergency preparedness, identifying key dimensions that influence public health resilience. By exploring the systemic barriers that hinder equitable water access, this paper aims to develop a framework for incorporating human rights principles into health crisis management. Through thematic analysis, it identifies the indicators necessary for integrating water security into public health strategies and evaluates their role in building resilience against future crises. Ultimately, this study contributes to the growing discourse on health justice, arguing that ensuring universal access to clean water is not only a moral obligation but a practical necessity for strengthening global health security.

2 Integrating Human Rights, Public Health, and Resilience

The intersection of water security and public health is a critical issue that requires a structured and multidisciplinary approach. Ensuring access to clean water is not only a fundamental human right but also a cornerstone of public health resilience. The COVID-19 pandemic, climate-induced water shortages, and ongoing sanitation challenges have highlighted that water security is closely linked to health outcomes. However, the relationship between the human right to water and public health crises is complex and influenced by various social, environmental, and political factors (Neal 2020). Research in this area has identified five key domains that impact the relationship between water security and health resilience: Social Determinants of Health, Health Impact Assessments, Equity and Justice, Vulnerability and Resilience, and Ecosystem Services. Research on social determinants of health shows that access to water and sanitation significantly impacts disease burden, hygiene practices, and overall well-being. Health impact assessments evaluate how water-related policies and projects affect population health, underscoring the need for equitable planning and implementation. The study of equity and justice examines how disparities in water availability contribute to broader social injustices and health inequalities. Research on vulnerability and resilience focuses on how different population groups are susceptible to water-related health risks and their ability to adapt to environmental and infrastructure challenges. Additionally, studies on ecosystem services highlight the importance of natural water systems in maintaining water quality, regulating hydrological cycles, and supporting human health (Buse et al. 2022). These research domains are supported by three key theoretical frameworks: Human Development, Ecological Modernization, and Political Ecology. The Human Development theory asserts that water access is a fundamental right and essential for sustainable development. Ecological Modernization suggests that environmental protection, including investments in water infrastructure—can be achieved within the existing economic growth paradigm. Political Ecology explores how power dynamics, governance structures, and social inequalities influence access to water and its allocation, emphasizing the political aspects of water security and public health. It seems to establish a robust framework for managing water and public health crises, six dimensions must be incorporated. These elements define the relationship between human rights and public health strategies, ensuring that water governance aligns with broader health resilience goals while addressing systemic inequities and environmental sustainability. Figure 2 shows the key components of the framework for water and health crisis management.

Figure 2 Key components of the framework for water and health crisis management.

By addressing these components, we can create a more effective and equitable framework for managing the interconnections between water security and public health. 

The Human Rights Framework

At the core of this framework is the recognition of the human right to water as a legally and morally binding principle under international law. Water is essential for life, dignity, and well-being. This recognition establishes a legal basis for governments and institutions to ensure equitable access. It emphasizes that water security should not be dictated by economic or geopolitical constraints but should be safeguarded as a universal entitlement.

Broader determinants of health

Water security and public health are shaped by various social, economic, environmental, and political factors. A comprehensive framework must consider these determinants to fully understand how disparities in water access led to health inequities. Factors such as socioeconomic status, geographic location, environmental degradation, governance structures, and policy frameworks all influence the availability and quality of water resources. Addressing these determinants ensures that solutions are holistic rather than fragmented.

Equity and justice

One of the most pressing issues in water governance and public health is the disproportionate impact of water insecurity on vulnerable populations. Marginalized communities, including those in low-income regions, displaced populations, and rural areas, often suffer from inadequate access to safe drinking water and sanitation. The framework prioritizes equity and justice by ensuring that water distribution policies and crisis response strategies specifically address the needs of underrepresented and high-risk populations, thus preventing further disparities in health outcomes.

Vulnerability and resilience

A community’s ability to withstand and recover from water-related public health crises depends on both their vulnerabilities and resilience mechanisms. Factors such as climate change, natural disasters, economic instability, and inadequate infrastructure heighten the risks associated with water scarcity and contamination (Mishra et al. 2021; Narula 2021). The framework emphasizes the need for adaptive strategies that strengthen community resilience, including investment in sustainable water infrastructure, early warning systems, and emergency preparedness programs.

