Arsenic -- a silent killer

Clockwise from top left: Affected hands. Affected foot. A restricted tubewell in affected area.

Arsenic in ground water was detected in Bangladesh more than a decade ago when the country had just achieved more than 95% coverage in supplying safe drinking water in the rural areas and making available irrigation water for the high yielding variety crops. More or less that was a win-win situation for drinking and irrigation water in the rural areas. But this achievement was outshined after the detection of arsenic in the ground water. Basically arsenic is a natural water contaminant originated from naturally occurring sulfide ores. It has a geological origin. The main source are the arsenic containing rocks from the Himalayas which were taken out by torrents of water and washed down by the rivers to the low lying areas of Bangladesh and West Bengal. These had been getting deposited together with sand, silt and clay for thousands of years forming a part of aquifers that have been releasing the poison today. Arsenic is a hazardous material and recent studies showed that it is a carcinogen, reportedly responsible for lung and skin cancers.
Considering the adverse impact of arsenic an human health, the government in late 90s conducted a nationwide tube well screening and patient identification programme. It was found from the study that around 29% of the tube wells in 271 upazilas had high level of arsenic contamination (over the Bangladesh standard 0.05 mg/l). The DG Health mentioned in 2008 that there were around 24389 patients in the country which increased to 38320 in 2009 indicating that the number of patients was increasing. Potential threat of arsenic contamination of food grains was also observed in recent days. High level of arsenic was found in rice by many researches when irrigated with arsenic contaminated water. Still now the country is failing to decide a standard of arsenic in food crops.
There are two important notations in the MDG about the drinking water supply all over the world namely "safe water" and "coverage". The countrywide situation of safe water and coverage is frustrating. The surface and ground water source is chemically and microbiologically contaminated. Availability of underground and surface water has decreased abruptly especially in dry season due to inadequate recharge of the aquifers and un-fashioned rainfall in rainy season due to climatic impact. Water, the most important determinant of health and socioeconomic development, should be safe wholesome and the provision of safe drinking water is one of the prior conditions for overall social development of any country. But now presence of arsenic in the groundwater has appeared to be a serious public health problem in rural Bangladesh. NGO Forum being an apex service delivery networking organization has undertaken some measures to combat the problem by establishing an independent working set-up, Arsenic Cell. Recently it initiated an arsenic mitigation program named as "Integrated Community Based Arsenic Mitigation Project, Bangladesh" with the financial assistance from European Union and MISEREOR to address the problem for 2010-2012 with a number of activities like community mobilization, sensitization and collaboration, capacity building, health campaign and patient management, interest free loan to poor arsenicosis patient, alternative safe water options, research studies, advocacy activities, etc. The project has been working in 133 most affected villages under 61 unions of 35 upazilas of 22 districts targeting 95,000 direct beneficiaries.
A baseline survey was conducted under the project by considering a total number of 2111 respondents and 1818 tube wells. The survey findings indicated that present level of tube well contamination is 68% irrespective of new, old or time of instillation but respective of the depth of the tube well. The reason behind that is, almost 51% of the tube wells in the survey villages were installed after the last nation wide tube well screening program. The survey findings also indicated, in these 133 emergency villages 18.6% of households have arsenicosis patients. This result necessitates a further nationwide tube well screening for arsenic and patient identification. The qualitative analysis (FGDs) indicated a common discrimination that the regular income has been reducing among the arsenicosis patients day by day and unemployment rate has been increasing. The survey findings also indicated that 74.5% respondents had been using the water from shallow tube well followed by 19.8% from deep tube well, for drinking and cooking purposes. But it is very interesting that among these respondents 18% have been still using the arsenic contaminated water for drinking and cooking purposes. Among those who were drinking arsenic contaminated water 56% was doing that because they have no alternative sources of arsenic free water and 25.30% was doing that because the safe water option is far from their houses more interesting is that 15.80% people have been drinking arsenic contaminated water, because they were not facing any problems which is an indication of lack of awareness.
Constructive criticisms, sustainable activities and integrated programmes are needed to strengthen the arsenic mitigation policy and implementation plans. Basically arsenic mitigation requires a sequence of practical steps involving enquiry and associated action and considering the findings of the baseline some short time and long time interventions are suggested for future intervention. The suggested long-term interventions are institutional development for water quality testing and arsenicosis patient management, installation of arsenic free safe water source including village pipeline water supply system to address large community of people, strengthening the public private partnership for sustainability of different interventions and institutional development for ensuring arsenic free safe food side by side the drinking water. The short-term interventions will include a nationwide survey for status of overall situation of arsenic contamination and patient number and status in the country, strong political commitment for comprehensive arsenic mitigation programme, dissemination of actual appropriate information to the community people in the arsenic contaminated area for avoiding disharmony within the societies, advocacy activities for addressing the problem and more social, applied and scientific research to mitigate this problem.

Dr. Ahammadul Kabir is Chief, Arsenic Cell and Farhana Rahman is Research Officer, ICBAMP, Bangladesh, NGO Forum for Drinking Water Supply and Sanitation.