Aid - Bangladesh / WATER

All photos: Shehzad Noorani / Drik

‘Once upon a time in a lush, green country, criss-crossed with swift-flowing rivers, thousands of poor people were dying every year from drinking unclean water at monsoon time. Then a fairy godmother came along and, waving her intermediate-technological wand, promised: “Sink these shallow tubewells and your diarrhoeal illnesses will go away.” And the fairy godmother and her friends helped the government of the country to sink the tubewells and the people got better. But they all lived happily for only a short time after...’

To understand what Bangladesh was like in the pre-tubewell era, you need to take a walk around a village with its elders. They will tell you of the former beauty of their surroundings – where the ponds were, which were for washing and bathing and which were reserved for drinking. They will show you the half-dozen village wells and the homes that were occupied by families whose traditional job was to manage the village water supplies and ensure year-round availability. You will also see the many tubewells and hear how at first they were disliked because they were noisy and lessened the social contact brought about by shared water-gathering. Acceptance at village level only came when the benefits of the new clean water supply were understood, thanks to the expensive aid-funded awareness campaigns of the 1970s. These made tubewells hugely popular whereas previously they had been left to choke up and fall into disuse.

Most tubewells were sunk after aid agencies flooded into Bangladesh in the 1970s. Led by UNICEF and the Government, millions were installed in the belief that this was the way to achieve safe water for everyone. There are now probably more than 11 million nationwide. Initially the tubewell revolution was held responsible for ridding the country of the terrible cholera and typhoid epidemics of the 1940s and 1950s. Yet these diseases still occur extensively and it seems likely that it is improved knowledge about the treatment that has significantly decreased the death rate, not a cleaner water supply. UNICEF has acknowledged that ‘the widespread use of tubewell drinking water has made almost no detectable impact on the rates of diarrhoeal disease and parasitic infection’.²

So tubewells may not have achieved as much as was thought. But this pales into relative insignificance beside the monumental tragedy with which they are now associated – millions of people in Bangladesh are being slowly poisoned by arsenic, which has contaminated the drinking water drawn from tubewells. It is not fully understood why arsenic, which occurs naturally, is increasingly being released into groundwater. But studies indicate that 1 in 10 people who regularly drink arsenic-contaminated water may ultimately die from cancers, including those of the lung, bladder and skin.¹

Fatima assists in the outpatients department in a Dhaka hospital, working as a chaperone. She is welcoming and helpful to patients. After the department closes, she sits quietly embroidering. She came to the hospital for treatment when her skin became blemished, the dark, blotchy patches diagnosed as symptoms of arsenic poisoning. Her family no longer wanted her at home and saw little chance of getting her married, so she stayed on at the hospital.

By contrast, in another village the local community has helped Ali to continue supporting his ailing family. He was a labourer until pain from the black warty nodules on his palms and soles made it impossible. He now sells betel nuts and runs a small stall bought with a donation from his village.

In the hospital ward above Fatima, Jostna lies recovering from a leg amputation after her nodules changed to cancerous gangrene. She is just 10 years old. Recently discharged from hospital is Abu, who was treated for bladder cancer. Rekha has died from lung cancer. Many more internal cancers go undiagnosed.

How long it takes for the symptoms of arsenicosis to appear is uncertain. Tubewell contamination does not happen in a day and cancerous gangrene develops slowly. In 1996 doctors from Dhaka Community Hospital working at a mobile health clinic noted that a large number of patients had a range of skin conditions that could indicate chronic arsenicosis. Locating the source was essential. Then they encountered a man who had been told by doctors in India that he definitely had arsenicosis and that it came from Bangladeshi tubewells which were contaminated with arsenic.

With great difficulty, the following history of silence was unearthed. The Bangladesh Government had been told about the possibility of pollution in 1984, had tested a few tubewells and found at least one with arsenic. It kept quiet. Tubewells continued to be installed. In 1993 the Government and the World Health Organization (WHO) were officially told.³ They kept quiet. In 1995 a delegation of Government and UN agencies went to an international conference on arsenic poisoning in Calcutta but on their return they continued sinking tubewells and remaining silent.