Ecosystem services and sustainable water management

Healthy ecosystems play a crucial role in maintaining water resources by regulating hydrological cycles, reducing contamination, and sustaining biodiversity. A comprehensive approach to water and public health management must incorporate ecosystem-based solutions, such as watershed conservation, reforestation, and sustainable land-use planning. Protecting ecosystems not only enhances water availability but also reduces the likelihood of health crises stemming from environmental degradation (Ray 2022).

Governance and institutional frameworks

Effective water governance is essential for ensuring equitable access to clean water and safeguarding public health. However, governance structures are often fragmented, lacking coordination between local, national, and international entities (Rodenbiker 2021). The framework underscores the importance of transparent, accountable, and inclusive governance mechanisms that facilitate participatory decision-making and inter-sectoral collaboration. Strengthening institutions through legal reforms, capacity-building initiatives, and international cooperation is vital for implementing water security policies that promote health equity.

3 Implementing the Human Right to Water in Health Management

To effectively address the Water and Health Crisis Management framework, it is vital to recognize the interrelated indicators that contribute to this multifaceted issue. These indicators highlight the complex interplay between water access and health outcomes, necessitating an integrated approach from governments, international organizations, and civil society to align water security with public health resilience. Key strategies for achieving this integration include embedding human rights principles in water governance to ensure equitable access for all communities, investing in decentralized and sustainable water infrastructure to enhance resilience in vulnerable areas, and developing policies that prioritize access for marginalized populations to promote health equity. Additionally, incorporating environmental conservation into public health planning is essential for sustaining long-term water availability and ecosystem health. Finally, fostering international cooperation and encouraging multi-stakeholder engagement will be crucial in crafting scalable solutions to the global challenges posed by water and health crises. Through this comprehensive approach, as illustrated in Figure 3, the significance of human rights in water management becomes apparent in bolstering resilient public health outcomes across communities.

Figure 3 Integration of human rights to water into resilient public health management.

3.1 Equity and disparities

Understanding the link between the human right to water and health crises requires examining socioeconomic factors, discrimination, and water access. Marginalized communities often face significant disparities that inhibit their access to water and sanitation, leading to dire health consequences, particularly during crises (Gerlak et al. 2022; David and Hughes 2024). Research must focus on how these socioeconomic disparities and discrimination influence water access, investigating specific health risks such as waterborne diseases, malnutrition, and maternal and child mortality. Table 1 shows key dimensions of the equity and disparities indicator. 

Table 1 Water equity and disparities component on resilient health crisis management.

Factor	Description
Vulnerable populations	Examines how marginalized groups—such as low-income families, Indigenous communities, and refugees—face disproportionate impacts from water scarcity and inadequate sanitation.
Discrimination	Investigates systemic barriers, including caste-based discrimination and gender inequality, that limit access to clean water and sanitation services.
Health consequences	Highlights the heightened health risks faced by underserved communities, including increased susceptibility to waterborne diseases, malnutrition, and maternal and child mortality.
Policy interventions	Evaluates effective policies and programs aimed at reducing water inequities, enhancing sanitation infrastructure, and improving access for marginalized populations.

Water scarcity and sanitation challenges disproportionately affect marginalized groups, influenced by factors such as economic disadvantages, discrimination, geographic location, and environmental issues. For example, residents in informal settlements often lack basic infrastructure, while indigenous populations and refugees face overcrowded, unsanitary conditions, further limiting access to clean water and sanitation. Geographic location is crucial, as rural or remote areas may have inadequate water infrastructure, particularly in regions affected by climate change, which can exacerbate vulnerabilities. Caste-based discrimination and gender inequality also severely limit access to water and sanitation, perpetuating cycles of poverty and social exclusion. Traditional gender roles assign water collection and household chores to women and girls, detracting from their education and economic opportunities. The health impacts are substantial; communities lacking water and sanitation face higher incidences of waterborne diseases, malnutrition, and increased maternal and child mortality rates due to unsafe birthing practices linked to inadequate resources (Matamanda et al. 2024; Mehta and Movik 2014). Access to clean water can reduce infant diarrhea, a major cause of death for children under five, and mitigate respiratory and chronic health issues. To improve water access and sanitation for these communities, effective assessment of policies and programs is essential. Key factors include outcome indicators (to measure success), equity and inclusion (ensuring marginalized voices are heard), and challenges/barriers faced. Collecting disaggregated data by socioeconomic status, gender, and caste will aid in tracking progress and ensuring that initiatives effectively reach vulnerable populations. Therefore, to examine water equity and inequality as a core part of water rights in resilient health strategies, the factors shown in Figure 4 should be considered.

