|Contamination of Drinking-Water by Arsenic in Bangladesh: A Public Health Emergency (WHO, 2000, 16 p.)|
Classifying contamination of groundwater by arsenic as a public health emergency would facilitate the rapid allocation of funding and the prompt expansion of interventions. Issues central to the argument in favour of an emergency response are listed in Box 3.
Arsenic exposure may be mitigated in a relatively straightforward manner. However, in Bangladesh the situation is complicated by the weak economy and the need to rely largely on external aid to resolve public health problems. There are also significant difficulties in communication and transportation within the country that create obstacles for community education and intervention programmes. Nevertheless, in contrast to diseases like malaria, cholera and tuberculosis, which require a more complex public health response, the response to arsenic contamination is clear-cut: provide arsenic-free water. Although the precise extent of the problem is not known, this does not invalidate the need for an emergency response. The extent of the problem may be more accurately determined during the course of the response. The health of the population is at risk and relief cannot wait for further surveys.
Box 3. Arsenic-contaminated drinking-water: a public health emergency
· Arsenic exposure in Bangladesh is widespread and involves thousands of wells
· Estimates indicate that at least 100 000 cases of skin lesions caused by arsenic have occurred and there may be many more
· If exposure continues, skin lesions will continue to occur
· Skin lesions are unpleasant and may be debilitating
· Skin lesions are occurring in children aged 10 years and younger
· Large numbers of cancers are predicted to occur in the future, including fatal internal cancers
· The cause is known: each day of continued exposure increases the risk of morbidity and death
· Sustained drinking of water containing 500 µg/l of arsenic may result in 1 in 10 people dying from arsenic-related cancers
· Unlike other major health problems experienced in Bangladesh, arsenic-caused diseases can be eradicated at relatively low cost