3.2. Community Perspective on Wastewater and Its Impact
Based on the result of community perspectives on wastewater (WW) treatment, a significant portion, 41.5%, believe wastewater treatment is necessary. Meanwhile, 19.2% of the community have no knowledge about WW treatment, and 34.6% think it does not exist. Only a small percentage, 4.6%, consider WW treatment to be unnecessary. These results indicate that while many recognize the importance of wastewater treatment, there is still a considerable lack of awareness or misinformation among the community. But on the other hand, the community shows an awareness of wastewater reuse, showing that 62.3% have knowledge of it, while 37.7% lack awareness.
The data reflect the community’s attitudes toward wastewater management in their environment, with 59.2% viewing it positively as “Good” and 40.8% expressing a less favorable opinion as “Not So Good”. Related to this, the respondents revealed the instances within families where members experienced diarrhea three months prior, with 73.8% reporting ‘Yes’ and 26.2% reporting ‘No’. Based on this result, the opinion of the community on an alternative solution for domestic wastewater management shows that 34.6% prefer continuing with off-site wastewater systems, 15.4% opt for on-site wastewater systems, 46.2% favor ecological sanitation, and 3.8% choose other low-cost options (
Table 5).
Based on the research data, an analysis has been performed showing that the sources of wastewater in Timor-Leste are derived from domestic, commercial, industrial, and hospital environments. Domestic wastewater—wastewater from bathrooms, showers, kitchens, and laundry—is mostly discharged directly into the public open sewers. The data show that 47.7% of domestic wastewater is disposed of into open sewers, 24.6% disposed it into home gardens, and 27.7% discharged it into septic tanks (
Table 3). There is a wastewater treatment station in the Tibar area, but it is mostly for blackwater or toilet wastewater treatment, and it does not cover all the domestic greywater of Timor-Leste. A proportion of 35.4% of the domestic blackwater is treated in this Tibar station and 64.6% is not treated, because the cost of blackwater absorption and transport is very expensive; therefore, it is often just left to infiltrate into the ground (
Table 6).
There is no specific treatment station provided for domestic wastewater treatment in Timor-Leste and some communities have just developed their own models or systems for domestic wastewater treatment. Based on the research findings, some households have either built open boreholes for their households or share them. After constructing the borehole, they would deposit or accumulate only wastewater from the kitchen without oil or detergent, and they would plant Xanthosoma sagittitolium and banana plants around the borehole. The infiltration of wastewater would contribute to the survival of the plantation around the borehole. Commercial wastewater is that produced from car and motorbike washing, restaurants, and hotels.
Car wash companies’ wastewater treatment
There are 19 car washing companies in the urban areas, such as in Dili capital, where 18 companies are classified as private and 1 is public, or state-owned. A total of 8 of them are registered or licensed by the government and 11 companies are not registered. Their water sources are mostly from groundwater; 11 companies use groundwater, 6 companies use water provided by the SAS/government, and 2 companies use water from rivers (
Table 7).
The wastewater generated from car washing can reach an average of 3000 L per day depending on the number of cars. The volume of produced wastewater is similar to the quantity of used clean water and 73.7% of this wastewater is disposed of directly into open public sewers by 14 companies; 2 companies dispose of their wastewater in gardens; 3 companies discharge their wastewater into constructed sinkholes (
Table 8 and
Figure 11).
All their produced wastewater is contaminated with detergents that will have an impact on human health and the environment.
Restaurants’ and hotels’ wastewater treatment
There are 21 restaurants and 35 hotels in the urban area of Dili including the capitals of other municipalities. Most of their water sources are from groundwater provided by the SAS/government. Their greywater is commonly disposed of into open sewers and only blackwater is transported to the ETAR in Tibar. Meanwhile, some restaurants and hotels have developed their own systems for wastewater treatment, for example, Barry’s Place—an Eco-Lodge in Atauro Island, Dili municipality (
Figure 12). The main water sources are provided by the SAS/government and from groundwater extraction. Barry’s Place has created its own water conservation method for the treatment of greywater from the kitchen, bathrooms, and composting toilets, small sinks, bucket showering, and laundry services.
Barry’s Place’s wastewater treatments are natural and ecological without any chemicals or modern technology. The final treated wastewater can be reused for plantations (
Figure 12).
Home industries’ wastewater treatment
Ten small-scale home industries were identified, which produce tofu and tempeh, in Timor-Leste. Six home industries use groundwater, and three home industries use the water supply from the SAS/government. Four companies discharge their wastewater into open sewers. One company disposes of their wastewater into their garden and five home industries discharge their wastewater into constructed sinkholes or wastewater treatment tanks (
Table 9 and
Figure 13).
The level of communities’ knowledge and abilities, including an understanding of wastewater management, treatment, and reuse, are vital for maintaining human health and environmental quality. Most Timorese communities have limited knowledge about wastewater management and treatment; 41.5% stated that it is necessary to perform wastewater treatment and 4.6% mentioned that it is not necessary to treat their wastewater (
Table 10). And in terms of communities’ knowledge on wastewater reuse, 62% understood the importance of reusing wastewater and 38% did not understand the purpose of reusing wastewater.