Figure 4 Water equity and disparities on resilient health strategies.

3.2 Governance and accountability

Researching water governance structures and policies is crucial for ensuring the human right to water, especially during health crises. It’s important to understand how these frameworks impact a country's ability to guarantee water access in emergencies, as well as the challenges and opportunities for enhancing governance and accountability. An institutional analysis can reveal effective practices and areas needing improvement, guiding recommendations for a more robust response to crises. Table 2 shows how water governance and accountability components are related to public health crisis management.

Table 2 Water governance components effect on resilient health crisis management.

Factor	Description
Institutional frameworks	Analyzes the effectiveness of water governance institutions in crisis response, identifying strengths and gaps in regulatory frameworks.
Policy coherence	Evaluates the alignment of water policies with national and international development goals to ensure integrated and sustainable water management.
Accountability mechanisms	Examines the effectiveness of legal and institutional mechanisms in holding governments accountable for providing equitable water and sanitation services.
Corruption and inefficiency	Investigates the impact of corruption and bureaucratic inefficiencies on water accessibility and their role in exacerbating health crises.

Clear and consistent laws aligned with international standards provide a solid foundation for water management. The legal and policy frameworks should clarify mandates and responsibilities, enabling institutions to make effective decisions (Lauwo et al. 2022; Ardigó 2022). In this indicator also investigating institutional capacity, accountability and transparency, crisis response capacity and adaptive capacity is crucial. Qualified personnel, adequate financial resources, and advanced technology are essential for effective water management and monitoring. Mechanisms must be in place to hold institutions accountable, ensuring transparency and public participation in decision-making processes, while addressing corruption and inefficiency. Institutions should be equipped to anticipate and respond to water crises (droughts, floods, pollution) through coordination with relevant stakeholders and evidence-based decision-making. Flexibility and innovation in governance are necessary to address changing conditions such as climate change and population growth. Learning from past experiences is key for long-term sustainability.

Aligning water policies with national development goals and international commitments, such as the Sustainable Development Goals (specifically SDG 6), is essential. Cross-sectoral policy coherence analysis can identify synergies and conflicts, guiding effective integration of water policies with agriculture, energy, and health sectors. Lastly, ongoing monitoring and coordination among governmental and stakeholder entities are vital for tracking the impact of water policies (Dickin et al. 2022). How to strengthen water governance in resilient health strategies is illustrated in Figure 5.

Figure 5 Strengthening water governance on resilient health strategies.

3.3 International cooperation

Water-related challenges necessitate international cooperation, especially in cross-border contexts, to effectively manage shared resources and promote the human right to water. This management supports health agencies during crises and fosters sustainable and equitable solutions for long-term water security. Table 3 shows the impact of international water cooperation on resilient health crisis management. Key factors include exploring transboundary water management issues, assessing international agreements, and evaluating the effectiveness of financial assistance, all while encouraging knowledge sharing among nations.

Table 3 International water cooperation impact on resilient health crisis management.

Factor	Description
Transboundary water management	Examines the governance, challenges, and opportunities in managing shared water resources across borders, ensuring equitable access and minimizing conflicts.
International agreements	Evaluates the role of international treaties and conventions in upholding the human right to water, enhancing cooperation, and mitigating water-related health crises.
Financial assistance	Assesses the effectiveness of international financial aid in developing water infrastructure, improving sanitation, and expanding access to clean water in vulnerable regions.
Capacity building and knowledge sharing	Investigates how knowledge exchange and training initiatives enhance regional preparedness, strengthen institutions, and improve responses to water-related disease outbreaks.

