Population centers in low, small islands have water supply problems that are among the most critical in the world. Limited land areas and extremely large soil hydraulic conductivities severely reduce surface runoff and surface storage, so that thin lenses of fresh groundwater floating over seawater comprise the major source of fresh water for people in many atolls. Atoll groundwater is extremely vulnerable to frequent El Niño Southern Oscillation (ENSO)–related droughts, salinization due to storm surges and sea‐level rise, and to human activities with vadose zone transit times from surface to shallow groundwater being less than 1 h. We examine the relationship between groundwater, rainfall, and ENSO events in a low atoll, Tarawa, in the central and western Pacific Republic of Kiribati. Droughts can last as long as 43 months and occur with a current frequency of 6 to 7 years. The impact of droughts on the quality and quantity of a fresh groundwater lens is explored. The local drawdown of the water table due to pumping from long horizontal infiltration galleries is found to be less than diurnal tidal variations. The saturated hydraulic conductivity, K0, of the Holocene unconsolidated coral sands was estimated from infiltration gallery drawdown in two islands. The geometric mean K0 was 14.6 m d−1 with a range from 0.9 to 111 m d−1 These large K0 values cause the rapid transmission of rainfall and surface pollutants through the unsaturated zone to groundwater. An example is given of Escherichia coli pollution due to traditional activities. Strategies for improving the adaptation of island communities and increasing resilience to climate change are discussed.

Population centres in low atoll islands have water supply problems that are amongst the most critical in the world. Fresh groundwater, the major source of water in many atolls, is extremely vulnerable to natural processes and human activities. Storm surges and over-extractions cause seawater intrusion, while human settlements and agriculture can pollute shallow groundwaters. Limited land areas restrict freshwater quantities, particularly in frequent ENSO-related droughts. Demand for freshwater is increasing and availability is extremely limited. At the core of many groundwater management problems are the traditional water ownership rights inherent in land tenure and the conflict between the requirements of urbanised societies and the traditional values and rights of subsistence communities living on groundwater reserves. Resource limitations and geographic isolation restrict the potential for increasing wealth through crop exports. Water governance reforms and the provision of knowledge to communities are critical. Regional water organisations, fostering self-support, are a key to developing island-adopted and owned solutions.

The Solomon Islands, like other small island developing states in the Pacific, face significant challenges from a changing climate, and from increasing extreme weather events, while also lagging behind the rest of the world in terms of drinking water, sanitation and hygiene (WaSH) services. In order to support planning for the implementation of national WaSH strategies and policies, this study contextualizes representative urban and rural baselines for Sustainable Development Goal (SDG) 6 ("by 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation"). We highlight specific threats to the current sanitation services under extreme weather events such as flooding and drought, both of which are commonly observed in the country, and provide suggestions for structural improvements to sanitation facilities to increase resiliency. As the first detailed nationally representative crosssectional sanitation study in urban and rural areas in the Solomon Islands, the results of this paper inform national WaSH policy, strategic planning and programming by the Solomon Islands Government and stakeholders. Highlights  First representative water, sanitation and hygiene study in the Solomon Islands.  Inadequate sanitation and open defecation are more widespread in rural than in urban areas.  Our baseline data shows that the sanitation situation is worse than presented in official country-wide estimates (JMP).  Assessment of vulnerability, adaptability and resilience of sanitation infrastructure during flooding and drought.  Relevance for national policies, planning and programming.

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The availability of water, sanitation and hygiene (WASH) services is a key prerequisite for quality care and infection prevention and control in health care facilities (HCFs). In 2020, the COVID-19 pandemic highlighted the importance and urgency of enhancing WASH coverage to reduce the risk of COVID-19 transmission and other healthcare-associated infections. As a part of COVID-19 preparedness and response interventions, the Government of Zimbabwe, the United Nations Children’s Fund (UNICEF), and civil society organizations conducted WASH assessments in 50 HCFs designated as COVID-19 isolation facilities. Assessments were based on the Water and Sanitation for Health Facility Improvement Tool (WASH FIT), a multi-step framework to inform the continuous monitoring and improvement of WASH services. The WASH FIT assessments revealed that one in four HCFs did not have adequate services across the domains of water, sanitation, health care waste, hand hygiene, facility environment, cleanliness and disinfection, and management. The sanitation domain had the largest proportion of health care facilities with poor service coverage (42%). Some of the recommendations from this assessment include the provision of sufficient water for all users, Menstrual Hygiene Management (MHM)- and disability-friendly sanitation facilities, handwashing facilities, waste collection services, energy for incineration or waste treatment facilities, cleaning supplies, and financial resources for HCFs. WASH FIT may be a useful tool to inform WASH interventions during the COVID-19 pandemic and beyond.