Access to safe water is a significant problem in Somalia, aggravated by the destruction and looting of water supply installations during the civil war, the continuing conflict, and a general lack of maintenance. This situation is compounded by erratic rainfall patterns, which produce both drought and flooding. It is estimated that less than 20 percent of the population has reliable access to safe water throughout the year. Less than 50 percent of the population of Somalia are living in households with sanitary means of excreta disposal. The impact of poor environmental sanitation is particularly felt in the cities, towns and large villages or other places where people live in proximity to each other. Defecation is generally close to dwellings and water resources and lack of garbage collection and the proliferation of plastic bags affect the urban environment and water sources. Poor hygiene and environmental sanitation are major causes of diseases such as cholera among children and women. Cholera is endemic and claims hundreds of lives annually particularly in densely populated areas. Access to clean water is essential for prevention of diarrhoea diseases and cholera.