International collaboration fosters sustainable and equitable solutions to water-related issues, ensuring the long-term security of water resources. Managing transboundary waters presents both challenges and opportunities. Crucial factors include establishing robust legal frameworks through international treaties and agreements, bolstered by regional institutions. Effective assessment of water resources—which includes evaluating quantity, quality, and climate impacts—is essential (Golovina et al. 2021; Sarfaraz et al. 2022; Varady et al. 2023). Engaging all stakeholders, including governments, communities, and civil society, is vital for building trust and resolving conflicts. Additionally, addressing the impacts of climate change and assessing economic and social consequences are necessary for sustainable water management. International agreements play a pivotal role in promoting the right to water. The effectiveness of these agreements relies on their legal structure, ratification, and implementation practices. Monitoring adherence and examining national cases can help identify gaps and successes. Challenges such as conflicts over national sovereignty and financial constraints must also be addressed. Strengthening international cooperation involves reforming existing agreements, attracting new members, and enhancing regional collaboration to uphold the right to water.

International financial aid is crucial for improving water infrastructure in developing countries. Effective financial assistance aligns with national priorities and engages local communities. Principles of sustainability, scalability, and equity are essential to ensure that projects benefit marginalized groups and promote women’s empowerment. Strengthening institutional capacities for managing water infrastructure and supporting green water initiatives contribute to long-term success. Monitoring and ensuring transparency in fund allocation promotes an efficient and accountable use of resources, while strong partnerships and coordination enhance the impact of aid. Finally, knowledge sharing and capacity building are vital in addressing water challenges and promoting sustainable management. Identifying knowledge gaps in various countries enables targeted initiatives. Establishing mechanisms for South-South and North-South cooperation fosters the exchange of information and technical assistance. Capacity-building efforts, such as training and mentoring, improve institutional and human resources, leading to better water management. Joint research, partnerships, and conferences promote collaboration and learning from diverse experiences. Ongoing monitoring and evaluation ensure that these initiatives result in tangible enhancements in water and health management practices. Figure 6 shows how international water management impacts resilient health strategies.

Figure 6 International water management impact on resilient health strategies.

3.4 Community engagement and participation

Community participation is a critical dimension in defining the human right to water, which is vital in health emergencies because it empowers local members to participate in decision-making and ensures that water policies are aligned with community needs (Leal Filho et al. 2022; Nelson et al. 2021). Effective community-managed water projects focus on tailored solutions that address local challenges while fostering sustainability, equity, and inclusion among all users. Key factors for evaluating collaborative water management include promoting community ownership, ensuring financial stability, and enhancing transparency and accountability in governance. Participatory decision-making not only boosts community empowerment but also relies on informed dialogue and conflict resolution to strengthen social cohesion. It is crucial to prioritize marginalized groups to achieve equitable resource distribution and measure the impact through indicators related to access, water quality, and overall community well-being. Furthermore, social movements and advocacy efforts are essential in raising awareness about water rights, necessitating public education campaigns that engage and inform the broader community. Participatory approaches must prioritize equitable representation, especially for marginalized groups, ensuring fair water resource distribution. Finally, assessing outcomes through indicators related to access, quality, and community well-being, along with case studies, can demonstrate the effectiveness of these processes. Social movements and advocacy play a vital role in raising awareness about the human right to water, necessitating public education campaigns to engage the broader community.

Table 4 Water community engagement component on resilient health crisis management.

Factor	Description
Community-led initiatives and local practices	Assesses the effectiveness of community-driven water management initiatives, incorporating traditional ecological knowledge to enhance local water access and crisis response.
Participative decision-making	Examines the role of inclusive decision-making in water governance and its impact on empowering communities to influence policies and resource management.
Social mobilization	Analyzes the contributions of social movements and advocacy groups in promoting the human right to water, raising awareness, and driving policy reforms.
Social norms and behaviours	Investigates community-based water conservation practices, the role of local management structures, and the influence of social stigma on water use and sanitation behaviours.