Correlation Analysis
The study found that the understanding of what constitutes “good” wastewater management is statistically significant, with a
p-value of 0.024. Among respondents, 55.9% know good management practices, while 44.1% do not. This suggests that educating the remaining population could significantly enhance wastewater management. Additionally, the functionality of the discharge wastewater network is considered statistically significant with a
p-value of 0.01965. About 74.5% of respondents find the discharge network functioning well, while 25.5% do not. Ensuring efficient network operation is crucial for the successful reuse of wastewater (
Table 11).
Regarding wastewater treatment, 59.3% of respondents consider it necessary, yet a significant portion, around 80%, lacks awareness about it. Moreover, 55.6% believe that wastewater treatment doesn’t exist, and 66.7% view it as unnecessary. The locations for domestic wastewater deposits vary, with 51.6% acknowledging open sewers, 81.3% preferring farm gardens, and 63.9% recognizing constructed sinkholes. These findings underscore the importance of education and awareness campaigns to improve wastewater management practices and promote sustainable alternatives. By addressing knowledge gaps and encouraging community involvement, more effective wastewater treatment and reuse practices can be achieved. According to Kabito, It is clear that improving knowledge, attitudes, and practices towards wastewater management is crucial for addressing public health issues.
We observed in
Table 12 that the residents with higher education had less diarrhea than those with lower education, as indicated by the odds ratio of 4.24 and a significant
p value of 0.004. Similarly, having a knowledge of the health impact untreated wastewater correlates with fewer cases of diarrhea, with an odds ratio of 3.51 and a
p value of 0.0014. Attitude also appears to play a role; those with a “good” attitude had less diarrhea than those with a “poor” attitude, with an odds ratio of 4.24 and a significant
p value of 0.004. These data are relevant to public health studies assessing risk factors associated with disease prevalence.
Results of survey and field visits
Based on the findings of the field investigation, it was observed that in rural areas such as the Bobonaro, Baucau, Ainaro, Covalima, and Liquica municipalities, there is no wastewater treatment infrastructure, and the existing legal framework inadequately addresses these issues. The majority of residents transport their wastewater and use flush toilets, with the Tibar Wastewater Treatment Plant in the capital being the primary disposal point.
The demographic profile showed a slight majority of women compared to the male respondents. Most respondents were employed, with the next largest groups being employed and business owners. The average age was 37, with many participants in the 30–40 age range. A significant number of participants had a high level of education, while the rest had lower levels. In terms of family size, the majority lived with 6–10 people, followed by those with 1–5 people, and a smaller percentage had other arrangements.
Understanding wastewater information requires examining the community’s water sources. Most participants (56.9%) obtain water from public taps, 32.3% from boreholes, and others purchase water from commercial tanks. The wastewater disposal habits reveal that 47.7% of the participants use open sewers or streams, 27.7% utilize sinkholes, and a minority repurpose the wastewater for gardening or farming. Regarding wastewater transportation costs, 82.3% perceive them as expensive, contrasting with the 17.7% who do not share this view. The septic tank infrastructure analysis indicates 60% have a bottom layer of sea sand or coral. The pump-out frequency analysis shows that 67.7% occur every 1–3 years, suggesting regular maintenance, while the tank depths primarily range from 2 to 3 m. The majority (61.5%) of the tanks are situated 1–5 m from water sources. This proximity suggests a high risk of groundwater contamination in the city.
The community’s perspectives on wastewater (WW) treatment reveal a nuanced understanding: 41.5% recognize its necessity, yet 19.2% lack knowledge on it, and 34.6% believe it does not exist, with only 4.6% deeming it unnecessary. This suggests a significant awareness gap despite the recognition of its importance. Conversely, regarding wastewater reuse, 62.3% are knowledgeable, highlighting a better understanding in this aspect. The community attitudes towards wastewater management show a split, with 59.2% viewing it positively and 40.8% expressing a less favorable opinion. Moreover, 73.8% of the families reported instances of diarrhea three months prior, indicating potential health concerns. Regarding alternative solutions for domestic wastewater management, preferences vary: 34.6% prefer off-site systems, 15.4% opt for on-site systems, 46.2% favor ecological sanitation, and 3.8% choose other low-cost options. These findings underscore the complexity and diverse perspectives within the community concerning wastewater management and its alternatives.
Impact on Human Health
Wastewater’s impacts on human health and environment quality should be considered by all Timorese communities within the national territory because pollution by wastewater can affect human health with various diseases, such as asthma, itchy skin, diarrhea, etc., (
Figure 14) as documented in the several public health centers in Timor-Leste. Carawan et al. (1979) described that the public health aspects of wastewater reclamation to reuse the renovated wastewater for human consumption or in processes that normally require potable water (i.e., food processing) must be evaluated with potential health risk and hazards [
26]. Therefore, UN Sustainable Development Goal 6 described that by 2030, the availability and sustainable management of water and sanitation must be ensured for all. Thus, with inadequately managed wastewater being the key driver of water pollution, this target represents the principal action for achieving the overarching goal of an improved water quality environment [
27].
