Compared to the richest children, the poorest children are: 1.9 times as likely to die before age 5 destruction of infrastructure and lack of personnel, equipment and medicines have hindered access to maternal and newborn health services, leading to a large increase in unassisted births in a country where 96 per cent of deliveries in 2009 23 were attended by skilled personnel. Crisis conditions have also sparked a rise in vaccine-preventable and infectious diseases, including diarrhoea and pneumonia, 24 among children under age 5. Globally, access to land, credit and property rights has a further impact on child survival prospects. Marginalized groups living in informal settlements, illegal dwellings or urban slums are vulnerable to health threats because of overcrowding, unsanitary conditions, high transportation costs, discriminatory practices and lack of access to basic services. These factors also create barriers to demand, impeding the initial and continued use of services by the most disadvantaged. When combined with low rates of immunization, this situation exacerbates the transmission of diseases such as pneumonia, diarrhoea, measles and tuberculosis.25 Climate change brings added risks. When water becomes scarce because of drought, the poorest children and families are most likely to resort to unsafe water sources, making them more vulnerable to diseases such as cholera and diarrhoea. Climate change is also associated with an increased incidence of vector-borne infectious diseases such as malaria, as well as with food insecurity, rising air pollution, diarrhoeal disease and malnutrition.26 failure to mitigate these and other background risks associated with ill health in childhood will dampen the benefits of any progress countries make towards universal health coverage. Sanitation provides a case in point, illustrating how the 2030 goals are interconnected. in low- and middle-income countries in 2012, inadequate drinking water, sanitation and hygiene accounted for around 1,000 under-five deaths per day.27 research in nigeria suggests that lack of access to improved water and sanitation facilities may elevate the risk of mortality among children aged 1 to 11 months by as The STaTe of The World’S Children 2016 11