Cultural and social norms play a significant role in community engagement, shaping individuals' attitudes, behaviors, and the decision-making processes regarding access to clean water, which is a basic human right. Understanding these norms is essential for developing effective responses to various water-related challenges (Filmer-Wilson 2005). Communities provide a platform for leveraging cultural and social norms to promote social participation and uphold the human right to water, demonstrating more resilient management during health crises such as pandemics. When assessing the strengths and weaknesses of these cultural and social norms, several key considerations arise. The first consideration involves how cultural values and beliefs regarding water scarcity or abundance affect both water use and conservation practices within different communities. These beliefs can influence individuals' interactions with water resources and contribute to varying sustainable practices. Many cultures place a high value on water, which significantly impacts attitudes toward its use and conservation. Understanding these beliefs can shed light on community practices and the emphasis placed on preserving local water sources. In addition to cultural beliefs, traditional water management practices, often rooted in historical approaches, can be vital for ensuring sustainable access to water. Evaluating these practices may yield valuable insights for managing scarce water resources effectively.

It is also crucial to consider the influence of gender roles and societal norms on the distribution of responsibilities related to the collection, management, and decision-making concerning water. Discrimination against women can hinder their access to water and limit their involvement in crucial discussions and decision-making processes about water management. Empowering women in these roles can lead to better governance in water management and promote equity within communities. The importance of indigenous knowledge in understanding local ecosystems and managing them sustainably cannot be overstated. Combining indigenous practices with modern techniques can inspire innovative solutions that respect the rights of indigenous peoples in relation to their water resources. Furthermore, it is imperative to evaluate how social norms and behaviors can either facilitate or hinder water conservation and waste reduction (Nehaluddin and Lilienthal 2021; Shunglu et al. 2022).

Community-based approaches to water management often prove effective in fostering equity and sustainability, encouraging collective action toward shared goals. Lastly, it is essential to recognize that social stigma can sometimes act as a barrier to adopting new water management practices or technologies. By understanding and addressing these stigma factors, approaches can be developed that promote smoother transitions toward innovative strategies for maintaining sustainable water use. Figure 7 shows the components of community-managed water systems in resilient health crisis management.

Figure 7 Components of community-managed water systems on resilient health crisis management.

3.5 Human rights frameworks and public health crises management

During pandemics, the human right to water is crucial for enhancing public health crisis management. This importance arises from the legal obligations’ states have under international human rights law, the enforcement mechanisms designed to promote water justice, and the advantages of adopting a human rights-based approach to water governance. Building on the legal and moral responsibilities of governments to ensure the availability of water and sanitation during emergencies, governments must be held accountable for collective and participatory actions to guarantee access to water in all its forms while also protecting its integrity (Beyrer and Pizer 2007; London 2008). A human rights-based approach ensures direct access to water, which is a fundamental right, and provides a means for holding governments accountable through courts or similar mechanisms if they fail to meet their obligations (Bayntun et al. 2012).

Table 5 Human rights framework components on resilient health crisis management.

Factor	Description
International law	Evaluates state obligations under international human rights law regarding the accessibility, availability, and quality of water and sanitation.
Domestic legislation	Analyzes the alignment of national laws and regulations with international human rights standards to identify gaps and inconsistencies.
Enforcement mechanisms	Assesses the effectiveness of legal and institutional mechanisms at both domestic and international levels in upholding the human right to water.
Human rights-based approaches	Explores the benefits of integrating human rights principles into water governance and public health responses to ensure equitable access for all.