When Dhaka Community Hospital discovered what was happening, they went to the agencies involved to expose the problem. They were accused of being scaremongers trying to create public panic. The hospital went to the press but official attempts to suppress the news continued.

Finally, in January 1997, survey results from 14 of Bangladesh’s 64 districts were published showing high arsenic toxicity levels in tubewell water. It was another three months before the problem was publicly acknowledged in a WHO statement saying that arsenic in drinking water was a ‘Major Public Health Issue’ which should be dealt with on an ‘Emergency Basis’. It was a further two years before UNICEF admitted publicly on US television that they had been ‘a part of the problem’.

So years of possible remedial action were wasted. Instead the donors pursued their policy of continually sinking tubewells, claiming the problem was confined to the southwest of the country. Yet testing was revealing arsenic contamination in 54 of the 64 districts. Under pressure the Government, funded by the UN Development Programme, did its own survey in 1998 and confirmed the extent of the problem.

This Government research threw up all sorts of issues. During the survey contaminated tubewells were painted red and safe tubewells green. Tubewells need re-testing at least every three months – yet no re-testing policy has been formulated and field-testing kits are neither publicly available nor cheap. So while people still using green tubewells feel they are safe, they may well not be.

Moreover, the Government and donors use an early WHO safety level of 0.05 mg of arsenic per litre of water. Yet in 1993 the WHO revised its safety guideline to the much lower level of 0.01 mg per litre, and added the warning that even this ‘…is provisional because of the lack of suitable testing methods. Based on health concerns alone it would be lower still.’

Such a rapid survey also gave little consideration to social repercussions. What could be better after a hard day’s work than to stop off on the way home at the local café and sit with friends drinking tea and sampling freshly fried snacks? A prosperous business would be destroyed if the café’s tubewell suddenly turned red. As Mr Bidyut, a survey supervisor, forlornly reported: ‘Overnight the red tubewell became green, otherwise the business was finished.’ Household tubewells would also change colour: who would want to marry into a family that had been drinking poison for years?

Two years on, all agree that Bangladesh has a massive problem. Yet the Government’s and donors’ ‘emergency’ response is still inadequate and slow. Almost all aid agencies have money earmarked for arsenic relief or research but with no united approach and no accountability, donors and researchers do as they please. The Government’s attempt to oversee projects and make them transparent has been dismal.

Most donors are concentrating their efforts on removing arsenic from the water. That means devising filters to use with contaminated tubewells. It also means that all tubewells need testing and re-testing, though it is estimated that 95 per cent of the country’s tubewells remain untested and probably in use. The crying need is for a safe, reliable and cheap testing kit that could be distributed to every village – yet aid funds are not being used to deliver this.

As for aid devoted to those already poisoned, the little being done is mostly research into the nature of arsenicosis. Patients willingly give blood or other samples desperately hoping for a cure. Months later they still await the test results. UNICEF has begun implementing some relief projects via local organizations but the proportion of its funds going into patient management is very small. The US Superfund, which provides money for research into safety levels for the American public – arsenic contamination also affects some areas of the US – is funding several projects, though none involving rehabilitation of patients. The World Bank in Dhaka holds $43.4 million to alleviate the problem, yet not one dollar of this is allocated for patient treatment.

No aid is going towards the development of a system that could treat not just existing patients but also those who will need treatment in the future. There are currently 8,000 known patients living in areas kilo-metres from any medical centre who need specialized treatment. It is estimated that as many as 85 million Bangladeshis are at risk. Yet today tubewells are still being sunk.

And all this because a country adopted a water strategy determined by overseas aid...

lives in Dhaka. She is a voluntary project worker.

1 Allan H Smith, Elena O Lingas, Mahfuzar Rahman, ‘Contamination of drinking water by arsenic in Bangladesh: a public health emergency’, WHO Bulletin 2000, 78.
2 Maggie Black, From handpumps to health, UNICEF 1990.
3 A letter was sent to the Government and WHO by an international expert on arsenic, Dr Dipankar Chakraborti of Jadevpur University, Calcutta.