The "flush and forget" system is expensive, water-intensive, it disrupts the nutrient cycle, and it is a major source of disease in developing countries. As water scarcity spreads, the viability of water-based sewage systems will diminish. Water-based sewage systems take nutrients originating in the soil and typically dump them into rivers, lakes, or the sea. Not only are the nutrients lost from agriculture, but the nutrient overload has led to the death of many rivers and to the formation of some 200 dead zones in ocean coastal regions. Sewer systems that dump untreated sewage into rivers and streams are a major source of disease and death. Sunita Narain of the Centre for Science and Environment in India argues convincingly that a water-based disposal system with sewage treatment facilities is neither environmentally nor economically viable for India.

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