To understand the obligations that governments have under international human rights law regarding water and sanitation, several key aspects should be considered. First, international legal instruments provide a foundational basis. The International Covenant on Economic, Social, and Cultural Rights (ICESCR) is central, as it outlines the right to water and sanitation. Other important documents include the Universal Declaration of Human Rights, the Convention on the Rights of the Child, and various regional treaties. Second, a states’ obligations are clearly defined by international law. Governments have a primary duty to ensure access to water and sanitation, adhering to the principle of progressive realization. This principle means that governments must take measurable steps towards fulfilling this right, in alignment with the resources available to them. Third, non-discrimination is a core principle. Governments are required to ensure that everyone has access to water and sanitation without discrimination based on race, color, gender, religion, political beliefs, national origin, wealth, birth status, or any other factor. Marginalized groups, such as minorities, indigenous communities, and persons with disabilities, may require additional support to fully access water and sanitation. Fourth, accountability and enforcement are vital. There must be systems in place to monitor and report government compliance with international human rights law. Human rights treaty bodies play a critical role, and enforcement mechanisms—such as complaint processes and international courts—are essential for addressing violations of the right to water and sanitation. Fifth, domestic implementation is necessary. Countries must create national laws and regulations that align with their international human rights obligations concerning water and sanitation. Harmonizing international and domestic legal frameworks ensures consistent protection of the right to water. Sixth, it is important to acknowledge the challenges and limitations that may exist. Governments might face governance constraints or limited resources, making it difficult to fulfill their commitments. Furthermore, the limitations of international courts and regulatory mechanisms can complicate efforts for implementation.

When assessing the alignment of domestic laws with international human rights standards, several key aspects should be considered. First, a legal review through a comparative analysis of domestic laws and international instruments such as the ICESCR can identify inconsistencies and highlight areas of conformity. Second, substantive rights must be clearly defined in domestic laws. This includes outlining the scope of the right to water, government obligations, available remedies for individuals, and the prohibition of discrimination in access to water. Third, procedural rights are critical, ensuring access to justice and effective legal processes. Public consultation and participation in water management decisions are essential for promoting transparency and accountability. Fourth, enforcement mechanisms—such as courts, administrative agencies, and inspectors—are vital for ensuring adherence to water-related laws. Monitoring and reporting systems can also support governments in assessing and improving compliance. Fifth, it is essential for domestic laws to maintain homogeneity with international human rights standards. This alignment is necessary for the legal framework to effectively protect the right to water. Lastly, challenges and limitations, such as concerns over sovereignty and resource constraints, may complicate the alignment process. These issues require careful consideration to establish a protective domestic legal framework for access to water. When assessing the effectiveness of domestic and international mechanisms in enforcing the human right to water, several factors must be considered as shown in Figure 8.

Figure 8 Enforcement of the human right to water.

Adopting a human rights-based approach to water governance and pandemic response offers numerous advantages, including promoting equity and inclusion by ensuring that marginalized groups have equitable access to water and sanitation services, regardless of socio-economic status, gender, ethnicity, or other factors. It also fosters accountability and transparency by clearly defining governments' obligations under international human rights law, enabling effective monitoring and enforcement. This approach enhances participation and empowerment by encouraging community engagement and empowering marginalized communities to demand their rights and influence policy. Moreover, it supports sustainability by promoting long-term water resource management and resilience, especially during crises like pandemics, while ensuring intergenerational equity for future generations. Policy coherence is strengthened as the approach integrates human rights considerations across various sectors, such as health, agriculture, and energy. Lastly, monitoring and evaluation through human rights indicators allow for tracking progress toward realizing the right to water and sanitation, while impact assessments help measure the effectiveness of the approach in reducing access gaps for marginalized communities.

4 Discussion and Conclusion

This article has explored the intricate and interdependent relationship between the human right to water and public health resilience. It highlights that access to water is not just a technical or infrastructural issue, it is a fundamental legal, social, and public health necessity. The findings support a growing body of research that shows inadequate access to safe water and sanitation significantly increases vulnerability to health crises, especially among marginalized and socioeconomically disadvantaged populations. Water scarcity, poor sanitation, and insufficient infrastructure are strongly linked to a higher incidence of waterborne diseases, increased maternal and child mortality, malnutrition, mental health challenges, and preventable illnesses, all of which weaken the resilience of health systems during crises.

The analysis confirms that the right to water is closely linked to other fundamental human rights, including the rights to health, food, housing, and an adequate standard of living. This interconnection highlights the limitations of isolated policy approaches and underscores the need for integrated legal and governance frameworks. Addressing health risks related to water cannot be separated from broader structural factors such as poverty, social exclusion, and institutional capacity. Previous research on the social determinants of health shows that inequities in water access act as both a cause and a consequence of larger patterns of inequality, reinforcing cycles of vulnerability during public health emergencies (Beyrer and Pizer 2007; London 2008).

