It’s the largest poisoning of a population in history. More than 20 million people are thought to be at risk of drinking water contaminated by arsenic in Bangladesh.
Arsenic occurs naturally in groundwater supplies throughout parts of Bangladesh, India and Nepal. It was first identified as a problem in Bangladesh in 1987, and concentration levels in some places exceed 50 milligrammes per litre (mg/l) way beyond the maximum level recommended by the World Health Organisation of 10 mg/l.
Each year, an estimated 43,000 people die from arsenic poisoning in the country. The government has taken a number of steps and made policies to try to address the problem. But despite a country-wide campaign and social mobilisation activities by the government and NGOs, knowledge and awareness levels among communities remain far below expectations.
We know that there are cheap and potentially life saving solutions to this problem. What we need to do now is promote these solutions, and increase access to them.
Arsenic doesn’t change the taste or colour of water so the first problem we encounter is making people understand that it is present in their community.
From skin lesions, stomach cramps, diarrhoea and vomiting blood, to cancers of the bladder, lungs, skin and kidneys, the symptoms and effects of arsenic poisoning are debilitating and palpable. But without a proper diagnosis, often people do not know whether they are suffering from typical diseases or ones caused by long-term exposure to arsenic.
It is even more difficult, therefore, to make people realise that prolonged contact with arsenic-contaminated water may cause illness or even death. Liza Akhter, a 21-year-old girl in Bagerhat District, south-west Bangladesh, said to one of my colleagues: “The thing about arsenic is you get poisoned slowly, so you don’t know who has been affected around you already. Arsenic kills you every day, slowly.”
It is the poorest who face the biggest problems and those suffering from the symptoms of arsenic poisoning often find themselves in a vicious circle. Even though they may be suffering from multiple debilitating diseases, they often cannot afford to get treated. Many do not have enough land to install a water point so they are reliant on community points or the traditional untreated shallow tube wells. Often the roof of their home is not strong enough to support a rainwater harvesting system.
Those who are better off are more involved in the decision-making process and therefore have more control over where water is distributed. Very often, they can afford to install deep tube wells on their own land and access safe sources of water below the contamination levels.
In affected areas Practical Action has been working to educate people about the symptoms of arsenic poisoning. We have provided testing kits so that people can check if their water supply is contaminated and, if need be, install arsenic-removal systems or look into alternative safe water supplies.
Arsenic removal systems, where contaminated water if filtered through four chambers, are one available option. Due to a lack of testing systems, however, households don’t often know whether the removal system is working properly. We also find that the distribution of these filters is usually done in an ad hoc manner through government projects or by NGOs.
The distribution of arsenic removal systems should be linked with suppliers to ensure post-installation services for repairing, replacing and changing the filter for long-term sustainability. Proper pricing plans are also essential for running a community-managed water point sustainably, and ensuring they are not abandoned due to financial problems.
Rainwater harvesting does offer an alternative, but a lack of rain and the deterioration of water quality and taste during the dry season make it less popular. Usually, the equipment is not cleaned properly before the monsoon season which means that the water can become contaminated, causing sickness and diarrhoea. Other alternative sources of water could be found through “conjunctive use”, where surface water is stored in a groundwater basin in wet years, and withdrawn in dry years.
Facilities to test water quality are also needed at home along with a national testing mechanism; science clubs in schools or laboratory facilities in colleges could even be explored for establishing such facilities. Most importantly, an integrated approach between the health and water sectors is needed for working with the communities in arsenic affected areas. We would also like to see government mapping of awareness levels among communities, as this is something we just do not know presently.
All patients suffering from arsenic poisoning arsenicosis have less capacity to work, their income reduces, and their households are gradually marginalised. The provision of safe water alone is not enough; proper treatment for arsenic poisoning is also essential.
We know that there are solutions, but we need to scale up this work so that the 20 million people in Bangladesh, and millions more in India and Nepal, who are at risk from arsenic poisoning, can at least take a drink of water without worrying it is killing them.