The current situation of wastewater management has caused several diseases impacting public health, indicating that sewage treatment plants could be a solution. Sewage treatment plants discharge toxic metals and pesticides, affecting the environmental quality, human health, and agriculture in areas receiving wastewater, with potential risks to human health [
28].
This research has observed that in 3 years, the existing population has been affected by waterborne diseases (
Figure 14). The occurrence of asthma is very high at 56.6%, and skin disease (13%) and diarrhea (12.1%) are also prevalent. Data from four health centers in Dili city indicated that diseases such as asthma, skin problems, and diarrhea, potentially caused by inadequate wastewater treatment, were more prevalent (
Figure 15). According to the World Health Organization’s reports in 2022, at least 1.7 billion people globally used water contaminated with feces. Access to safe water is crucial to the prevention of diseases like diarrhea, cholera, dysentery, typhoid, and polio, which cause an estimated 505,000 deaths annually. Despite the global significance of the issue, during 2015–2020, the proportion of the population with access to safely managed drinking water services improved from 70 to 74% [
29].
A WaterAid report documented that 75 children under the age of five die every year due to diarrhea diseases caused by poor water and sanitation in Timor-Leste. Addition lay, 174,000 people do not have access to clean water near their homes, and 558.000 people lack adequate toilets. According to the report, many do not have a decent toilet of their own [
30] and the high infant, under-five, and maternal mortality rates in Timor-Leste are associated with the poor access to and utilization of health care [
31]. On the other hand, children living in households using unimproved water facilities or surface water are more likely to die before five than those with basic water facilities [
32].
Intensive rainfall events can bring large-scale flooding that washes pollution into bodies of water. This water quality is often poor, and malaria was a major problem during the last 3 years in this country. The climate is favorable to mosquitoes, and the poor sanitation in the cities means that malaria is one of the major causes of diseases, which impacts economic and educational development [
33].
Figure 16 shows that during February–April and June, asthma is very frequent. Skin problems occur later on from December to February. It is confirmed that in the rainy season, there is a high possibility of infection with waterborne diseases.
Based on the results of the research questionnaire, most of the children suffer from diarrhea (73.8%). Most participants in a household have children who suffer diarrhea once per month (45%) and who need to be transported to hospital for treatment (74.6%).
Regarding the management of household wastewater, car washing companies and home industries in Timor-Leste dispose of their wastewater directly into open sewers and sinkholes. Inadequate wastewater management and sewage systems will impact the water quality and public health in the region. For example, in Kupryś-Lipińska, Kuna and Iwona [
34] stated that desiccant air affects human health in two ways; firstly, by causing dryness and damage to the skin and mucosa, making it easier for bacteria, viruses, and allergens to have a detrimental effect on the body. Secondly, particulates and pollutants are more easily suspended in dry air and hence there is an increased risk of disease. Recently, WHO, reporting on the water quality in Timor-Leste, calculated that 70% of the water sources were contaminated with a microbiological unit, and this was frequently connected to the possibility of disseminating diseases like typhoid and cholera.
In addition, the water quality monitoring data from the national laboratory of water supply showed that the drinking water in Dili city has been contaminated by physicochemical and microbiological entities from four types of water such as groundwater, surface water, tap water, and process water (
Figure 17). The contamination of the water supply can be explored, focusing on groundwater as the main source of water supply in Timor-Leste. In this case, the government authorities may apply certain technological approaches such as artificial intelligence and machine learning in the management of water treatment and wastewater management sectors [
35]. The application of advanced wastewater treatment technologies can help in improving the quality of treated wastewater and minimize the risk of waterborne diseases because it will play a pivotal role in addressing complex wastewater contaminants and achieving higher purification standards in industrial wastewater treatment [
30].
The lack of wastewater collection and treatment facilities in urban municipalities are critical issues for the local government to act on in wastewater management. Therefore, the improvement of the drainage systems in Dili, including the management and the construction of sewerage collection and treatment facilities, is needed [
33]. For this reason, we have mapped several points of interest related to the water system in Dili on the open-source platform climatescan (
Figure 18a) [
36].
Flood-related solutions such as permeable pavements (grass-filled grid pavers is a separate category in climatescan.org, see
Figure 18b with 3 locations, see
Figure 18c) and vegetated ponds are mapped that can be transformed in a cost-effective manner into constructed wetlands [
37] for the purification of grey wastewater, as has been utilized in many other parts of the world (
Figure 19). Low-cost nature-based solutions such as constructed wetlands and bioswales in The Philippines and The Netherlands can be implemented with local skills and materials from Timor-Leste to improve the wastewater situation and address other challenges such as biodiversity loss, heat stress, drought, and floodings. These installations are easier to rebuild and maintain than large-scale grey infrastructure (where only one is still in function of the three wastewater treatment plants) given the multiple hazards that occur in Timor-Leste: landslides, earthquakes, strong wind, and pluvial and fluvial floodings, and they can serve as coastal protection.