The findings highlight that achieving the human right to water requires coordinated strategies across multiple sectors that go beyond just emergency responses. Investments in resilient water supply systems, sanitation and hygiene services, and health system planning must be accompanied by governance reforms that prioritize equity, accountability, and participation. Evidence from comparative policy analyses shows that health outcomes improve most significantly when water governance is integrated into broader public health and social protection strategies, rather than being treated as a separate technical area.

A key contribution of this study is the identification of essential governance principles—interdependence, accessibility, social inclusion, and participatory decision-making—that are crucial for building resilient water and health systems. Engaging marginalized communities in participatory water governance enhances the legitimacy, responsiveness, and sustainability of these systems. Research shows that community involvement in water management improves service delivery, fosters local ownership, and strengthens the capacity to adapt during crises. This type of participation is especially important in areas where centralized governance structures have historically failed to reach vulnerable populations (Dickin et al. 2022).

Good governance and institutional accountability are crucial for translating the legal recognition of the right to water into meaningful public health outcomes. Transparent decision-making processes, effective regulatory oversight, and enforceable accountability mechanisms are essential to prevent corruption, inefficiency, and political exclusion—issues that undermine water service delivery. Weak institutional capacity and governance failures not only restrict access to water but also heighten health risks during emergencies, ultimately eroding public trust and system resilience. The analysis highlights the growing influence of climate change as a factor that worsens water-related health risks. Climate-induced variability, manifested through droughts, floods, and extreme weather events, intensifies water insecurity, disproportionately impacting communities that are already socio-economically marginalized. Therefore, integrating climate resilience into water governance and public health planning is vital. Adaptive water management strategies, supported by strong legal protections and inclusive governance, can help reduce vulnerability and improve communities’ capacity to deal with health crises linked to climate stressors (Gerlak et al. 2022; David and Hughes 2024).

Importantly, this research stresses that resilience-building must happen at both the community and institutional levels. Empowering marginalized populations, strengthening local coping mechanisms, and recognizing the social, cultural, and gender aspects of water access are essential for effective management during health crises. Gender inequality, caste-based exclusion, and economic disparities continue to create uneven exposure to water-related risks, underscoring the need for targeted, rights-based approaches such as gender-sensitive programs and community-driven water management initiatives.

The discussion emphasizes that incorporating the human right to water into public health strategies is both a legal obligation under international human rights law and a practical approach to building more resilient, equitable, and sustainable health systems. By integrating legal accountability, participatory governance, and climate resilience into water management frameworks, governments and institutions can more effectively protect public health, especially during times of crisis. This comprehensive approach offers a strong foundation for promoting both water justice and health resilience in an increasingly uncertain global environment.

In conclusion, ensuring the human right to water requires robust legal frameworks, effective enforcement mechanisms, and a multi-dimensional approach that addresses the cultural, social, and economic barriers to water access. Civil society organizations, as advocates for the right to water, play an essential role in holding governments accountable and pushing for inclusive, gender-sensitive, and community-based solutions. Governments must not only establish policies that integrate water and health initiatives but also foster international cooperation and a shared commitment to water security in the face of global challenges, such as climate change. To effectively address the human right to water and its implications for public health, a comprehensive approach must be adopted—one that recognizes the interdependencies between water and health issues. This involves developing policies and programs to integrate water and health initiatives, providing equitable access to water and sanitation services for marginalized communities, strengthening governance and accountability mechanisms, investing in sustainable water management infrastructure, building climate change resilience, promoting community participation, and fostering international cooperation.

Future research should focus on identifying best practices through comparative case studies to understand how different regions have successfully implemented water-related health policies. This research can help refine long-term solutions and technological innovations such as decentralized water treatment, smart water management, and desalination, which can play a crucial role in addressing water scarcity. In addition, integrating water security strategies into broader climate change adaptation policies will be critical for confronting the growing challenges of water scarcity.

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