About a third of Madagascar’s 20 million people do not have access to water for washing and most of the rest share unsanitary toilet facilities, according to a July 2011 World Bank Water and Sanitation Programme (WSP) report. The threat of diarrhoea and other diseases is particularly acute in some of the poorer suburbs of the capital Antananarivo. A network of canals, storm water drains and channels criss-crossing the city are choked with rubbish, causing flooding in low-lying areas during the March to November rainy season. In April 2011, the UN Children’s Fund (UNICEF) reported a worrying rise in pneumonic plague.